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Unique Healthcare Offering First in Florida East Orlando Chamber of Commerce provides members affordable options By PL JETER

A local chamber of commerce recently unveiled a unique type of healthcare policy new to Florida. The East Orlando Chamber of Commerce (EOCC) is offering group health benefits to its members’ employees at a cost as low as $14 a month with no co-pays or deductibles. Coverage extends to the employees’ entire household. Avalon Insurance Services, an Orlando-based firm, administers the benefits program that features no employer liability with finance, payroll or administra-

ON ROUNDS

PHYSICIAN SPOTLIGHT

Owen Kieran, DO ... 3

HEALTH INNOVATORS

Open Source Interoperability ... 5

CANNABIS CORNER Interview with a Marijuana Doctor ... 7

PHYSICIAN ADVANTAGE Conventional Loans Can Bring Savings ... 8

INDEPENDENT PHYSICIAN Mark S. Chaet, MD, of Pediatric Surgery, PA ... 9

RADIOLOGY INSIGHTS When the Brain Goes Haywire! ... 22

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tion. Employers simply offer the option to employees, whether they have healthcare coverage or not. “As part of our leadership development and community involvement outreach, we were discussing members’ needs, and healthcare was all the talk,” said Andrew Cole, CEO of EOCC. “Affordable healthcare has been lacking for our members with small- to mid-sized businesses. The healthcare landscape is rapidly changing and somewhat confusing with question marks and changes surrounding Obamacare. Our goal was to create an advantage

to help those members retain their employees and attract new ones. We’re very happy to have pulled this together as an added benefit to membership.” EOCC members’ employees may sign up for group benefit plans as a standalone product or to bridge gaps in existing healthcare coverage. These plans cover telehealth, comprehensive accidents, cancer, specific diseases, cata-

strophic events a n d WellCard ings. At the savtime of the June 1 implementation, EOCC was the only such organization in the state offering this level of affordable healthcare. “A lot of small businesses can’t afford a health benefit plan because they’re not eligible,” said Cole. “Maybe they don’t

(CONTINUED ON PAGE 3)

HEALTHCARELEADER

For Marshall Cress, Neurosurgery Was a Really Good Decision At the beginning of his career, when Marshall Cress, MD, was deciding what practice area he wanted to specialize in, it was the potential for technological advancement that drew his interest and imagination to neurosurgery. Today, as a highly respected neurosurgeon at Orlando Health, he is part of a rapidly growing neuro-services practice that is in the process of doubling the number of neurosurgeons. "For several years we hovered around four neurosurgeons," Cress said in a recent interview. But by this fall, the eighth neurosurgeon will be joining the Orlando Health team.

“Our skillsets are going to run the gamut: Vascular neurosurgery, fellowship trained spine surgeons, surgeons who perform deep brain stimulation and epilepsy surgery, and a surgeon who specializes in tumors of the skull base – and who has specialized training in taking them out with endoscopes, so only a very small incision is needed,” said Cress. Treatment doesn’t begin and end in the surgical suite, however. “It takes a collaborative, established team to work together. You need neurologists, neuropsychologists, pain management physicians, as well as surgeons. And we have that here.

“Beyond that, all those surgeons are also very well-versed in taking care of tumors. And so, we have a very busy and capable neuro-oncology service for both the brain and the spine, and we work very closely with the cancer center and the surgeons in that arena to give patients access to easy, centralized care for their cancer treatments, which I think is important, because oncology patients have to make a lot of appointments and see a lot of people.” Orlando Health has made a strategic decision to make the neuro-service line a focus point for its growth, said Cress, and (CONTINUED (CONTINUEDON ONPAGE PAGE11) 6)

PHYSICIAN VIDEOS HEALTH PODCASTS UP-TO-DATE CONTENT

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PHYSICIANSPOTLIGHT

Owen Kieran, DO

Military service revealed the value of teamwork

For general surgeon Owen R. Kieran, DO, a traumatic event early in his career altered his path forward. In 2014, Kieran was stationed at Fort Hood in Killeen, Texas, when the base suffered its second mass shooting in five years. As a staff surgeon at Carl R. Darnall Army Medical Center, Kieran had just come home from a shift and was sitting down to eat dinner when he got the call to turn around. “I was in disbelief,” he recalled. “I rushed back in, not knowing what was going on or even where the shooter was. Half of me was scared out of my mind, while the other half was calm, knowing what I needed to do as a physician.” Kieran operated on two of the victims, one of whom was ultimately transferred to another facility. Both survived, but the experience left a lasting mark on Kieran. While he had recently finished a general surgery residency at St. Barnabas Hospital, a busy Level II trauma center in the South Bronx of New York City, this was his first real-life active shooter scenario. It ended in 14 injuries and four deaths, including the gunman. “Our team came together that day, and it reinforced for me that wherever you work, you need to have a strong, cohesive team,” he said. “When situations like that occur, it’s critical that everyone is in the

same frame of mind.” From that day forward, Kieran sought out environments where he could operate as part of a unified team. While at Fort Hood, he completed a short tour as a forward-deployed Army surgeon in Eastern Afghanistan, where he continued to hone his surgical skills and earned several additional advanced trauma certifications. While Kieran valued the lessons he learned in the military, he wanted a more settled lifestyle for his wife, a former nurse, and school-aged son and daughter. After leaving the Army, he served as a staff surgeon in Southern Georgia, obtaining certification on the da Vinci® robotic surgical system. 

MAKING AN IMPACT FROM THE GROUND UP

In 2017, Kieran joined Poinciana Medical Center, an HCA Healthcare hospital near the border of Osceola and Polk counties. “We’d always liked Florida and have family in the area and thought we might retire here, so when this job opened up, I thought it was a great opportunity to make an impact from the ground up,” he said. “It was a new hospital, and the community needed a surgeon. We’ve been building this program ever since.” About half of his procedures are elective, outpatient surgeries, such as hernia repair and treatment of skin lesions. Kieran also has a special interest in treating women’s health issues, because his wife’s grandmother was a breast cancer survivor, and he has six sisters and four nieces. His practice offers genetic testing for breast cancer, colon cancer and prostate cancer,

as well as removal of breast tumors. In addition, Kieran treats a high percentage of emergencies, such as appendicitis, organ obstructions and gallbladder disease. “Compared with some other communities, we typically see a much higher acute surgical blend, as opposed to elective surgery,” he said. About half the patients Kieran sees in the hospital have surgical complications related to uncontrolled diabetes, such as abscesses, cellulitis and gangrenous wounds. “Many patients don’t realize that diabetes is a significant disease, and only when they have a serious complication do they realize they were diabetic,” Kieran notes. Some patients also postpone seeking treatment because they are underinsured or self-payers. As a result, their conditions often worsen and require multiple surgeries.

WORKING AS A COHESIVE TEAM

As he did in the military, Kieran sees himself as part of a cohesive team working toward the same outcome. He works closely with hospitalists and primary care providers to treat patients, particularly those with comorbidities. “They manage the medical issues, which allows me to focus on surgical needs of our patients,” he explains. “After surgery, I stay on board to manage any surgical issues, while Dr. Zakaria Razick and his team of specialized hospitalists takes care of ongoing needs for our patients, like adjusting insulin and blood pressure medications.” Envisioning a solution to a complicated challenge is an inborn trait for

Kieran. Once an aspiring architect, he realized that architecture was more of a passion for him than a lifelong vocation, so he switched tracks to medicine. While at the University of New England College of Osteopathic Medicine in Maine, he discovered his interest in surgery, in part because of the ability to rapidly change a patient’s life. “I like to see the immediate results we can provide,” he said. “We directly impact someone’s health, right then and there.” In the future, Kieran hopes Poinciana Medical Center’s surgical team can further expand its impact. The hospital recently brought on board its first da Vinci robot and offers surgeons with credentials in robotic surgery. Kieran and others are also working to expand women’s health screenings, biopsies and breast cancer treatment options. “As physicians, we want to do as much as we can here in Poinciana, to spare patients from traveling 35 to 40 minutes to Kissimmee, Davenport or Celebration for surgery,” he said. “Our goal is bringing all the specialties here and ensuring Poinciana has a well-developed surgical program. I’m proud to say we’re making real progress.” Dr. Owen Kieran is a board-certified general surgeon at Poinciana Medical Center who practices at the hospital’s affiliated practice, Medical Specialty Group at Poinciana. Medical Specialty Group at Poinciana is located adjacent to Poinciana Medical Center in the Medical Arts building. To learn more about Dr. Kieran, or to schedule an appointment, visit www. SurgeryatPoinciana.com

Unique Healthcare Offering First in Florida, continued from page 1 have enough employees. Or their employees don’t work enough hours.”

EOCC OFFERS THREE BENEFIT PACKAGES: Package 1 costs $14 monthly, with services via MDLive Telehealth. The no co-pay plan covers the employees’ entire household via a portal that may be accessed by smartphone, tablet or laptop computer. A majority of doctor visits, and roughly 40 percent of urgent care and emergency room visits can be managed online by Florida board-certified physicians. For example, a young part-time restaurant worker who is too old to qualify for coverage on a parent’s healthcare plan would be an ideal candidate for Package 1. “You can’t work in a restaurant if you’re sick, and you can’t afford to miss work,” Cole explained. “An urgent care clinic visit could be up to $150. You’ll wait for hours to see a doctor, and then deal 3

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with getting a prescription and then picking it up. When you’re sick, you don’t want to go through all that hassle.” Joseph Filice, owner and president of Avalon Insurance Services, pointed out the benefits for working mothers. “The next time your child is sick, you don’t have to take two hours away from work and take the child out of school, then sit in a doctor’s office waiting to get a prescription or amoxicillin,” Filice explained. “With this plan, it can all be done in 20 minutes, a prescription is called in, and nobody has to leave work or school.” Package 2 costs $30.40 a month and adds Allstate Accident and WellCard benefits. The Allstate Accident insurance provides financial support by paying cash benefits directly to the employee. Coverage pays cash benefits that correlate with hospital and intensive care confinement. The plan also covers maladies from sim-

ple burns and lacerations to fractures, xrays, urgent care and ambulance benefits. It also comes with a $20,000 accidental death life insurance policy. “Let’s say you go on telehealth and show the doctor that your finger looks crooked,” explained Cole. “He might tell you to go to the emergency room. You’ll get reimbursed for that visit.” The WellCard savings plan provides access to value-added, money-saving programs for pharmacies, dental care and vision providers. The plan, with a network of more than 10,000 vision providers alone, provides savings up to 50 percent on dental and vision fees. At a monthly cost of $58.36, Package 3 adds Allstate Cancer and covers 23 specified diseases for patients aged 18 to 64. The plan pays cash benefits directly to the employee to help with the cost of treatment and expenses and provides additional financial support against exorbi-

tant expenses associated with cancer and other specified diseases. When diagnosed, the employees’ assets are protected from out-of-pocket medical expenses and provides funds for access to expert providers and specialized life-saving treatments. Other health benefits offered through EOCC and Avalon cover critical illness, life insurance and hospital indemnity plans, 100 percent customizable with optional dependent and family coverage. “We wanted to create options for segments of the population that have typically been overlooked for various reasons,” said Filice. “These plans do just that.” Established in 1964, EOCC plans to expand its line of insurance products offered to chamber members, noted Cole. For more information, call (407) 277-5951 or email eocc@eocc.org.

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HEALTH INNOVATORS

Open Source Interoperability: Is the Entrepreneur's Dream Becoming a Reality? By NINA TALLEY, MedSpeaks

In late August, Amazon, Google, IBM, Microsoft, Oracle, and Salesforce, came together to sign a pledge of healthcare data interoperability. Although short on specifics as to the actual schematics of their implementation plan, the statement did make one thing crystal clear. The key to frictionless exchange of data is open standards and open source tools. Essentially stating that no one company should have the right to hold the keys to the healthcare data kingdom. That if we want health data interoperability, we all have to use the same tools, and those tools must be available to everyone. The idea of open source, easily accessible and free-to-use development tools is by no means a new development. Most tech giants, like Adobe, Facebook, and Google, have been utilizing open source development for years. But the healthcare industry has been widely reluctant to utilize open source standards for the development of EHR software, largely due to misplaced security concerns. Patient data is of the highest sensitivity and needs to be protected at all costs, but open source systems have proven themselves to be no more vulnerable than their proprietary counterpoints, and it appears healthcare may finally be getting that message. With the EHR landscape as it stands, small businesses are chained to large vendors such as Cerner or Epic. But even with these titans of industry creating Application Programming Interfaces (APIs) to give hospital developers access to their stored patient data, there are still large drawbacks. For example, Epic’s EHR API only allows you to extract data. While this improves data analytics, it drastically limits the amount of new value that can be added to the clinical experience. In

order to improve hospital workflows in any meaningful way, you must be able to write new data in to a database. So what does widely adopted open source interoperability EHR standards mean for entrepreneurs? Everything. No longer being chained to privatized systems and their proprietary restrictions means that hospitals may finally be able to be truly third-party vendor agnostic. It is also likely to kick-off a “dataquake,” a term coined by John Doerr, chairman of Kleiner, Perkins, Caufield and Byers. Stores of data that were previously inaccessible to small businesses will now allow applications and data-dependent technologies, such as artificial intelligence and predictive analytics, to thrive in a healthcare setting. This will likely create a new era of medical application developments, with real-time patient data unlocking technology innovations across the board. However, the pledge was merely the

READ THE FULL PLEDGE BELOW: We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs. In engaging in this dialogue, we start from these foundational assumptions:

• Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project.

• We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assess• Healthcare data interoperability, to be suc- ment to foster agility to account for the accelerated cessful, must account for the needs of all global pace of innovation. Together, we believe that a robust industry stakeholders, empowering patients, healthcare providers, payers, app developers, device and dialogue about healthcare interoperability needs pharmaceuticals manufacturers, employers, re- will advance this cause, and hence are pleased to searchers, citizen scientists, and many others who issue this joint statement. will develop, test, refine, and scale the deployment of new tools and services. • The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem.

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first step. The healthtech renaissance will not come overnight. There are currently no announced plans for the implementation of these open source interoperability standards. What’s more, it will be very difficult for startups that will be depended upon to rapidly innovate around these new standards, to solidify strong business models without any clear terms of service. There are even those such as Cerner President, Zane Burke, who questions the impact of the pledge. It would be more helpful if the tech giants committed to sharing their data with EHR vendors, he says, but that it is “a positive first step by companies that haven’t been associated with this in the past.” Regardless, the pledge serves as a breath of fresh air for healthcare technology developers and enthusiasts. A proverbial light at the end of the interoperability tunnel, this announcement may well mark a change in the tide of EHR application development. We can only keep our fingers on the pulse of the industry, and prepare ourselves to seize on this opportunity as it begins to present itself.

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HEALTHCARE LEADER For Marshall Cress, Neurosurgery Was a Really Good Decision, continued from page 1

INTERNAL & FAMILY PHYSICIANS Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking Internal and Family Physicians to provide volunteer care for our patients (one three hour shift per month) at one of our five convenient locations in Central Florida.

that means ensuring patients have access to other specializations such as pain management in addition to neurosurgeons. “Our goal is to hire people who have specializations that can take care of a number of problems,” he said, “and then put them all in a collegial collaborative system that helps get patients to the right people quickly.” Getting people help quickly is a core element of the neuroscience department, which makes them leaders in patient care and experience. Their goal is to have patients seen by the appropriate provider within one week of the referral. Simple demographics are one factor in making the neuro-services practice a growth area. For example, with an aging population, one would expect to see an increase in age-related ailments, such as back problems, strokes, certain cancers and Parkinson’s Disease. An even bigger factor in this arena, however, is the advances that are being made in treatments. These advancements, for example, include the ability to do less invasive surgeries through small incisions for problems such as back pain, said Cress. “We also are starting to see the introduction of robots in spine surgery, and we are starting to see the introduction of a lot of imaging modalities in neurosurgery. And so, the technology aspect is exciting from both a surgeon standpoint and from a patient standpoint. The problem is that not all facilities have the ability or interest to get into those areas.” A native of Arkansas, Cress joined Orlando Health Physicians Neurosurgery Group in 2015. He earned his medical degree from the University of Arkansas for Medical Sciences and completed an internship in general surgery at Baylor University Medical Center in Dallas. He then com-

For volunteer information contact Abby Seelinger, Manager of Volunteer Programs (407) 876-6699, ext. 233 | abby.seelinger@shepherdshope.org or visit www.shepherdshope.org/volunteers.

pleted a residency in neurological surgery at the University of Missouri, followed by a fellowship in endovascular neurosurgery at University at Buffalo Neurosurgery, New York, one of the leading programs in the world for that specialization. Drawing him to neurosurgery was the “recognition that there is a lot of advancement of medicine in general, but … the most opportunity for advancement and some of the most exciting technological applications had yet to really be developed in the neuro-science realm,” he said. “And so, in that sense I felt that the world was wide open.” Stroke is one of the pathologies that draws the focus of much of Cress’ work. And this is one of the areas in which a lot of progress has been made that Cress finds especially exciting. “Stroke is one area where it was just a hopeless event for a lot of people,” he said. “You had a stroke; you were put in the hospital; you were put on aspirin; you went to rehab, and that was your life.” “Now, with our new advances in treatments and technologies and systems care it has really made a lot of difference in a lot of people’s lives. It is not easy work, but it is extremely rewarding work.” And that is one of the key pieces of advice that Cress passes along to future doctors. “I still think of myself as young,” he said, “but I find myself having conversations with prospective medical students who are trying to decide what to do. And the bottom line, I tell them all, is at the end of the day you don’t want to make a decision based just on money. You are going to work hard no matter what you do in medicine, so you need to make sure that the specialty you chose is the specialty you enjoy, because otherwise you won’t enjoy your life as you move forward. And I think I got lucky and that I made a really good decision.”

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Interview with a Marijuana Doctor: Medical Marijuana, a miracle in the making? By JOHN SINGLETON

In an interview with Robert Hannum, DO, one of Marijuana Doctor’s leading physicians, I asked about his practice and the patients he works with. Hannum currently sees patients out of two of Marijuana Doctor’s offices. Their Orlando facility is located across from the University of Central Florida, and also their Clearwater facility is located on the west coast.

How long have you been a physician? 've been a practicing physician for 29 years. I graduated medical school in Philadelphia in 1987 and then came to Tampa to do my internship. I stayed for a year and fell in love with Florida, so I never went back to Pennsylvania. I've been practicing as a family practitioner in Florida since. When and why did you decide to start doing medical marijuana evaluations? enerally, I was doing alternative medicine since 1997 which made me open to

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alternative types of therapies. However, with the financial crisis of 2008, most of the alternative medicine and weight loss clinics went out of business because most people couldn't really afford any type of non-necessary medical care. I was doing mainly long-term care AKA geriatrics for a lot of the patients who were having classic issues such as sun-downing, poor appetite, and anxiety. I was always of a mind, only half joking at the time, but what would happen if we could be able to give them medical marijuana. When the process started in terms of the amendments in Florida, I was looking forward to doing that but generally it's tough to do any type of medical marijuana long-term care because they're still incumbent upon federal funds and they’re little reluctant to do so at this time. I decided to open up an office practice, which really didn’t tend to do all that well, so I was more than happy when I was able to start working with the Marijuana Doctor corporation in November of last year.

PTSD probably equals about 60 percent of the number of patients compared to that of chronic pain, but they are by far the two major illnesses we qualify for.

What does the typical patient you see suffer from? Although there are nine qualifying conditions listed and chronic pain most of those are relatively rare, so the majority of our patients come from either those with PTSD and with a chronic pain syndrome. I will say that psychiatrists still believe that PTSD by necessity needs to come from battlefield trauma, but I think there's a variety of things such as the sudden loss of a loved one and being told you have a potentially fatal illness apply here. I also think generally that the school system is producing a lot of people with PTSD. I would say that

How have you seen patients’ lives changed by the medicine? By and large I think the patients’ lives are benefited so much more than I, or I think most people, could have even thought. You know in terms of what we're talking about in those two illnesses, very frequently patients tell me they're actually nightmare free now. People with pain get significant to remarkable improvement in pain even more so than your typical patient with herniated discs and muscle spasms. We've had patients with diabetic neuropathy and fibromyalgia, who even with a high dose of our standard of therapeutics such

as Gabapentin and Lyrica don't get relief, that people are saying with the proper strain, get 100 percent relief of their pain. What would you tell fellow physicians who are on the fence about referring patients to us and for medical marijuana in general? In terms of what I would tell other physicians, I would just say that to me it’s an eyeopening experience. Science is being done every day which shows more and more the safety of medical marijuana as well as the possibility that it’s going to be efficacious in a variety of illnesses and diseases which we had never foreseen. I suggest that they open their practice to referrals or even qualifying patients themselves.

What would you tell fellow physicians who are on the fence about referring patients to us and for medical marijuana in general? In terms of what I would tell other physicians, I would just say that to me it's an eyeopening experience. Science is being done every day which shows more and more the safety of medical marijuana as well as the possibility that it's going to be efficacious in a variety of illnesses and diseases which we had never foreseen. I suggest that they open their practice to referrals or even qualifying patients themselves. John Singleton is the Brand Marketing Director for MarijuanaDoctor.com, a medical marijuana recommendation clinic, providing qualified medical recommendations to patients seeking a Medical Marijuana Use Registry Card in the state of Florida. With more than 15 locations throughout the state and Florida's first and only Medical Marijuana Clinic and CBD Dispensary, Marijuana Doctor seeks to make the process for medical marijuana approval as simple and stress-free as possible for new patients. For more information, please visit https://marijuanadoctor.com

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Conventional Loans Can Bring Savings, Opportunities for Growing Medical Practices By TED SHEPPE

Along their professional journeys, physicians experience many graduations: college, medical school, residencies and fellowships. From a financial perspective, here’s another graduation to keep in mind — moving on from your first Small Business Administration 7(a) loan to conventional financing. SBA loans, as the 7(a) loans are often known, can be a critical first step for healthcare providers seeking to acquire or grow a business. Providers often use these funds to expand office space, buy equipment, hire new staff or make other strategic business moves. While SBA loans are designed to be easier to get than conventional financing, they’re usually not the most cost-effective long-term solution. Over time, the lower interest rates on a conventional loan can yield significant savings. It may mean the difference between paying 8 percent and 5

percent each year. A community bank can be a valuable partner in reassessing your funding goals. At Maitland-based Axiom Bank, we specialize in helping our customers navigate growth with resources tailored to their needs. If you’ve had an SBA loan for at least three years, you may want to consider refinancing with a conventional loan. Here are some signs you might be ready:

Your financial trends are positive.

When your patient list, revenue, profits and cash flow are trending up over a sustained period, it signals stability in your business — which may mean you’re ready for the next stage of financing. On the other hand, if your financial indicators are choppy, flat or trending down, you will likely need to delay that conversation until they become steadier.

Your debt-to-worth ratio is modest.

If you have equity in the business and if your current financing agreement is leveraged properly, you may be able to revisit the terms of your loan. In this scenario, you likely have some wiggle room to add debt, provided you have cash flow to repay it. The common guideline is to stay below a 3:1 debt-to-worth ratio.

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of a business typically bring a heightened need for capital to cover expenses such as new equipment and employees. However, many businesses can moderate their capital expenditures starting in years three to six. If your spending, debt and equity are sufficiently balanced, you may be able to qualify for a conventional loan, which gives you the freedom to add capital as needed.

Your bank isn’t paying enough attention to you. Does your banker have

an outdated perspective on your business? Ideally, he or she should meet with you quarterly to discuss your projections and long-term goals. Regular conversations are critical to understanding your company’s lifecycle and crafting a financing package that fits the next two to three years. Make no mistake: short-sighted banking relationships can hinder the growth of your business. One of our clients in the healthcare industry had a stellar growth profile and contracts with major drugstores, but his former bank couldn’t see past his humble beginnings, so he went elsewhere. Bankers should work in your best

interest, and that might mean suggesting you reconfigure your financing arrangements. If your banker isn’t regularly adding value to your business, it may be time to revisit the relationship. As an SBA Preferred Lender, we frequently recommend SBA loans as a viable first step, while recognizing that many businesses will eventually outgrow them. Often, a bank with Preferred Lender status can easily convert SBA loans into conventional loans. If your business is getting traction and generating solid financial indicators, it may be time to graduate from an SBA loan. With steady cash flow and an improving balance sheet, conventional financing can come sooner than you may think. In turn, that can spell out a more profitable future, full of possibilities to expand your impact as a healthcare provider. Ted Sheppe is the Executive Vice President for commercial banking at Axiom Bank, N.A., a Maitland-based bank that specializes in commercial loans for small and medium-sized businesses. He has spent much of his career helping physicians and healthcare businesses with their lending needs. He can be reached at tsheppe@axiombanking.com or 321-249-7847.

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THE INDEPENDENT PHYSICIAN

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Mark S. Chaet, MD, of Pediatric Surgery, PA

President & Founder of Independent Physicians Network Spending most of his youth growing up in Pensacola influenced by his dad’s career as a marine biologist and physiologist, Mark Chaet developed a life-long interest in physiology and zoology. Both parents had a passion for teaching that “has been an important and powerful influence in my life,” he said. “Although there had been no physicians in our family, the pursuit of a medical career was something that came quite naturally to me early on.” Now, with a daughter in her second year of medical school, he looks to the future of medicine. “The changes in the business of medicine have changed the practice of medicine by decreasing two measurable factors – time spent with patients and financial reward for that time. In order to 'keep the lights on,' caregivers have had to increase the number of interactions per day. It is not difficult to see who loses in this scenario,” he said. Chaet, a Pediatric Surgeon and president and founder of Independent Physicians Network (IPN), has chosen to remain an independent physician because he sees it as the best way to care for his patients.

In order to 'keep the lights on,' caregivers have had to increase the number of interactions per day. It is not difficult to see who loses in this scenario… “IPN was founded to create a place where the independent physician could find support and advice on how to continue to succeed in today's ever-changing medical environment. With a national trend of physicians becoming employees, we sought to optimize the potential of those who chose another path,” he said. Chaet says the DNA of the independent physician model is all about the physician/patient relationship and doesn’t see a reason to shift that focus. From the beginning, he saw IPN as a means for physician support to allow them to better meet the needs of patients. “IPN has had great success working with payors on value-based shared savings programs. Our physicians practice high

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quality medicine and utilize a network of outpatient facilities. Through the judicious use of these independently-owned, high-quality entities, IPN physicians have demonstrated that healthcare delivery can be both top box in medical outcomes and patient satisfaction while being economically sound,” he said. Chaet stressed that the commercial payors have known for decades that when a group of physicians get together with a plan, the insurance companies 'win.' Now, the physicians and patients can benefit from the winning formula as well, he said. “The costs of medical care have steadily grown while the quality has been stagnant. The network that our physi-

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cians have built is designed to improve patient care and outcomes while avoiding unnecessary emergency room or hospital visits. Our outpatient ancillary care facilities and urgent care centers direct those who need hospital level acuity of care to the hospitals while keeping the remainder, and majority, of patients under the care of their own physicians,” he emphasized. Chaet reminds that the entire system of healthcare in the U.S. depends on welltrained and dedicated caregivers. “Decades of experience supports the notion that opportunities for these individuals should include both hospitalbased jobs and independent practice. The media has made a big deal about how being the most expensive healthcare system in the world hasn’t made us the best in the world. I firmly believe that U.S. medical care is the best in the world – and we have the tools to make it more economically sound. Organizations such as IPN are poised to do just that.”

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GrandRounds Stars from ‘Disney On Ice’ visit Florida Hospital for Children

THE LAKE-SUMTER MEDICAL SOCIETY

2018 ANNUAL

MEETING & EXPO Mickey Mouse and other performers from “Disney On Ice presents Mickey’s Search Party” made a whimsical visit to Florida Hospital for Children today, where they spent the morning participating in activities with the children. “It means a lot to see my daughter take a break from her hospital room to come out and play with Mickey,” said Ana Fernandez, whose daughter is a patient. “I don’t remember being able to have fun like this in a hospital when I was young, so it’s nice to see her having fun.”

“Disney On Ice presents Mickey’s Search Party” follows Mickey Mouse and his friends as they follow Captain Hook’s treasure map and look for clues in the search for Tinker Bell in enchanted worlds. "It’s special that we can come visit the kids and see their faces light up,” said Sophia Adams, who is a skater in the show. “Maybe they weren’t having the best day – but getting a hug from Mickey might make it the best day ever.”

Osceola Regional Medical Center Celebrates One Year of Comprehensive Stroke Care

vanced imaging capabilities, including the 3D Biplane Imaging System and 256 Slice CT Scanner, which are key in endovascular interventions used to rapidly return blood flow to affected areas of the brain. Osceola Regional Medical Center provides 24/7 access to minimally invasive stroke procedures, on-site physicians, dedicated Neuro Intensive Care Unit, Neuro Telemetry Unit, and an Inpatient Rehabilitation Unit. The hospital’s Comprehensive Stroke Center is staffed with a specially trained team of Neuro-Interventionalists, Neurologists, Neurosurgeons and healthcare professionals. The core stroke team includes physicians, residents, nurse practitioners, stroke coordinator, and ancillary staff. Osceola Regional has also received the highest honors from American Heart Association/American Stroke Association’s Get With The Guidelines®Stroke Gold Plus Performance Achievement Award and Target: StrokeSM Honor Roll Elite Plus Quality Achievement Award. The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment

Osceola Regional Medical Center recently celebrated the first anniversary of its Comprehensive Stroke Center, which opened on August 21, 2017, and is the only Comprehensive Stroke Center in Osceola County. In the past year, the hospital has treated more than 1,000 stroke patients, of which 228 underwent interventional stroke procedures. A Comprehensive Stroke Center has the ability to provide more advanced stroke treatments than primary stroke centers, which means patients suffering from all types of strokes (including severe cases such as large brain clots and hemorrhages) can now receive immediate care closer to home – a critical factor, as immediate assessment and treatment has been proven to reduce the effects of stroke and lessen the chances of a permanent disability. The Comprehensive Stroke Center at Osceola Regional offers ad10

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GrandRounds according to nationally recognized, research-based guidelines based on the latest scientific evidence. “Celebrating a year of comprehensive stroke care is a major milestone for our team, and for the community,” said Dr. Ankur Garg, Neuro-Interventionalist and Medical Director of the Comprehensive Stroke Center at Osceola Regional Medical Center. The treatments we provide at Osceola Regional can mean dramatically better outcomes and quality of life for stroke patients … many times we see patients walking out on their own when discharged, versus suffering a life-changing disability.” According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 800,000 people suffer a new or recurrent stroke each year.

Cornerstone Hospice Spiritual Care Manager Publishes Book to Help Connect with Dementia Patients Cornerstone Hospice and Palliative Care Spiritual Care Manager Rich Behers, DMin, BCC, CFHPC understands the frustration family members feel when caring for a loved one who has dementia. As a chaplain working for another hospice organization several years ago, Behers found he had little training and little connection with patients he was assigned to provide spiritual comfort. Behers consulted with various colleagues and developed a process for connecting with patients who seem to live in a different world by using sensory tools to expose them them to vivid and pleasant reminders of their past. After spending more than five years on research, development and implementation of his approach at Cornerstone Hospice, Behers has completed a guide for chaplains to enhance communications with Alzheimer’s and dementia patients. Spiritual Care for People Living with Dementia Using Multisensory Interventions was published by Jessica Kingsley Publishers earlier this summer. “The book begins with an explanation of how dementia affects a person. The reader then learns my proven process for connecting with patients using photos of familiar subjects, music, aroma and affirmations of personal worth,” said Behers. “While written as a resource for chaplains and other clergy who provide support for their congregants, the book is appropriate for anyone dealing with a dementia patient.” “Chaplain Richard Behers pro11

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vides a deep understanding of the challenges of communicating with Alzheimer's patients, particularly in the late stage of the disease. His ability to recognize their limits and develop a method for effectively reaching deep into their being, and extracting their excitement and interactions is extraordinary,” said Kathleen Winters, Executive Director of the Alzheimer’s Family Organization, based in Spring Hill, Fla. Jessica Kingsley Publishers has posted many of the images that Behers has used to engage dementia patients on their website which can be downloaded and printed for use. They include pictures of flowers, animals, the beach, religious objects and other images that may be familiar. All Cornerstone Hospice chaplains are trained in the dementia care protocol that Behers developed. “It has happened several times that one of our chaplains is showing photos to a patient who is unresponsive, and it sparks something familiar that makes the patient speak just as a family member walks into the room,” explained Behers. “The caregivers often cry hearing their loved one’s voice for the first time in a while.” Behers says his goal is for the book to be in the hands of every chaplain in the U.S. so that wherever there may be someone with dementia, there will be someone who can care for the patient and their family.

Bioprinting Holds Wealth of Promise for Future of Healthcare, says GlobalData In June 2018, US-based biotech company BIOLIFE4D successfully demonstrated its ability to 3D bioprint human cardiac tissue in patch form in just a few days, well ahead of 6-8 month development time predicted in scientific literature. Although bioprinting is still in infancy, it holds a wealth of promise for the future of healthcare, says leading data and analytics company GlobalData. Bioprinting is a form of 3D printing that employs living cells or ‘bioink’, as the printing material. Generally, bioink is deposited onto a gel in layers, resulting in a 3D-printed biological structure. BIOLIFE4D’s technique uses a patient’s own white blood cells, which are reprogrammed into induced pluripotent stem cells and then cardiac cells. Besides BIOLIFE4D, companies such as TeVido, BioDevices and Organovo are innovating with proprietary bioprinting technologies. TeVido is developing nipple reconstruction implants for breast cancer survivors by employing a patient’s own skin cells in a proprietary process. Organovo creates functional 3D human tissue prod-

Florida Department Of Health In Orange County Welcomes Preventive Medicine Resident Dr. Tolu Adebanjo The Florida Department of Health in Orange County is pleased to welcome Preventive Medicine Resident Tolu Adebanjo, M.D., M.P.H. One of the four candidates selected by the Centers for Disease Control and Prevention (CDC) to participate in the Preventive Medicine Residency and Fellowship program in 2018, Dr. Adebanjo is assigned to Florida Department of Health in Orange County and Orlando Health for a 12-month fulltime training program. As a board certified pediatrician with over five years of clinical experience, Dr. Adebanjo will work closely with Florida Department of Health in Orange County Health Officer Dr. Kevin Sherin. “The Florida Department of Health in Orange County is delighted to participate in this first ever preventive medicine fellowship with the CDC and Orlando Health,” said Dr. Kevin Sherin. “Dr. Tolu Adebanjo is an incredible addition to our team. Her ability to work on projects within Orlando Health and the health department will pay future dividends by improving systems of care.” Although born in Palo Alto, California, Dr. Adebanjo is an Orlando native and graduated from of Olympia High School. A pediatrician by training, she has a passion for Adverse Childhood Experiences (ACEs), which she has chosen as her transformational practice and policy project for her fellowship. Dr. Adebanjo indicated her learning goal during the 12 months is, “To learn more about the practice of public health, including the collaboration with healthcare delivery systems and community and advocacy organizations, and build upon my policy development, program evaluation, and leadership skills.” While completing her fellowship with Florida Department of Health in Orange County, Dr. Ade-

ucts using the company’s proprietary NovoGen Bioprinters and bioink technology. The company’s first program is targeting rare liver disease. Jennifer Ryan, Medical Device Analyst at GlobalData, says: “Innovations such as bioprinting are part of the next wave of medical advancement and hold a wealth of promise for the future of healthcare. Bioprinted tissue can be used for drug development and safety, as well as other medical research efforts. In the future, the aim is to create replacement organs for patients in need of a transplant.”

banjo will promote Baby Safe Sleep awareness to fight against Sudden Infant Death Syndrome (SIDS), collaborate on a Fetal Infant Mortality Review, and develop a project to increase awareness and screening for ACEs. Dr. Adebanjo received her medical degree from the University of North Carolina at Chapel Hill School of Medicine; and completed her undergraduate degree in Nutritional Sciences at the University of Florida. While completing her medical degree, Dr. Adebanjo was a recipient of the prestigious Davis Scholarship, which honors a third-year medical student who demonstrates a scholarly approach to pediatric medicine, high moral standards and ethical values, and a desire for enhancing the well-being of children. Dr. Adebanjo’s post-graduate training includes a Pediatric Residency at the Baylor College of Medicine / Texas Children’s Hospital, where she later served as Chief Resident, and working as an Epidemic Intelligence Service Officer at the CDC. Since 1972, the Preventive Medicine Resident and Fellowship programs has developed over 430 public health leaders skilled in program evaluation, management, policy, and population health improvement.

According to American non-profit organization, United Network for Organ Sharing (UNOS), nearly 15,000 patients in the US are currently on the organ transplant waiting list and 20 patients die each day, on average, while waiting for a transplant. The need for organ transplants continues to far exceed the number of registered donors, leaving patients with no option but to wait. Advancements in bioprinting capabilities aim to one day 3D print an entire functioning organ, complete with all component parts, for transplant patients.

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GrandRounds After successfully bioprinting a cardiac patch, BIOLIFE4D has now focused its attention on printing other heart constructs, such as heart valves and blood vessels and a mini-heart as it seeks to progress to 3D bioprinting a full human heart. Ryan concludes: “Already other 3D printing techniques such as selective laser sintering and material jetting are employed in the medical device industry to create a variety of products such as surgical guides and patientspecific orthopedic implants. With the progression of bioprinting technology, 3D printing will have an even greater impact on patient treatment through evolving drug therapies and engineered organ replacements.”

Orlando Named Among Healthy Community Champions by the Florida Department of Health The Orange County communities of Apopka, Eatonville and Orlando were among 46 that were recently named Healthy Community Champions by the Florida Department of Health. “Apopka, Eatonville, and Orlando are leading the way in Orange County by creating a ‘health in all policies’ approach for their residents,” said Dr. Kevin Sherin, the Health Officer for the Florida Department of Health in Orange County. “By promoting healthy lifestyles and conditions for health they are adding value to the community and to Orange County. We are delighted to see them recognized by the State Surgeon General for their efforts.” Local governments have implemented a variety of policies that have been shown to increase physical activity and improve nutrition. Between February and April 2018, local governments were invited to submit best practices to demonstrate how they met the Healthy Community Champion criteria.

AMA Releases 2019 CPT Code Set The American Medical Association (AMA) today announced the release of the 2019 Current Procedural Terminology (CPT®) code set. There are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the health care community’s combined annual effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services. “The CPT code set is the foundation upon which every element of the medical community - doctors, hospitals, allied health professionals, laboratories and payers - can ef12

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ficiently share accurate information about medical services,” said AMA President Barbara L. McAneny, M.D. “The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures. That’s why we believe CPT serves both as the language of medicine today and the code to its future.” Among this year’s important changes to CPT are code additions that reflect the tremendous potential of using connected health tools to better support clinicians in patient population health and care coordination services, and other novel delivery systems that are vital for improving the overall quality of health care. These include three new remote patient monitoring codes that reflect how health care professionals can more effectively and efficiently use technology to connect with their patients at home and gather data for care management and coordination. Also, two new interprofessional internet consultation codes have been added to reflect the increasing importance of using non-verbal communication technology to coordinate patient care between a consulting physician and a treating physician. “The AMA has urged the Centers for Medicare and Medicaid Service to adopt the new codes for remote patient monitoring and internet consulting and designate the related services for payment under federal health programs in 2019,” said Dr. McAneny. “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care." Additional CPT changes for 2019 include new and revised codes for skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis, and central nervous system assessments including psychological and neuropsychological testing. Broad input from practicing physicians, medical specialty societies and the greater health care community was considered by the CPT Editorial Panel to produce the latest practical enhancements to CPT that reflect the coding demands of the modern health care system. New CPT category I codes are effective for reporting as of Jan. 1, 2019. To assist the health care system in an orderly annual transition to a new CPT code set, the AMA releases each new edition four months ahead of the Jan. 1 operational date and develops an insider’s view with detailed information

BankUnited Names New Assistant Vice President in Orlando BankUnited recently announced the hiring of Michele Nichols as assistant vice president for business banking in Orlando. With 13 years of industry experience, Nichols will be responsible for business development, portfolio administration, and client relations. She joins BankUnited from Fifth Third Bank in Maitland, where she served most recently as financial center manager responsible for business development. A resident of Longwood, Nichols supports the Florida Association of Veteran Owned Businesses and volunteers her time with Feeding Children Everywhere and the Children’s Home Society of Florida. She earned a bachelor’s degree from Rollins College in Winter Park

Nichols will be based at 189 South Orange Avenue, Orlando. For information call 407-308-3514 or visit www.BankUnited.com.

Community Health Centers Named Top 100 Company For Working Families For Third Year In A Row For the third consecutive year, Community Health Centers, Inc., a Federally Qualified Health Center (FQHC) with locations throughout Central Florida, was selected as an Orlando Sentinel Top 100 Company for Working Families. The Orlando Sentinel’s “Top 100 Companies” program is a celebration of elite employers who have proven that they know what it takes to create an environment where people love to come to work. The goal of “The Top 100 Companies” is to raise the bar among our region’s employers, creating excellence and employee engagement in the workplace that will attract talented people for years to come. For the more than 20 years, the Orlando Sentinel has recognized organizations that are committed to making their company a great place to work. Community Health Centers ranked 15th in the 100-499 employees category. The award is based on 75% employee (confidential) satisfaction feedback and 25% is based on employer benefits. Qualities measured include; communication, workplace flexibility, leadership/management, career opportunities, community service, compensation and benefits.

“Each year, Community Health Centers looks for ways to improve the workplace environment for team members and employee benefits to create a successful and prosperous place where people love to come to work. Meeting the needs of our employees and engaging them is critical to ensuring that we provide the best care possible to the patients we serve. We feel that our great benefits package including zero or low medical co-payments and prescriptions, vision, subsidized dental coverage, short and long-term disability, bi-weekly retirement contributions and a generous PTO & holiday program contributed towards us being selected, again.,” states Margaret Brennan, President/CEO of Community Health Centers.

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GrandRounds on the new code changes. The AMA invites the health care community to learn more about the significant changes to CPT codes and descriptors by attending the CPT and RBRVS 2019 Annual Symposium in Chicago from Nov. 13-16, 2019. For additional information and registration, please visit the AMA website. The 2019 CPT codes and descriptors can be imported straight into existing claims and billing software using the downloadable CPT 2019 Data File. The file contains the updated code set’s complete descriptor package, including official descriptors for consumers and physicians, and the complete official CPT coding guidelines.

CMS Announces New Model to Address Impact of the Opioid Crisis for Children The Centers for Medicare & Medicaid Services (CMS) announced a new Innovation Center payment and service delivery model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers. The InCK Model will help state Medicaid agencies and their local health and community-based partners identify and address risk factors for behavioral health conditions, understanding that the earliest signs of a problem may present outside of clinical settings—such as in schools or at home—and may be known not to clinicians but rather to teachers and to child welfare and foster care programs. The interventions outlined in the InCK Model are designed to respond to this crisis by supporting state Medicaid agencies and local health and community-based partners to increase access to behavioral health for vulnerable children and build capacity in communities to provide more effective, efficient, and affordable care through home- and community-based services. While the existing, required Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is comprehensive, variation remains among states in how and when children receive behavioral health screening, diagnostic and treatment services. In addition, despite the variety of federal, state, and 13

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local services that do exist to support children’s health, limited information sharing and differing eligibility and enrollment processes have created barriers to putting children and families at the center of their care and coordinating across services. InCK Model participants will benefit from systematic integration, coordination, and management of core child services, including clinical care, school-based health services, housing, and other health-related supports. The InCK Model aims to positively impact the health of the next generation through early identification and treatment of behavioral health risk factors of children up to age 21 covered by Medicaid and CHIP in selected states. Testing the use of a state-specific payment model to cover integrated care coordination and case management, the InCK Model will be tailored to the unique challenges faced by providers and patients at the local level, ultimately leading to long-term improvements in child health services and health outcomes. The CMS Innovation Center anticipates releasing a detailed Notice of Funding Opportunity in Fall 2018 with additional details on how state Medicaid agencies and local health and community-based organizations can apply to participate in the model. CMS intends to award funding for up to 8 states at a maximum of $16 million each in as early as Spring of 2019 to implement the seven-year model. The CMS Innovation Center was established by section 1115A of the Social Security Act to test innovative healthcare payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or CHIP benefits. For a fact sheet on the InCK Model, please visit: https://www.cms.gov/ newsroom/fact-sheets/integratedcare-kids-inck-model. For more information on the InCK Model, please visit: https://innovation.cms.gov/initiatives/integratedcare-for-kids-model/.

Interoperability Pledge from Six AI Players Will Improve Disease Diagnosis and Treatment Google, Amazon, and IBM joined forces with Microsoft, Salesforce, and Oracle to pledge to speed up the progress of health data standards and interoperability. This historical collaboration between the biggest artificial intelligence (AI) players will lead to enormous advances in AI, which itself will lead to earlier diagnoses and better treatments at lower cost, accord-

Orlando Health, West Orange Healthcare District Celebrate Opening Of New Cancer Center

Orlando Health UF Health Cancer Center – Health Central Hospital is opening its doors and bringing cutting-edge cancer treatment to the residents of West Orange County. The new $28 million facility, funded primarily by a $21 million grant from the West Orange Healthcare District (the District), will offer expanded chemotherapy and radiation treatment areas, medical oncology services, surgical oncology consultations, laboratory facilities, and Cancer Support Community programs. At 30,000 square feet, it almost doubles the size of the existing facility located near the Orlando Health Health Central Hospital campus. Orlando Health UF Health Cancer Center – Health Central Hospital will be the first in Central Florida and one of only six facilities in the country to treat cancer with MRI-guided radiotherapy. The cancer-fighting technology is called MRIdian® and allows specialists to track and adjust its radiation beam to any subtle changes in the tumor and surrounding tissue during treatment. As a result, cancer patients benefit from truly personalized radiation therapy while minimizing radiation exposure to surrounding tissue. “This new facility is greatly needed and there’s no better place for it than right here on this campus, in this community, where families in West Orange County live, work, and play,” said Mark Roh, M.D., president of Orlando Health UF Health Cancer Center. “In fact, evidence proves that patients battling cancer have better results when they are treated closer to home.” The Cancer Center is part of a $100-million expansion currently underway to bring much-needed healthcare services to West Orange County. It includes $75 million in funding from the District for the Cancer Center ($21 million), a 100bed skilled nursing facility currently under construction on the Health Central Hospital campus ($24.5 mil-

lion), and a new freestanding emergency department and medical pavilion scheduled to open soon in the rapidly-growing Horizon West community ($29.7 million). “These three projects are all part of our original vision,” said West Orange Healthcare District Board Chair Norma Sutton. “They help us boost access to healthcare, deliver the latest medical technologies and attract topnotch physicians to our community. We’re excited to be able to expedite these new facilities with our funding support." Mark Marsh, president of Health Central Hospital, led the ribbon-cutting ceremony welcoming the community to the new Cancer Center, saying “Orlando Health is extremely pleased and thankful for the West Orange Healthcare District’s support and collaboration. Together, we’re ensuring that West Orange County residents will be able to access more world-class healthcare services in their communities, close to home.” A couple of high-resolution photos are attached. Below are captions: DSC09065: The 30,000-squarefoot Orlando Health UF Health Cancer Center – Health Central Hospital was primarily funded by a $21 million grant from the West Orange Healthcare District and will offer a full range of cancer care services, including expanded chemotherapy and radiation treatment areas, medical oncology services, surgical oncology consultations, laboratory facilities and Cancer Support Community programs. DSC09963: Leadership from Orlando Health, the West Orange Healthcare District and the community gathered at the new Orlando Health UF Health Cancer Center – Health Central Hospital gathered to cut the ribbon on the $28 million facility. The first patients will be seen at the Cancer Center on Monday, August 27.

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GrandRounds ing to GlobalData, a leading data and analytics company. The companies claim that this project will lead to better outcomes, higher patient satisfaction, and lower costs—a so-called ‘Triple Aim’. Valentina Gburcik, PhD, CVMD Director at GlobalData, comments: “This big new alliance’s pledge will have a very positive impact on healthcare as it will become easier to share medical data among hospitals. Both physicians and patients will have easier access to information, which will lead to faster diagnosis and treatment. In the same time, the six tech giants will eventually profit from speeding up their AI research. “In particular, this deal is good news for the companies’ AI sectors. If health data is fully standardized and interoperable, the ‘smarter’ AI can progress faster. Breaking down barriers between chunks of big data will create extremely large data sets, allowing extensive machine learning to boost AI effectiveness and revolutionize healthcare systems.” The Information Technology Industry Council (ITI) issued a letter, signed by all six tech giants, which states that they are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability. In the letter, the technology giants also claimed that they will base this alliance on four foundational assumptions. The first one is about frictionless and safe exchange of healthcare data; the second covers healthcare data interoperability; the third looks at open standards, open specifications and open source tools; while the fourth is about commitment to actively engage “among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation.” There are currently over 100 companies that are applying AI algorithms and predictive analytics to healthcare, with the above mentioned six giants leading the way. The highly developed AI programs now have the increasing capacity to delve into big data, identify patterns, and generate algorithms to explain them. Gburcik adds: “These programs can help researchers generate more accurate hypotheses faster, making the drug discovery process less expensive and more effective. In addition, the database of electronic medical records and public health data can be analyzed to identify hidden patterns that can lead to the quick identification of potential molecular targets for a disease.”

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Encore at Avalon Park Partners with Orlando Repertory Theatre on New Program for Seniors Heart of Florida Physician Group Adding New Primary Care Providers Heart of Florida Physician Group welcomes two new Primary Care providers to the staff at the Davenport office who will be offering extended hours to better serve patients who need early morning or after work appointments. Bettye Brown, a board-certified Advanced Registered Nurse Practitioner, is currently seeing patients and Dr. Hall, who will be joining the practice on September 4, will also begin seeing current patients and accepting new patients as well. “We are very excited to have both Dr. Hall and Bettye Brown join our physician group,’’ said Sabrina Robinson, market director for the physician group. “We have seen a need for additional Family Medicine health care providers in our area and we want to be able to best serve the needs of the community.’’ The physician group office, which is located at 410 Lionel Way in Davenport just across from Heart of Florida Regional Medical Center, will be open from 7 a.m. to 6 p.m. during the week. Brown brings more than 16 years of experience in the Family Medicine field to the physician group. She credits her six years as a military medic with her passion for her profession. “I know that I can apply my personal experience and contribute to a patient’s recovery, health and wellness, which gives me a sense of personal pride, which in turn, strengthens my commitment to this profession,’’ Brown said. Brown sees patients ranging from children, teens, adults and senior citizens. She is also a Certified Medical Examiner for the Department of Transportation in providing DOT physicals. Dr. Hall said she wants to make sure her patients feel like they are active participants in their health care decisions. “Collaboration is key. Healthcare decisions should be made with patients, not for them. I want my patients to be informed decision makers when it comes to their health. I want them to know we are working together and have the common goal of getting them where they need to be with their health,’’ Dr. Hall said. Dr. Hall will be seeing patients ranging from infants to senior citizens. Both Brown and Dr. Hall offer a wide variety of services from well checks to immunizations, prevention and management of diabetes, high blood pressure, upper respiratory infections and other chronic diseases. To make an appointment with

As a leader in innovative programs for seniors, Encore at Avalon Park has teamed with Orlando Repertory Theatre to provide a new program pairing middle school students with residents at Encore. The program, Come to the Table, will involve 20 Avalon Middle School students interviewing residents over four sessions about their favorite recipes. After completing the interviews, the students will help playwright and Orlando Repertory Theatre Teaching Artist, Kate Kilpatrick, develop an original play. Students will perform the play at Orlando REP on January 19 at 11 a.m. Tickets are free. “We found that interactions such as these are wonderful for our seniors,” says Stephanie Lerret, Senior Vice President, Encore at Avalon Park. “Our goal is to ensure our residents experience all that life has to offer and being a part of this program will enrich ev-

either Bettye Brown or with Dr. Hall, please call the office at 863-419-2420 or visit the web site at HeartOfFloridaPhysicianGroup.com. Some same day appointments may be available.

Florida Hospital Association And Central Florida Health Nationally Recognized For Achievements In Quality Care And Value Central Florida Health, the 636bed not-for-profit healthcare system comprised of Leesburg Regional Medical Center and The Villages® Regional Hospital, announced today that it has participated along with 91 other hospitals in the state in a joint quality improvement effort guided by a working committee of the Florida Hospital Association. The American Hospital Association recently recognized this committee and FHA leadership for accomplishing significant improvements in patient safety in the past 12 months, including:  A 40 percent reduction in clostridium difficile hospital acquired infections;  a 21 percent reduction in central line-associated bloodstream infections;  a 23 percent reduction in catheter-associated urinary tract infections; and  a 21 percent reduction in methicillin-resistant staphylococcus areus infections. The overall goal of the program, which is still in effect, is to work to improve the overall culture and effectiveness of patient safety measures by

eryone.” The program is similar to Encore’s Songbird program, where students from Avalon Middle School spend time with residents to develop music playlists and programs that help awake those residents who have disconnected from life. This new program combines the element of theater with food and residents will be able to watch the play performed on January 19, 2019. “The arts are critical to living a fulfilling life and theater is an excellent way to bring generations together in a medium that people love,” says Emily Freeman, Community Engagement Director at Orlando REP. “Orlando Repertory Theatre is committed to providing high quality theatre to youth and families in our community. This project is a beautiful example of how we can bring family members of all ages to our stages.”

sharing and implementing best practices among FHA hospitals. This approach has been proven to improve hospital safety and reduce patient harmful events. Other patient safety improvements recognized by the AHA include reductions in patient falls, increased medication safety and improved safety for hospital workers. Phyllis Baum, RN, chief quality officer for CFH, served in a leadership capacity on the committee. “It was an honor to serve and to ultimately achieve these improvements,” says Baum. “CFH hospitals remain steadfast in their ongoing commitment to continuously improve the quality of care—each patient, every day and every time.” Don Henderson, president and CEO of Central Florida Health, has also served on the board of the Florida Hospital Association for the past five years. “Congratulations to Phyllis Baum and the other clinicians on the FHA team who achieved this outstanding result,” says Henderson. “At Central Florida Health, we were proud to have played a part in this critically important effort.”

Orlando Health Simulation Program earns accreditation from the Society for Simulation in Healthcare The Orlando Health Simulation Program was recently granted accreditation by the Society for Simuorlandomedicalnews

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GrandRounds lation in Healthcare in the areas of Teaching/Education and Systems Integration. “We are honored to receive recognition for our efforts in developing a high-quality simulation program,” said Linda Knorr, MSN, RN-BC, corporate director, Clinical Learning. “Education through simulation learning is essential for our team members to provide excellent patient care.” Teaching/Education and Systems Integration are key components to providing ongoing simulation learning for clinicians. “Our strengths in Teaching/Education reflect our team’s dedication to the expanding science of simulation and experiential learning, along with the various disciplines and specialized certification achievements among team members,” said Knorr. “Our commitment to Systems Integration is demonstrated in our continual collaboration with quality, safety, and patient experience and satisfaction to educate team members to provide evidence based care to our patients and guests. Simulation offers team members a psychologically safe environment to learn skills with a team approach prior to caring for patients.” Simulation learning, including hands-on education and learning with high-fidelity patient simulators, synthetic tissue and real-life medical scenarios, is imperative to providing excellent quality care for patients on a daily basis and in time of crisis. Simulation learning experts at Orlando Health help ensure nurses, doctors and other health care providers are ready to deliver patient care to the community. The Simulation Team is comprised of learning consultants, a simulation technician, doctors, administrators and other health care professionals. Weekly and monthly drills prepare clinicians to meet emergency medicine and trauma, critical care, life support, obstetrics, and other patient care. Simulation learning at Orlando Health includes the Orlando Health Institute for Learning Simulation Lab, the Medical Education Center for Simulation Based Training, and simulation labs located at Orlando Regional Medical Center, Arnold Palmer Hospital for Children, Winnie Palmer Hospital for Women & Babies, Health Central, Dr. P. Phillips Hospital, and South Seminole Hospital. These simulation sites provide the latest available technology to enhance application of conceptual knowledge in a dynamic environment that allows integration of theory with practice.

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Orlando Health’s Heart Care Earns Highest Quality Rating Orlando Health received its seventh consecutive Overall 3 Star Rating from The Society of Thoracic Surgeons for providing excellent care to patients undergoing coronary artery bypass surgery (CABG) as well as a 3 Star rating for aortic valve replacement (AVR) and its fourth consecutive 3 Star rating for aortic valve replacement with coronary artery bypass surgery (AVR+CABG). The 3 Star Rating, the highest achievable, is based on STS Adult Cardiac Surgery Database participant outcomes. The most recent evaluation period is January 2017 through December 2017. Historically, approximately 10 percent to 15 percent of participants receive the three-star rating for isolated CABG surgery; approximately 6 percent to 8 percent of participants receive the three-star rating for isolated AVR surgery; and approximately 5 percent to 7 percent of participants receive the three-star rating for AVR+CABG surgery. “Achieving and maintaining the highest quality rating for heart surgeries demonstrates our continued dedication to excellent outcomes for our patients,” said Jeffrey Bott, MD, a cardiothoracic surgeon at the Orlando Health Heart Institute. “Our commitment to quality and transparency are important considerations as patients choose our program. It is an honor to be recognized by peers.” The Heart Institute’s success in cardiac surgery performance is the result of expertise, experience, collaboration, and a voluntary, self-run quality council. The council — comprised of surgeons, nurses, pharmacists, respiratory therapists, infection control specialists, risk managers, administrators, doctors and other team members — works diligently on various quality improvement initiatives and care reviews for each of our processes including pre-surgical preparation, surgical management, avoidance of complications and death and post-surgical medical management. The composite measure for isolated coronary artery bypass graft (CABG) surgery consists of four quality domains over a twelve month period: 1. Absence of mortality (Deaths) 2. Absence of major morbidity (Complications) 3. Use of Internal Mammary Artery (s) (Arteries located in the chest and commonly used in bypass surgery because they have been shown to have the best long-term results.) 4. Receipt of required periopera-

Florida Hospital Kissimmee Plans Surgical Expansion Florida Hospital Kissimmee will soon break ground on a new expansion, which will bring a modern surgical suite and expanded services to Osceola County. The 27,000-square-foot surgical suite will start with four operating rooms, with the capacity to add more to accommodate future growth. The operating rooms will feature state-of-the-art lighting, camera and recording capabilities. Robotic services are planned as well. “This expansion is part of a journey of growth over the last several years to meet the area’s health-care needs,” said Florida Hospital Kissimmee CEO, Shei-

tive medications (Appropriate perioperative (before, during and after) medication usage.) The composite measure for isolated AVR and for AVR+CABG consists of two quality domains: Absence of mortality, and Absence of major morbidity.

Orlando Health is the First Hospital in Florida to Perform Life-Changing In-Utero Surgery Orlando Health announced today that it is the first hospital system in the state of Florida to perform inutero surgery to repair spina bifida, a spinal defect developed by the fetus during the early stages of pregnancy. The first surgery took place on May 23, 2018 at Winnie Palmer Hospital for Women & Babies and the mother delivered her baby via C-section on July 10, 2018. To date, the team has successfully performed this operation on three patients and the first two healthy babies have been born. Myelomeningocele, the most common and severe form of spina bifida, occurs in approximately 1 in 3,000 births in the U.S. With an average of 14,000 babies born at Winnie Palmer Hospital each year, there is a great need for this type of specialized surgery. There are only 12 centers in the country that perform this procedure and the next closest are in

la Rankin. “It demonstrates our commitment to bring wholeness to the Kissimmee community, today and for years to come.” The project coincides with the hospital celebrating its 25th anniversary as part of the Florida Hospital system, and it caps a series of recent upgrades. In 2014, the hospital opened an expanded Emergency Room, followed by an 80-bed patient tower in 2015 and a cath lab in 2016. The most recent of these updates is a new, on-site retail pharmacy, scheduled to open in December 2018. Completion is expected in September 2019.

Tennessee and North Carolina. Many mothers who need this procedure are unable to have it, as the financial and physical burdens of traveling out of state are too great. The fetal surgery program at Orlando Health has been in the making for over a year. It began with the recruitment of Samer Elbabaa, MD, a pediatric neurosurgeon who has performed 65 of these procedures in his career. This is a very delicate surgical procedure that requires a multidisciplinary team of experts to care for two patients -- the mother and her baby,” said Elbabaa. “We have built an excellent fetal surgery team that includes fetal neurosurgery, maternal-fetal medicine, neonatology, anesthesiology and more. This is a collaborative effort, and it continues even after the baby is born.” Fetal surgery is not a cure for spina bifida, however studies show that it can significantly reduce the need for a spinal shunt at birth and improve the child’s mobility and leg function. Pregnant mothers must go through a robust screening process to determine if this surgery is the best option for them. The procedure must be done within a tight window between 19 and 26 weeks of pregnancy to offer the best outcomes for both the mother and her baby. “We are thrilled to have this innovative and life-changing surgery available at Orlando Health,” said David Strong, president and chief

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GrandRounds executive officer of Orlando Health. “Orlando Health is always advancing to meet the needs of our patients. We are pleased to be able to offer moms across the southeastern U.S. access to this service.” This new program is part of the hospital’s Fetal Care Center, which helps families navigate the fetal surgery process and the care needed after birth. For more information about the center, click here.

SuperMoney Launches Unprecedented Point of Sale Financing Platform for Service Providers SuperMoney, a leading financial service comparison site, has announced the launch of an innovative new No-Fee Financing Platform that offers affordable point of sale financing opportunities for service providers nationwide. Built on top of SuperMoney’s consumer loan offer engine technology – which has exceeded more than half a billion dollars in loan requests since launching one year ago – the company’s new No-Fee Financing Platform is making point of sale financing available for merchants and service providers across all industries including healthcare, home improvement and specialty retail. Service providers and merchants can get set up to offer financing in a matter of minutes with this sleek new platform and SuperMoney is partnering with banks, credit unions, and direct lenders to provide competing financing offers for the consumer. Millions of businesses have been suffering from expensive and inefficient financing solutions for their customers – with rates typically up to 10%. “We’re expanding opportunities for merchants to boost sales at no cost to them,” said Lulic. “It’s also allowing consumers the opportunity to receive competing financing offers with more transparency when making purchases. This is a game-changer for economic growth.” For more information, visit https://www.supermoney.com/pointof-sale-financing/.

More than 400 uninsured children receive free physicals and followup specialty care from Shepherd’s Hope The new school year is underway in Central Florida, and 402 children are in their classrooms thanks to free back-to-school physicals they received from Shepherd’s Hope. This year’s physicals also identified 51 young patients who required specialty follow16

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up care ranging from otolaryngology (ENT), ophthalmology and cardiology. It is the fifth consecutive year Shepherd’s Hope has partnered with Nemours Children’s Health System to offer free school physicals and other medical services for local uninsured and underinsured families. A grant from the Harper Family Charitable Foundation also helped fund this year’s 10-day initiative. The children needing specialty follow-up care were referred to Shepherd’s Hope’s Community Referral Provider Program (CRPP) for assistance. The CRPP gives sovereign immunity to volunteer physicians and other health care partners in the community who provide free specialty care services to Shepherd’s Hope patients at their office or clinic locations. “Hundreds of uninsured families every year rely on Shepherd’s Hope for their children’s school physicals. And each year, we also provide assistance to help many of these children who require specialty follow-up care,” said Marni Stahlman, president and CEO of Shepherd’s Hope. “Our ability to meet the essential health care needs of these families is only possible because of our partnerships with Nemours.” “We are honored to be part of a program that offers so many families the ability to start the school year off right,” added Dr. Al Torres, Chief of Critical Care at Nemours Children’s Hospital. “As a pediatric health system that is focused solely on children,

we understand the importance of creating healthy habits early on in life.”

Florida Hospital set to open doors of new infusion center at Celebration Health campus In a welcome development for cancer patients receiving outpatient infusion therapies, Florida Hospital Celebration Health opened its doors to its new, full-service infusion center. The opening brings to six the number of Florida Hospital infusion clinics now operating in our region, and provides residents of Celebration and its surrounding communities a convenient, state-of-theart option for outpatient cancer care. The other infusion center locations are: Orlando, East Orlando, Altamonte, Kissimmee, and Winter Park. The infusion center joins a robust lineup of established cancer services at the campus, including world-class specialists in breast, head-and-neck, and prostate cancers. Florida Hospital Celebration Health continues to grow with new comprehensive cancer services coming in early 2019, positioning the facility as the only one of its kind in the region. These services provide Osceola County with the expertise of additional sub-specialized medical oncologists, surgical oncologists and radiation oncologists while providing the

latest in cancer-treatment options. “We are dedicated to providing world-class, state-of-the-art care close to home for as many cancer patients as possible,” said Dr. Mark A. Socinski, executive medical director of the Florida Hospital Cancer Institute. “Opening this infusion center in Celebration increases the options patients have to receive cancer care at a place most convenient for them.” Infusible and injectable drugs require preparation by medical professionals and monitoring of patients while the drugs are administered. Infusion centers allow patients to receive this care in an outpatient setting that they visit regularly over the course of their treatment regimen. Services offered at Florida Hospital Infusion Centers include chemotherapy, IV therapy and hydration, immune system therapy, blood and blood product transfusions, injections, administration of antibiotics and pain medications, and centralline care and maintenance. The center will feature private patient bays, allowing advanced infusion services in a soothing environment, as well as access to clinical trials for patients. It’s located at 380 Celebration Place on the campus of Florida Hospital Celebration Health.

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THE HR LADY

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y d a L HR By WENDY SELLERS

Q: Is it my responsibility as a business owner to train and/or develop employees? A: Well it depends who did the hiring. Did you hire the right person for the job or did you under-hire assuming that they can learn the job through your close supervision and training and then you can pay the new hire less? There is nothing wrong with this decision, but if that’s the case, then you are responsible for training because that was the agreement you made (spoken or unspoken). Additionally, if you intend on promoting from within then yes you are responsible for developing an employee to prepare them for the future job within your company. Promoting from within is a great career path plan for employees and a smart decision for your bottom line. It creates loyalty which improves retention and it also prevents the loss of organizational knowledge and expertise. Please know that training is for the job the employee is doing today, while development is for the job that an employee may do tomorrow either at your location or at another company. In the end, it really comes down to your business philosophy as well as compensation. As we know, if you were bringing in the best of the best (in regard to skills), you’re also hiring them at the highest rate of compensation for that position. Many small businesses say I cannot afford that, but I can afford to wait it out and train them. But then, what really happens is you run out of time to actually conduct the training and development and lose the employee anyway. If you plan on conducting your own training and development, make sure the trainer is

suited to do that – plenty of time must be allotted over several months and someone with patience and empathy should be in charge of these tasks. If you need assistance with training and development, contact BlackRain Partners. Review our course summaries to discover how we motivate, engage and educate employees towards improved communication and productivity. Also, review our 6 and 9 month programs for Sales and Leadership skills.

Q: Should I conduct drug testing at my practice? Why and how? A: Yes. As a small business owner who is dealing with highly sensitive medical information of patients and also potentially sample prescriptions, a drug test is highly recommended. Why and how? The answer to why is related to lower workers compensation insurance rates, increased workplace crimes including theft, fraud, violence and workplace accidents which can destroy your business. The National Safety Council reported that 80 percent of those injured in “serious” drug-related accidents at work are not the drug abusing employees but innocent coworkers and others. If you were involved an accident at work caused by your co-worker, how would you feel if it was preventable? What would you do? Call a lawyer. You bet! The great news is that the how is pretty easy. Most walk-in clinics or urgent cares can conduct drug testing for new hires random screenings and or after accidents that happened in the workplace. They’re fairly cheap and you could probably get a decent pricing of about $100 a person. You can set up an account with the clinic and possibly get a discount as well. Setting up an account is easy and

during times of chaos, such as hiring and/ or a workplace accident, you will not have to worry about going with the employee to the clinic to pay the bill. They usually have your credit card on file or send you an invoice. Most clinics can also assist you with the selection of employees for random drug screenings throughout the year. Obviously if you only have four people in your company and you do a random every month the odds of them getting chosen are extremely high. It is even more important to make sure there’s no discrimination involved in these random decisions, therefore outsourcing the selection is critical. Finally, a third-party vendor can also help you through the sticky situations dealing with medical marijuana and other prescriptions drugs that may be dangerous for use in certain workplaces. Until marijuana is legal at the federal level, it is still a substance that most workers compensation insurance companies do not approve of.

Speaking of safety, did you know that OSHA has an On-Site Consultation Program which offers no-cost and confidential safety and occupational health advice to small and medium-sized businesses in all states across the country, with priority given to high-hazard worksites? Be prepared by starting with drug screenings for new hires and consider random drug screenings for current employees, especially for those who are driving a vehicle as part of their job and/or handling highly sensitive information such as patient files, patient credit cards, sample prescriptions and prescription pads. “The HR Lady,” is Wendy Sellers, leadership coach, author, speaker and COO of BlackRain Partners www.blackrainpartners.com, a business consulting company focused on coaching, training, development and HR. She has a Master of Healthcare Administration, a masters in human resources, SHRM-SCP and SPHR certifications. Wendy’s leadership book, “Suck It Up, Buttercup” is on www.Amazon.com

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Three Pillars of the Medical Cannabis Industry

The roadmap to a successful statewide medical cannabis system and successful cannabis business By MICHAEL C. PATTERSON

I speak to groups all over the country about legal cannabis. One of the most common misconceptions that I encounter is the idea that a legal cannabis system automatically equates to financial success of individuals who operate legal cannabis businesses. As you are aware, Florida passed a constitutional amendment legalizing medical marijuana. Within minutes of the law passing on November 8, 2016, I received four texts from friends which all read, “Are you a millionaire yet?” My first reaction was “Are these people serious?” Yes, they were all serious. Millions of people believe the cannabis business is the “golden ticket” to money and riches. While that can be true for some, it is important to understand how laws and regulations affect your ability to succeed as a cannabis related business. Since the legal cannabis industry is so new, most people who are entering the industry have no experience in cannabis whatsoever. They want to understand how to get a license to grow, process, dispense, or transport cannabis. It is imperative to understand the state medical cannabis law and how it can determine your success or failure as a business owner. State medical cannabis laws must have balance of three areas or “pillars” in order to be successful. These pillars are public safety, patient access, and commerce. Public Safety - The policies, laws, and rules that prevent diversion of cannabis and ensure medication is produced safely, proper state government oversight of providers, as well as education of law enforcement and education/outreach to the general public. Patient Access - How hard is it to access the medication? How costly is a doctor visit and how many times a year must a patient see a physician to maintain their medical cannabis card? How long does a patient have to wait to access medicine after being seen by an approved physician who has recommended cannabis? How much does the medication cost? Commerce - Can the dispensaries or stores make money? Does the law allow enough patients to receive the medicine to support the stores? Are there enough licensed operators to drive a free market to maintain competitive pricing and propel industry innovation? If these three pillars do not balance, the system does not function properly, and the entire legal framework can fail. For example, in New York State public safety is extremely strict because the MMJ 18

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law does not allow many qualifying conditions (which limits patient access). It does not allow physicians to advertise to the public that they provide medical cannabis referrals (which limits patient access). The law initially allowed only 20 dispensaries in the entire state which limits patient access and the ability for (commerce) dispensaries to make money. Over the last three years in New York the legislature has gone back and modified the law five times because it was setup for failure. Public safety is too strict, which caused few patients to have access to the medicine and caused commerce (dispensaries) to charge $700 to $1000 per month for product to break even (which no operator has done as of 2017). Unless changes were made, the system would have failed. Another example of imbalanced pillars is California. Prior to 2018, California had poor public safety and laws, which created too much patient access and too much commerce. This unbalanced system has put licensed operators in jail because of ambiguous laws and regulations allowing for local law enforcement to interpret the law. A new recreational cannabis law went into effect in January 2018 but will take years to fix the problems of a poorly planned legal cannabis system. So, how does the Florida Medical Marijuana law stack up? Overall the three pillars are fairly balanced. The law dictates that Medical Marijuana licenses be vertically integrated, which means each licensee, called a Medical Marijuana Treatment Center (MMTC) must cultivate, process, dispense, and transport medical marijuana (MMJ) throughout the state. Furthermore, each MMTC can open up to 25 dispensaries, but after 2020 each MMTC can open an unlimited number of dispensaries. As of August 2018, there are 14 licensed MMTCs in the state and approximately 50 dispensary locations currently open. The law mandates that for every 100,000 active patients, the state must issue 4 new MMTC licenses in order to keep up with demand. Recently, a judge in Lee County ruled certain parts of the MMJ law have been ruled unconstitutional, specifically the number of licenses issued being too limited, and the mandate that each MMTC license be vertically integrated. However, this ruling will be appealed by the State Department of Health Office of Medical Marijuana Use (OMMU), and is by no means binding as of now. Physicians are required to take a 2-hour CME course on MMJ to be allowed to certify patients to use MMJ. As of August 2018, there are approximately 1600 Physicians who

have been approved to write MMJ certifications. Current patient counts are around 140,000 and increasing 3,000 patients per week. So, on the surface the FL MMJ system seems to be balanced allowing for good public safety by requiring strict oversight of MMTCs, ability for physicians to recommend MMJ and many qualifying diagnoses, and numbers of stores increasing as well as the ability to deliver MMJ anywhere in the state is allowing for good patient access and ability for dispensaries to make money. Challenges to the Florida MMJ system – The glaring problems with the current MMJ are zero tax revenue and funding for public education. The Florida legislature wanted to help MMJ patients by not taxing the medicine. However, the problem with that decision is that it doesn’t provide any money to fund the enforcement division of the MMJ system which is the FL Department of Health Office of Medical Marijuana Use (OMMU). Without its own funding source, the OMMU must rely on the state legislature for approving funding annually. The concern is the state legislature may disagree with the MMJ system and choose not to fund the OMMU or limit funding for political or ideological reasons. If you don’t think that is possible, it has already happened in West Virginia where the legislature passed a new MMJ law in 2017 but refused to fund the Department of Health to oversee the program, which has killed the new law for now. Regarding education, the law

authorized $500,000 to be spent on educating the public. That money has been given to the University of Florida to study the effects of the new MMJ law on the state, but not to provide any real-world education to the citizens the Florida. This creates a lot of problems for all of us. If you don’t educate a population on something that used to be illegal but is now legal then you are asking for problems. The general public and most healthcare workers do not know how the law works, who qualifies, what is now legal, what is still illegal, etc. This is causing persons to be arrested for something they assumed was legal and causing patients to suffer who otherwise could be benefitting from this new legal medication. Overall, the Florida MMJ system is balanced but will still be modified for years to come in order to help the most patients possible. It is up to all of us as healthcare workers to educate ourselves about this law in order to help our qualified patients benefit from this natural medicine. The more we know about the law and how it affects the success of the entire system, the better we can work together to ensure the systems success. 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.

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Doctors and All Healthcare Professionals Are Welcome!

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Medical Marijuana Why We Did It? By ADRIAN L. BURROWES, MD, FAAFP

Since late 2016 when Floridians overwhelmingly voted to legalize medical marijuana, almost 150,000 patients have registered with the Florida Department of Health’s Office for Medical Marijuana use. Patients who have been suffering with conditions that may have been sub-optimally treated like Parkinson’s disease, chronic non-malignant pain, and uncontrolled seizures, just to name a few, now had renewed hope that perhaps there was an alternative treatment option to improve their quality of life. Those patients began seeking physicians who could help identify and enroll them in the process. In response to the demand, existing dispensaries are expanding, and new dispensaries are attempting to seek licensure. And while the dispensaries are rising to meet the needs of the demand, many physicians still remain at a loss as far as how to meet the needs of their patients who may qualify for medical marijuana use. Despite the increasing demand for medical marijuana, physicians have been hesitant to enroll as certified prescribers. For some it’s because they don’t believe in medical marijuana. For others, they simply don’t want it as part of their

medical practice. I, for one, struggled initially to decide whether or not I would participate in this undertaking. Having held a medical license in California, medicinal marijuana was not a new concept to me. I have seen and treated patients utilizing medical marijuana and seen the way it has improved the quality of life for many of my patients— so pragmatically, I had no reservations. Procedurally however, I struggled to understand the processes that were initially put in place by the state of Florida after the passage of medical marijuana legislation. The fees that physicians had to pay to enroll as a prescriber changed, as did the amount of education necessary to become a prescriber. Then, of course, there was the debate as to where this would fit in the armamentarium of treatment options and how patients would be selected for treatment. That was followed by the decision of which dispensary to recommend, the unfortunate stigma associated with being a prescriber and reconciling the reality that while it is legal to prescribe in Florida, it is in violation of federal law. Despite all of those headaches, one of the partners in my practice and I elected to proceed with the necessary

certification to become prescribers. We did so for two reasons: one, because we believed that we could positively impact some o f our patients’ conditions and secondly, because our patients were going to medical marijuana practices where they didn’t feel that the ordering physician was educated on the types of treatments available. Patients began coming into the office on all of these new medications with “strange” names and delivery devices. Despite the fact that I was not the prescriber, they would inevitably asked me if I thought they were on the “right” regimen. That’s a difficult position to be in as a physician because it’s hard to know exactly what the patient is getting. I ask my patients not to focus on the names, but rather the type. Is it just a cannabinoid (CBD) or does it contain THC as well? Is the THC dose low or high? I’ve found that keeping it simple is the best way for both the patient and me to understand exactly what it is that they’re getting, and also the best way to communicate it to specialists who may also be treating them. I also try to educate the patient that it’s important to

notify their local pharmacist as well of what they’re taking, since many of the medical marijuana dispensaries ship the product directly to the patient’s home. In addition to the potential medical benefits some studies conducted at the state level have shown that in states where medical marijuana use is legal, the rates of opioid use, misuse, and overdose are declining. Like most things, the internet is also filled with evidence of the contrary. Hopefully, more studies and research on this topic will prove my initial statement to be true. In any case, medical marijuana appears to be here to stay and we will have to continue to adjust and adapt our medical practices as patient use rises and the science of medicinal marijuana continues to evolve. Adrian L. Burrowes, MD, FAAFP, is CEO of CFP Physicians Group and is a Board Certified Family Physician. He may be reached at Drb@cfppg.com For more visit www.cfpphysiciansgroup.com

Why We Integrate Aesthetics at CFP? By AKILA BALASUBRAMANIAN MD, MBA, FAAFP

The history of beauty is as old as mankind itself. The technical basis for the aesthetic procedures began over a hundred years ago and evolved to the modern standards. People have always tried to improve their physical appearance. Who doesn’t want to look great? This has led to the field of aesthetics. Aesthetic medicine was in its infancy in the 1980s and 1990s. Due technological advances in the mid2000s, cosmetic medicine has attained an explosive growth and has become a very well accepted field of medicine. Aesthetic medicine basically involves three categories – injectables (botox and dermal fillers), laser (for hair removal, vein removal and collagen stimulation) and minimally invasive cutting (face lift). Technology has made aesthetic procedures simple and easily accessible. Most of the procedures can be done in an outpatient office setting nowadays as opposed to a hospital operating room. According to American Society for Aesthetic Plastic Surgery (ASAPS), the overall number of cosmetic procedures has increased by 197 percent since the 20

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tracking of the statistics began in 1997 through 2011. In 2011, almost 9.2 million cosmetic surgical and non surgical procedures were performed in the US. In 1987, a major breakthrough happened in the cosmetic industry when botox was accidentally discovered. Jean and Alastair Carruthers discovered cosmetic properties in a toxin normally used by ophthalmologists. The couple’s discovery changed the face of beauty and botox later became a billion dollar industry. Now, botox is North America’s number 1 cosmetic procedure and the inspiration behind a crowded new generation of fillers and other agefighting products. Cosmetic procedures were mainly done by plastic surgeons in the past. Technological advancements have enabled physicians in almost all specialties to do these procedures in the office setting thereby increasing consumer access. Why CFP into aesthetics now? While providing medical care to the elderly people in the long term care and outpatient setting for over a decade, I have seen the effects of aging. Aging causes profound effects on the human body leading to physical, psychological and social issues. While aging is inevitable,

it can certainly be postponed and the effects of aging can be minimized. This makes me to educate my young patients focus on preventive care, lead a healthy lifestyle and be proactive. Our physicians are strong advocates of preventive care. Of course, prevention is better than cure. I believe in treating the patient not just the disease. While educating the patients about healthy lifestyle and preventive care, I realize the importance to focus on their external appearance as well. Aesthetic medicine helps patients’ need for social acceptance and psychological well being. It can improve their selfconfidence and help them to stay away from mental illnesses. Aesthetic medicine can actually help people achieve a healthy lifestyle by fixing a physical ailment such as facial wrinkles on a woman impacting her confidence and affecting her life in a negative manner. It is important to look at the limitations of these minimally invasive procedures as well. Botox and dermal fillers are not for everyone. In the advanced stages, these procedures may not be appropriate; one may need a facelift instead. These procedures do not last lifelong. They last for a few months to a year depending on the product

injected. As the effects of aging start to appear as early as in the twenties, it is recommended to start these procedure in the twenties to maintain a youthful appearance. It is necessary to have these procedures done under the supervision of a physician. There are certain medical contraindications to these procedures. Pregnant and breast-feeding women have to stay away from these procedures. Botox and fillers are minimally invasive procedures that can be done with a topical anesthetic. The procedures take only a few minutes. Even though they are simple procedures, it is recommended to get those done in a physician office setting since these procedures have to be strictly sterile. With these aspirations, we are integrating aesthetic medicine to our well-rounded medical practice and continue to serve our patients for their physical, psychological and social needs. Akila Balasubramanian MD, MBA, FAAFP, is vice-president of CFP Physicians Group in Casselberry. After graduating from her medical school in India, Dr Balasubramanian finished her residency in Family Medicine at the University of South Florida Morton Plant Mease Family Medicine Residency program in Tampa, FL. She joined CFP Physicians Group, Casselberry, FL in 2006.

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Cybersecurity Insurance for Medical Practices – the Basics By DAVID J. EISMONT

More medical practices are purchasing – or at least considering – an insurance policy to cover the substantial costs of a data breach. Medical malpractice policies often provide basic coverage for this threat, but many practices find their risks have grown to the point where they are looking to a stand-alone cybersecurity policy to better meet their needs. The following provides an overview of what your practice can expect from a cybersecurity policy. Keep in mind that not all policies are the same and actual coverage will be determined by a policy’s terms, conditions, and exclusions. Coverages are typically split into two types— first-party and third-party:

First-Party Coverage First-party coverage addresses the costs and expenses your practice incurs from a data security or privacy breach event, such as: • A physician comes to the office one morning and logs in to the computer, but the screen goes blank and a message pops up claiming to have hijacked the data and demands payment to get it back. The “extortion threat” section of a cybersecurity policy may assist with this type of breach. Professional experts hired by the carrier will contact the cyber criminals to attempt to get the data released, including potentially paying the ransom. You should also be concerned with not only the financial impact to your practice, but also the impact on the treatment of your patients if your systems are down for any length of time due to a breach. The business interruption section of a cyber policy may provide reimbursement of lost profits during your downtime. Many standard property policies do not cover this exposure, since there was no physical damage to the equipment. • A physician discovers her system has been hacked and worries her patients’ personal health information may have been compromised. If you discover your system has been hacked, your carrier can provide data breach response services to work with your IT staff to ascertain what happened. These forensic experts assess the nature of the hack and evaluate how much data has been compromised. This section of your coverage can assist with the costs of required patient notification. If you have records of patients from outside your home state, your insurance company should know the notification requirements for those states. You may also be required to provide those patients 21

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with credit monitoring services. Your coverage should help set up these services and cover the costs. The costs to notify patients and set up credit monitoring is approximately $8-$10 per patient record. If patient records are compromised, the data recovery and restoration section of your coverage could reimburse you to unencrypt, recover, restore, recreate, or recollect data. • The CEO of a company sends an e-mail to the CFO instructing the movement of funds into an account. The CFO makes the transfer, only to discover that the CEO’s e-mail was a spear phishing attack in which the email address was a clever fake, and those funds are long gone. Your coverage’s cybercrime section may cover the cost of the funds that were transferred. Employees who click on such phishing links could compromise your system. This section of your policy may also assist in those situations.

Third-Party Coverage Third-party coverage provides protection from claims made against you by outside parties. • It would not be unusual to have claims brought by regulatory agencies, such the U.S. Department of Health and Human services in the case of an alleged HIPAA violation involving a breach of patient records. Cybersecurity coverage for regulatory fines and penalties may allow for payment of fines on your behalf. • If your practice accepts credit card

payments and is not PCI-compliant (adhering to all the Payment Card Industry Data Security Standards), you could be subject to fines from the credit card companies. Policies with payment card industry coverage may provide payment for those fines. • Some patients may bring claims against you for violating applicable privacy laws. The data security and privacy section of your cybersecurity policy may help in providing a defense and make payment to these claimants, if necessary. Employees of your practice could file such claims if their information was compromised. • If you maintain a website or social media platforms, you might have a claim brought against you in the event someone believes your site or media content is defamatory or

reveals private information about them. The cyber media section of a cybersecurity policy may also provide coverage in this case. Healthcare accounted for 53 percent of reported data breaches in 2017, more than double the total of any other industry, according to Privacy Rights Clearinghouse. With healthcare data breaches on the rise, cyber liability insurance can help you recover faster in terms of financial coverage and remediation. In 2015, U.S. healthcare data breaches cost companies an average of $363 per record, the highest of any industry, according to the Ponemon Institute. Depending on the size and scope a fines and damages for a HIPAA violation related to a breach of unencrypted personal health data can run into the millions of dollars. Ask your agent or underwriter for more details about what’s included in your policy and whether it meets your needs. If you have cyber insurance, check your liability limits to determine if you need to increase your coverage. To learn how to comply with HIPAA rules in the event of a breach, how to thwart ransomware attacks and prevent spear phishing, and more, download the free guide Your Medical Practice Is at Risk of a Data Breach from The Doctors Company. More resources are available on the company’s cybersecurity page. David J. Eismont, ARM, is senior director of business development for The Doctors Company

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RADIOLOGY INSIGHTS

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Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy and it affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely and can include: temporary confusion, a staring spell, uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness, or psychic symptoms such as fear, anxiety or déjà vu. At least two unprovoked seizures are generally required for a diagnosis of epilepsy. Seizures are classified as either focal or generalized based on how the abnormal brain activity begins. Focal seizures are when seizures appear to result from abnormal activity in one area of the brain and fall into two categories: focal seizures without loss of consciousness and focal seizures with impaired awareness. Generalized seizures appear to involve all areas of the brain and six types exist: absence seizures, tonic seizures, atonic seizures, clonic

seizures, myoclonic seizures, and tonicclonic seizures. Treatment with medications or sometimes surgery can control seizures for many people with epilepsy. Other therapies include vagus nerve stimulation, ketogenic diet, and deep brain stimulation.  Tests to diagnose epilepsy and determine the cause of seizures include: a neurological exam, blood tests, electroencephalogram (EEG) and radiological imaging. Imaging includes CT, MRI, and PET. CT and MRI scans are cross-sectional imaging of the brain that can reveal abnormalities that might be causing seizures, such as tumors, bleeding and cysts. PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help visualize active areas of the brain and detect abnormalities. The radiologists from Radiology Specialists of Florida at Florida Hospital are very well trained and experienced. We have radiologists specifically trained in neuroradiology and can interpret x-rays, MRI, and

CT scans of the brain, spine, and peripheral nerves. They also perform angiographic studies of the brain and spine and interpret the findings. We keep up to date on the latest technology and information so that we can offer patients the best care. The Florida Hospital Care Network delivers seamlessly connected healthcare services for all ages. Quality Imaging and Diagnostic starts today.

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