Page 1


May 2009 2013 >> $5 December


Derek J. Cuff, MD

Special Deliveries

Tower at SMH will take childbirth options to new heights By JEFF WEBB


SARASOTA - It’s an arrival that perinatologist Felice Baron, MD, has been expecting for 18 years, and she couldn’t be more excited that Sarasota Memorial Hospital is poised to give birth to a dream. As director of SMH’s Maternal and Fetal Medicine Department, Baron, who specializes in complicated and high-risk pregnancies, has been a strong, long-term advocate of creating a facility that provides expectant mothers with natural childbirth options and on-site intensive care in case something goes wrong. “This has been an idea that has had many stops and starts over the years, but we are building a fantastic facility,” said Baron. “When I got

Succession Planning

How to concoct a good exit strategy ... 6

The Move from Social Media Marketing to Social Business Strategies

At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. ... 9



IT Acceleration

MedEvolve finds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide “preoccupied and disinterested,” and customer support was practiLITTLE ROCK – When Bill cally non-existent. “Our practice Hefley, MD, was a junior partner collections soon approached zero. at a Little Rock orthopedic practice I knew there had to be a better more than two decades ago, he was way.” tasked with choosing a new informaA hobbyist computer tion technology (IT) system to replace Dr. Bill Hefle programmer, Hefley devoted his an antiquated one. After completing energies to filling the void in the due diligence on various options, he played marketplace. From it, he established it safe and purchased a new system from the MedEvolve as a truly collaborative nation’s largest vendor. industry partner to solidify the “It was a complete disaster,” recalled IT backbone of medical Hefley, noting the software was different than practices. The success the demonstration version, the trainer was (CONTINUED ON PAGE 8) By LyNNE JETER

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MAY 2013




Derek J. Cuff, MD Suncoast Orthopaedic Surgery and Sports Medicine By JEFF WEBB

VENICE – When he was growing up in a small town near Pittsburgh, Derek Cuff often would awake to the sounds of his father getting ready for work at 5 a.m. The man Cuff described as “the definition of a self-made” who navigated his way from low-income housing in the city to become the chief financial officer of a Fortune 500 company, “was always the first guy in the office and the last guy to leave,” said Cuff. “His work ethic was amazing.” “I remember as a teenager thinking it must be brutal getting up at that hour every day to do what he did. One day, Cuff said, he asked him why he did it. “What he said was simple and has always stuck with me. He told me ‘The key to life is to find something that gets you up in the morning,’” Cuff recalled. “He was fortunate in that he had found a career he was incredibly passionate about and each day was excited to get up, head into work and advance his career.” Cuff lost his father to prostate cancer in 2012, but the sage advice has been a touchstone and “played a big role ... when I started my career in medicine,” he said. “I had truly found something I was passionate about ... Now I am very lucky to have a job that has me excited to get up and face the challenges of being a surgeon each day.” For the past five and a half years Cuff has embraced his passion at Suncoast Orthopaedic Surgery and Sports Medicine in Venice, where he sub-specializes in repairing upper extremity conditions. “Ninetyfive percent of what I do is shoulder and elbow surgery,” Cuff said. “It’s a very specialized, niche practice,” that includes replacements and arthroscopies that result mostly from degenerative or athletic injuries, of which there is no shortage in this region, he said. “The activity level of the people who retire here is phenomenal – golfers, tennis players, swimmers,” Cuff said. That reality “keeps all orthopedists busy,” he said, estimating that about 65 percent of his patients are older than 50. Cuff said he works in the office on Sunset Lake Boulevard three days a week and two in the operating room, usually at Venice Regional Medical Center. “The staff there is great. We do a lot of complex reconstruction cases and we’ve built a nice little shoulder center there,” he said. Another niche in Cuff’s private practice, he said, is his heavy academic interest. “I collaborate a lot with the Foundation for Orthopaedic Research and Education in Tampa, which assists me in my research projects. In the last five years I have been fortunate to be the lead author on five different papers published in major international orthopaedic journals, and we have more in the works,” he said. Evidence of the impact of his research came in 2011 medicalnews


when Cuff earned the prestigious Charles Neer Award by the American Shoulder and Elbow Surgeons Society at the annual American Academy of Orthopaedic Surgeons meeting. The journey into medicine that eventually led Cuff to Florida, began when he left Pittsburgh to accept an academic scholarship to attend Washington College in Chestertown, Md., which had the added opportunity of playing basketball for the Division III Shoremen. “I was a biology major and I took a comparative anatomy course and loved it,” said Cuff, who graduated in 1997. His intrigue with anatomy continued at the University of Maryland School of Medicine where he decided early on he wanted to be an orthopedic surgeon. After earning his MD, Cuff spent the next five years completing his surgical residency at the University of Maryland Medical System’s John Hopkins Hospital. His parents had since retired to Clearwater, so he began to explore his options on Florida’s west coast. He found an ideal opportunity at the Florida Orthopaedic Institute, working mainly out of Tampa General Hospital, where he accepted a one-year fellowship focusing solely on shoulder and elbow reconstruction. “I had a chance to receive impeccable training while also being near my family and the water,” said Cuff, adding that the high volume of those particular sur-

geries at TGH is one of the highest in the world. “It’s a sneaky fact that not many realize.” Cuff’s mentor during that fellowship was Mark Frankle, MD, who Cuff praised as “one of the greatest living shoulder surgeons in the world.” Frankle’s admiration for Cuff is mutual. “I have trained around 25 shoulder and elbow surgeons. Each has his own strengths. ... The Manatee-Sarasota area is fortunate to have Dr. Cuff, (who is) hardworking, dedicated, caring, disciplined and brilliant. ... Derek has done exceptional research,” said Frankle. Cuff’s mother, a former school teacher and travel agent, still lives in Clearwater, but she’s a frequent traveler on I-75 to Sarasota, where her son lives with his wife Silke (pronounced Silk-ah) and their 20-month-old son, Miles. Cuff said he has been “very fortunate in many areas of life, but meeting my wife is hands-down the best thing that has happened for me. She is the brains in the family.” Silke is a native of Belgium and lived in Berlin before moving to the U.S. where she played soccer and graduated from Emory University in At-

lanta. She was selling orthopedic equipment in Tampa Bay when they met – in an operating room. Cuff likes to play golf, lifts weights two days a week and runs 5 miles four days a week. But Silke is the real athlete in the house, having completed several ironman triathlons, Cuff said. “She is the bionic woman and I am just trying to keep up!” But when it comes to spectator sports, especially those that involve professional teams from Pittsburgh, Cuff is king. “I am obsessed with my hometown Steelers,” he said. On game day he rises early, eats a good breakfast, dons his game gear and awaits kickoff. “Silke teases me ‘You’re not on the team!’” he laughed. And a sense of humor is a constant arrow in this talented surgeon’s quiver. A large portion of the surgeries he performs are to repair rotator cuffs. Those patients find it pretty funny that Dr. Cuff is their surgeon. “I hear the joke every day and each one says it like they are the first ones to make the joke,” he said. “But I don’t mind a bit.”

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Special Deliveries, continued from page 1 hired there were plans in place for this and it has been a very long process to bring it to fruition. I am ecstatic that we are so close to having a brand new facility for the women of Sarasota Dr. Felice Baron County,” she said. The facility Baron describes is the Courtyard Tower, a $186-million, ninestory structure that will have separate floors for obstetrics, surgery, orthopedics and cardiac care. Scheduled to open this fall, floors four, five and six in the tower will be dedicated to pregnant moms and their babies. Those floors will include labor and delivery suites, mother/baby suites, the neonatal intensive care unit, or NICU, three operating rooms, and homey amenities for expectant mothers who opt for an all-natural or low-intervention childbirth experience. Consolidating these obstetrical services under one roof is an investment driven both by medical care, efficiency and patient demand. According to spokeswoman Kim Savage, SMH is the only hospital in Sarasota County that offers obstetrical care. About 3,000 babies are born each year at SMH, she said. About 925 of those require treatment by neonatal specialists, and about 400 are admitted to the NICU, said Savage. Forty-two percent of the total births during 2012 were by Caesarian section, she

said, and of that number, about half were women who previously had a C-section. “The timing is perfect” for opening the tower and offering these services, said Baron. Nationally and locally, she said, “women are saying ‘Pregnancy is not an illness.’ There can be complications that need to be managed, but we need to get back to the roots of this natural process.” The trend to which Baron referred was echoed by Kyle Garner, MD, the chief of obstetrics and gynecology at SMH. “There clearly is a new momentum for patients to take ownership of their health and Dr. Kyle Garner their labor process,” said Garner, who practices at Gulf Coast Obstetrics & Gynecology of Sarasota. “Given that the United States has such a high C-section rate, institutions now are trying to look at policies and procedures to see how we can maximize dollars and improve patient outcomes,” he said. To that end, SMH is tightening up its policies on non-medically indicated inductions, reducing C-sections, offering alternative pain control methods and supporting VBACs (vaginal births after Caesarians) for low- and moderate-risk births, said Savage. Garner said “there is pressure from patients who want to minimize the (possibility) of a C-section,” and to give birth as

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naturally as possible. “We see evidence of this trend with the (prevalence) of birthing centers. People are turning to those types of facilities because they are more comfortable and it’s less invasive. With this opportunity to create and move to a new space, we are looking for ways to give those patients what they are asking for. (SMH) will provide a better experience for our patients and reduce the number of C-sections,” he said. “Patients are saying they want a hospital that will accommodate their wishes. They don’t want to be tied to a bed. Allowing them to ambulate during labor, giving them the right environment and alternatives to pain management helps meet those demands,” Garner said. Garner said his role has been mainly to help plan and coordinate the move, and help with policies that improve patient safety. He and Baron are working together to help the administration, doctors and patients make the transition as they move Sarasota Memorial into a new era. For Baron, who oversees decisions to transport patients from outlying community hospitals to Sarasota Memorial’s NICU, which is the only Level III unit in a four-county area, the new 32-private-bed facility will better serve mothers who have prepared for a lowintervention childbirth, but who may experience unexpected complications. “Women want as gentle and sooth-

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ing a childbirth experience as possible, but they also don’t want to take any chances,” she said. “We are committed to providing as natural a delivery as we can – with little to no intervention – in the safety of a hospital setting.” Low-intervention childbirth features that will be included in the 14 labor and delivery suites, which are adjacent to three operating rooms, and 30 mother/ baby suites of the tower include: Bright, colorful rooms large enough for family and friends. Wireless fetal monitors that allow moms in labor to move about instead of being confined to a bed. WiFi and flat-screen televisions. Family lounges with refrigerators and microwaves. Whirlpool tubs and birthing balls in the labor and delivery suites. Private baths in all rooms. Medical equipment built into custom cabinetry or suspended from ceilings, leaving more floor space for patients, visitors and health care providers.    But, Savage added, the changes at SMH go beyond new construction and equipment. “Our OB team is committed to transforming the birth experience for new moms ... and to customizing birth plans that meet each family’s unique preferences and needs,” she said.

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MAY 2013



Succession Planning How to concoct a good exit strategy By LYNNE JETER

In uncertain economic times, planning for the future – retirement, selling a company, or transitioning a family business into the next generation – is critical to maintaining financial stability in a medical practice. Despite industry projections reflecting that half the nation’s active doctors will reach traditional retirement age by 2020, and physicians typically live into their early eighties, very few practitioners are succession ready.

Plan Ahead

Plan years in advance to mitigate risks associated with succession planning. “The earlier, the better,” said Jim Ray, senior vice president and commercial banking executive for Fifth Third Bank (South Florida affiliate). “One to three years is short and the bare minimum. Sometimes, depending on the complexity of the issues at hand, it can be 5 to 10 years in the making.” Why? The legal, financial and tax implications of succession planning can be extremely complex, based on the organizational structure of the business, composition of ownership, and whether the business will be sold to employees, a third party, or transferred within the family.

Trying to resolve issues take that business to the correct just prior to a sale or transpotential buyers. Having a bank fer is virtually impossible with specialty in the healthcare to do properly. There’s too industry, for example, will help much value at stake,” said doctors better understand the Ray. “You should start process and may bring major early and over the years players in the industry to the make changes as the busitable to garner maximum dolness evolves.  It’s not unlars possible.” usual to start down one path and then course correct as Ask about the Money conditions change. As an Succession planning isn’t example, by starting earlier, very expensive. Compared to Succession planning involves determining how one you’re able to diversify the the value created, the process will transfer wealth to the future generation. business, which can add sigbecomes quite affordable. “That game plan changes frequently, depending on life events,” nificant value. And if com“Providing solutions could explained Jim Ray, senior vice president and commercial banking executive for Fifth Third Bank (South Florida affiliate). “For instance, petitive landscape changes, get expensive, but doesn’t need a 35-year-old with young kids should make sure they have very you can be prepared to move to be,” explained Ray. “Imagine good insurance coverage. Once children are through college and quickly … whether your having a lawn overgrown with the company matures, the focus should turn to the next step – sucgoal is to sell, exit, acquire weeds and vines. The longer you cession planning. Anyone who owns a company should be thinking or grow. Without early planlet it go, the tougher and more about the long-term position of their business.” ning, and on-going mainteexpensive it’ll be to get it back nance of that plan, it will be into shape. But if you maintain more difficult to achieve your goal.” it, the incremental investments are much “A wealth advisor can identify and smaller. Depending on how active you are help rectify potential issues that result Find the Right Wealth with managing personal affairs, it could be in significant estate tax savings and help Management Advisor simple adjustments, but if we undo years avoid potential conflicts between family Accountants and attorneys often recof neglect, it can potentially grow into a members,” said Ray. “If the goal is to sell ommend involving a wealth management complex and intensive project. The botthe company, business owners need to advisor to the succession team to provide tom line is start early and maintain often work with someone savvy in their industry. critical financial planning advice prior to – you won’t regret it.” This has many advantages, including havthe business transition. ing the network and inside knowledge to (CONTINUED ON PAGE 10)

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MAY 2013



Pay or Play … What Makes Sense for Your Company? Preparing for the Affordable Care Act Implementation in 2014 By CHARLES EGERTON

When it comes to health benefits, the rules are about to change dramatically for companies with 50 or more full-time employees. The so-called “employer mandate” of the Patient Protection and Affordable Care Act (ACA) includes so-called “pay or play” regulations, which will soon begin imposing significant penalties on those who fail to offer “adequate and affordable” health insurance coverage.

Understanding the Penalties

After December 31, 2013, ACA provisions levy penalties on “applicable large employers” – those with more than 50 full-time workers – that don’t offer employees and their dependents the chance to enroll in a minimum essential coverage health plan. The fine for noncompliance is $166.67 per month per employee, except for the first 30 employees. For a business with 60 employees, the penalty would add up to $5,000 each month, or $60,000 each year, beginning in 2014. And a 600-person company that failed to comply with the law would be fined $95,000 a month,

or $1.14 million a year. Penalties are even less forgiving when it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from exceeding 9.5 percent of their household income. Employers that don’t offer a “qualified health plan” and premium assistance to employees to keep their cost below 9.5 percent will be subject to this penalty. The fine is $250 per month, multiplied by the total number of full-time employees who buy coverage through a Health Insurance Exchange (not just those in excess of the first 30, as with the other aspect of the law). In other words, if your company attempts to offer a plan, but it doesn’t measure up to federal standards – the penalty can be as much as $3,000 per employee. This second penalty cannot exceed the total amount of the first penalty. Both of the law’s penalty provisions will be adjusted for inflation each year. The ACA penalties that go into effect next year can represent a significant cost for a business of any size. But since offering health insurance is typically more expensive than that, some businesses are considering whether to simply pay the fines. As

Penalties are even less forgiving when it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from

exceeding 9.5 percent of their household income.

a financial professional, how should you advise your company … pay or play?

Evaluating Your Company’s Standing as an Employer

The first step is to determine whether the federal government will regard your organization as an “applicable large employer.” Your company is exempt from the law if it has less than an average of 50 fulltime employees. But defining a full-time employee is complicated; especially for companies that employ lots of part-time or seasonal workers. Simply put, according to the ACA regulations, a full-time employee is one

who works an average of at least 30 hours per week. This news won’t come as a shock to many human resources professionals, who have long used the 30-hour mark as a litmus test for determining whether an employee was considered full-time and eligible for healthcare coverage. But beginning in January 2013, companies must also take into consideration the average amount of hours logged by all workers within a calendar month. The statute requires businesses to determine their number of “full-time equivalent” employees. To get this figure, add the hours of all of your company’s part-time employees and divide by 120, or a month’s worth of hours for one full-time employee at 30 hours per week. This provision was included to prevent businesses from trying to circumvent the law by cutting their employees’ hours to less than 30. Similarly, the ACA prohibits companies from subdividing their business into separate companies to create the appearance of multiple employers with less than 50 full-time workers. The law was written so no matter whether companies “pay or play,” they must play fairly. (CONTINUED ON PAGE 9)

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MAY 2013



IT Acceleration, continued from page 1 of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing Board

In searching for a better solution in the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Horsham, Pa., and a pioneer in the emerging field of electronic medical records (EMR). “Intrigued, I became an early investor and a development partner focused on orthopedic clinical content,” he said, noting that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development partner with NextGen in 1994, working on the development of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing computerized billing and scheduling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet.  More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering support and customer



MAY 2013

service. I frequently heard my physician friends and colleagues recount horror stories of flawed software systems with dismal support that were making it impossible to run their practices successfully.  I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.” In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service.  “My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States.  We integrated our PM product with several specialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.” With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM.  “Physicians were struggling with increasingly complex third-party payor systems,  growing documentation requirements, mounting government regulations, and threats of audits, fines and imprisonment,” said Hefley. “Practices were searching for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of


With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry

– 97 percent firstpass claims success, 27 percent average increase in practice revenue and a 38 percent average reduction in


accounts receivable days…

- Bill Hefley, MD, President and CEO of MedEvolve.

the ever-changing rules and regulations. Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.” MedEvolve developed an RCM division, acquired three small RCM companies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists.  “With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers immediately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”

Health Reform Impact

The 2009 American Recovery and Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system. “With the new criteria defined, MedEvolve saw a need for a modern EHR product designed from the ground up to meet Meaningful Use mandates and finally deliver on the industry’s promise of a cutting edge, customized solution that helps practices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.” Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excellent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature.  As a result, employees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.” “In the software business, that means several operators are at the ready for periods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less support is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some detached, impersonal entity; we partner with the practice in achieving their goals.” Today, MedEvolve offers PM and EMR software and RCM services to physician partners, and also electronic prescribing, data analytics and other ancillary products and services.  With four offices, the company covers all specialties and the entire United States, from solo practitioners to practices with more than 50 physicians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide.  By year’s end, MedEvolve will outgrow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion.  “We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”



The Move from Social Media Marketing to Social Business Strategies By CINDy SANDERS

Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer Andrew Dixon for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular

tool being used today to do that is email, but email was never intended to be a collaborative tool.” In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business

Three Trends Driving Change

software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information (CONTINUED ON PAGE 10)

Three trends are driving change in the workplace – social, mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space. “It’s incredible how powerful each of these trends are alone, and they are all converging,” said Andrew Dixon of Igloo Software. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statistics. “All of their IT requirements will be outsourced and provided to them by the cloud.” Citing recent research from business and technology research

firms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.” Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Taking the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone professionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent. Furthermore, half of the tablet-owning doctors have used their device at the point of care.

Pay or Play … continued from page 7 Weighing the Options

If you establish that your company is affected by the ACA regulations, you must then weigh the consequences of either offering healthcare coverage that complies with the law or paying the penalties. From a fundamental business standpoint, many organizations would certainly save money by paying $2,000 per full-time employee rather than offering employee health benefits. But there are intangible considerations – such as employee relations, morale among workers and the company’s public image – which must be evaluated. The bottom line? This is a complex law and the stakes are high. Even the most experienced financial professional would benefit from legal counsel as they decide whether to “pay or play” in this new realm of healthcare regulation. Charles Egerton is a founding shareholder of Dean, Mead, Egerton, Bloodworth, Capouano & Bozarth, P.A., a commercial law firm that has provided full-service legal representation to businesses and individuals throughout Florida since 1980. Charles can be reached at



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Succession Planning, continued from page 6 Be Candid

According to the Institute for Family Business, about one-third of family businesses survive into the second generation. Roughly 12 percent remain viable into the third generation. Yet only 3 percent operate into the fourth generation or beyond! “From what I’ve seen, you usually have a founder with a strong entrepreneurial gene who has created an idea or product,” said Ray. “They then build a company around it. In most instances, they hope and pray that the kids share the same entrepreneurial gene and want to continue the family business. However, that’s not always the case.” Even though it’s rare, sometimes children come into a family business with the energy and talent – matched with an entrepreneurial gene – to improve it. “If handing the business off to a family member isn’t in the cards, you still have other options for the business to flourish,” said Ray. “You can find talented components, such as hiring a professional CEO, and build the company/ infrastructure around it. For some, this might be a better route, but then one must consider how to build an estate instead of counting on the business.”

Cover the Bases

Having business partners makes it even more important to have a plan in

place so all parties are prepared for succession, noted Ray. “With partners involved, it can be very complicated,” he said. “It’s incredibly important to have candid conversations with them in a business to discuss what would become of a company if something unfortunate happened to one of its owners. Sometimes, the business has to be sold to cover estate taxes if a partner dies. Stakeholders in multi-physician practices need to be prepared. What happens if one of them leaves, dies or is injured?” Therefore, having the right insurance program, including life and disability coverage is a critical component to a succession plan. “Injury, as opposed to death, is a higher risk, higher probability scenario for many,” explained Ray. “For instance, a surgeon who hurts his hand won’t be able to perform his job.”

Reconcile Goals

“Have a realistic picture of what your company’s worth if you’re considering selling it,” said Ray. “Going through an advisor can help develop a capital strategy plan based on the end goal. It’s important to get a true valuation of company. Business owners need experts to help maximize gains in these areas depending on your corporate goals – max dollars from a sale in three years – versus personal goals

– wanting to maintain the company and minimize the estate gap.”

Pay Attention to Trends

Right now, hospitals are snapping up physician practices. “From cardiologists in Naples to gastroenterologists in Sarasota, most are employed by or have collaborated with a major hospital system,” said Ray. “A recent example of this consolidation trend playing out locally is Health Management Associates joining forces with Bayfront Health System. I see this trend continuing and physicians should be proactive to maximize their transaction by planning early. If practitioners are thinking about selling to a hospital and they haven’t gone through the process of succession planning and business positioning, they need to now.”

Be a Good Client

Avoid the frequent phrase: “I’m too busy.” “Estate and wealth planning deserves high priority and can be very risky should you leave it uncared for,” said Ray. “We help them think through it, but we bring solutions to the table so they don’t have to figure it out by themselves. Some might believe the process of facing one’s mortality and putting a plan in place is uncomfortable … but at the end, they’re always relieved.”

The Move from Social Media, continued from page 9 outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.

Creating Engaged Communities

Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also al10


MAY 2013

lows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.


“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social

business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”

Avoiding Information Overload

Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said. However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.

The Bottom Line

With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”

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GrandRounds NurseLineMD Launches Anytime, Any Place, Any Device Efficient Medical Communications NurseLineMD is announcing the national launch of DoctorDirect, a new communication system for healthcare service. DoctorDirect by NurseLineMD improves office efficiencies and allows the medical staff to spend more time with patients. Patients can simply log-in to enter a message, and be notified immediately when a nurse or doctor replies. Likewise, doctors and nurses are alerted when a patient has an inquiry or urgent need. Created for use in various medical environments, DoctorDirect can be implemented and accessed simply, through the easy to use interface and cloud architecture. The system enables patients to communicate at their convenience about any medical or billing issue, as well as to notify medical staff of changes and updates to their personal information and insurance, eliminating many cumbersome administrative duties for the nursing staff.  It also enriches the patient/provider relationship by enabling patients’ access to quickly and easily communicate with their provider at any time. The DoctorDirect solution was created out of a personal experience with a high risk pregnancy.

Physician of the Year Announced at Doctor’s Hospital Brian Angsten, MD has been named as the 2013 Physician of the Year at Doctors Hospital of Dr. Brian Sarasota. The annual PhyAngsten sician of the Year winner is chosen by the employees of Doctors Hospital through an anonymous nomination process. Dr. Angsten attended the University of Miami School of Medicine. Upon graduation with his medical degree in 1995, Dr. Angsten completed his residency at the Kalamazoo Center for Medical Studies in Michigan. Dr. Angsten is Board Certified in Critical Care Medicine, Internal Medicine and Pulmonology. The 2013 Top Ten Physicians are Brian Angsten, MD; Michael Barron, MD; Sean Dingle, MD; Thomas Dudenhoeffer, MD; Scott Elsbree, MD; Jeffrey Lyons, DO; Frederick Romano, DO; Michael Schandorf-Lartey, MD; Gino Sedillo, MD; Frederick Yturralde, MD.

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Herbert Pegues ii, md, FaaFP Family Medicine Physician Board Certified in Family Medicine Treats children age 5 and above, adolescents, adults and older adults Suite 350 For an appointment, please call 941.907.0588.

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