Orlando Medical News April 2014

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Lee Zehngebot, MD ON ROUNDS

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Decoding Healthcare

Fifth Third’s Mike Miller discusses capital investments and industry trends By lyNNE JETEr

The growth of local collaborations and specialty pharmacies, and the significant change in focus on outcomes highlight industry banking trends impacting Central Florida throughout 2014. “As healthcare entities try to get their arms around surging expenses, their goal is to reduce costs,” said Michael Miller, Vice President of healthcare banking for Fifth Third Bank in Orlando. “Institutional payers, insurance companies, Medicare and

Medicaid are reducing what they pay for healthcare services. The only way for providers to make money is to reduce costs. The goal for payers is to focus on outcomes, not procedures, to reduce costs. They want to pay for the value and effectiveness of the treatment process, not the number of procedures in the process. Similarly, providers need to focus on improved outcomes to reduce treatment and procedural costs to be profitable under the lower reimbursement for payers.”

Even though healthcare costs as a whole haven’t declined, their rate of growth has slowed significantly over the last five years, noted Miller. “However, not everyone is seeing this,” he cautioned. “There’s also a cost-shifting going on between employers, insurance payers and patients that’s led to increased payouts for some and reduced payouts for others. Right now, (CONTINUED ON PAGE 5)

Caring for a Graying Village New Health Specialty Care Center in the Villages By lyNNE JETEr

THE VILLAGES – The nation’s largest 55-and-up retirement community is fertile testing ground for cost-savings healthcare initiatives as American medicine shifts from fee-for-service to fee-for-quality. USF Health partnered with The Villages in 2011 to create a national model of coordinated healthcare for optimal health in retirement, with a goal of transforming it into “America’s Healthiest Hometown®.” On a chilly morning in late January, USF President Judy Genshaft celebrated a milestone in that journey (CONTINUED ON PAGE 4)


Photos by Eric Younghans/USF Health

L to r: Drs. David Ethier, Reed G. Panos, Adrian Finol-Hernandez, Roger Sherman, and Kathleen A. Steepy, will care for patients at the new USF Health Specialty Care Center

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Lee Zehngebot, MD Hematology & Oncology Consultants By JEFF WEBB

ORLANDO - After being in the same practice for almost 30 years, Lee Zehngebot – hematologist, oncologist, husband, father, road biker and ski-bum – said his “biggest problem is I don’t have enough time and energy to get through a day and do everything I want to do.” But the 63-year-old does the best he can, he said, and the rewards make it worthwhile for all those endeavors. Zehngebot is a senior partner at Hematology & Oncology Consultants. He went there in 1985 on the advice of a college friend who assured him “Orlando is a great place that’s really opening up,” Zehngebot remembered. “He introduced me to doctors David Smith and Phil Dunn. Dr. Smith is retired now, but Phil is still in the practice,” which now has six physicians, “about 60 or 70” other employees, and a second location in Winter Park, he said. His specialty has special challenges, Zehngebot said, noting the need to be both emotionally and scientifically supportive. “You have to be constantly talking to people and be sensitive to their needs. On the other hand, you have to be honest with them and provide them with the information they need. It’s a balancing act.” Zehngebot said he always tries to “do the best job for my patients, despite all the impediments.” Asked to elaborate, Zehngebot’s experience amplifies his candor: “Being a doctor today is an incredibly difficult job. You’re up against insurance companies, getting things authorized and paid for, getting consultations and X-rays done, getting patients admitted to the hospital, getting them out of the hospital, getting them the services and drugs they need. It’s very, very trying,” said Zehngebot. “It’s a very hard job these days and very difficult to do well. It requires a huge team. There’s nothing about (being a physician) that has become easier.” Zehngebot said physicians are “kind of caught in the middle between the patient who wants the services and a society that doesn’t necessarily want to pay for them. Everyone expects us to have the right answers and be available 24 hours a day. Trying to do that job (every day) is very hard,” he said. But Zehngebot said fulfillment offsets frustration. “There are two things: First, sometimes people get better and that is incredibly rewarding. And people appreciate what you do,” he said. “Second, there’s the feeling of getting up in the morning and seeking to do something to the best of your ability and getting it done. … I feel like I’m contributing. I don’t always get it right and I don’t always make people happy, but I really try,” he said. Most days, Zehngebot starts “trying”



about 7 a.m. as he makes patient rounds at Florida Hospital, where he also is head of the Cancer Institute’s research department. He’s back at one of his clinics in Orlando or Winter Park about 9 and sees patients until 5-ish, when he does more rounds until about 7 p.m. He said he spends every Thursday, and many weekends, in his role at the Florida Hospital’s Cancer Institute. His latest focus is on personalized can-

cer chemotherapy. “Cancer medicine right now is evolving,” said Zehngebot. “We have the ability to do genomic testing, looking for specific gene mutations within the cancer. We can take cancer tissue and send it off and do genomic testing and then find drugs specifically, after the abnormalities are found, and then treat patients with those drugs and see how they respond. That is a project we are just starting to work on here (and) we are hoping will come to fruition. Before, we didn’t have a target. Now the whole thing is targeted therapy,” he explained. His department at Florida Hospital also is involved in “cooperative group trials that have a lot of detail work,” Zehngebot said. “I am fortunate to have a great team that takes care of that.” Being a physician consumes most of this time, he said. “I haven’t watched a complete television show in 25 years. All I do is practice medicine, eat, sleep, road bike, ski and go to an occasional movie or show,” he said. Those casual references to his outside interests should not be underrated. He is deeply involved in road biking. “There is an incredibly vibrant road biking community here. I’ve met a lot of people who have helped me in biking clubs. I work out with a bunch of guys from Winter Springs.


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Caring for a Graying Village, continued from page 1 by officially opening the USF Health Specialty Care Center in The Villages. USF Health doctors staff the new 25,000-square-foot facility. “We’re excited to see USF Health extending the benefits of an academic health center – all the latest, most cutting-edge research, education and care – to serve residents in a new region of Florida,” Genshaft told an eager and curious crowd. The USF Health Specialty Care Center is designed to align with The Villages Health primary care centers being built in the 5-square-mile community to provide a model of seamless, coordinated healthcare. It houses 32 exam rooms and four procedure rooms, with the ability to provide onsite laboratory work, ultrasound, stress echocardiography, cardiac nuclear stress tests and other tests. Specialties include obstetrics and gynecology, cardiothoracic surgery, plastic and reconstructive surgery, orthopedic surgery, endocrinology, and general surgery. “We’re already hearing great things from our patients about the opportunity to visit the center,” said Elliot Sussman MD, chair of The Villages Health. “Having specialists aligned with USF Health available right here in The Villages is vital to our patients’ health, convenience


States, with nearly 200 “village” programs on track or in the works. (The “village” network doesn’t include The Villages in Florida.) Their common goal: helping people stay in their homes through their 70s and 80s and, in a growing number of cases, into their 90s. Among their goals, “village” programs aim to provide low-cost medical care. So far, these efforts have been fragmented and minimal. For example, in Madison, Wisc., a program called SAIL (Supporting Active Independent Lives) works with a geriatric pharmacist and university pharmacy students to provide personal health coaching to its members. “Older adults are oftentimes overmedicated,” SAIL executive director Ann Albert has said. “They’re taking medications that over the years can build up in their systems, and have Cutting the ribbon at the opening of the new center with USF President Judy Genshaft, center, were (l to r) USF Trustee Scott Hopes; Florida Senator Alan Hays; USF Trustee Nancy Watkins, Gary Lester, vice president of commu­nity relations, The interactions that maybe a 40-year-old Villages; Dr. Elliot Sussman, chair of The Villages Health; Donna Petersen, interim senior vice president, USF Health, and dean, or 50-year-old person wouldn’t experiCollege of Public Health; and Dr. Jeffrey Lowenkron, CEO, USF Physicians Group. ence.” In an intensive screening program aided by volunteer pharmacy students, and peace of mind. We look forward to Work began last year on the new spefour of five 30 SAIL members tested were working with the health professionals at cialty center, following analysis of the USF identified with adverse drug reactions. the Specialty Care Center to provide our College of Public Health’s comprehensive “Just in our home county alone, more patients with a full range of healthcare health needs survey of the The Villagers, than 1,500 seniors are hospitalized each and services … just a few steps away from the largest such survey of an aging populayear because of adverse drug events,” Alhome.” tion. Nearly 40,000 responded. bert said, noting the free screenings could “What makes this center so wonderproduce significant savings for Medicare ful is that it truly began with residents of and Medicaid. The Villages,” said Donna Petersen, ScD, In a San Diego “village,” ElderMHS, CPH, interim senior vice president Help, a philanthropically-supported soof USF Health. “It began as we built our cial agency, is testing a unique model that partnership with this community. We provides significant support services to a asked residents, ‘What do you need to imlargely lower-income group of seniors. prove your health?’ And you shared your College of Medicine of Yeshiva University Members support the services through vision. You want a more coordinated netin the Bronx. A fellowship in hematology annual dues. However, the classic village work. You want a healthcare system that and oncology brought them back to the model works in affluent neighborhoods, works for you – not one where you have University of Pennsylvania in Philadelphia. but not so well in lower-income commuto ‘work the system.’ We set out to create At first, Zehngebot thought he would nities. The mission is to demonstrate the the patient-centered medical home of the follow an academic path. He spent almost village model’s cost-effective solutions that future in The Villages.” three years as an Assistant Professor of government programs have traditionally The university’s statewide initiative Medicine at Albany Medical College, but provided. at The Villages also includes onsite health it didn’t work out. “I just hated it. I hated “Our vision is to make the villages seminars, assessments and other services. the politics,” he said, and that’s when he a model that’s going to make an impact The unique partnership provides residents set his sights on Orlando. by serving an older population that has of The Villages the benefits of an academic Along the way, he and Wendy had a higher level of chronic disease and a health center with high-level specialty care two children: daughter Corey, an architect higher level of need, but is lower-income,” and access to the latest clinical trials. works in Boston, and son Jay is a graduate ElderHelp executive director Leane Mar“Creative partnerships will provide student in computer graphics New York. chese has said. insight into solutions that improve health“I’m very proud of them,” he said. Even though these small efforts have care,” said Jeff Lowenkron, MD, CEO of That parental pride takes on extra helped nationwide, The Villages project the USF Physicians’ Group. “This care meaning when Zehngebot shares that that started the grass-roots movement has will be integrated and coordinated by deWendy has struggled with multiple sclerosis grabbed the spotlight. sign, not by accident.” most of their 38-year marriage. “She was “We’ve even had venture capitalists The Villages’ developer, Gary Morse, diagnosed not long after we were married come see how we’re going to serve 90,000 moved with his dad from Michigan to but didn’t become symptomatic until the people,” said Stephen Klasko, MD, Dean of Florida in 1983 to sell homes with a spemid-90s,” he said. “Unfortunately she’s the USF Morsani College of Medicine and cial pitch: free golf. Snowbirds helped sales been having a more and more difficult time CEO of USF Health from 2004 to 2013. reach $40 million by 1987, and grow the walking. She has a lot of guts and gets out Klasko considers The Villages partclose-knit community to 3,500 acres by and does a lot of things. It’s hard, but she’s nership among the university’s greatest 1992. Now stretching across more than keeps trucking and getting it done,” he said. achievements during his time at USF. 20,000 acres and three counties, The VilZehngebot said he has no intention of “It’s probably the nation’s first true lages is expected to accommodate nearly slowing his pace. “I’ve been very fortunate university-community partnership,” he 60,000 homes by 2018. that I have relatively good health and a very said. “It’s very, very exciting.” The timing for experimentation is successful practice. And I’m very fortunate ripe. By 2020, statisticians project that 45 that people still want to come see me. I have Editor’s note: Medical News’ series on The percent of American households will be a great staff and great people to work with. Villages’ goal as a national healthcare model conheaded by someone at least 55 years old. As long as all those things are true, I want to tinues next month with Jeff Lowenkron, MD, The Villages’ “aging in place” conkeep working. As long as I have something CEO of the USF Physicians’ Group. cept has taken flight across the United to offer, I want to keep doing that.” Photos by Eric Younghans/USF Health

Lee Zehngebot, MD We have so many places to go. It’s a great way to exercise,” he said. One of his motivations for road biking is to stay in shape for his favorite recreational sports passion: Heli-skiing. Twice a year for the past 7 years he has traveled to British Columbia to “ski in places that people normally can’t get to,” he said. “It’s not the daredevil hobby you may think it is. It’s not about jumping out of helicopters like you see on television. The helicopter lands and then you ski a normal run. The big difference is this is totally untracked powder snow, which is the greatest,” Zehngebot said. “I don’t jump off things. I’m not that good and I really don’t even want to be that good.” No one else in Zehngebot’s family “is crazy enough to do this with me,” he said. He usually meets a friend and fellow physician who introduced him to the sport. “It’s the only kind of skiing I do any more. I’m spoiled. Once you have done this” nothing compares, he said. Watching Zehngebot’s high-altitude adventures from afar is his wife Wendy, whom he met at a fraternity function when he was an undergraduate at Union College in Schenectady, N.Y., and she was at Vassar College. They waited until he graduated in 1976 from medical school at the University of Pennsylvania to get married, mainly because “I didn’t have any money,” Zehngebot laughed. The couple moved to New York City, where Zehngebot completed his internship and residency at Albert Einstein 4


APRIL 2014



Decoding Healthcare, continued from page 1 “With reimbursements from insurance payers, Medicare and Medicaid declining, the primary way for providers to make money is to reduce costs. The goal for payers and providers is to focus on outcomes, not procedures, to reduce costs.”


Michael Miller, Vice President, Healthcare Banking, Fifth Third Bank, Orlando.

we’re in a transition phase. There’s been an upheaval in the marketplace and people don’t like change, but things are changing.” Miller, Fifth Third Bank’s chief investment strategist Jeff Korzenik, and other local experts have been making the rounds in the community, discussing healthcare’s economic impact in Orlando. “Healthcare has been a major economic catalyst through collaborations by companies in the Lake Nona Medical City area,” said Miller. “Florida Hospital, Nemours and Sanford Burnham are all continuing to grow there and produce new jobs, not only healthcare jobs, but construction jobs as well. Florida Blue is also playing a major role by taking substantial space in Medical City and focusing on better delivery of health insurance.” Specialty pharmacy is another area for growth in 2014, said Miller, noting that more than 21 specialty pharmacies in Central Florida create a sizeable pool of skilled workers to assist in pharmaceutical delivery and treatment management. “Drug research is expensive, leading to expensive treatments,” he said. “For example, treatment for Hepatitis C can cost more than $84,000 for a 12-week treatment, and if the patient isn’t compliant with the treatment, sometimes they have to start over. This can lead to increased costs for the insurer. So when the specialty pharmacy is monitoring patient compliance with treatment and ultimately the treatment outcome, it saves money in the long run.” Because CMS and insurance payers focus on outcomes and scrutinize expenses, specialty pharmacy is providing better pharmaceutical services while also improving patient monitoring concerning treatment. “They’re monitoring compliance with the treatment protocols, side effects, helping people work through health issues at home, or getting the healthcare they need at the most affordable price for everyone,” said Miller. The recent great advancement in treatments for various diseases will reduce

providers’ expenses long-term and create the best outcomes financially and for the health of the patient, said Miller. “For diseases that we used to just be able to stabilize symptoms, we now have a cure,” he said. “For instance, Hepatitis C can now be cured with proper treatment. This means that both treatment costs are reduced by not having to treat the numerous medical complications the disease creates, and the numbers of deaths from the disease are being reduced in the long run.” To help providers better control outcomes and lower costs, Fifth Third Bank provides capital and loans for physicians to acquire online reporting systems for treatment information by updating computers and software to make reporting more efficient. “For example, upgraded software can allow providers to combine medical records from different locations and multiple healthcare providers,” he said. “Patients can access their information through an online portal that allows them to research diseases, find doctors and specialists, view their medical and drug history and even view their billing information. Doctors and patients alike will be able to easily pull up that information in any setting.” The capital Fifth Third Bank provides will help providers create efficiencies in operations, improve client service and payment collections, said Miller. “The technology will also ease the payment and information transmission process for healthcare providers and insurance companies after the treatment is provided,” he said. “For example, hospitals receive payment from insurance companies in a lump sum. That lump sum can represent 200 patients and thousands of treatments. Technology can now process those payment records and funds to allocate them to the correct patient’s accounts. This improvement in efficiency of tracking patient records, accounts, and payments through technology can reduce costs for everyone in the long run.”

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Coping with Medical Malpractice Depositions By Karl G. Sieg, MD, MRO, FAPA

Most physicians try their best to provide quality care for their patients and do not anticipate being the subject of a medical malpractice lawsuit. However, legal complaints are a reality with which doctors have to contend. Once the patient becomes plaintiff and their attorney proceeds with formal allegations of negligence, the parties to the lawsuit then go about collecting as much pertinent information as possible well before trial occurs. This discovery phase of litigation includes carrying out legal procedures like interrogatories which are written questions to the other party in the suit that must be answered under oath. Requests for documents are also made as well as the taking of oral depositions. A deposition is another discovery procedure by which a witness’s testimony is taken under oath prior to trial. A stenographer or court reporter transcribes all of the questions and answers creating a resultant manuscript. It is the defendant physician’s deposition which is of chief importance. During the deposition, opposing counsel typically has an expan-

sive agenda with the goal to obtain as much information as possible. Another objective that they have in mind is to “lock-down” testimony so that what was said at deposition can be used for impeachment in the event there is inconsistent testimony at trial. The deposition experience is indeed stressful as a physician suddenly finds their integrity and actions called into question. Nevertheless, the defendant needs to be well prepared. Remember that the strengths and weaknesses of the witness are being assessed so the impression being made could potentially influence the case in a way which would aid the defense. Preparation begins with a review of the entire database so that there is a clear recollection of the case. A pre-deposition conference with the defense attorney is also obligatory and should include clarification of any potentially confusing matters. Do not attempt to conceal any information, even that which you perceive to be unfavorable from your defense team. Honesty and candidness are thus a necessity. The physician’s CV should also be checked for any discrepancies, and counsel should be alerted to any web sites or online

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profiles that are relevant. It is advisable to conduct a mock deposition to further increase the witness’s preparedness. Despite any practice demands, the physician should plan ahead and accordingly allow sufficient time scheduling for the deposition. It is also important to be clear about the deposition’s location and do not allow it to occur at the defendant’s office. Following these suggestions will reinforce confidence during the deposition which will in turn be reflected in the final written transcript. Once the deposition begins, remember that a sworn witness is required to tell the truth. Opposing counsel will ask questions in an attempt to foster answers which might reveal new facts or open up problematic areas. The physician should make every effort to keep their answers clear and concise. Listen carefully and pause before answering to allow time so that each question asked receives prudent consideration. It is helpful to remember that the written transcript itself does not reflect the length of time it takes to answer a question. Exceptions to being brief may occur when an explanation is necessary as well as when defense counsel provides specific instruction. A particularly deceptive scheme to watch out for is a pattern of questioning by opposing counsel intended to prompt only “yes” answers making it hard to say “no” in response to a subsequent ambiguous question. The witness may ask for clarification of confusing or convoluted questions, but should never speculate, guess, or make inaccurate/unfounded statements. If the question is ultimately not understood, it should not be answered with the response simply being “I don’t know.” Alternatively, an answer may be qualified by saying “approximately” or “to the best of my memory.” Definitely avoid the use of adjectives and superlatives such as “always” or “never” as these qualifiers can be later used to distort testimony. If questions are asked about a particular document, ask to see that document and take time to review it to make sure that it has not been quoted out of context or mischaracterized. Any pertinent concerns should be noted by the witness on the record. There are circumstances where both attorneys may wish to have a discussion “off the re-

cord.” For the witness however, remember that nothing said is ever “off the record.” Many attorneys reserve especially important questions for later on into the deposition hoping that the defendant will be less guarded, so it is important to be well rested and ask for breaks when needed. Composure and concentration must be maintained while resisting the urge to become overly emotional and hostile as there is vulnerability to behave in ways which could negatively affect the outcome of the case. Opposing counsel will test the defendant and hope for mistakes which are recorded in the transcript. Alternatively, they may wait and later on prompt for such behavior at trial. If a mistake is made, simply state for the record that you were in error and correct your statement. There are times where the physician is approached in a congenial manner as a tactic to attempt to gain additional information. And if the attorney becomes silent after an answer, the witness should resist the compulsion to continue talking. Never volunteer extra information, agree to supply any additional documents or provide other evidence. Some physicians going into a deposition believe that if they are allowed to explain their case, opposing counsel will dismiss the complaint which is in fact unlikely to occur. If the deposition is to be videotaped, realize that the recording will likely be played for the jury. It would therefore be important to dress appropriately, look directly at the camera, speak clearly and avoid long pauses in this circumstance. Fortunately, initiating a medical malpractice lawsuit and winning it are entirely different matters for the plaintiff. Only about 7 percent of medical malpractice lawsuits ultimately go to trial, and most of these, about 80 percent, result in a verdict for the defense. By being educated and thoroughly prepared, the defendant physician will not only be better able to cope with completing their deposition, but they will also enhance their likelihood of a favorable judgment. Karl G. Sieg, MD, MRO, FAPA is Medical Director of La Amistad Behavioral Health Services located in the Orlando metropolitan area. Dr. Sieg has also served as a litigation consultant and expert witness in civil matters including medical malpractice and personal injury cases over the past twenty years.





APRIL 2014



Home Care Provides Enhanced Continuity and Quality of Care for a Rapidly Changing Market By JIM NEUMANN

The healthcare delivery marketplace is rapidly changing and here are the facts that underscore the changes within the senior care segment of the marketplace: • In 2014, more than 10,000 people will turn 65 every day; • By 2025 the senior population of America will increase from 49 million to nearly 72 million; • The population of people 85 and older is the fastest growing segment of the US population and will grow from 5.3 million to nearly 21 million by 2050; • 89 percent of all seniors want to age in their homes for as long as possible; • 80 percent of seniors have at least one chronic health condition and over half of them have two; • The average annual cost of a nursing home is $90,030 and the average annual cost of assisted living facilities is $45,600. This huge shift in the age of our population presents both challenges and opportunities. Today, we stand on the brink of a home care industry that is poised for unprecedented growth. With compelling demographic, social and economic factors all favoring home care expansion it is not surprising that health services experts predict that home care, in par-

ticular non-medical companion and personal care at home, will experience exponential growth for decades to come. Each and every day families are faced with the reality of an aging loved one slowly losing their independence and ability to live safely and securely at home. Families and their trusted advisors are turning to high quality and credible home care providers to professionally assess the situation and provide immediate and long term home care service plans and solutions. Healthcare experts also conclude that the advent of the Affordable Health Care Act will further alter the health delivery landscape which will result in more long term chronic care needs of seniors being addressed within the community, at home, rather than in traditional high cost institutional settings. The market for home care services has grown over 105 percent in the past five years, and the market is estimated to be well over $50 billion/year today. Furthermore over 82 percent of revenue in the home care market is paid for privately. Home care service delivery systems are be expanded to meet both the growing medical and non-medical needs of our senior population. Technology is being designed and retrofitted to address the long term home care needs of our seniors. The

home environment itself must be “seniorproofed” and altered to accommodate the long term needs of our aging population. With this confluence of events and changes impacting our society, physicians are expected to play a pivotal role in the professional system of home care delivery. Physicians will be well positioned to provide direction, oversight and continuity of services beyond the traditional office setting and into the home. This is a great opportunity for forward thinking physicians to enhance the scope and reach of their practices while meeting the current and future needs of their patients and their families. Essential aspects of home care services will be the continuity and coordination of high quality services at home. The expanding home care market will

require the need for comprehensive home care assessments, precise home care plans and the coordination and continuity of a broad range of services and products to meet the needs of our aging population. It is anticipated that medical practitioners will be at the center of this home care expansion. Alignment with home care providers who are committed to providing the highest quality home care services will be essential. Jim Neumann, President of Best Franchise Choice, LLC, is a member of the Franchise Brokers Association where he is a Certified Franchise Broker as well as a Franchise Immigration Specialist. Jim is also licensed to help entrepreneurs buy or sell businesses in Florida and does so as a member of the Florida Business Exchange. Through Commercial Funding Services, he provides the money entrepreneurs need to get into business and to grow it. He can be reached at jim@ bestfranchisechoice.com


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APRIL 2014



Reflux KO

Torax Medical rolls out LINX procedure for GERD patients to select specialists Magnetic Sphincter Augmentation (MSA), which TAMPA—A few dozen uses attraction forces to approved surgeons specialaugment weak or defecizing in gastro-esophageal tive sphincter muscles to reflux disease or gastro-intestreat GERD that often tinal surgery across the nation irritates the esophagus, are offering a revolutionary causes heartburn and procedure for patients with other symptoms. Left ungastro esophageal reflux distreated, reflux could lead ease (GERD). It’s so new; to serious complications, many primary care physicians such as esophagitis, stricand some specialists aren’t ture, Barrett’s esophagus Dr. Gopal Grandhige aware of it as an option. and esophageal cancer. “The FDA approved the “Torax Medical LINX Reflux Management System two has been extraordinarily concerned with years ago, but when the New England Journal patient outcomes and patients’ well-being of Medicine published an article discussing by only releasing the LINX device to the efficacy of the system … then healthcenters that do a lot of reflux work, in order care providers, patients and the media that the proper evaluation and appropriate took notice,” said Gopal Grandhige, MD, patients are chosen for this minimally a board-certified, Yale fellowship-trained, invasive procedure,” said Grandhige. laparoscopic general surgeon with SunThe LINX System’s new device is a coast Surgical Associates in Tampa, direcquarter-sized flexible band of magnets entor of the Tampa Bay Reflux Center, and cased in tiny titanium beads. The magnetic a LINX-approved surgeon. attraction between the beads helps keep a Torax Medical opted to launch the weak esophageal sphincter closed to prevent procedure nationwide at approved cenreflux. Implanted around a weak sphincters, one or two per state. The company ter just above the stomach, the minimally develops and markets products designed invasive procedure typically takes less than to restore human lower esophageal sphincan hour to complete. Most patients even go ter function via its technology platform, home the same day of the procedure. By LYNNE JETER

Florida LINXApproved Surgeons: Florida Hospital Celebration Health James C. Rosser, MD Florida Hospital Orlando Steve Eubanks, MD Mayo Clinic in Florida, Jacksonville Kenneth R. Devault, MD C. Daniel Smith, MD Tampa Bay Reflux Center Brandon, Tampa, & South Tampa Gopal Grandhige, MD “The force of swallowing breaks the magnetic bond to allow food and liquid to pass through, and then the magnetic attraction closes the lower esophageal sphincter back to form a barrier,” said Grandhige. A procedure developed in the 1990s called the laparoscopic Nissen fundoplication currently is the most common proce-

dure performed for heartburn. “The problem with the procedure is that each surgeon performs it differently because it’s best used for a completely dysfunctional sphincter,” said Grandhige. “In this procedure, the top part of the stomach – the fundus – is wrapped around the lower esophagus to improve the reflux barrier. In patients who have severe reflux, this procedure works very well and has minimal side effects of bloating and dysphagia. The problem with the Nissen fundoplication is that it works too well in those patients with mild to moderate reflux, and these patients may report gas bloating because of the decreased ability to belch. The LINX Reflux Management system standardizes the surgery, leading to more reproducible results, he said. Three years after sphincter augmentation with the LINX System, the majority of treated patients were able to substantially reduce or resolve their reflux symptoms, while also eliminating their use of refluxrelated medications, according to the New England Journal of Medicine summary. In 100 percent of patients, severe regurgitation was eliminated, and nearly all patients (93 percent) reported a significant decrease in the need for medication. Ninety-four percent reported (CONTINUED ON PAGE 11)

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APRIL 2014



Best Practice: Evidence-Based Standards of Care

Therapy for Venous Insufficiency The mainstay in treatment of venous insuffiency be it varicose veins, spider veins or advanced skin changes- ulcers, is elastic compression. The elastic compression should be graduated- greater pressure at the ankle, than the upper leg. Adequate compression does not include support hose or TED stockings. TED’s give 15mm Hg compression which is adequate while a patient is lying (thus the name anti-embolic stockings) but is inadequate with the leg in the dependent position. They really have no place other than the hospital setting. Medical grade stockings includes compressions over 20mm Hg. The most commonly prescribed compression is 20-30 mm Hg. For preventative purposes in those who have jobs that entail a lot of standing- beauticians, nurses, cooks, surgeons , teachers and others 1520 mm Hg is adequate. The stockings only need to extend over the calf. Compression in the thigh is only useful for those with large varicosities which ache. They are also used with treatment and for considerations of comfort or where a dress would expose the top of a knee high. We must persist when patients say that they are hot or difficult to put on. Once the patient has worn compression hose they acknowledge that their legs feel better. I tell patients that we wear them when others can’t see our legs so we look good when the legs are exposed. Use of rubber gloves or various devices can facilitate putting the stockings on. For patients who can’t put on stockings due to back problems, obesity or other physical limitations, Velcro devices are now available and affordable. To eliminate varicose veins there have been significant advances in the last 10 years. Previously surgery was the mainstay for therapy. Sclerotherapy with liquid, although frequently successful in the short term had a high rate of recurrence in 20 to greater than 50% of patients. Surgery, in most cases, entailed general anesthesia and multiple incisions with the attendant problems of wound healing in the obese and when incisions were placed in areas of advanced stasis changes. Dealing with perforator veins-often the underlying culprit in patients with ulcers was often challenging, especially when located under an ulcer or in an area of significant lipodermatosclerosis. Even in the best of hands there was a significant recurrence rate, especially if there was a subsequent pregnancy or the patient had a job than entails significant standing. With the new millennium there has been a significant paradigm shift with the advent of endovenous therapy. The two modalities available are radiofrequency closure and laser ablation with multiple devices using

different wavelengths. There are also devices on the horizon which glue the vein, or abraid the inner vein wall and inject a sclerosant at the same time. In essence, laser and radiofrequency use heat to denature the proteins in the vein wall causing the vein to fibrosis. Because the target vein isn’t actually removed, there is much less discomfort and recovery is much shorter. More importantly, the long-term results are actually better than surgery. Another modality which shows great promise is transcatheter chemical ablation. A solution of sclerosant is converted to a foam and then injected into the vein while pulling back on a catheter. The results have been nearly as good as radiofrequency and laser and the procedure is very well tolerated. After the initial procedure on the great or small saphenous vein follow up for the varicosities can be performed using ambulatory phlebectomy or ultrasound guided sclerotherapy. Ambulatory phlebectomy consists of small stab incisions over varicosities with a #11 scalpel or #18 gage needle and then removing vein segments with a small hook after injecting local anesthesia. Ultrasound sclerotherapy consists of identifying the target vein using ultrasound and then injecting foam scleroant. This is my preference. The keystone to all thee procedures is a complete detailed ultrasound using compression maneuvers with careful attention to the perforators. Nothing can replace experience with venous and arterial disease and an understanding of venous physiology. Patients with significant arterial disease or who lack mobility should generally not be treated. Treatment of patient’s with ulcers can be very. gratifying, but should be coordinated with a wound care center. Not only can wound healing be accelerated but recurrence rates are lowered. Treatment of spider veins is generally accomplished using sclerotherapy. This is accomplished using a very small 31g needle. Some spider veins, especially those which are very small or those on the face are best treated with the appropriate laser, Again, experience and appreciation for underlying venous insufficiency is invaluable. Spider patterns in certain locations on the legs often indicates underlying disease which will compromise results if not addressed. New developments in therapy, have made treatment available to many who, in the past, would not be considered because of the risks of general anesthesia. There is still a need for experience that comes from years of training and practice in matching the right modality to the patient.

Presented in Partnership by Orlando Medical News and Vascular Vein Centers

Samuel P. Martin, M.D. F.A.C.S., Founder & Medical Director Dr. Samuel P. Martin one of the leaders in venous diagnosis and treatment. Since their inception, the Vascular Vein Centers have served the Central Florida community as a recognized, educated resource with more than 25 years experience treating venous disease.



APRIL 2014




Getting Ready to Sell Your Practice By JiM NEUMaNN

The healthcare industry is experiencing dynamic changes as it relates to declining reimbursements, healthcare reform and increasingly stringent regulations; thus, physicians are considering selling their practice, merging with other practices, integrating with hospitals, or liquidating their practice. During this transformational period, it is imperative that physicians develop a strategic plan that will allow them to attain the maximum value for the practice. This is best achieved by creating an exit plan well in advance and then continually monitoring the practice’s performance over time. It is also true that in these times of regulatory change, it takes almost every waking minute just to keep up with day-today operations of a practice. In most cases, you seldom have time to survey where you are, where you are headed, and what you should be doing to improve and meet your future goals. Nonetheless, it is important to create and implement a high quality practice valuation plan to ensure a profitable and seamless experience. This article will address strategic methods to get the most value from your practice, while having the least amount of impact on your time. Even if you are not currently planning to sell, by actively managing the value of your practice each quarter, you will be prepared if an offer to purchase is made to you at an unexpected time. Phase I – Discovering Current Values – note the plural: values. Your practice does not have an inherent value that will be the same without regard to the type of buyer. Stark laws and Anti-Kickback rules can transform a practice worth $1M to an independent buyer into a practice worth $0 to a tax exempt hospital if enough revenue is generated between you and the buyer through referrals. The most prudent strategy to get the most defensible valuation with the least time, effort, and real cost, is to hire a licensed business appraiser who specializes in healthcare – ideally one which specializes in your type of practice. However, to achieve an accurate and

beneficial valuation, you must ensure that your practice’s documentation (i.e. financials, operating statistics, etc.) are in good order. If you have determined the type of buyer you would like to target, advise your appraiser, so they can tailor the valuation to the specific prospect. If your target market is more general in nature, then negotiate for a valuation that can apply across a broad spectrum of potential prospects. There are people who will prepare an assessment for free, but the money spent on a professional appraisal could be worth its “weight in gold” in terms of increased price or lower legal expenses later. (The cost of settling with the IRS over a sale to a tax exempt buyer could make the “free” assessment the biggest expense in the sale.) The valuation of your practice will be a blend of methods over a set of inputs. Furniture, fixtures, equipment, etc., will be valued using one of the cost appraisal methods. The building and real estate will be assessed based on a comparative market valuation method. It is the valuation of the intangibles that requires the highest level of expertise. Intangibles tend to be worth the present value of future cash flows they will generate. The valuation of intangibles is what draws the most scrutiny from the government and astute buyers. The logic and data used here must be bulletproof.

Phase II – Value Optimization – Analyze the valuation report with the appraiser to identify which elements are increasing the value and determine the strength with which they are doing it. Conversely, identify which elements are driving the value down and determine how significantly they are eroding value. Decide the most appropriate plan to maximize the value until the time of sale. Managing to the best business model may not be as simple as drive revenue up and costs down. A full analysis of value optimization is beyond the scope of this article, but is critical to getting the best deal when you exit the practice. Value Retention – There is an old saying: “It’s not what you make that counts, it’s what you keep.” Engage a financial and tax professional that specializes in your type of practice to determine which strategy will yield the best post-sale result and build that into the plan. Plan Management and Execution - Knowing what to do and how to do it is necessary, but not sufficient, to succeed. Having a knowledgeable third party help you stay on track can be invaluable. Here in the Orlando area, the Florida Small Business Development Center at UCF provides experts, and advisory boards, at no charge. Working with them to keep the plan up-to-date and to ensure excellent execution can be the key to achieving your dream without getting sidetracked in the day-to-day urgent distractions. Phase III – Selling – When the time is right, engage a business broker to help you find and close with the right buyer. Selling any business is not like selling a house. A business can lose substantial value if its employees, clients, or vendors learn it is up for sale. Business brokers are experts in marketing without disclosing the seller. They are also experts in managing the nuances and intricacies of a purchase and sale transaction. Hiring a professional can save a lot of time, effort, and money. Besides, it is always worthwhile to have an objective view of any proposed deal. The best time for a business owner to

Reflux KO, continued from page 9 satisfaction with their overall condition after having the LINX System procedure, compared to 13 percent before treatment while taking medication. “Surgical options such as the Nissen fundoplication offer a static solution to the treatment of reflux which is required in late-stage disease,” said Grandhige. “The LINX procedure is dynamic because opening and closing simulates the normal sphincter, except you’re keeping it closed so you don’t have reflux. Now we have a choice for patients that we can tailor-make the surgical approach to this problem.” orlandomedicalnews


The Tampa Bay Reflux Center offers three procedures for reflux: one endoscopic (incision-less) procedure and two laparoscopic procedures. “By offering various options, we’re able to tailor an appropriate treatment for our patients, without pigeon-holing all patients into one option,” said Grandhige. Like Nissen fundoplication, the procedure is done laparoscopically through five small punctures in the abdomen. “Once we’re in the OR, we can decide which procedure the patient is better suited for, depending on anatomy,” he said. “For

example, the LINX procedure cannot be done if the patient has a hiatal hernia larger than three centimeters.” Another patient benefit is a quicker return to eating solid food. “We try to get LINX patients to eat regular food right away to train the device,” he said. “With the Nissen procedure, they’re on a prescribed diet for at least two weeks.” Because the procedure is new, insurance coverage varies by provider and is usually approved on a case-by-case basis, but Medicare has started to approve a portion of the procedure.

start planning for, and working towards, a sale is the day the business opens its doors. The second best time is today. Jim Neumann is a small business advocate who provides services: to entrepreneurs as a business intermediary with Florida Business Exchange helping facilitate the buying and selling of businesses (Jim. Neumann@FBXbrokers.com); starting franchises and other opportunities as owner of Best Franchise Choice (Jim@BestFranchiseChoice.com); and providing funds for entrepreneurs to buy and grow businesses as owner of Commercial Funding Services (Jim@ CommercialFundingServices.com).


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Hepatitis C: What’s New


Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Chronic hepatitis C is one type of hepatitis virus. It is spread when a person is exposed to

the blood of another person who has the virus. Seventy-five to 85 percent of people who are exposed to the chronic hepatitis C virus develop chronic hepatitis C. Chronic hepatitis C is a lifelong infection that may damage the liver. Three to 4 million people in the United States have chronic hepatitis C. Eighty percent of them don’t know they have it. That’s because they don’t necessarily look or feel sick. It is important to be tested for chronic hepatitis C if you think you may be at risk.

Risk factors: • People with tattoos or body piercing done with non-sterile equipment • People who received an organ transplant or blood transfusion before July 1992 • People with clotting problems who took blood products prior to 1987 • People receiving hemodialysis or who have a history of hemodialysis for kidney failure • People with HIV infection. Since July 1992, all blood and organ donations in the U.S. are screened for the hepatitis C virus. According to the CDC, the number of hepatitis C infections declined by 90 percent from 1994 to 2006, partially as a result of this. Since 2006, the number of new infections each year has remained relatively stable. Symptoms: Many people who get hepatitis C do not experience symptoms for a number of years. Consequently, many do not find out they have the virus until they take a blood test for other reasons. In people with chronic hepatitis C, symptoms may include: • Fatigue • Upset stomach and diminished appetite • Joint and muscle pain • Also, patients may experience symptoms related to liver cirrhosis, such as: • Jaundice, which is a yellowing of the skin and eyes • Urine of a dark yellow color • An increased tendency to bleed or bruise The presence of hepatitis C infection can be determined by a blood test checking for the presence of antibodies to the virus. The CDC has recommended that everyone born from 1945 through 1965 get a blood test for hepatitis C. Treatment: The goal of antiviral therapy in patients with chronic HCV is to eradicate HCV RNA, which is predicted by attainment of a sustained virologic response (SVR). An SVR is associated with a 97 to 100 percent chance The decision to treat a patient with chronic hepatitis C virus (HCV) infection is based upon several factors, including the natural history and stage of the disease, the efficacy of therapy, and potential side effects. In general, patients being considered for treatment should have histologic and virologic evidence of chronic HCV infection. When identifying patients who are candidates for treatment, factors that are associated with a favorable response (e.g., HCV genotype 2) should be weighed against factors associated with a lower likelihood of response of being HCV RNA negative during long-term follow-up and can therefore be considered cure of the HCV infection . Attaining an SVR has been associated with decreases in all-cause mortality, liver-related death, need for liver transplantation, hepatocellular carcinoma rates, and liver-related complications, even among those patients with advanced liver fibrosis. New Medications/Treatment Hepatitis C treatment is on the cutting edge of medicine. Treatment of hepatitis



APRIL 2014

C evolved from monotherapy with Interferon to Infergen and ribavirin combination to Interferon, ribavirin and protease inhibitors. Recently FDA unanimously approved Sofosbuvir for the hepatitis C genotypes 1,2, 3 and genotype 4. Sofosbuvir and simeprevir for genotype chronic 1 Sofosbuvir, a hepatitis C virus (HCV) polymerase inhibitor, and simeprevir, an HCV protease inhibitor, are currently becoming available in the United States and elsewhere for treatment of chronic genotype 1 HCV infection. Regimens that include these agents offer high sustained virological response (SVR) rates, more favorable adverse effect profiles than earlier regimens, ease of administration, and relatively short treatment durations . However, regimens for genotype 1 infection generally continue to include interferon. Interferon-free regimens are expected in the near future, and it is reasonable for many patients to defer treatment while awaiting newer therapies. Most patients with chronic genotype 1 HCV infection who are candidates for and desire therapy at this time should be treated with peginterferon, weight-based ribavirin, and a direct-acting antiviral (DAA). If available, we recommend the DAAs sofosbuvir or simeprevir rather than telaprevir or boceprevir Sofosbuvir for genotype 2 and 3 chronic hepatitis C infection Sofosbuvir, a hepatitis C virus (HCV) polymerase inhibitor, is becoming available in the United States and elsewhere for the treatment of genotype 2 and genotype 3 chronic HCV infection. Despite relatively high sustained virologic response (SVR) rates with only 24 weeks of peginterferon and ribavirin among most patients with genotype 2 or 3 infection, the many contraindications and side effects associated with interferon have precluded therapy for many patients. Thus, the introduction of sofosbuvir, which offers the possibility of an effective, well-tolerated, all-oral, interferon-free regimen for most genotype 2 and 3 infected patients , represents a major milestone in the management of chronic HCV infection. Where available, for most patients with chronic genotype 2 and 3 HCV infection, we recommend the combination of sofosbuvir and ribavirin, rather than peginterferon and ribavirin. For patients who are treated with interferon, the common side effect of depression can be prevented with antidepressants. Randomized trials have previously yielded conflicting results about the benefits of prophylactic antidepressants, but meta-analyses have found that prophylaxis is beneficial. A new analysis of eight trials including nearly 600 patients compared antidepressants (selective serotonin reuptake inhibitors) with placebo for preventing depression in patients who were about to start interferon for hepatitis C or malignant melanoma . Major depression was less likely to occur during interferon treatment in patients who received antidepressants (odds ratio 0.4). Srinivas Seela, MD, completed his fellowship in Gastroenterology at Yale University School of Medicine. He is board certified in both Internal Medicine and Gastroenterology.



The Digital Revolution is Here for Healthcare By MATT BOHANNON

I was recently taken back by a presentation done by a VP of Google in Orlando. This presentation was about the digital revolution and how technology has advanced at an accelerated pace. We all know that Google is a leader in the technology industry and it was really interesting to get some insight into what they thought was the next revolution in technology. During the presentation they discussed how mobile searches on the Internet will outpace desktop searches in 2014. They also elaborated on pace in which our society has embraced mobile phones and tablets, 500 percent faster than the adoption of radio and TV. Think about that for a minute, TV and radio have been the staples of our lives for generations, you can’t go a single day without watching or listening to them, yet our society has adopted the use of smart phones and tablets 500 percent faster. It is undeniable that we are in the middle of a digital revolution. So where does healthcare fit into this digital revolution? It would seem by all indicators that healthcare is a lacking industry, but that may not be the case. I was recently at the HIMSS, (Health In-

formation and Management Systems Society) conference in Orlando, and what I experienced was a pleasant surprise. Instead of feeling like I was at a healthcare conference, it felt more like the consumer electronics expo in Las Vegas. Every major healthcare company, many startup companies, and healthcare professionals from around the world were there to experience the elaborate displays of technology and

the digital revolution of healthcare. Even household names like Sony and Konika Minolta had huge displays, and that is when I began to realize that healthcare is also in the middle of a digital revolution. What the healthcare industry is finally starting to understand is that to be competitive it is about patient engagement and convenience. With the rate at which we are using our mobile phones and tablets to be consum-

ers it exposes one glaring truth, technology is convenient. Technology allows us to do things on the go, it gives us what we need at our finger tips, and we can access it from anywhere. We don’t have to call, wait on hold, or drive to the store. We can take action on our own terms, when and where we want to. Technology has also allowed us to become more engaged. We can now communicate better through text message or Skype, we can find answers to our questions faster, and we can make decisions easier. In the healthcare space patient engagement will be the next frontier. An environment that allows patients to communicate easier with their doctors, get solutions to their problems faster, and manage their health better. Healthcare is a 3 trillion dollar market. Population growth and the demographics of consumers is why we have seen such a huge advance in healthcare IT over the past 10 years. With all of this taking place right now, healthcare is in the middle of its digital revolution. Matt Bohannon is the President of BookThatDoc.com, a healthcare website providing a streamlined process for finding and booking healthcare providers where and when you need them with real time referrals. Matt can be reached at matt.bohannon@bookthatdoc. com, or found at www.bookthatdoc.com.

“I OWE THEM MY LIFE.” Steve Sanchez, Stroke Survivor

After suffering two strokes, 47-year-old Steve Sanchez was admitted to The Rehabilitation Center at Central Florida Regional Hospital, an acute inpatient medical rehabilitation facility designed to help seriously ill patients regain their quality of life. Within three weeks, Steve was back home, enjoying his independence. Located in Sanford, the 13-bed center offers the only program of its kind in Seminole and West Volusia counties. The Rehabilitation Center’s interdisciplinary team offers intensive, comprehensive care, including physical, occupational and speech therapy for patients with a variety of conditions including: • Stroke

• Brain Injuries

• Spinal Cord Injuries

• Burns

• Congenital Deformities

• Deconditioning Resulting from Extended Illness

• Amputations • Major Multiple Trauma • Fracture of Femur

• Neurological Disorders • Severe Arthritis

To learn more about The Rehabilitation Center at Central Florida Regional Hospital or to schedule a tour, call (407) 314-3368 or visit us online at CentralFloridaRegional.com



APRIL 2014



Business Succession and Exit Planning for Professionals By SARAH GULATI, Esq.

When professionals begin thinking about a succession plan or an exit strategy for their business, many challenges arise. Many professionals are so busy with day-to-day activities that they do not have time to think about planning for their business after-the-fact. I know I was once guilty of this! One main challenge that most professionals face is that they are required to be licensed, and most state professional regulatory authorities limit ownership to licensed professionals. Unfortunately, a professional does not have the ability to pass ownership to future generations unless the professional’s children happen to follow in their footsteps. To have a plan which entails all the fundamentals of a successful business is one thing, but to have a plan that sustains a business in your absence is another. Whether you are taking a vacation or a long extended vacation with no return, what you put in place during your presence is what will essentially decide the sustainability of your business in the future. With healthcare being such an extremely complex field, it is essential for physicians with their own practice to set up a succession plan. A succession plan will ensure that in the their absence, particularly after death or retirement, the protocol put in place, will either sustain or dissolve the business in the way they want.

There are a few predominant questions that you should keep in mind when creating a succession plan. When should I prepare for business succession? How can the process of creating a business succession plan be started? What will be the legal implications involved? There is no better time than now to prepare for a business succession. It is unknown to anyone when the owner of a business will become absent either temporarily or permanently. If it is known that the owner will be retiring in the near future, a smooth transition will be beneficial to the company, thus, having a business plan is essential. The process of creating a business succession plan can be started by gathering the right team. The defining factor regarding the success of the physician’s practice lies in the hands of the operating team. Whether this team is a long term or short term team

also plays a key role. Discussing issues and making sure the operating team and the key owners are on the same page is vital to the succession plan. The legal implications involved in a succession plan will be over the ownership of the company. What is written in the succession plan and estate plan of the owner is what essentially will be followed. Attorneys will and should be involved in this process. In case of a sudden absence such as death or illness, it is important to have each day planned out as if the owner could just walk away and the business would be sustainable. This will be covered by specific guidelines and procedures to be followed by the practice outlined in the succession plan. Methods of operation is the most important; this includes, customer service, payments, human resources, marketing and a chain of command. Succession planning is not a fixed event. It must be continuously evaluated and improved to ensure it has your interest at play at all times. You need to ensure that your succession planning is aligned with your mission and core values so that you identify successors who are on the same page with your company strategy and culture, who can then continue your success. Attorney Sarah Gulati of Gulati Law, P.L., is a Florida real estate and business attorney with offices in Orlando and Jacksonville, who helps business professionals plan and protect their business ventures. She can be reached at Office@GulatiLaw.com.

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APRIL 2014

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GrandRounds Nemours Launches Nemours Children’s Urgent Care The thousands of Central Florida families who receive care at five different After Hours Pediatrics Urgent Care centers will now be directly connected to Nemours, one of the nation’s leading pediatric health systems. The centers located in Altamonte Springs, Dr. Phillips, Hunter’s Creek, Sanford and Waterford Lakes will now be known as Nemours Children’s Urgent Care. Nemours purchased the centers from After Hours Pediatrics, Inc., based in Tampa on March 1, 2014. Nearly 200,000 Central Florida families will now be within five miles of a Nemours Children’s Urgent Care Center. The board-certified pediatricians who currently provide care at the centers will join Nemours. Prices are not set to increase and the convenient hours of service will also remain the same. Nemours Children’s Urgent Care will continue to provide children the treatment they need for flu, broken bones, cuts, burns and sports injuries during evenings, weekends and holidays. Nemours will also add to each center its award-winning electronic health record system. As a result, when doctors at Nemours Children’s Urgent Care enter information, the team at Nemours Children’s Hospital can immediately see every detail, should the child be sent to the hospital. Nemours will be able to connect and coordinate every aspect of a child’s care through this shared electronic health record according to Winder. This means less chance of a duplicated test. Nemours will also offer a new approach when a child receives an X-ray. The scan will be read by an urgent care physician and, within 24 hours, it will also be reviewed by a board-certified pediatric radiologist at Nemours Children’s Hospital. Nemours has a track record of success when it comes to electronic health records. The Healthcare Information and Management Systems Society (HIMSS) Analytics awarded Nemours Children’s Hospital its highest possible honor for best practices in implementing electronic health records. Nemours is the first pediatric hospital in Florida to attain this designation.

LRMC Names New Chief Clinical Officer Central Florida Health Alliance is pleased to introduce Teri Keel, RN, MSN, Chief Clinical Officer [CCO] at Leesburg Regional Medical Center [LRMC]. Keel joined the LRMC team in June 2013 as the interim director over the Intensive Care Unit and Intermediate Care Unit. In October 2013, she stepped into the interim CCO role. Under her leadership, LRMC has begun to see positive traction around patient perception scores and operational improvement in ER flow metrics according to Central Florida Health Alliance Senior VP and Chief Operating Officer, Saad Ehtisham. Keel has over 25 years of leadership and executive experience within multiple hospital settings inclusive of community based tertiary and academic institutions. She has



previously served as a Chief Nursing Officer, Chief Operating Officer and Chief Executive Officer. Throughout her career, Keel has successfully demonstrated her leadership abilities and capacity to motivate those around her. She holds a BSN/MSN in Nursing Administration from The University of Akron College of Nursing in Akron, OH.

St. Cloud Regional Medical Center Names New Chief Executive Officer St. Cloud Regional Medical Center (SCRMC) has announced that Brent Burish has been named the new Chief Executive Officer effective April 1, 2014. Burish comes with nearly a decade of healthcare management experience, most recently serving as chief executive officer of Shands Starke Regional Medical Center in Starke, Fla. During his tenure, the hospital provided high quality care as demonstrated by recognition from the Joint Commission as a Top Performer on Key Quality Measures based on Core Measure outcomes. He oversaw renovations to the Med/Surg floor and pharmacy, expanded surgical services, and successfully recruited specialty physicians to the community, including establishing full-time Cardiology in collaboration with UF Health. Burish previously served as Chief Operating Officer at Heart of Florida Regional Medical Center in Haines City, Fla. and Chief Operating Officer at Barrow Regional Medical Center in Winder, Ga. Active in the community, Burish served on the Boards of CareerSource North Florida, Haines City Economic Development Council and Barrow County Family Connections/Communities in Schools as well as participating membership in Rotary and Kiwanis. He holds a Master of Business Administration and a Bachelor of Science in Biological Science from University of Notre Dame.

Anesthesiologists of Greater Orlando (AGO) welcomes Interventional Pain Medicine Physician Anesthesiologists of Greater Orlando, has announced that interventional pain medicine physician, Jessica Sola-Acevedo, M.D., has joined their Pain Physicians of Greater Orlando (PPGO) team. Dr. Sola-Acevedo specializes in interventional pain management and overseeing medication management to treat acute and chronic pain conditions. Dr. Sola-Acevedo is Board Certified by the American Board of Anesthesiology. She completed her Pain Management Fellowship at Carolina’s Pain Institute. Dr. Sola Acevedo has privileges at South Seminole Hospital and Winnie Palmer Hospital. PPGO centers offer a variety of ways to help relieve pain including epidural injections and nerve blocks, joint injections, radio frequency modulation and nerve stimulator implants The doctors will provide pain relief from conditions, such as spine, back, neck, knee and hip pain, post laminectomy pain, cancer pain, neuropathic pain, joint pain, whiplash pain, and pain caused by chronic disease.

Dr. Jessica Sola-Acevedo is now welcoming new patients at the new PPGO office, at 691 Douglas Ave., Altamonte Springs.

Stroke Advocate Celebrates Milestone Year of Life’s Mission Nearly twenty years ago, Valerie Greene almost died from two debilitating strokes. She was just 31 years old. Now, the Central Florida entrepreneur is celebrating many achievements including her 50th birthday in April, a milestone that may have never happened as result of stroke. Empowered by the grace of God, Valerie is rejoicing her blessed survival by improving the lives of the 15 million people who suffer strokes annually worldwide through Bcenter, the nonprofit global stroke resource center that Greene founded to serve stroke survivors and their families. After being told she may never fully regain her ability to walk or talk, Greene explored and experienced diverse interventions on her quest to identify treatments to enhance her rehabilitation. Among many milestones, Greene was labeled a “Stroke Hero” by the American Stroke Association, raised the highest individual financial contribution in the history of the Train to End Stroke program, served as a lobbyist to pass the Florida Stroke Act (signed by Gov. Jeb Bush) and authored two educational stroke books. Her biggest accomplishment, thus far, is Bcenter’s online stroke center, which provides guidance surrounding cutting-edge therapies, support groups and offerings of inspiration. Bcenter.com ‘is like a GPS for stroke survivors’ allowing easy navigation 24/7 through three main functions: Bwell, an outline of 20+ conventional and holistic therapies such as hyperbaric oxygen, nutrition, stem cell and physical therapy; Bempowered, motivational tools including testimonials and uplifting resources; and Bconnected, an interactive map populated with stroke-related professional providers. Visit Bcenter.com or call (888) 942-Bwell (9355).

Dr. Pamela Tronetti of Parrish Medical Group Receives AGS 2014 Clinician of the Year Award This year the American Geriatrics Society Board of Directors and its 2014 Awards Committee has chosen Parrish Medical Group’s own Pamela Tronetti, DO for the AGS 2014 Clinician of the Year Award. This award is intended to honor clinicians who make outstanding contributions to the delivery of quality healthcare to older people, who communicate well with patients and their families, and who make generous contributions to community health efforts. Because of the exemplary clinical care and sincere compassion that Dr. Tronetti provides to her patients, the committee felt she was the deserving recipient of this award. Dr. Tronetti is well known for the way she and her staff care for patients. Her practice is built around the well-thoughtout details that when added up, significantly increase the comfort level of her patients—such as carefully selecting magazines and providing warm blankets during cold weather. Dr. Tronetti and her

staff are so focused on delivering quality of care they celebrate their patient’s birthdays and send sympathy cards to families when they lose a patient. Dr. Tronetti’s motto is, “Once you come through those doors you are part of our family too, so if you have to call here every day, call!” The Clinician of the Year Award will be presented during the 2014 AGS annual scientific meeting on Friday, May 16 between 9:15 and 10:00 a.m. at the Walt Disney World Swan and Dolphin Hotel.

Windermere Medical Center Opens Windermere Medical Center has announced that the practice is officially open and accepting new patients. Offering a comprehensive approach and complete access to primary care, pediatrics and chiropractic medical services for the entire family, the facility, located adjacent to Lakeside Village Plaza on SR 535, is a literal one-stop shop for Southwest Orlando’s healthcare needs. The unique health concept also offers an urgent care facility for new and established patients open extended hours from 9 a.m. to 9 p.m. Monday-Friday and from 9 a.m. to 5 p.m. on Saturday. A physician is always on-site to see patients and no appointment is necessary to visit the urgent care facility. For established patients of the practice, the co-pay for an urgent care visit is the same as for a regular visit.

Orlando Pain & Spine Center Across from Dr. P. Phillips Hospital

Amr H. Badawy, MD • Graduate of The University of Cairo in Egypt • Completed training in Anesthesiology at Hahnemann University in Philadelphia • Fellowship training in interventional pain management at the renowned Mount Sinai Hospital in New York • Board certified anesthesiologist • Board certified pain medicine


Practicing pain Medicine since 2004, Dr. Badway’s philosophy leverages a multidisciplinary approach to treating pain and suffering, offering many of the most advanced treatment options to restore your quality of life.

PAIN CONDITIONS WE TREAT: Chronic pain conditions | Herniated disc Spinal stenosis | Facet arthropathy Fibromyalgia | Myofacial pain syndrome Post laminectomy syndrome Neuropathic pain | Cancer pain Complex regional pain syndromes Headaches | Whiplash injury | Joint pain

www.orlandopainandspine.com 407-985-4700 – O, 407-985-4702 –F 7364 Stonerock Cr., Suite A, Orlando, FL 32819 Mon – Thur 8 – 5:00 PM | Friday 8-12:00 PM

APRIL 2014



Same daY, nexT daY aPPoinTmenTS available at all of our central Florida locations.

G. Grady McBride, MD

Board Certified in Orthopaedic Surgery Specializing in Cervical and Lumbar Spinal Surgery, Scoliosis, Adult Spinal Reconstruction

Joseph D. Funk, DPM

Board Certified in Forefoot Surgery Board Certified in Reconstructive Rearfoot/Ankle Surgery, Specializing in Foot and Ankle Surgery, Podiatry

Jeffrey P. Rosen, MD

Craig P. Jones, MD

Board Certified in Orthopaedic Surgery Specializing in Sports Medicine, Joint Replacement, Knee and Hip Surgery

Board Certified in Orthopaedic Surgery Specializing in Sports Medicine, Orthopaedic Oncology, Joint Replacement

Tamara A. Topoleski, MD

Daniel L. Wiernik, DPM

Board Certified in Orthopaedic Surgery Specializing in Pediatric Orthopaedics

Eric G. Bonenberger, MD

Board Certified in Orthopaedic Surgery Board Certified in Sports Medicine Specializing in Sports Medicine Joint Replacement, Knee, Hip and Shoulder Surgery

Edman Fuentes, PA-C

Lawrence S. Halperin, MD

Steven E. Weber, DO

Board Certified in Foot Surgery Board Certified in Orthopaedic Surgery Board Certified in Reconstructive Specializing in Adult Spinal Rearfoot/Ankle Surgery, Specializing in Reconstruction, Cervical and Foot and Ankle Surgery, Podiatry Lumbar Spine Surgery

Daniel M. Frohwein, MD Interventional Pain Medicine Diagnostic and Therapeutic Spinal Injections

Emanuel King, PA-C

Stephen R. Goll, MD

Samuel S. Blick, MD

Board Certified in Orthopaedic Surgery Board Certified in Orthopaedic Surgery Board Certified in Orthopaedic Surgery Specializing in Hand Surgery and Specializing in Cervical and Lumbar Spine Specializing in Sports Medicine, Upper Extremity Surgery Surgery, Adult Spinal Reconstruction Knee and Shoulder Surgery

Bradd G. Burkhart, MD

Board Certified in Orthopaedic Surgery Board Certified in Sports Medicine Specializing in Knee and Shoulder Surgery

Randy S. Schwartzberg, MD Board Certified in Orthopaedic Surgery Board Certified in Sports Medicine Specializing in Sports Medicine, Knee and Shoulder Surgery

Travis B. Van Dyke, MD

Board Certified in Orthopaedic Surgery Specializing in Sports Medicine, Joint Replacement of Shoulder, Knee and Hip, and Trauma

Brad A. Kramer, PA-C

ServiceS include TreaTmenT For: Back • Foot • Ankle • Shoulder • Hip Pediatrics • Elbow • Knee • Neck • Hand/ Wrist

Alicia Reiss, PA-C

Bryan L. Reuss, MD

Board Certified in Orthopaedic Surgery Board Certified in Sports Medicine Specializing in Sports Medicine, Knee, Hip and Shoulder Surgery

Michael D. Riggenbach, MD Specializing in Orthopaedic Surgery, Hand and Upper Extremity Surgery

Lynn Coetzee, PA-C

Alan W. Christensen, MD

Board Certified in Orthopaedic Surgery Specializing in Hand Surgery and Upper Extremity Surgery

Michael D. McCleary, MD Specializing in Primary Care Sports Medicine

Matthew R. Willey, M.D

Board Certified in Physical Medicine and Rehabilitation Specializing in Interventional Pain Management, Sports Medicine, and Electrodiagnostics

Stevie Waldman, PA-C

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