Orlando Medical News January 2014

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January 2014 December 2009 >> $5


Laszlo Nagy, MD, PhD ON ROUNDS

Right Partner is Key to a Smooth Transition When MOBS are Sold More and more hospitals and health systems are considering the sale of some of their medical office buildings or other “non-core” assets ... 5

Obesity: The New Chronic Disease? Updated guidelines encourage PCPs to focus on obesity ... 7

Trending Now: Lung Cancer

More non-smokers being diagnosed; national push for screening, research By LynnE JETER

Rabih Bechara, MD, says the most difficult part of his job is telling patients, “You’ve got lung cancer.” Unfortunately, chances are three of four patients with lung cancer will be diagnosed at a late stage, when cure isn’t an option. “Once you tell patients they have cancer, no matter the stage, they’re usually very distraught,” said Bechara, chief of the pulmonary division at Cancer Treatment Centers of America at Southeastern Regional Medical Center (CTA at Southeastern) and professor of medicine at Georgia Regents University. “The beauty is, if we catch it early, we can cure them.” Bechara is a staunch supporter of the national push for lung cancer screening, hoping to see it join the ranks of the mammogram for breast cancer or colonoscopy for colon cancer. The trend of more non-smokers being diagnosed with late-stage lung cancer, especially in Florida, has expedited the movement.

“More people will die from lung cancer this year than any other type of cancer, including breast, prostate, colorectal and colon cancers combined,” said Bechara. “Unlike other types of cancers that are prominent among certain genders and ethnicities, lung cancer doesn’t discriminate and remains the leading cause of cancer deaths, regardless of sex or race.” According to the most recent data from the National Cancer Institute (NCI), an estimated 16,204 Floridians live with lung and bronchus cancer. Every year, it’s estimated that 11,923 of them will die from the disease. Another troubling trend: roughly twothirds of all new lung cancer diagnoses are among patients who have never smoked. Some are former smokers who quit decades ago. “Despite the harsh realities of lung cancer, it simply doesn’t grab the headlines of more popular forms of cancers,” said Bechara. “It also doesn’t get near the research funding as other cancers.” (CONTINUED ON PAGE 6)

Cash Flow Optimization Keys to maximizing revenue and reducing inefficiencies for physicians By LynnE JETER

If cash is king, then cash flow optimization provides physicians the keys to the kingdom in terms of opportunities to grow and maximize their practices. With increased cash flow comes the flexibility to hire staff, invest in specialized equipment, take advantage of purchasing discounts, reduce potential borrowing expenses and make other operational decisions that benefit a practice in the long term. The implementation of the Affordable Care Act (ACA) is bringing numerous challenges – and opportunities – for doctors looking to get the most out of their revenues, said Michael Miller, vice president of healthcare banking for Fifth Third Bank in Central and North Florida. The Connection to Patient Care Few physicians enter the medical field because they’re passionate about business (CONTINUED ON PAGE 4) operations, noted Miller.


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Laszlo Nagy, MD, PhD Sanford-Burnham Medical Research Institute By JEFF WEBB

LAKE NONA - Laszlo Nagy said the best advice he ever received was “aim high.” As an internationally renowned genomic scientist, Nagy certainly has taken that advice to heart. But it was not until he left his native Hungary that he comprehended just how high he could aim. “My central European upbringing did not encourage ambitious goals,” said Nagy who arrived in October to become program director of the Diabetes and Research Center at Sanford-Burnham Medical Research Institute in Lake Nona. “Coming from a small country behind the Iron Curtain, you were supposed to be modest and know your place,” said Nagy, 47, who grew up in Vamospercs and Debrecen as the oldest child of a veterinarian (dad) and a pharmacist (mom). On top of the goal-limiting culture, Nagy also was a “sickly child,” he said, and had to be hospitalized several times. “It was not terribly serious, but it was frightening for my parents. I wanted to know what was going on with me,” Nagy said, and it became “a major motivation” to study medicine and become a physician. “My family anticipated that I would become a general practitioner or internist,” he said, recalling that he was drawn to physics, which gave him “a feeling of completeness” for the first two of his six years in medical school. But during his third year “that changed very abruptly when the clinical (education) started,” he said. “It didn’t give me the fulfillment I sought. It was not empirical. Clinical disciplines did not provide me with sufficient mechanistic details of the causes of diseases. That is why I decided to become a cell and molecular biologist with an interest in human diseases,” said Nagy. “I wanted to get to the bottom of things.” Having overcome the high fevers and low expectations of his childhood, Nagy came to the United States after graduating from medical school in Debrecen. He accepted an invitation to study at the University of Texas in Houston and that is where his mentors let him know that he should pursue his potential. “It was a life-changing moment for me,” said Nagy, who singled out his advisor, Peter Davies, MD. Davies professed a mutual admiration. “I first met Dr. Nagy over 20 years ago when he was a student at the medical school in Debrecen,” said Davies. “Dr. Nagy’s professor, Dr. Laszlo Fesus, told me he had a superb medical student who was interested in research and wanted to spend some time learning about research as it was conducted in the U.S. I invited Dr. Nagy to visit my lab in Houston. I was so impressed that I invited him to return to our lab after he completed his medical training,” said Davies. “He was a really bright young man with an absolutely infectious love of science orlandomedicalnews


and research. It is rare to find someone who combines the critical intellect of a serious scientist with the charm and enthusiasm for research that Laszlo displayed even at the earliest stages of his career. I am delighted my first impressions have been borne out by Laszlo’s many successes and the many scientific accomplishments …” said Davies. “Laszlo is one of the brightest, best and most productive scientists I have ever had the pleasure of working with. His success in tackling challenging research questions and making discoveries that are of profound importance speak to his talent and his dedication. Sanford-Burnham … will provide the perfect environment for Dr. Nagy to bring his science to the next level,” Davies said. “I am certain Dr. Nagy is going to make important new discoveries.” Nagy’s mission was explained on Sanford-Burnham’s science blog by Daniel Kelly, MD, director of the Diabetes and Obesity Research Center and scientific director of the Lake Nona campus. “Laszlo is an international expert in studies of how genes are turned on and off in different cell types and at different times, particularly in response to hormones. He’s also made valuable contributions to our understanding of the roles these processes play in the development of common metabolic dis-

eases,” said Kelly. “He will apply his expertise in genomics to decipher the complexity of processes driving cancer, cardiovascular disease, and diabetes, a first step toward personalizing our approach to therapies.” For Nagy’s part, the explanation of his complex work is uncomplicated. “The program’s goal is to look at thousands of genes and how they orchestrate,” said Nagy. “The reason (Sanford-Burnham) approached me is because for the past 15 years I have been studying how all these genes affect the genome. It is a big change in the paradigm, looking at every gene, not just one. It is systems biology, looking at it as a whole. It is made possible because of our knowledge of the human genome, but also because of the very rapidly developing

technology,” he said. Because Nagy had spent time in the U.S. prior to moving to Orlando, both in Texas and in California, the transition for he and his family has been relatively smooth. His wife, Andrea Karoly, is a physician who specializes in laboratory medicine. They have two high school-age sons who are taking advantage of opportunities to play sports that were not readily available to them in Hungary. Orlando’s terrain, minus the overdevelopment, is similar to where Nagy lived in Hungary: “We lived on the great Hungarian plain. It was equally flat.” Nagy said he will continue to travel frequently to share his findings and to check in on his research lab in Debrecen. But his priority now is to assemble research groups at Lake Nona, which eventually will link 20-30 people working independently. And, when he can find time, Nagy intends to enjoy passing time with his family playing tennis, snow skiing, swimming and cooking with his sons. “We shop and cook together,” said Nagy, who is “waiting for my big pot to arrive from Hungary,” which he will use to cook traditional Hungarian goulash over an open fire.




Cash Flow Optimization, continued from page 1 “The majority is in it for the patient care, and take great pride in how their clinics operate,” he said. “Running a tight ship operationally can significantly affect the quality of patient care. It can mean everything from more one-on-one time during appointments to the ability to build on-site labs that enable faster test results. Improving cash flow is a smart business decision that ultimately benefits patients most of all.” Track the Revenue Cycle Step one to optimizing cash flow is data gathering. Practitioners can use revenue-tracking software to map the ebb and flow of funds throughout the month. By reviewing this data alongside records of insurance claim denials, they can identify inefficiencies in the billing and collections process. Miller advises clients to obtain reports on a monthly, or ideally weekly, basis. “Successful practices have a disciplined approach to managing claims and an even more disciplined approach to managing denials, as they are the primary reason for collection delays,” he said. “The key is to go back to claim originations, determine why denials happen and use that feedback to improve the process.” Improper coding is the most common factor in denials, according to Miller. And the coding system is about to become even more complex. The Center for Medicare and Medicaid Services (CMS), which distributes payments to hospitals and physicians, will implement a new system in October 2014. The ICD-9 code sets currently used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 – a transition required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). The new codes are designed to improve the “granularity” of billing – for instance, certain procedures will be identified as being performed on the “left side” or “right side” of the patient’s body. As a result, billing de-

partments will need to be aware of as many as 87,000 codes. The ICD-10 system is already used by 99 other countries, and its implementation in the United States could eventually enhance global communication of patient information. That could have a positive effect on Central Florida’s healthcare system, which sees a heavy volume of international tourists in its emergency rooms and urgent care systems, Miller said. One element of the ACA implementation is the rollout of electronic healthcare records in an attempt to make patient information more readily available to multiple physicians. CMS has issued awards to hospitals and physicians who have already implemented the records, said Miller. “By 2014, we should see a vast improvement in terms of access to records,” he said. “By eliminating replication of tests and procedures, this will lead to more cost effective care and accurate billing. Since every one of a patient’s doctors will share access to the same information, it will support a more consistent revenue cycle.” Invest in Training To navigate this increasingly complex system, staff training is critical – starting at the top. “Doctors need to be trained in the new codes so they can be more detailed in their notes for coders,” Miller said. “Many smaller practices should consider outsourcing coding to a third-party physician management program or billing service that can help ease the burden.” Training the front-desk staff, who serve as patients’ first point of contact, is also paramount. During the first visit – or prior to the visit during an initial phone call – the receptionist should collect insurance information and set up a payment plan, if needed. During each visit, this staff member should verify any changes in insurance and identify for which specific charges the patient is responsible, said Miller. “You’d be surprised by the number of

practices that still mail post-visit bills with a 30-day payment deadline, which automatically builds in a month-long lag,” he said. “This means physicians have to float all the expenses associated with treatment or care until the time they’re reimbursed. It’s best to process that charge when the patient is physically present in the office.” Industry-wide, deductibles and copays are rising – and many patients are using higher-deductible plans, which translate to higher out-of-pocket fees and can be more difficult to collect, Miller noted. “Physicians need to have a collections strategy in place, even if it requires flexibility with payment plans,” he said. “The key is getting that monthly debit or credit charge authorized in the first place.” Several banks, including Fifth Third Bank’s merchant services division, offer payment software that can assist. Improve Staff Communication After patients have left the office, ongoing communication among key staff members is critical. Physicians, billing and accounting departments, and administrative staff need to create a “feedback loop” to share relevant information, said Miller. “Often we see a disconnect among those interfacing with patients and those collecting old bills,” he said. “If a patient comes in and a prior visit hasn’t been paid, or their insurance has changed, the frontdesk staff needs to know.” If a patient’s current insurance status is in question, staff can track it down using a clearinghouse. As another example, the accounting department should convey claim denials resulting from paperwork errors to the medical staff, said Miller. “It can be as simple as, ‘Dr. Johnson forgot to check the box at the bottom of page 2,’ and then you know to avoid that mistake going forward,” he said.

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Immediate Impact The impact of cash flow optimization can be immediate, Miller said. “Take, for example, a practice that wants to maintain a cash balance of $1 million with an average collection window of 45 days,” he said. “If the practice bills on average $50,000 a day, and they can shave 10 days off that collection cycle, it would boost their cash position by 50 percent,” he said. “Or, if a practice could get by with a $500,000 balance, the same technique would double their cash.” Gathering and analyzing the right data, investing in staff training and enhancing communication can yield solid results, said Miller. “Taking these simple steps,” he emphasized, “can be very impactful on what physicians are able to accomplish in their practices.”

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erations to oversee all aspects of coding and billing. “Having one person take ownership of cash flow along the entire spectrum of care can go a long way toward making the system less fragmented,” Miller said. This person can identify revenue trends and problem areas, communicate them to other staff and ensure denied claims are resubmitted on a timely basis. When a practice has five or more physicians, it’s time to start considering hiring someone for such a role – and Miller recommends adding another administrator at the 10-physician threshold.

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Right Partner is Key to a Smooth Transition When MOBS are Sold By MARK DUKES and KETAN SANGHVI

More and more hospitals and health systems are considering the sale of some of their medical office buildings or other “non-core” assets. But the change in real estate ownership and management can create uncertainty for both the hospital and physician-tenants, and that can be compounded when a third-party investor later re-sells the buildings to another. Here’s what buyers and sellers can do to lessen the uncertainty and ensure smooth transitions. Hospitals and health systems have many good reasons to sell medical office buildings (MOBs) and other “non-core” real estate assets to outside investors. Such sales create financial liquidity that frees up capital for other uses, allow providers to concentrate on their core business of healthcare, and help hospitals avoid potential Stark and Anti-Kickback Law violations, to name just three. So in this era of seemingly insatiable capital needs, it’s no wonder that more and more providers are selling or “monetizing” their MOBs – or at least considering it. When a hospital, health system or physician practice group sells a building to a third-party real estate investor, the physicians leasing space there find themselves with a brand new landlord. Sometimes the hospital itself ends up leasing back space in what used to be its own building. And sometimes the original third-party buyer of the building subsequently re-sells it to another investor. What are the implications of such transactions on the provider and its physicians? Does this mean they lose all control over the asset and how it’s managed and leased? How can the hospital protect itself and its physicians from that uncertainty? How can the seller and buyer ensure the transaction will be a success before, during and after the closing? Florida Hospital: Third-Party Acquisition from a Third-Party Owner A perfect example is Duke Realty’s recent acquisition of 14 healthcare facilities in six states from third-party owner Seavest Healthcare Properties, which had earlier acquired the properties from various health systems and then developed them. The acquired properties were 54 percent leased to hospital systems or their affiliates and 89 percent leased overall. Four of these properties, and a fifth property that was acquired later, are located on Florida Hospital campuses in central Florida: Celebration Medical Plaza, Kissimmee Medical Plaza and East Orlando Medical Surgical Plaza, all in the Orlando area; Sebring Medical Pavilion in Sebring; and Health and Wellness Center at Florida Hospital in Wesley Chapel. Florida Hospital, one of the country’s largest not-for-profit healthcare providers and a member of Adventist Health, serves patients through 22 campuses in Florida. The acquisition of the Seavest MOB orlandomedicalnews


portfolio posed a number of challenges for all parties involved. Seavest and Duke Realty had never before partnered on an acquisition. And although Duke Realty and Florida Hospital had been engaged in talks for some time about possible development projects, Duke Realty had never acquired or developed a Florida Hospital-owned or leased facility.

Post-Acquisition Successes Like Seavest, Duke Realty has specialized healthcare real estate experience, which went a long way toward making Florida Hospital and its tenants more comfortable with the latest ownership change. Although the acquisitions closed less than a year ago, the transaction looks like a success for everyone involved. Previously, the facilities were owned,



managed and leased by three different firms. Now, Duke Realty plays all three roles. Before, tenants were confused about who to contact but now, whether it’s a need for additional space or a concern about building services, the tenants have a much more streamlined process to communicate with ownership. Duke Realty also has implemented a (CONTINUED ON PAGE 8)





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Trending Now: Lung Cancer, continued from page 1 Lung Cancer Screenings In 2012, the American Lung Association (ALA) released guidelines on low-dose lung cancer screenings, based on the NCI’s National Lung Cancer Screening Trial. The U.S. Preventive Services Task Force recently issued draft recommendations for annual low-dose CT screenings for patients at high risk for lung cancer, which translates to an estimated 7 million Americans, including smokers ages 55 to 79 who have consumed the equivalent of a pack a day for 30 years. “We’re excited about launching this tool and the low-dose screenings,” said ALA president and CEO Harold P. Wimmer. “It’s a big step in the fight against lung cancer. We created this online tool to help people understand quickly whether they’re candidates for low-dose CT screening.” The upside of lung cancer screening was discussed in the Sept. 5, 2013 edition of the New England Journal of Medicine. “Probability of Cancer in Pulmonary Nodules Detected on First Screening CT” showed how the percentage of patients dying from lung cancer could be cut by 20 percent via a low-dose CT scan versus regular x-rays. The summary: “Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening lowdose CT scans are malignant.” “Catching lung cancer early requires a very streamlined and collaborative process between PCPs (primary care providers) and interventional pulmonologists,” said Bechara. “Getting the CT scan results in

a timely manner and discussing the results between specialists and subspecialists is vital so that patients have a ready plan when they receive a diagnosis.” Determining who will pay for lung cancer screening remains a question mark, said Bechara, noting that a low-dose CT scan may cost up to $400. Most insurers don’t automatically cover lung cancer screening costs, as they do other cancer screenings like mammography. “Most screening isn’t paid for,” he said. “Different institutions have taken it upon themselves to start a screening program for the benefit of patients at a reduced rate. Some offer free screenings. At Emory, we were working on (offering it free to patients) but couldn’t because of logistics and other obstacles. Because (CTCA at Southeastern) is only 14 months old, we would probably start screening with stakeholders and their families to make sure the process is streamlined before we offer it to the general public. If there’s a fee-for-service, it will be amazingly cheap.” Front Line Assistance “PCPs are at the forefront and play a major role in identifying or at least raising the knowledge of patients with lung cancer,” said Bechara. “Unfortunately, there are no specific symptoms for lung cancer. Patients may cough and be short of breath sometimes, but that can happen to anyone with sinus issues or allergies. I urge PCPs to recommend screening for high-risk patients. They should at least be aware of the screening recommendation if patients

Rabih Bechara, MD Rabih Bechara, MD, chief of interventional pulmonology at Cancer Treatment Centers of America at Southeastern Regional Medical Center (CTCA at Southeastern), joined the Florida practice last January to build a pulmonology division that offers advanced endoscopic diagnostic and therapeutic approaches to treating patients with abnormal growth and malignancies in the chest cavity. He routinely performs endoscopic ultrasonography, confocal microendoscopy, pleuroscopy, stent placement for airway stenosis, photodynamic therapy and fiducial marker placement procedures. “My goal for my patients is for them to have a better quality of life,” said Bechara. “If they have a good quality of life and I can make them feel comfortable during treatment, then I’ll be happy.” Recognized as one of Castle Connolly’s Top Doctors® in 2013, Bechara earned a medical degree from American University of Beirut in Lebanon, completed an internship and residency at Emory University School of Medicine, where he also finished a fellowship in pulmonary and critical care. He continued his education with an interventional pulmonology fellowship at Beth Israel Deaconess Medical Center at Harvard University. Before joining CTCA, Bechara founded and directed the interventional pulmonology program at Emory. His specific research interests lie in new endoscopic techniques for lung cancer.

come to them with non-specific symptoms they can’t explain. We can refer them to a low-dose CT scan of the chest, which identifies patients with lung problems and hopefully catches lung cancer in an early stage.” Until recently, lung cancer was considered a man’s disease; statistics show it’s now the leader of cancer deaths in both genders, said Bechara. “The rate of smoking for the subsection of young females is on the rise,” said the father of two adolescent daughters. “They may start smoking as young as 12 or 13, mainly because nicotine is an appetite suppressant and being thin is the main goal.

PCPs may tell them there are many other healthier ways to keep their bodies in shape. If we can reach them at an early age, and bring awareness to the younger generation of the consequences of choices they make early on, imagine how much cancer we can prevent down the road.” Bechara is optimistic about curbing lung cancer. “We’re collaborating with multiple institutions and new technology,” he said. “Our aim is to look at new ways to kill lung cancer via multidisciplinary approach which includes endoscopy. It’s still in research mode, and the findings need to be validated. Definitely, more research is needed.”

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Obesity: The New Chronic Disease? By LYNNE JETER

The new obesity guidelines – updated for the first time in 15 years – are geared to primary care providers (PCPs) and offer an algorithm for managing obesity. The protocol for the management of overweight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and developed by the American Heart Association and the American College of Cardiology to identify at-risk patients and prescribe appropriate interventions. The timing coincides with the American Medical Association’s recent classification of obesity as a “disease.” To guide weight management decisionmaking, an algorithm focuses on the identification of patients with excess body weight and those at risk for obesity-related health problems. Most information is straightforward: • Patients with a BMI of 30 or higher are considered obese and need treatment. • Patients with a BMI 25 to 30 are considered overweight and should be treated if they have additional risk factors, such as an elevated waist circumference of 35 inches or more for women, or 40 inches or more for men. However, even though research soundly shows the higher the BMI, the greater the risk for cardiovascular disease, diabetes, and cancer, the question about the use of BMI as a screening tool has drawn debate. Healthcare providers agree that every 5 to 10 percent of total body weight lost is a milestone that reaps health benefits. But with so many diet programs available – the guideline committee reviewed 17 different plans and concurred that as long as there’s a negative energy flow, and the intake of calories is reduced daily to 1,000 or less, it should work – determining the right one, and the amount of weight that’s safe to lose over the course of weeks and months, has also been the center of controversy. The diet, guidelines say, should be a component of a comprehensive lifestyle intervention including physical activity and behavioral changes, delivered by a trained counselor. The guidelines suggest that patients meet with the interventionist 14 times in the first 6-month period. Donna Ryan, MD, co-chair of the guideline committee and a professor emeritus at Pennington Biomedical Research Center in Louisiana, admitted the current approach is for PCPs to simply tell patients to lose weight but “they don’t really engage in helping patients achieve weight loss, either through referral or providing counseling or prescribing. They’ve been reluctant … but that’s changing.” What’s not addressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot successfully reach a more optimal weight for their body frame. “It’s not as simple as telling a patient, ‘you need to lose weight,’” said Gus Vickery, MD, a North Carolina family medicine physician. “Sometimes, it takes some investigating to determine the source. It might be thyroid issues, or a combination of medical problems. Unfortunately, we (PCPs) stay so orlandomedicalnews


busy … it’s helpful when patients come prepared. It’s OK for a patient to say, ‘I can’t lose weight and I don’t know why. It doesn’t always seem to be a matter of willpower.’” After Vickery talked to a colleague about the colleague’s doctor-supervised weight loss clinic focusing on a well-rounded, low-calorie, low-carbohydrate food plan, he ditched his own in-house program and began referring patients there. One couple, patients of Vickery, lost a combined 140 pounds in less than a year. Other patients returned to Vickery tens of pounds thinner – and much healthier. “My colleague,” said Vickery, “does the heavy lifting; I monitor the results.” The impetus for the proactive movement of PCPs may be practice for the future, when they may be accountable for patients who haven’t made sincere efforts to lose weight to get healthier. Patients could eventually be penalized by insurers for not taking documented action to achieve a healthier weight. “I could see (insurers) really increasing people’s premiums if they don’t follow certain preventive measures in the future,” said urologist Stan Sujka, MD, a partner of Orlando Urology Associates in Central Florida. “Unfortunately, we’re becoming a society of regulations. A lot of people don’t seem to want take personal responsibility for their well-being.” Recently, to set an example for patients and to improve his health, Sujka dropped 36 pounds in nine months with the assistance of a diet app on his smart phone, a practice he encourages patients to follow as a first course of action for losing excess weight. “Your smart phone can serve as your personal coach to shed those unwanted pounds,” he said. “It’s easy, free, and studies show it works.” The two most popular free apps are “Lose It” and “My Fitness Pal,” which allows patients to meet pre-set calorie and exercise goals. Sujka’s partner, Albert Ong, MD, gave him a kickstart on the new lifestyle modification by downloading the “Lose It” app on Sujka’s smart phone and programming it to lose one pound per week. Sujka is now very close to his college weight goal of 200 pounds. “Since losing weight, a lot of my patients have asked, ‘how did you do it?’ After explaining to them about using their (smart) phones to lose weight, many of them have come back to the office and told me their doctors for years have been telling them to lose weight but have never told them how,” explained Sujka. “They’ve told me they’ve found the app simple and effective. As a result, I wrote up the principle of using your smart phone to lose weight. A lot of patients appear more excited about losing weight than the affects of Viagra or Cialis!” Overall, the guidelines don’t focus on specific obesity medications. Only orlistat (Alli or Xenical) was available during the committee review process. Since then, the FDA has approved new diet drugs – lorcaserin (Belviq) and phentermine/topiramate (Qnexa) – that are recommended for use as “an intensification approach.” Bariatric surgery for weight loss was the fifth and final recommendation “when other interventions fail.”

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Right Partner is Key to a Smooth Transition, continued from page 5 number of building improvements in the facilities, including developing more visible signage; improving tenant directories; and adding new paint, carpeting and other enhancements. It added much-needed sound insulation in the surgery center of the Sebring Medical Pavilion to shield against the high noise level and is adding a console in the Celebration Medical Plaza lobby to assist patients with wayfinding and other needs. While Seavest did an excellent job with the buildings over the years, the new owner, Duke Realty, saw the improvements as an opportunity to make a good first impression and demonstrate goodwill

to the hospital client, as well as help them improve their image in the communities they serve. Those efforts are working if tenant feedback is any indication. In a recent survey, 90 percent of responding tenants expressed overall satisfaction with management and the quality of the buildings. That’s good news for the tenants, and there has also been good news for the new owner as the buildings have seen increased occupancy since the acquisition. The hospital is even in talks with Duke Realty about expanding the Celebration facility or developing another freestanding building.

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W W W. G L O B A L K T E C H . C O M

Lessons Learned Executives from both Florida Hospital and Duke Realty believe the Seavest acquisition shows how important it is for all parties to do thorough due diligence and really get to know one another. Before a hospital or health system considers selling its facilities, it should study the prospective buyer’s reputation, financial situation and track record. What’s the size and quality of the buyer’s current healthcare portfolio? How much experience does it have owning and managing healthcare facilities? Does it tend to hold onto its healthcare properties long-term or does it “flip” them? Is it well capitalized? Publicly traded? Is it a cash buyer and can it close quickly? These are all important questions. The health system and its tenants also should pay careful attention to whether the potential buyer learns as much as possible about them, takes their concerns into consideration and works to make them comfortable with the new ownership. The bottom line is that hospital executives who are considering selling their facilities should sell them to an organization they want to have a relationship with and that will be the best partner for the long term. But what should the health system do if the current owner sells to another thirdparty owner such as the acquisition of the Florida properties? One way the hospital can protect itself is with a long-term ground lease – selling the buildings but not the underlying land. This means that any new owners of properties on those grounds must

work in partnership with the hospital, and the hospital has a say in any potential sale. Sometimes hospitals even insist on having the right of first refusal to buy back their buildings if third-party owners decide to sell. In addition, just as when the hospital first sold its facilities, it should spend time getting to know the prospective, new third-party owner and make sure the potential owner understands its perspective and challenges. Responsible, smart healthcare real estate buyers will listen seriously and learn from these interactions. After all, the buyers want the transaction to be successful and know it’s imperative to ensure that the hospital and its tenants are satisfied and stay in the facility, keeping occupancy rates and patient traffic high. That’s definitely the case with the five Florida medical office buildings that Duke Realty purchased. Jody Barry, Florida Hospital Administrative Director, Strategic Development, noted that it has been a favorable investment for everyone, especially when considering all the improvements that have been made to the buildings. Mark Dukes is vice president, Asset Management for Duke Realty’s assets in Florida, and Ketan Sanghvi is executive director, Business Development and Leasing for Duke Realty. Mr. Dukes can be reached at Mark. Dukes@dukerealty.com and Mr. Sanghvi can be reached at Ketan.Sanghvi@dukerealty. com. Duke Realty’s healthcare experts can be visited at www.dukerealty. com/healthcare.

Dr. Angela Merzenich establishes practice in Lake Mary

THE DOCTOR Is In. After years of treating patients in Arizona, Dr. Angela Mer zenich has moved to Central Florida and established her practice in Lake Mary. She is Board Certified in family medicine and is especially interested in women’s health. Her practice accepts Florida Health Care Plans, Florida Blue, self-pay patients and other insurances.

Angela Merzenich, MD 2500 W. Lake Mary Blvd. Suite 109 Lake Mary, FL 32746 (407) 878-0910

Locally trusted. Nationally recognized.






Finding Doctors Online is Here to Stay By MATT BOHANNON

In today’s business environment it seems like almost 90 percent of business is done through e-commerce. Everyone from teenagers to grandparents have mobile computers in their pockets and usually a tablet or laptop to compliment it. With all this technology at our finger tips it is no wonder that consumers do research, and make their buying decisions online. Today, we see consumers who text instead of call, who message on social sites instead of meet up, and who go to the Internet first before shopping in store fronts. Even with the rapid expansion of mobile technology since the early 90’s, one industry has been lacking in their ability to reach consumers on the go, healthcare. Healthcare has been slow to adapt and accept the importance of being optimized in the technological world but new services are making it easier for patients to find doctors in their area that meet their required needs, and even book appointments online. In Central Florida, Google gets over 300,000 hits per month pertaining to healthcare, but Google is just a search engine that indexes individual websites that can help you. These individual websites are where the consumers find the technology that helps them complete the task at hand. The problem with many of the

existing websites that focus on healthcare is that they are self-service and require the patient to map out the location of the doctor’s office, find the relevant phone number, and call the practice to see what availability they have. Even worse are the websites that sell advertising, these sites make it even more confusing to find the relevant content for the patient and misrepresent the doctor. Out of the websites that focus on healthcare, BookThatDoc.com is trying to meet the needs of both doctors and patients. This service in Central Florida helps finding a doctor and booking appointments online an easy and convenient experience. Most families and individuals don’t have the time during a busy work day to call a doctor and book an appointment. This process is made more difficult with the frequency in which individuals and families are relocating to seek better employment opportunities. Patients that move to a new city have no idea who to call about local doctors, so they go to what is familiar, the Internet. Research also shows that healthcare decisions are usually made at night or on the weekends when a doctor’s office is typically not open and many doctors can’t afford a 24/7 staffing solution. With this new age of healthcare websites patients can find a doctor by zip code, health insurance carrier, languages spoken, and specialty. It is no longer an issue

if you are new to an area or can get in touch with your friends. It also gives doctors an opportunity to reach these patients at the time they are ready to make a decision. Healthcare websites in today’s environment should have all the information a patient needs to make a decision at their fingertips. A comprehensive profile for the doctor with recommendations for patients to read is ideal. Even better is a website that gives the patient the opportunity to request an appointment with the doctor 24/7, from any device they choose. Consumers are getting more accustomed to being able to manage their lives on-the-go and they are looking for a solution that helps them manage their health and engages them on their computers and mobile devices. The doctors are also just as excited that they now have an opportunity to attract new patients at a very minimal cost and with no additional staffing requirements. Doctors can also leverage the marketing and e-commerce knowledge of these companies without distracting them from focusing on medicine. With the innovation we are starting to see with technology in healthcare, finding doctors online is here to stay. 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


GrandRounds Florida Hospital Kissimmee Breaks Ground For New Patient Tower Osceola and south Orange County residents will soon have expanded access to healthcare as part of a new 80-bed patient tower at Florida Hospital Kissimmee. Kissimmee leaders gathered alongside Florida Hospital executives to break ground on the new three-story patient tower. The tower will feature large private patient rooms, cardiology services including two cardiac catheterization labs, with the capability of performing interventional cardiology procedures. The expansion will double the size of the hospital. The need for healthcare in the Osceola County community is growing as well. Over the last decade, the population has skyrocketed by 55 percent according to the United States Census Bureau. This year marks the 20th anniversary since Florida Hospital acquired the hospital. More than 20 physicians and hospital staff have watched the community and hospital transform over those two decades and are excited to see the largest expansion in Florida Hospital Kissimmee’s history first hand. The 94,000 square-foot patient tower is expected to be completed by spring 2015.

“My overall impression is that it is beyond anything I can put into words. It’s the most amazing, uplifting, spiritual journey... it transcends you to a higher state of consciousness. Amazing!” — Margaux Brooks, executive film producer


Bob Carr Centre, Orlando Call: 888-974-3698 | 800-745-3000 Visit: Shenyun.com/Orlando www.Ticketmaster.com

Witness The Divine Culture’s Return This Year, You Must Not Miss It!

“I believe that many artists in the world admire Shen Yun’s quality. It is the highest form of dancing art that mankind could possibly achieve. I am beyond admiring it!” — Joseph Kuo Nan-Hong, celebrated director and producer, known as the godfather of films in Taiwan

“The conductor is fabulous, the orchestra was fabulous— so, so wonderful... the composers, the people that did some of the work to bring this music together, mixed with the [dance] perfectly... the music, the conductor is the best I’ve ever heard.” — Rick Crompton, musical conductor

“I’ve seen many Chinese performances. I was touched by some of the performances and concerts, but I was never moved so deeply as I was today… The programs stirred me again and again. I was constantly trying to keep myself contained, but in the end I couldn’t control myself. I cried...” — Dr. Thomas Weyrauch, author and China expert

“The costumes, the colours, the dancing, they’re all at a very high level and very beautiful… There’s a lot of talent that [Shen Yun] has employed.” — Consiglio Di Nino, former Canadian Senator

“The dancers are some of the most phenomenal, especially the male dancers are absolutely amazing... it resonates through you, no matter you are 5 or 65, it was just an amazing show.” Presented by Florida Falun Dafa Association



— Jessica Black, Miss USA 2010




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Florida Hospital Cardiologist First in Orlando to Use New Technology for Coronary Artery Disease Cardiologist Dr. Rohit Bhatheja from Florida Hospital is the first cardiologist in Orlando to perform atherectomy with the Diamondback 360 Coronary Orbital Atherectomy System (OAS) from Cardiovascular Systems, Inc. (CSI.) The system gained U.S. Food and Drug Administration (FDA) approval in October and is the first and technology approved for the treatment of severely calcified coronary arteries. Dr. Bhatheja used OAS technology in the cardiac cath lab to treat a patient with coronary artery disease by removing the calcium inside the artery. The Diamondback 360 provides a solution for patients with a calcium buildup problem by reducing calcified plaque and facilitating stent deployment with low complications. The ORBIT II trial is the first study in history designed to treat severely calcified lesions. The Diamondback 360 is a 1.25-millimeter catheter that works by spinning around inside the artery to “sand down” the buildup of calcium along the artery walls. The orbital motion causes calcium to be released into tiny particles small enough to flow safely into the bloodstream. A balloon and stent are then deployed to increase blood flow.

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Orlando Health’s Next Step to Bring New Cancer Treatment to Central Florida

Save clinicians 30 minutes or more a day

Forty tons of equipment has been delivered to the Orlando Health construction site of the new Proton Therapy Center. The $25 million facility, which will house Central Florida’s first proton therapy center, will provide cancer patients with a form of radiation therapy that uses proton beams to shrink tumors. It’s a revolutionary tool to fight cancer, but building a proton therapy center is no easy feat. The very heavy parts of the proton accelerator, the machine that generates proton therapy, have to be transported on multiple semi-trucks all the way from Boston. Then, it takes a crane to move the pieces from the trucks into the proton center’s vault through the ceiling. This was the first of two deliveries of equipment. Once completed, the entire proton therapy machine will weigh 84 tons which is equivalent to the weight of a fully loaded Boeing 747-800 airplane.

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New Medical Director In Seminole County The Florida Department of Health in Seminole County (DOH-Seminole) is pleased to announce Meena Joseph, MD, as the new Medical Director for DOH-Seminole. As Medical Director, Dr. Joseph will be responsible overseeing the physicians, Executive Nursing Director and Dental Care Program. Dr. Meena Joseph received her Undergraduate Degree from Mercy College in Palghat, India and her M.D. Degree at Calicut Medical College in Calicut, India. She completed her residency in Pediatrics at St. Louis University in St Louis, Missouri.

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Providing a true continuum of care approach for physicians and their patients. The board-certified general surgeons at Advanced Surgical Care Specialists can properly diagnose, progressively treat and permanently solve both simple and complex surgical issues. Our team is at the forefront of the latest surgical techniques, including open, endoscopic, minimally-invasive laparoscopic, robotic and single-site incision procedures. Positive patient outcomes are among the best in the area, providing minimal pain, scarring and recovery time.

Nicole BaiRossi, MD, FACS


William L. Huether, III, MD, FACS

Altamonte Springs • Lake Mary NEW Location: 661 E. Altamonte Springs Dr., Ste. 316, Altamonte Springs, FL 32703 4106 W. Lake Mary Blvd., Lake Mary, FL 32746

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2014 10TH ANNUAL CUTTING EDGE CONCEPTS in Orthopaedics and Sports Medicine

SATURDAY, FEBRUARY 8, 2014 Rosen Centre Hotel | 9840 International Drive, Orlando, FL 32819



Registration Now Open Join fellow Orthopaedic HealthCare Professionals for a day complete with: • Up to 5.50 prescribed continuing education credits by the American Academy of Family Physicians • Insightful lectures from specialists around the country • Lunch and free parking

Register at OrlandoOrthoFoundation.org For more details, please contact Bob Hammons at 407.254.2501 or RHammons@OrlandoOrtho.com

6 Convenient Offices to Serve You: Downtown Orlando • Winter Park • Sand Lake • Lake Mary • Oviedo • Lake Nona