Orlando Medical News March 2014

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PROUDLY SERVING CENTRAL FLORIDA

March 2014 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

James ‘Butch’ Rosser, Jr., MD ON ROUNDS

Developing & Designing Effective Ambulatory Facilities

A Fruitful Collaboration

Orlando Health’s partnership with UF Health on joint oncology program hits fast-track in 2014 By LyNNE JETER

When leaders of two powerhouse institutions in Florida established dialogue to strengthen their partnership, which for the most part had included some fellowships and residency rotations, it was a good start that perhaps unexpectedly turned into a great collaboration. On Jan. 31, Orlando Health’s MD Anderson Orlando officially became known as the University of Florida (UF) Cancer Center at Orlando Health, a Florida-centric program with a research portfolio and patient volume attractive to pharmaceutical companies wanting to expedite clinical studies. The joint oncology program propelled the institutions’ status to the largest cancer program in Florida, and the fifth largest in the nation. (CONTINUED ON PAGE 4)

Celebrating 30 Years

The recession took a heavy toll on healthcare construction projects across the nation. However, as the economy has begun to improve, projects are beginning to move forward again. ... 6

Physician Associates CEO Dennis Buhring discusses how the nearly 100-physician group has adapted to decades of change By LyNNE JETER

ALTAMONTE SPRINGS – Central Floridians may remember a two-physician practice called the Orlando Health Care Group (OHCG). Central Florida’s largest multispecialty practice, now known as Physician Associates, is celebrating its 30th year, and its second year as part of Orlando Health

ONLINE: ORLANDO MEDICAL NEWS.COM

From left, Dr. Wayne Jenkins, President, Orlando Health Physician Partners; Dr. Jamal Hakim, Interim President, Orlando Health; Dianna Morgan, Chairman of the Board, Orlando Health; Dr. Bernie Machen, President, University of Florida; Dr. David Guzick, Senior Vice President for Health Affairs and President, UF Health; Dr. Mark Roh, President, UF Health Cancer Center at Orlando Health; and Timothy Goldfarb, CEO, UF Health Shands.

in a January 2013 $50 million buyout. Orlando Medical News caught up with Dennis Buhring, president of the group, who worked with Aetna Healthcare prior to 19 years at Physician Associates and knows both sides of the payor/provider fence, to discuss how the practice has weathered continuous industry challenges, why physicians decided to sell to Orlando Health, and what’s next.

Since the group was organized in 1984 as an “affiliated medical group” with Prudential Health Insurance, tumultuous changes have taken place industry-wide. How has Physician Associates adapted to those changes? So many changes have occurred! Fundamentally, it seems everything has changed ex(CONTINUED ON PAGE 5)

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In Honor of National Doctor’s Day We extend our deep appreciation to our VOLUNTEER PHYSICIANS for the thousands of hours of service donated to the men, women and children of Central Florida.

Abreu, Mayra, M.D. Achong, Ronald, D.M.D. Acosta, Luis, D.M.D. Adler, George, M.D. Adler, Lee, D.O. Aebli, Craig, D.D.S. Aggarwal, Anil, M.D. Ahmad, Saeed, M.D. Ahmed, Fawad, M.D. Ahmed, Imtiaz, M.D. Ahmed, Khurshid, M.D. Ahmed, Nadeem, D.M.D. Ahmed, Syed, M.D. Ahmed, Tanveer, M.D. Aina, Bisi, D.D.S. Akhter, Kauser, M.D. Alatriste, Anthony, M.D. Aldea, Ximena, D.D.S. Alexandraki, Irene, M.D. Ali, Raza, M.D. Ali, Samreen, M.D. Ali, Sohail, M.D. Alicea, Louis, D.M.D. Alidina, Laila, M.D. Allen, Luis, M.D. Allgeier, Joseph, D.O. Alonso, Luz, M.D. Alvarez, Jorge, D.M.D. Amilinemi, Ram, M.D. Anderson, Axel, M.D. Anderson, Robert E., M.D. Andrade, Antonio, M.D. Andreae, George, M.D. Andrews, Douglas, D.D.S. Andriole, Joseph, M.D. Angulo, Jorge, D.D.S. Anjum, Sumaya, D.D.S. Anim, Tanya, M.D. Ansari, Najm-Us-Sehr, M.D. Araujo, Gerson M.D. Arlonetti, Pablo, M.D. Armotrading, Joseph, M.D. Arthur, Allison, M.D. Ata, Jill, D.D.S. Ata, Joseph, D.D.S. Atfeh, Alaa, M.D. Atkins, James, M.D. Attermann, Steven, D.O. Aujla, Narinder, D.O. Awan, Muhammad, M.D. Azbel, Alexander, M.D. Azizi, Abdul, D.M.D. Baaqee, Suzanne, D.D.S. Badger, Michael, D.D.S. Bagby, Richard, M.D. Bahn, Sheila, M.D. BaiRossi, Nicole, M.D. Baker, Kristy, M.D. Baker, Norton, M.D. Baker, Robert, M.D. Baker, Ryan, M.D. Ballagas, Frances, D.M.D. Bancroft, Laura, M.D. Barcus, Ray, D.D.S. Barinas, Froilan, D.D.S. Barinas, Norma, D.D.S. Barnard, Thomas, M.D. Baron, Neil, M.D. Barr, Louis, M.D. Barrett, Robert, M.D. Barry, Brenda, M.D. Bates, Thomas, M.D. Bauer, Julie, M.D. Baylor, Jeffrey, M.D. Beattie, Jeff, D.M.D. Beattie, John, D.D.S., M.S.D. Bechard, Douglas, M.D. Bedney, Daniel, M.D. Behzadi, Ali, D.M.D. Belnick, Lucille, M.D. Bengaard, Katrine, D.O. Benjamin-Arias, Cavelle, M.D. Bennett, Ericka, D.M.D. Benzaquen-Parkes, Elly, M.D. Bermudez, Juliana, D.D.S. Berrios, Jan, M.D. Bertot, Charles, D.D.S. Bhargava, Amit, M.D. Bhasin, Robin, M.D. Bhatt, Tapan, D.O. Bierman, Arnold, M.D. Bifsha, Enea, D.D.S. Bigsby, Glenn, M.D. Bird, Eugenio, M.D. Bishop, John, D.D.S. Blatnoy, Vitaly, M.D. Blue, David, D.M.D. Boger, Gregory, M.D. Bonn, Kevin, D.M.D. Borrero, Margarita, M.D. Bourne, Kimberley, M.D. Bow, Lesley, M.D. Bowen, Audrey, M.D. Boyette, Melissa, M.D. Brady, Jeffrey, M.D.

Brady, Scott, M.D. Branch, Michael, M.D. Bravo, Stephen, M.D. Breit, Bruce, M.D. Brenner, Laurence, M.D. Brien, Patrick,D.D.S. Brint, Steven, M.D. Briscoe, Joshua, M.D. Brooks, Sherry, M.D. Brooks, Steven, M.D. Browning, Brian, D.O. Bui, David, M.D. Bullard, Timothy, M.D. Buonfiglio, Claudio, D.D.S. Burchfield, Tommie, D.D.S. Burks, Robert, D.D.S. Burroughs, Lisa, M.D. Busowski, Mary, M.D. Bustamente, Gustavo, M.D. Butler, Stephen, M.D. Cabreira, Anthony, M.D. Caggiano, Christpher, D.O. Cameron, Doris, M.D. Campbell, John, M.D. Cangiano, Thomas, M.D. Cantrell, Frank, M.D. Cao, Trang, D.D.S. Capo, Hilda, M.D. Carcamo, Antonio, M.D. Carducci, Theresa, M.D. Carlyle-Clark, Kimberly, D.D.S. Carmondy, Erin, D.D.S. Carr, Brandon, M.D. Carr, Jeffrey, M.D. Carrasquer, Luisa, M.D. Carson, Thomas, M.D. Carter, Anne, M.D. Carter, Ben, D.D.S. Carter, Kirsten, M.D. Cascio, Michael, M.D. Cassidy, David, M.D. Castiglioni, Analia, M.D. Chan, Alan, M.D. Chapman, Enrique, M.D. Chard, Christopher, D.M.D. Charnesky, Melissa, D.O. Chase, John, M.D. Chatfield, David, D.O. Chau, Son, M.D. Cheatham, Michael, M.D. Cheatham, Susan, M.D. Chen, Peter, D.D.S. Chin, Wei-Shen, M.D. Chiu, Jeffrey, M.D. Christian, David, D.D.S. Citron-Lopez, Jose, M.D. Clark, Clifford, M.D. Clark, Darwin, M.D. Claussen, Eric, D.D.S Clayman, Allen, M.D. Cobian, Laritssa, M.D. Cohen, Jeffrey, M.D. Cohen, Michael, M.D. Cohil, Kirk, D.D.S. Cohn, Richard, M.D. Coleman, Brian, D.D.S. Colimon, Liza, M.D. Collins, Jill, M.D. Colon, Agdha, D.D.S. Colon-Bengoa, Carlos, D.D.S. Colvin, Joseph, M.D. Conaway, Eileen, D.O. Condron, Colin, M.D. Conlan, Walter, M.D. Constant, Robert, M.D. Contestable, Clement, D.D.S. Cook, Barry, M.D. Cook, Gary, D.D.S. Cooper, Sharrell, M.D. Cooperman, Elliott, M.D. Cowan, David, M.D. Cox, William, M.D. Cox, Sr., William, M.D. Crandell, Rosemary, D.C. Crigler, Lisa, D.P.M. Crossman, Bruce, M.D. Crotty, Christopher, M.D. Cruz, Belisa, D.M.D. Cuadras, Aisha, D.D.S. Curley, Charles, D.M.D. Curry, Susan, M.D. Curtis, Craig, M.D. Czarniecki-Burzynski, Yolanda, M.D. Dalton, Robert, M.D. Dandashi, Moutaz, D.D.S. Daniel, Kathryn, D.D.S. Daouk, Ayman, M.D. Daphtary, Uday, M.D. Darakshan, Naveen, M.D. Daugharthy, Jennifer, M.D. Davila, Virgil, M.D. Davis, David, M.D. Davis, Wilbur, D.D.S. DeForrest, Brenda, O.D. De La Fuente, Sebastian, M.D.

De La Roza, Melissa, M.D. Deeb, Danuta, M.D. Dejesus, Samuel, M.D. Delgado, Lazaro, M.D. Demas, Maria, D.D.S. Demetrius, Robert, M.D. Desai, Nila, M.D. Desai, Prashant, M.D. Desau, Uday, M.D. Desiraju, Madhushree, M.D. DeWild, Chuck, D.M.D. D’Heureux-Jones, Ann Marie, M.D. Diaz, Nelson, D.D.S. DiBartolomeo, Glenn, D.D.S. Diebel, N., M.D. Doherty, Nicole, D.D.S. Domescek, Ronald, M.D. Douglas, Anthony, M.D. Dowling, Alan, D.M.D. Dowling, Patti, D.M.D. Dreyer, Lizette, D.D.S. Dubbin, Clifford, M.D. Dube, Debra, M.D. Dumois, Richard, M.D. Dunn, Ingrid, M.D. Dunn, William, D.D.S. Duran, Aurelio, M.D. Dure, Jean, M.D. Ekambaram, Anita, M.D. Elenberger, Charlotte, M.D. Ellis, George, M.D. Enfinger, Ross, D.M.D. Escandon, Juan Carlos, M.D. Ettedgui, Jose, M.D. Eubanks, Stephen, M.D. Everett, George, M.D. Evers, Natalie, M.D. Eyma, Rachel, M.D. Faas, Meghann, D.D.S. Fakih, Faisal, M.D. Falco, Mark, D.D.S. Falk, Jay, M.D. Farley, Timothy, M.D. Fatima, Rasha, D.D.S. Feldgoise, Louis, M.D. Feuer, Ken, M.D. Figueroa, Ruben, D.M.D. Filart, Esdras, M.D. Filart, Roland, M.D. First, Victor, D.D.S. Fishberg, Alexander, M.D. Flatley, James, D.D.S. Florin, Jorge, M.D. Fontaine, Pierre, M.D. Foss, Joseph, M.D. Franceschi, Alejandro, M.D. Franco, Cynthia, O.D. Franklin, Joe, M.D. Freed, Mitchell, M.D. Freeman, Pamela, M.D. Freilich, Ira, M.D. Friend, Vicki, D.O. Frisch, Mark, M.D. Fuentes de Sanchez, Alberto, M.D. Gal, Richard, M.D. Galceran, Manuel, M.D. Gallagher, Joseph, M.D. Gallas, Steven, D.O. Gammichia, John, D.M.D. Ganne, Sravanthia, D.M.D. Garber, Mitchell, D.O. Garcia, Armando, M.D. Garcia, Ediberto, M.D. Garcia, Maria, M.D. Garfinkel, Bob, D.M.D. Garrett, Kathryn, M.D. Gavino, Belinda, M.D. Gay, Madison, M.D. Geary, Paul, M.D. George, Richard, M.D. Georges, Cletus, M.D. Gerkovich, Jack, M.D. Gerrity, Diane, M.D. Gerstenblitt, Dan, M.D. Gfeller, Eduard, M.D. Gilbert, Ashley, M.D. Gill, Charles, D.D.S. Gindle, Jessica, D.D.S. Giorgis, Esaias, M.D. Glickman, Penny, M.D. Glosson, Charles, D.M.D. Gober, Jaime, M.D. Gomez-Amador, Jorge, M.D. Gomez, Nadia, M.D. Gomez, Rebecca, M.D. Gonzalez, Alfredo, M.D. Gonzalez, Juan, M.D. Gordon, James, M.D. Gordy, Bruce, D.M.D. Gousse, Ralph, M.D. Graham, Anthony, D.D.S. Gray, Daniel, D.D.S. Greenbaum, Lennard, M.D. Greenberg, Andrew, D.D.S. Greenberg, Martin, D.D.S.

Greenwood, Scott, M.D. Gros, Bernard, M.D. Gross, H. Eugene, M.D. Gross, Terrance, M.D. Guarneri, John, M.D. Guerra, Luz, D.D.S. Gummadapu, Ramkishan, M.D. Gundian, Julio, M.D. Guthrie, George, M.D. Haddock, David, M.D. Haidukewych, George M.D. Hajjah, Fouado, M.D. Halek, Mark, D.D.S. Hall, Matthew, D.D.S. Hall, Pamela, M.D. Hall, Steven, D.M.D. Hameer, Zanib, D.D.S. Hamilton, Thomas, M.D. Hammoudeh, Basil, D.D.S. Hand, Stanley, M.D. Hannah, James Edward, M.D. Hansen, Barbara, M.D. Hao, Tran, M.D. Harbour, David, D.O. Harden, David, D.M.D. Harden, Kelly, D.M.D. Harding, David, M.D. Hardy, Marvin, M.D. Hari, Aashiv, M.D. Harmon, Rhonda, M.D. Harris, Barbara, M.D. Hart, Hugo, M.D. Hartman, Melissa, M.D. Hartog, Jeffrey, M.D. Hasselbring, Caryn, M.D. Helmers, James, M.D. Hernandez, Caridad, M.D Hernandez, Danilo, D.D.S. Hertz, Amy, D.D.S. Hilal, Raouf, M.D. Hinton, David, D.D.S. Ho, Henry, M.D. Holehouse, Tomas, D.D.S. Holtery, Andrew, D.M.D. Hoover, Frederick, M.D. Hopkins, Lynne, M.D. Hotchkiss, Karen, M.D. Houle, Richard, M.D. Howell, Michael, M.D. Hsu, Vincent, M.D. Hu, Fay, D.M.D. Huang, Brandon, PharmD Hudak, Robert, M.D. Huether, William, M.D. Huhn, John, M.D. Hunter, Tom, D.D.S. Hurbanis, Matthew, M.D. Husain, Suraiya, M.D. Hussain, Basharat, M.D. Hussain, Shama, M.D. Iheme, Chiamaka, M.D. Ilagan, Maria, M.D. Ilagan, Marlon, M.D. Isaacs, Karl, M.D. Isler, Aaron, D.D.S. Ismail, Salma, M.D. Jaber, Reem, D.M.D. Jablonski, David, M.D. Jablonski, Donald, M.D. Jackson, Amy, D.O. Jackson, Craig, M.D. Jacobo, Elias, M.D. Jacobs, Daniel, M.D. Jaffe, Linda, M.D. Jager, David, M.D. Jaime, Diana, M.D. James, John, M.D. Janmeja, Milan, M.D. Jean-Phillippe, Nicouly, D.D.S. Johnson, Christopher, D.M.D. Johnson, Jeremy, M.D. Johnson, Jerri, M.D. Johnson, Lucien, D.M.D. Johnson, Lyn, D.O. Johnson, Melvin, M.D. Johnson, Seth, M.D. Jones, Daniel, M.D. Jones, David, M.D. Juhasz, Jason, M.D. Kahn, Bernard, D.M.D. Kalidas, Kirti, M.D. Kallepali, Vamsi, D.D.S. Kalser, Gary, M.D. Kang, Barry, M.D. Kannan, Geetha, M.D. Kansol, Harvey, D.D.S. Kapil, Sanjiv, M.D. Kapitan, Richard, D.D.S. Kaplan, Albert, D.P.M. Kasu, Suriaya, D.D.S. Katsur, Justin, D.D.S. Katz, Barry, M.D. Katzman, Robin, D.M.D. Kaviani, Kia, D.D.S. Keating, Michael, M.D.

Keehbauch, Jennifer, M.D. Keown, Marcy, D.D.S. Kerkes, Michael, M.D. Khan, Adnan, M.D. Khan, Farzana, M.D. Khan, Jaseem, M.D. Khan, Muhammad, M.D. Khan, Rumi, M.D. Khan, Vajih, M.D. Khan-Assad, Bibi, M.D. Kielmovich, Izak, M.D. Kilgore, Kimberly, M.D. Kilgus, William M.D. Kim, Rebekah, M.D. Kim, Thomas, M.D. King, Troy, D.D.S. Kitson, Joanne, M.D. Klaiman, Allan, M.D. Kleckner, Kimberly, M.D. Knipe, Ronald, M.D. Knol, Michael, D.M.D. Koren, Daniel, D.M.D. Koren, Jeffrey, M.D. Kossow, Alan, D.O. Kramer, Lawrence, D.O. Krupitsky, Andrew, D.O. Kubert, Jason, M.D. Kuhn, Larry, M.D. Kumar, Mukesh, M.D. Kupiszewski, Stanley, M.D. Kurup, Suraj, M.D. Kwok, Gigi, M.D. Kwong, Raymond, D.M.D. Laddu, Prashanta, M.D. Lalchandani-Lalwani, Geeta, M.D. Laliberte, Michel, D.P.M. Landa, Jennifer, M.D. Lane, Mary, M.D. Lane, Timothy, D.D.S. Langford, Joshua, M.D. Lanzas, Ramiro, M.D. Larson, Lewis C., D.M.D. Lauridsen, Deborah, M.D. Lauzan-Madruga, Maria, D.D.S. Lavansani, Leela, M.D. Lawson, Scott, D.D.S. Layson, Joseph, M.D. Layish, Daniel, M.D. Lazar, Adam, D.D.S. Lazar, Arnold, M.D. Lebioda, David, M.D. Lee, Alice, M.D. Lee, Raymond, D.M.D. Lee, Theodore, M.D. Lee, Wha-Joon, M.D. Lehman, Jeffrey, M.D. Lemieux, Peter, D.M.D. Lemke, Katia, D.M.D. Lemoine, Jason, M.D. Lense, Jorge, M.D. Levitt, Adam, M.D. Li, Shenjing, M.D. Licitra, Carmelo, M.D. Lim, Iris, M.D. Lincourt, Ester, M.D. Lipkin, Brad, D.D.S. Lizama, Anna, M.D. Lodhi, Abdul, M.D. Logan, Sheryl, M.D. Lombana-Cano, Edward, D.D.S. Londono, Jorge, M.D. Long, Hoang, D.D.S. Lopez-Cintron, Jose, M.D. Lopez, Michael, D.D.S Lopez-Torres, Minta, D.M.D. Losada, Nelsa, O.D. Lovett, Rodney, M.D. Lu, William, M.D. Maddipatla, Sreeram, M.D. Madhany, Nasir, M.D. Madison, James, III, M.D. Magruder, Brock, Jr., M.D. Mahan, Mark, M.D. Mailler-Savage, Erica, M.D. Maluso, Paul, M.D. Mammas, Adamantia, M.D. Mancero, Carol, M.D. Mangiaraci, Melchiorra, D.O. Maniar,Gigi, M.D. Manon, Aisha, D.M.D. Manoucheri, M., M.D. Mantalvo-Vega, Wifredo, M.D. Marcelo, Claudia, D.O. Marcos, Jose, D.D.S. Marsh, David, M.D. Martin, Briggette, D.M.D. Martinez, Javier, D.D.S. Martinez, Julio, D.M.D. Martinez, Pablo, D.M.D. Martinez, Santiago, M.D. Mascoe, Maurice, M.D. Mason, Christopher, M.D. Mason, Matthew, D.O. Massey, Johnson, M.D. Matar, Ramsey, D.D.S.

Mathias, Patrick, M.D. Matos, Ruth, M.D. Mavrofrides, Elia, M.D. McAleer, James, M.D. Mcbride, Daniel, D.C. McCarus, Tamberly, M.D. McCastlain, Morris, M.D. McCarly-Warner, Dinah, M.D. McCorkle, Ryan, M.D. McDonald, Douglas, M.D. McDonald, Gary, D.O. McIntosh, David, D.D.S. McIntre, Amanda, D.D.S. McNair, Reem, D.D.S. McNamara, Charles, D.M.D. Mehta, Krishnakmal, D.D.S. Mehta, Rahul, M.D. Mengel, Marvin, M.D. Merzenich, Angela, M.D. Middleton, Robert, M.D. Miller, Javier, M.D. Miller, Katie, D.D.S. Miller, Mandel, M.D. Mina, Sherwin, M.D. Miner, Jean, M.D. Mir, Hamza, D.D.S. Mohandas, Usha, M.D. Mokris, Michael, M.D. Mokris, Patrick, D.D.S. Molthrop, David, M.D. Moore, Michael, M.D. Moosa, Mohammed, M.D. Morales, Ofilio, D.M.D. Morgan, Thad, D.M.D. Moroose, Rebecca, M.D. Morris, Len, M.D. Mueller, Jeffrey, M.D. Muhherjee, Amrita, D.O. Mund, Larry, D.D.S. Muneer, Badar, M.D. Munro, Mark, M.D. Muqueem, Mohammad, M.D. Muriel, Michelle, M.D. Murphy, John, M.D. Myers, Nicole, D.O. Myrie-Richards, Velma, M.D. Nair, Rajesh, M.D. Nair, Santosh, M.D. Namvar, Christina, D.O. Nasir, Shazia, M.D. Nathanson, Richard, M.D. Naughtin, Ryan, M.D. Neall, Kerry, M.D. Needham, John, M.D. Nelson, Jeffery, D.O. Nelson, John, D.D.S. Nelson, Richard, M.D. Nerness, David, M.D. Nerness, John, M.D. Newman, Charles, M.D. Ngo, Hung, M.D. Nguyen, Carolyn, D.M.D. Nguyen, Christine, D.D.S. Nguyen, Duy, D.D.S. Nguyen, Hanson, M.D. Nguyen, Jennifer, D.M.D. Nguyen, Maria, D.D.S. Nguyen, Michelle, M.D. Nguyen, My Duc, M.D. Nguyen, Van, M.D. Nhu Tran, Hao, M.D. Nicola, Raina, D.D.S. Nieves-Quinones, Daniel, M.D. Nobie, Brian, M.D. Nofsinger, Roger, D.M.D. Noor, Nadia, M.D. Norestrant, William, D.D.S. Nowell, John, O.D. Nunez, Eric, D.D.S. Oberoi, Ravi, D.M.D. O’Brien, John, M.D. O’Brien, Patrick, D.D.S. O’Brien, Paul, M.D. O’Donnell, Arlene, D.O. Offenbeck, Mark, D.D.S. Oh, Cheryl, M.D. Oh, Gregory, D.O. Olavarria, Lissette, M.D. Olmos, Rodolfo, D.D.S. Olson, John, M.D. Ordona, Natividad, D.D.S. Oristaglio, Robert, D.O. Oshinowo, Adeoti, M.D. Otto, Adriana, M.D. Outlaw, Jim, D.D.S. Pacheco, Carlos, M.D. Packing-Ebuen, Jennifer, M.D. Pagan, Aida, D.D.S. Pagan, Sasha, M.D. Pal, Parul, M.D. Pallarin, Robert, D.D.S. Pandya, Sumanchandra, M.D. Panzer, David, M.D. Panuccio, Denise, M.D. Paolillo, Joseph, M.D.

Pappas, Harry, M.D. Pardon, Alberto, M.D. Parekit, Kevin, D.D.S. Park, Alice, M.D. Park, Linda, D.M.D. Parker, Claude J., M.D. Parks, Ross, M.D. Parpia, Sophia, D.D.S. Parramoure, Marc, D.D.S. Partain, Jonathan, M.D. Patange, Vijay, M.D. Patel, Ashwinkumar, M.D. Patel, Chirag, M.D. Patel, Mittalben, M.D. Patel, Nishita, M.D. Patel, Pavin, M.D. Patel, Pinkal, M.D. Patel, Rakesh, M.D. Patel, Ravi, D.M.D. Patel, Ripak, D.D.S. Patel, Sushil, D.D.S. Patil, Gargey, M.D. Patni, Aftab, M.D. Patterson, Neil, M.D. Paulk, Laura, M.D. Pederson-Buck, Lauren, M.D. Pellarin, Robert, D.D.S. Peralta, Jose, D.D.S. Perceval, Paul, M.D. Petrilli, Richard, D.D.S. Pham, Lac, M.D. Phamnguyen, Bryan, D.M.D. Philip, Philip T., D.M.D. Philips, Wallace, M.D. Pillai, Aravind, M.D. Pimentel, Paul, D.D.S. Pinango, Kyra, M.D. Pinillos, Kathleen, D.D.S. Pinto, Marco, D.M.D. Pirozzolo, Jason, D.O. Plumley, Donald, M.D. Poiley, Jeffrey, M.D. Popat, Vipin, M.D. Popli, Raaj, M.D. Poppell, Magaly, D.D.S. Porter, Jason, M.D. Porterfield, James, M.D. Portoghese, Joseph, M.D. Portnoy, Barry, M.D. Posgai, Scott, M.D. Posniak, Robert, M.D. Prairie, John, M.D. Price, Alan, D.M.D. Prince, Timothy, M.D. Priyawat, Nupporn, M.D. Pryor, Norman, M.D. Purnima, Rao, M.D. Putigna, Floriano, D.O. Qureshi, Imtiaz, M.D. Ragno, Joseph, M.D. Rahmatullah, Mehr, M.D. Ralls, George, M.D. Ramesh, Seela, M.D. Ramos, Augustine, M.D. Ramos-Vivas, Luz, M.D. Ranjan, Rachna, D.D.S. Rao, Purnima, M.D. Rasool, Abid, M.D. Reddy, Sanjay, M.D. Reddy, Tadur, M.D. Reddish, Gregory, D.D.S Reeber, Cliff, M.D. Reese, Bradley, M.D. Rehman, Arshad, M.D. Reid, Anne, D.D.S. Reid, Robert, D.D.S. Reimer, Faith, M.D. Rey, Rosalia, D.D.S. Reyes, Aurelio, M.D. Richbourg, Samual, M.D. Richman, Laurence, D.P.M. Rivera, Inoel, M.D. Rivera, Jannette, M.D. Rivera-Ramirez, Inoel, M.D. Rivero, Carlos, D.D.S. Robbins, Marla, M.D. Roberson, Jessica, M.D. Roberts, Victor, M.D. Robertson, John, M.D. Rocker, Jeffry, D.O. Rodgers, Robert, M.D. Rodriguez, Arsenio, M.D. Rodriguez, Maria, M.D. Rodriguez, Richard, M.D. Rodriguez, Wilfredo, D.D.S. Rogers, William, Jr., M.D. Romain, Josette, M.D. Rosario Cacho, Joaquin, M.D. Rosendo, Leyberth, M.D. Rosenthal, Bennett, M.D. Ross, Richard, O.D. Rothschild, Dennis, D.D.S. Rousseau, Paul, O.D. Ruderman, William, M.D. Russow, Linda, D.D.S.

Ryan, N. Thomas, M.D. Sachdev, Manu, D.D.S. Sadek, Nadia, M.D. Sadler, Larry, M.D. Sadhu, Sanghamitra, M.D. Sadowsky, Jeffrey, M.D. Saffran, Alan, M.D. Salagubang, Jason, M.D. Salatich, Dale, M.D. Salazar, Michael, D.D.S. Salazar, Sergio, M.D. Sanchez, Sabrina, D.C. Sandifer, Johnny, D.D.S. Sandoval, Javier, D.O. Sanjar, Louis, M.D. Sanchez-Wohlever, Amaryllis, M.D. Sanchez de Fuentes, Alberto, M.D. Santambrosio, Marc, D.O. Sarvotham, Grace, M.D. Saunders, Holly, M.D. Savage, Christopher, M.D. Schmitt, Scott, D.M.D. Schoedler, Scott, M.D. Schwartz, Barbara, M.D. Schwartz, Regan, M.D. Schoonmaker, Dana, M.D. Schwartzman, Jonathan, M.D. Scoma, Andrew, M.D. Scott, Aaron, D.D.S. Seals, Ryan, M.D. Sedaros, Steve, D.D.S. Seela, Harinath, M.D. Seela, Srinivas, M.D. Serafin, Denise, M.D. Serrano, Yaharia, D.D.S. Seth, Monisha, M.D. Shaik, Naushad,M.D. Shaikh, Naazli, M.D. Shami, Halla, M.D. Shay, Sam, M.D. Sheikh, Asad, M.D. Shephard, Harry, M.D. Sherin, Kevin, M.D. Shirley-Williams, Lisa, M.D. Siddiqui, Muqeet, M.D. Siddiqui, Nasimul, M.D. Sidhu, Harmanjit, M.D. Sieger, Barry, M.D. Silberbusch, Mark, M.D. Simmonds, Arlic, M.D. Simms, David, D.D.S. Simms-Cendan, Judith, M.D. Simpkins, Jennifer, M.D. Singh, Shanta, D.D.S. Siino, Michael, M.D. Sladek, Gary, M.D. Sloan, Richard, D.O. Smith, Edwin, M.D. Smith, Jeffrey, M.D. Smith, Richard A., M.D. Smith, Richard, M.D. Smith, Susan, M.D. Smith-Gonzalez, April, D.O. Snow, Stephen, M.D. Sohail, Ishrat, M.D. Solberg, Kirk, D.M.D. Spector, Brian, M.D. St. Matthew, Tejumade, D.D.S. Stanford, Thomas, M.D. Starks, George, D.M.D. Steele, William, M.D. Stefan, Manuel, D.D.S. Steiner, Mark, M.D. Steppie, Michael, M.D. Sticker, Jeffrey, D.O. Stieg, Frank, M.D. Stine, Sandra, M.D. Stone, Harry C., M.D. Storr-Jones, Kenya, D.D.S. Storrs, Bruce, M.D. Straker, Richard, M.D. Stricker, Jeffrey, D.O. Striker, Richard, D.O. Styne, Philip, M.D. Sudarsky, Laura, M.D. Summers, Laura, M.D. Sutton, David, D.M.D. Swana, Hubert, M.D. Synder, Brett, M.D. Szurkus, Dennis, M.D. Taggart, John, M.D. Tak, Ravi, M.D. Tamayo, Raul, M.D. Tambunan, Daniel, M.D. Tang, Lydia, M.D. Tarver, James III, M.D. Temple, Timothy, D.M.D. Tesar, James, M.D. Tew, Franklin, M.D. Thill, Jeffrey, M.D. Thomas, Donald, D.M.D. Thompson, Beth, D.O. Thompson, Eddie, D.M.D. Thompson, Veronica, D.D.S. Tilley, Don Jr., D.M.D.

Timmel, Michael, M.D. Timoshkin, Elena, D.O. Tipirneni, Kiran, M.D. Topoleski, Tamara, M.D. Torres, Annabell, M.D. Trach, Mark, M.D. Tran, Deanna, D.O. Tran, Diane, D.M.D. Tra, Hao Nhu, M.D. Tran, Faye, D.D.S. Tran, Truc, D.O. Tran, Truc, M.D. Tringas, Andrew, D.M.D. Trivedi, Aileen, D.D.S. Trumble, Eric, M.D. Tubio, Abigail, D.D.S. Tutorino, Joseph, M.D. Uppalapati, Madhavi, M.D. Usmani, Shahid, M.D. Vahidi, Navid, M.D. Valentin, Eden’s, M.D. Van, Jennifer, D.D.S. Vandervoort, Robert, PharmD Vargas, Lillian, M.D. Vaughan, David, M.D. Vaught, Jessica, M.D. Vega-Montalvo, Wilfredo, M.D. Velez-Munich, Carlos, M.D. Verardi, Mary, D.D.S. Verma, Bishnu, M.D. Verma, Nacvin, M.D. Vivek, Deepak, M.D. Vogt, Michael, M.D. Voirin, James, D.O. Vuyyuru, Sujatha, M.D. Vyas, Veda, M.D. Wadina, Paul, M.D. Wagner, Curtis, D.P.M. Walcott, Sean, D.D.S. Walczak, Steven, M.D. Waldheim, Eddie, M.D. Waldman, Adam, M.D. Wallace, Kevin, D.D.S. Wallace, Mark, M.D. Walters, Natalie, PharmD Wang, Charles, M.D. Ward, Michael, D.D.S. Wardlaw, Wendi, D.D.S. Warner, Scott, D.O. Warner-McCarley, Dinah, M.D. Warren, Ashlee, M.D. Wasif, Sandra, D.D.S. Wasliw, Christopher, M.D. Watkins, Mike, D.M.D. Watters, Jacob, D.O. Watzman, Max, D.O. Weatherly, Mark, M.D. Weaver, Robert, M.D. Weber, Rebecca, M.D. Webster, John C., M.D. Weinstein, Irwin, M.D. Weinstock, Rebecca, D.D.S. Welch, Rebecca, M.D. West, H. Kenneth, M.D. Westmoreland, Pamela, D.M.D. Wierzbicki, Joanna, M.D. Wiest, Karyn, M.D. Williams, Chris, D.M.D. Williams, Latania, D.D.S. Williams, Marcus, D.M.D. Williams, Michael, M.D. Williamson, Paul, M.D. Wilson – Kidd, Joan, M.D. Wilson, Michael, M.D. Windham, Wayne, M.D. Winfrey, Gary, D.O. Winfrey, Kelley, D.O. Wong, Carol, D.D.S. Wortman, Ivan, M.D. Wright, David, D.O. Wright, Chad, D.D.S. Wu, Eric, D.M.D. Yao, Effie, D.D.S. Yeung, Victor, D.M.D. Yonkosky, Donna, M.D. Yoon, Sydney, M.D. Yudenfreund-Sujka, Shari, M.D. Yunk, Craig, M.D. Yunk, Johanna, M.D. Yurkiewicz, Lisa, D.M.D. Zagari, John, D.D.S. Zak, Brett, D.M.D. Zakari, Ahmed, M.D. Ziajka, Paul, M.D. Zilioli, Armand, M.D. Zirgibel, Brian, M.D. Zittel, Colleen, M.D. Zittel, Gregory, M.D. Zoch, Robert, D.D.S.

“Making Healthcare Available For Everyone In Our Community” Shepherd’s Hope, SpecialCare, Dental Care Access Foundation, Grace Medical Home, Florida Department of Health-Orange, and Florida Hospital Community After Hours Clinic are all members of the Primary Care Access Network (PCAN). For volunteer opportunities, contact: Maureen Kersmarki, Chairwoman, PCAN www.pcanorangecounty.com Phone: 407-836-PCAN

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Dental Care Access Foundation 407-898-1525 | Grace Medical Home 407-936-2785 | Shepherd’s Hope, Inc 407-876-6699 SpecialCare, Inc. - 407-836-2519 | Orange County Health Department 407-858-1400 x1123 We regret if a Physician’s name has been overlooked.

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PhysicianSpotlight

James ‘Butch’ Rosser, Jr., MD

Advanced Laparoscopic Surgeons, Florida Hospital Medical Group By JEFF WEBB

CELEBRATION - Introduce yourself to James “Butch” Rosser, Jr., at three different times of the day, and you are likely to meet three different men. Very early in the morning Rosser begins his “global life,” where he is “a futurist and technology assimilator,” he said. Then he starts his “clinical life” at Advanced Laparoscopic Surgeons at Florida Hospital’s Celebration Health, where he uses his skills as a general surgeon specializing in minimally invasive procedures. And at night you meet the man who places a very high priority on his family life. The global life Here, Rosser combines his work as an inventor and an author to satisfy his passion as an educator. He has lectured all over the world about remote control surgery, has written more than 50 peer-reviewed articles and 16 chapters in medical textbooks. He holds two patents and created the Rosser Top Gun Laparoscopic Skills and Nursing Program, which he called an “edutainment-based surgical educational module. More than 6,000 surgeons have taken the course since he created it in 1991, and it is in use in more than 50 institutions worldwide, he said. Rosser is a video game enthusiast and that entertainment fascination allows him to meld that pastime with his scientific innovation. He authored Playin’ to Win: A Surgeon, Scientist and Parent Examines the Upside of Video Games, and has another book coming out in a few months, Saving the World: The Birth of Stealth Learning and the Digital Learning Revolution. He also has developed a program called SteathSurgeon, which is described on his website as a “hip-hop National Spelling Bee meeting the ESPN X Games.” Rosser’s goal is to draw children into medicine and surgery. His work has been featured in numerous television documentaries. Next up on Rosser’s global front: (1) Develop mobile telemedicine applications for underdeveloped countries; (2) convert the entire GED curriculum into a video game and “inspire others to change our outdated educational system,” he said. “I love dreaming and I have no fear of executing,” Rosser said. “Failure does happen, but it does not define you. It only positions you to succeed.” The clinical life Rosser grew up in Jim Crowe’s backyard, the son of respected school teachers in Moorhead, Miss., where he was given the nickname Butch because he often helped his grandfather, an animal butcher. He attended the University of Florida and later the University of Mississippi while playing football in the slow-to-integrate Southeast-

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ern Conference. It was the first time he had ever been in a classroom with a white person, he said. Rosser stayed at the University of Mississippi to complete his medical degree in 1980, and then went to Akron, Ohio for a five-year residency in general surgery. His curiosity about minimally invasive surgery emerged at that time, he said. Since then Rosser has held academic appointments at Yale University School of Medicine, the Albert Einstein College of Medicine in New York, and served as professor of surgery at the Morehouse School of Medicine in Atlanta. Rosser arrived at Celebration in 2012, reuniting in practice with a colleague from his days at Yale, Jay Redan, MD. “This area means a lot to me,” said Rosser, who noted that he has been involved with the Orlando Science Center for 6 years. “I walk into the hospital and I’m smiling every day. My staff is like family and Jay is like a brother from another mother,” Rosser said. Florida Hospital leaders “give me the freedom to stretch my wings and bring some of my cuttingedge ideas into practice,” he said. “I want to work hard to earn the privilege of staying here and retiring,” said Rosser, 58. Rosser said he is excited about “our big blockbuster initiative to fight gastroesophageal reflux disease (GERD) and the fastestgrowing cancer in the world, esophageal cancer. We are starting a new screening program with primary care physicians using

space age technology and telemedicine. We also are creating a special heartburn center at Celebration that will give one-stop, cutting-edge care for this problem,” he said. Rosser’s clinical work reaches far beyond central Florida. Since 1992 he has used telemedicine to provide remote care and education about minimally invasive surgery to patients in underprivileged countries, including Curacao and Jamaica, via a program called Modern Day Miracles. The family life Rosser has overcome challenges to get where he is today. When he was in Akron, for example, “I was a homeless single dad,” he said. “I had two kids that I was taking custody of and I had to save money, so I slept in my van for about 9 months. Those were tough times.” But then he set his sights on a woman at church. Her name was Dana and even though he had performed surgery on her mother, it took him 6 months to work up the nerve to ask her to dinner, he said. “She wound up marrying us all,” Rosser said. The couple have been married 20 years and now they have five children, aged 1738, and two grandchildren. Rosser said he always has taken his kids wherever he travels. At night, he said, “I come home and I do not bring work so I can spend at least a couple of hours with them. I’m nothing without my family. They

are all quality kids and good citizens. That’s a blessing that a lot of people don’t have.” Rosser has overcome another huge personal challenge - morbid obesity. Today he carries 295 pounds on his 6-foot, 4-inch frame. But not too long ago he weighed about 465 pounds. “I was dying, but with the help of my wife and friends I made the decision to become a patient,” Rosser said. “A friend performed a laparoscopic gastric bypass. I lost 160 pounds.” Rosser even shared his story on The Dr. Oz Show. When he is not multi-tasking his responsibilities as a physician and family man, you might meet a fourth Butch Rosser who indulges his fascination with video games, comic books and cinema (particularly futuristic action movies) and piloting unmanned drones. “I’m a terminal 12-year-old,” he laughed, “but that’s what helps me relate to people from 9 to 90. I’m a dreamer and I prefer to be happy.”

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Addressing the Emotional Side of Cancer UF Health Cancer Center at Orlando Health joins forces with Cancer Support Community to provide free specialized cancer support services By LyNNE JETER

Around the same time Orlando Health changed its cancer program from MD Anderson Orlando to UF Health Cancer Center at Orlando Health, the metro area’s second largest health system unveiled another collaboration to benefit the Central Florida community: a pact with the national Cancer Support Community (CSC) to mark the second hospital partnership in the United States to offer free cancer support services to patients and their families. “CSC’s first hospital was part of a healthcare system in Greenville, South Carolina, that’s fairly similar to ours,” said Diane Robinson, PhD, a neuropsychologist and program director of CSC and Integrative Medicine at Orlando Health, who took the post last year, after serving as an adjunct professor at the University of Central Florida and a staff psychologist with the Veterans Health System. “However, we have the bragging rights of being the first hospital in the nation to offer a full CSC program curriculum.” The timing of the CSC program rollout with the cancer center name change is coincidental, said Robinson, noting the

Women Playing For T.I.M.E.® presents a check for $600,000 to the UF Health Cancer Center at Orlando Health. From left, Dr. Jamal Hakim, Interim President, Orlando Health; Kim Thiboldeaux, President and CEO, Cancer Support Community; Dr. Diane Robinson, Program Director, Cancer Support Community at Orlando Health; Beth Rudloff, COO, UF Health Cancer Center at Orlando Health; Lynda Canatay, Foundation Events Manager, Orlando Health; Lisa Cohen, Vice President, HR Consulting, Hilton Grand Vacations; and Dr. Mark Roh, President, UF Health Cancer Center at Orlando Health.

agreement between Orlando Health and CSC was inked in October 2012. “It took some time to get the agreement signed through MD Anderson Houston,” she explained. “Our COO Beth Rudloff had so much passion for the programming. She knew we could do something no one else had offered, that we had all the pieces, but they hadn’t been put in place.”

Persistence prevailed, along with philanthropic support of Women Playing for TIME (Technology, Immediate diagnosis, Mammography, and Education). In January, the local group that has raised money for the Orlando Health Foundation through golf and tennis tournaments since its inception in 1993 presented the UF Health Cancer Center at Orlando Health with a $600,000 check to support the CSC

and other programs. The funds allow the creation and expansion of cancer support groups, educational workshops and social groups offered free to anyone impacted by cancer in Orange, Seminole, Osceola and Lake counties. “We had a couple of pilot programs in the fall, and a mind-body-spirit program in place through December, so turning the calendar year made it an easy starting point,” said Robinson. “I was also able to tweak some programs, such as a support group that met monthly without particular structure to one that meets weekly with a purpose.” Three of the nearly 20 new CSC programs include Cancer Transitions: Moving Beyond Treatment®, a six-week program that focuses on wellness, exercise, emotional health, nutrition and medical management tips, and includes training in relaxation and stress management; Kids SupportSM, a 10-week CSC program designed for children ages four to 12 that works to reduce the stress of cancer in the family by helping them learn cancer concepts; and CancerSupportSource SM, a comprehensive distress screening tool that delivers screening, (CONTINUED ON PAGE 8)

A Fruitful Collaboration, continued from page 1 “This didn’t come out of the blue,” said David S. Guzick, president of UF Health, and UF senior vice president for health affairs. “We began discussions in 2012 to work toward an affiliaDr. David Guzick tion agreement.” Those discussions bore richer fruit than either institution initially expected, of particular importance at a time when cancer eclipsed heart disease as the leading cause of death in Florida. In a Memorandum of Understanding (MOU) announced Oct. 14, 2010, between UF, Shands HealthCare, and Orlando Health, the second-largest hospital network in Central Florida and the fifth-largest nonprofit hospital in the United States, the intent was to work on new health initiatives to make care more accessible to patients in a 20-county region and expand training opportunities for physicians. Under the terms of the agreement, the organizations were poised to form joint clinical programs in the areas of pediatrics, neuroscience, oncology, women’s health, transplantation and cardiovascular medicine, including a plan to develop a regional comprehensive cardiac care program. UF Health also had an eye on increasing undergraduate and graduate medical residency and fellowship training opportunities at Orlando Health, and opening opportunities for conducting clinical trials through 4

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MARCH 2014

UF’s impressive clinical research program, while also launching common approaches to quality care and safety initiatives. The MOU announcement didn’t specifically mention oncology. “It’s had unexpected benefits,” said Mark Roh, MD, president of UF Health Cancer Center at Orlando Health, leader of MD Anderson Orlando since January 2012, when long-time Dr. Mark Roh leader “Buck” Brown III, MD, retired from the post after 36 years with Orlando Health. At the time of the transition from Brown to Roh, both men expressed concerns about potential changes taking place under new leadership at the University of Texas MD Anderson Center in Houston. Since then, MD Anderson Houston has altered its mission, with the ambitious goal of treating 5 percent of all new cancer patients in the United States with sites nationwide. Its affiliation in 2009 with Banner Health in Phoenix, Az., to create Banner MD Anderson Cancer Center resulted in a new direction focused on high patient volume, one that didn’t mesh well with Orlando Health’s culture. “Last July, we were still thinking maybe this could work out, but we made clear to Houston that Gainesville was a part of our future,” said Roh. “We really wanted a three-way partnership, with

NCI Designation Possibly Expedited The new partnership between UF Health and Orlando Health to combine both oncology programs flourished before the affiliation agreement with MD Anderson expired on Jan. 31. Three days earlier, Gov. Rick Scott announced a proposed bill to create the Florida Consortium of National Cancer Institute (NCI) Centers to have more NCI-designated centers in Florida to address the state’s rising cancer rates. “We’re well-positioned to meet the criteria outlined in the governor’s proposal,” said David S. Guzick, MD, PhD, president of UH Health, and UF senior vice president for health affairs. “We have more than 100 ongoing cancer studies, and research funding for cancer alone totaled more than $36 million last year. Our joint oncology program uniquely posi-

three diverse strengths coming together in a unique way that created a lot of excitement. But I met with the president in Houston. He was not very interested, but said nevertheless, let’s explore it.” When leaders of the three institutions began negotiating details on a conference call last August, “the first 45 minutes were really good,” said Roh. “I was starting to feel a little hopeful. In my view, I’d spent 10 years in Houston, so I have a lot of affinity and affection (for MD Anderson Houston) and would like to see this pursued. But in the last 15 minutes of the conference call, it just plummeted and was clear they were

tions us to be successful applicants for NCI designation, which is our goal and intention.” The proposed legislation would be funded through the William G. “Bill” Bankhead, Jr. and David Coley Cancer Research Program. The $80 million cancer research budget includes $20 million for peer-reviewed research grants and $60 million for helping existing cancer centers achieve NCI designation. “The exciting part is together, yeah we’re almost there,” said Scott. “We need that extra investment. The government hopefully will step forward and provide that.” Guzick said UF Health and Orlando Health leaders look forward to competing for funds under the proposed budget allocation “that would accelerate this process.”

interested only in signing a deal and not addressing the details. When it came down to meaningful change and program building, it just wasn’t there.” By October, Roh knew a change must be made. “I often use the analogy that when you were an infant and toddler, you needed mom around,” he said. “Once you became an adult and went to college, the needs weren’t as great. That’s where we were.” Brown, who had helped bring MD Anderson to Orlando, expressed his displeasure yet supported the decision. “Dr. Brown wasn’t a proponent,” noted Roh. (CONTINUED ON PAGE 8)

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Celebrating 30 Years, continued from page 1 cept the physicians’ dedication to their patients. In 1998, Prudential elected to sell their HMO business to Aetna Health Plans. At that time, rather than sell the practice or merge with a hospital, why did OHCG elect to become a free-standing, independent medical group? The environment in 1998 was very different than the environment we face in 2014. As a statistician and financial person, I was deeply concerned about the unsustainability and continued rise of healthcare costs. That wasn’t the focus in 1998. Then, payors were the focus of cost control in contracts and negotiations. Now there’s been a shift to healthcare systems, with primary care physicians actively working with hospitals to provide the entire continuum of the highest level of quality care possible and the total elimination of unnecessary and wasteful expenses. That’s a huge difference! Today, the industry is in a crisis. The payor products have changed. Way back then, we were an HMO and a PPO. Today, we see ACOs forming and we’re hearing employers talk about narrow network products and employer-sponsored clinics, care clinics from Wal-Mart and Walgreen’s, and other solutions to contain healthcare cost increases. Physician Associates has been ahead of the curve on many trends covering three decades. For example, in 1998, the practice was organized into four principle departments: family practice, internal medicine, pediatrics and obstetrics and gynecology – an early adoptee of the Patient Centered Medical Home movement. True. For example, we wanted to practice more evidence-based medicine, so we teamed up with NCQA before it was in vogue. We required every single adult medicine physician, as a condition of employment, to be NCQA-credentialed in heart, stroke and diabetes. I believe we’re in our third renewal period, so it wasn’t a one-time thing. Last year, we formally moved to PCMH, which we do with population management. Talk about a profound difference between 1998 and 2012. That’s a biggie! So why did Physician Associates decide to sell? In 2012, we faced a decision. Just to cover cash flow for the delayed reimbursement in the change from fee-for-service to fee-for-quality, I was going to have to take out a $2.5 million loan to keep the doctors whole. And you hate to talk about money when you talk about healthcare, but like any business, it has expenses that can’t be ignored. Carrying that cash flow for us was an impelling reason to sell. We’re not even talking about expenses related to ICD-10 conversion. And we’re a large multispecialty group with a lot of efficiencies! For freestanding physicians to do this, it’s almost unaffordable. We also looked at this trend: Primary care physicians, specialists and hospitals working in a fee-for-service environment are part of a fragmented delivery system orlandomedicalnews

.com

FAST FACTS: Physician Associates: Employs 670, including 96 physicians. Records more than 500,000 patient visits annually. Delivers more than 3,000 babies – roughly eight births daily. Works in 25 locations around Central Florida. Administered 29,000 flu shots during the last flu season

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Physician Associates President Dennis Buhring and Administrative Assistant Debbie McLaughlin celebrate the 30-year milestone.

with almost every person for themselves. There was no real incentive for collaboration in 1998. Now we’re moving to an integrated delivery system. We realized that Physician Associates on its own wasn’t well positioned to be effective in an integrated delivery system. That was significant. It became very important and strategic to find the right partner, with a common culture. How did Physician Associates choose Orlando Health as a partner? Culturally, we were more aligned with Orlando Health in terms of strategic planning. They were taking very aggressive steps to reduce their costs. Also, when you look at the Orlando Health system, it’s all about patients first and quality, with the goal of improving quality and making healthcare more efficient. We saw that, and it philosophically totally aligned with us. Importantly, their system recognized the importance of, and values and pays for the transition of fee-forservice to fee-for-quality. Before we signed, we evaluated everything thoroughly. Physicians value their independence. Orlando Health allowed us to retain much of our independence and remain very much physician-led. That’s a real testimony to Orlando Health to allow us to continue that leadership. When everyone is aligned with the same goals and is working hard to improve communication throughout the whole system, it energizes all. How have Physician Associates doctors been affected by the change? Even though some thought the sale might be an exit strategy for some of our physicians, I haven’t lost a single one. This wasn’t about money. It was all about the future. As for changes, our primary care physicians are working directly with the hospital (hospitalist program), and within the hospital, working with all specialists. We’re striving to make the programs we’re working on – cardiology, oncology, and all discharges – operate more efficiently and

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MARCH 2014

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5


Developing & Designing Effective Ambulatory Facilities By CINDY SANDERS

The recession took a heavy toll on healthcare construction projects across the nation. However, as the economy has begun to improve, projects are beginning to move forward again. Experts in healthcare real estate development and evidence-based design recently shared their insights with Medical News regarding the current state of healthcare construction projects in the ambulatory setting. Real Estate Development After seeing a number of plans put on hold over the last few years, Bond Oman, chief executive officer of OGA, a national full-service real estate development and project management firm based in Nashville, said there has been an increase Bond Oman in activity lately. While dialysis projects have remained fairly steady throughout, he said, the improved financial environment has resulted in an uptick in ambulatory surgery centers, urgent care centers and behavioral health facilities, among other sectors. Oman said OGA presently has 21 proj-

ects in various stages of production. That is about a 30 percent increase over what the company was doing during the recession and quickly approaching prerecession numbers, according to Oman. The company’s current portfolio includes work crossing the United States from California to Texas, Ohio to Florida. One trend Oman said he is seeing nationwide is an emphasis on building smarter. He noted clients are trying to be more efficient by using basic green design to lower ongoing costs and keeping the building footprint as tight as possible. “With the health systems we are working with, we haven’t done a total gold or silver building,” he said, referring to Leadership in Energy and Environmental Design (LEED) status. However, Oman added, many employ green design when it comes to choosing lighting, insulation, windows, paint, and other elements that increase energy efficiency. In most cases, developers are still trying to strike a balance between the cost of adding green elements and the payoff in reduced monthly costs. As a whole, Oman said he thinks facilities are being built a little smaller on the front end but with room for growth. “We are designing a large number of our buildings for expansion,” he noted. Rather than creating facilities with shell space to be finished off later, Oman said

he is really seeing more facilities completely finished but designed from the outset with the ability to blow out a wall for future outward expansion. What might be surprising to some is how quickly pricing has rebounded. Oman noted those considering developing healthcare properties aren’t going to find any real deals. “The cost of doing business is getting back to where it was pre-recession,” he noted. “I’d say we’re definitely going to see an increase in cost because the economy is doing better … not doing great but definitely doing a little better each year.” Oman noted landowners who survived the recession are holding firm on real estate prices. Many municipalities that dialed back or waived impact fees to try to entice developers a few years ago have reinstated, and in many cases increased, those fees. He

said prices are also inching up for mechanical, electrical and plumbing. In general, Oman said healthcare development doesn’t tend to be speculative in nature. “It’s a different animal than a lot of the other real estate sectors,” he said, noting a demonstrated patient base and service need must be present before most in the medical industry will consider building. He added that while some markets — including Dallas, Denver, Houston and Nashville — are “on fire” right now, there is still a feeling of cautiousness across most of the nation. Still, projects that were halted a few years ago are beginning to get the green light again. An Evidence-Based Design Aesthetic Where facilities are sprouting up, more and more of them are relying on research to inform design decisions. Ellen Taylor, AIA, MBA, EDAC, an architect for more than 25 years, began volunteering with the Center for Health Design (CHD) before she began working with the organization in 2008. As Ellen Taylor director of research, the New York-based Taylor (CONTINUED ON PAGE 9)

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MARCH 2014

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7


Celebrating 30 Years, continued from page 5

A Fruitful Collaboration, continued from page 4

effectively. It’s a work in progress, and also an exciting time for all of us.

“He was there from the beginning. You can imagine his allegiance.” Meanwhile, Guzick and Roh worked out details. “The goal is to recognize that we have two extremely talented groups of individuals working at these cancer centers,” said Guzick. “In the Orlando Health center, it’s more tilted toward clinicians. In the cancer center at UF in Gainesville, it tends to be tilted toward a greater percentage of research scientists. The idea is to take advantage of the talents of all those individuals, put them together, and the whole exceeds the sum of the parts.” Addressing questions about possible employment changes in the transition from MD Anderson Orlando to UF Health Cancer Center at Orlando Health: the staff remains intact, said Roh, pointing out that Orlando Health employed all medical staff at MD Anderson Orlando. “Very happily, everyone’s stayed. In fact, some of those people like my-

What challenges remain for the practice integration into Orlando Health? It’ll really help when we’re all on one system. Until then, it’s a little harder to communicate, but changing systems takes time. Every year is going to get better and better for all involved. We joined Orlando Health 15 months ago. If you asked me post-mortem, what do you think? I’d say it couldn’t be better. Everything we’ve talked about has happened. For that, we’re very grateful.

One outcome of the partnership: Orlando Health and Physician Associates have established significant care coordination/ population health departments for inpatient and discharge patients. Tell us more. As a statistician, I’m intrigued with the 20/80 rule, by which 20 percent of patients consume 80 percent of healthcare expenses. There, we’re risk-stratifying all patients. Very sick patients are (labeled) red. Patients to be treated with evidencebased medicine are (labeled) yellow. Very healthy patients are (labeled) green. For example, let’s say as a primary care physician that you see four patients an hour. In 15 minutes, you can’t treat a ‘red’ patient, perhaps someone with five co-morbidities. The doctor will need 50-60 minutes to cover everything with that patient. Let’s say you see four ‘red’ patients a day. As a result, that means you’ve lost nine patient visits. If you get $100 a visit and do that for 230 days, you’ve lost $100,000 per year. Who pays for that? Right now, no one is. We spent a lot of time coordinating optimal care needed for ‘red’ and ‘yellow’ patients because there will be a 12- to 18-month delay before we see a difference in being paid based on fee-for-quality than fee-for-service. The shared savings for hitting quality parameters and reducing costs comes later.

What challenges remain for physicians in general? When you think about it, we’re asking our doctors to make a lot of changes. When we moved from paper to electronic records, there was a tremendous loss of productivity. Now they have to report and track and have corrective action plans for all quality metrics. Then we have the PCMH system of ‘red, yellow and green’ patients. Couple that with changes coming to ICD-10, and our industry is going to have a really tough time getting through October. We’ve managed to weather three significant changes, but four? I sure hope it’s not the knock-out punch.

Margaret Bashore, Candy Earlywine and Howard Pelteson, MD, have been employed with Physician Associates since it was organized as OHCG in 1984.

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self, who’d hoped to work out something with MD Anderson, are energized by the change,” said Roh, a world-renowned liver oncologist who continues seeing patients in between administrative duties. “Now, they’re our biggest cheerleaders. They see the opportunities and value of working at a table where both sides are equally represented. They see the clinical trial portfolio already starting to change considerably.” Guzick echoed Roh’s comments. “The doctors at Orlando Health stay the same,” he said. “People here stay the same. The difference is we’re coming together to establish jointly the best protocols we can develop to bring better quality of care to our oncology patients.” Orlando Health leaders will “always be grateful to MD Anderson,” said Roh. “Without their participation and collaboration, the program wouldn’t have grown to where it is now, and be attractive to UF. The gratefulness will always be there; we were just going in different directions.”

Addressing the Emotional Side, continued from page 4 referral and follow up care via a single, streamlined, web-based program. “It’s intuitive that if someone has cancer, they need support,” said Robinson. “Often, the cancer patient’s primary care doctor may ask how they’re doing, and often, the patient will say something like, ‘I’m doing fine. I have my family.’ The doctor may ask if they’re depressed and the patient likely won’t admit they are. And that’s the end of the conversation about the emotional side of the disease. In both minds, it’s been covered.” It’s a myth, said Robinson, that cancer patients must be “good soldiers” and therefore underplay the emotional anguish related to the disease. “Part of our task is educating physicians to change the tone of the conversation and ask the question in a different way,” she said. “A better question is ‘how are you coping?’ perhaps followed by ‘would you like more coping skills?’ and ‘would you like to join a group of people who are experiencing the same thing?’” Robinson also encourages patients to

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be candid with their primary care doctor about the emotional brunt of the disease. The CSC program at Orlando Health “creates a really big net,” she said. “We’re not treating the depression. We’re teaching ‘hoping and coping’ skills. But we’re also a referral center. For example, if someone is struggling to a greater extent, we can make the proper referral to a mental health professional.” Robinson pointed out the strong focus on programming for children affected by cancer. “Every year, some 11,000 children are diagnosed with cancer,” she said. “Compare that to children who are siblings or children of patients with cancer. That’s 2 million kids! And they’re often inadvertently overlooked.” Robinson’s paternal grandfather died from prostate cancer when she was a teenager, and her dad passed away from lung cancer complications when she was a young mother. “When my dad died, my son was four or five years old, and his granddad was the universe to him,” shared Robinson. “At the funeral home, he kept wondering why people were talking about him, but his granddad wasn’t there. He was really insistent on learning where he was, so I finally pointed and said, ‘he’s in that box, sleeping and already in heaven.’ My son asked ‘why is granddad in a box? To have children wrap their heads around complex life and death issues is very challenging.” Caregivers, who face the brunt of juggling the care for cancer patients, are also provided retreats and other rejuvenation opportunities. Last year, CSC – the result of combining The Wellness Community and Gilda’s Club in 2009 – delivered more than $40 million in free services to cancer patients and families.

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Developing & Designing Effective Ambulatory Facilities, continued from page 6 helps spread the word about the best available information and latest credible research to help those creating healing spaces. “The Center for Health Design is a nonprofit based in California that looks at how the built environment can affect health outcomes … whether for the patient or staff,” she noted, adding CHD accomplishes this goal through research, education and advocacy. While elements of evidence-based design (EBD) have intuitively been incorporated in healing spaces for centuries, the formalized concept is relatively new. Taylor said a landmark 1984 study by Roger Ulrich, PhD — which found surgical patients with a view of nature had a reduced length of stay, required reduced levels of narcotics and had fewer complications — really captured people’s attention and launched the EBD movement. Since 2009, CHD has offered the Evidence-Based Design Accreditation (EDAC) to those who have proven their expertise in the field. Although launched in the acute setting, Taylor said an increased awareness of how design impacts outcomes and a focus in the Affordable Care Act on engaging patients and keeping them out of the hospital have combined to create a recognition that EDB has an important role in outpatient settings, as well. Another major trend for ambulatory spaces, she said, is the notion of flexibility and adaptability. It isn’t uncommon for one specialty to utilize a space two days a week

2014 HEALTHCARE DESIGN CONFERENCE With a theme of “better care through better design,” the annual Healthcare Design (HCD) Conference is scheduled for Nov. 15-18, 2014 at the San Diego Convention Center in San Diego, Calif. The premier event devoted to how the design of responsibly built environments directly impacts the safety, operation, clinical outcomes, and financial success of healthcare facilities, the conference attracts architects, interior designers, top hospital and practice administrators, facility managers, healthcare construction professionals and researchers. For more information on the 2014 agenda or to register, go online to healthcaredesignmagazine.com/conference.

with another specialty using it the rest of the time. “There’s this real need to be nimble,” Taylor said. “You can’t have a room that’s just designed for one purpose.” Taylor added the concept of the patient-centered medical home has really had an impact on facility design, as well. It is increasingly common to see outpatient clinics and facilities, particularly community health centers, include larger multipurpose rooms that could be used for a support group, to teach a health class or to hold neighborhood meetings.

When working on safety net facility design in California, Taylor noted a center added a walking trail behind the facility so that a physician could prescribe ‘four loops’ to a patient in need of physical activity. To make it truly useful, a playground was installed in the center of the trail so parents could easily keep an eye on children, who coincidentally were also engaging in fun, physical activity playing outside. Similarly, some facilities have begun hosting a farmer’s market or have created a community garden and offer cooking classes to demonstrate the benefits of making simple, nutritious meals. Along the same vein, Taylor said it is becoming increasingly common for outpatient settings to be embedded in retail locations. Vanderbilt One Hundred Oaks in Nashville is an example of having mixed health and retail venues under one roof. Storefronts featuring supplies a patient needs to support a prescribed treatment sit next to national retailers featuring clothing or home goods. “It’s that concept of the one-stop-shop … if you can make it easier, you’ll have better compliance,” Taylor said. The Mayo Clinic, she continued, offers another example of innovative, flexible design. “They started realizing not everyone needed to disrobe for every appointment with physicians,” Taylor said. To address this, ‘Jack and Jill’ rooms were created — two offices with an exam room in between them. One patient could meet with his physician in the office, while another patient was using the exam room … or a patient

might begin in the physician’s office and then move to the exam room to complete the appointment. “You have a more efficient flow,” Taylor pointed out. “You are freeing up that valuable exam space.” In addition to efficiency, however, Adelante Healthcare in Arizona is also studying whether or not the setup might also reduce stress levels and lead to increased patient satisfaction. Is it easier to pay attention and be more engaged in a conversation with a physician when fully clothed in an office compared to sitting on an exam table in a cold room while wearing a thin gown? Does the setting change patient behavior? Does the setup change outcomes? Finding quantifiable answers to those types of questions is key to EBD. Adelante is also studying other design tweaks that might shift the traditional power concept between physician and patient. Something as simple as having patients and physicians sit side-by-side and share a computer screen while discussing treatment options or giving a patient the ability to choose what they wish to view on a video monitor while waiting to see a provider can shift the perception of power. “That’s creating much more equality in care,” Taylor said. “There is a cultural awareness that needs to happen from a physician side, but then the design needs to accommodate that, as well.” Taylor concluded, “Ultimately what we hope is that the design of the built environment is one tool in the toolkit to improve outcomes and improve health overall.”

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The Unknown Synovial Joint By BRIAN D. FUSELIER, DDS, and BARRY A. LOUGHNER, DDS, MS, PHD

Heuristic Short-Cut The unknown synovial joint is the TMJ, even though its diagnosis is simple, it is poorly understood when compared to other synovial joints worked on by the medical professions. The investigational short-cut used to diagnosis TMJ takes 10 seconds of clinical time. Abnormalities of the TMJ are easily identified by briefly palpating with your finger (any finger) placed in the outer extent of the external auditory meatus and pushing forward when the patient’s jaw is opening and closing. The osseous tympanic plate that separates the deep medial one-third between the anterior wall of the ear and the deepest aspect of the TMJ will not hinder effective palpation. ENT physicians have long used this heuristic logic especially when their diagnostic schema reveals no ear pathology. When they have ruled out all ENT pathologies for patients whose initial complaint is ear pain, they palpate the anterior wall of the outer ear, push forward and ask the patient to open and close their mouth. Any noise or vibration felt at the finger tip, with or without pain or discomfort is sufficient to diagnosis the early signs of TMJ. A normal TMJ makes no noise or vibration when the mandible is moving. Abnormal noise or vibration originating from the TMJ is dysfunctional. Early diagnosis using this 10 second palpation test can lead to further investigation by a TMJ specialist, and help prevent further dysfunction and the beginning of jaw pain or discomfort. Remember to do both ears. Pathophysiology Any noise or vibration felt by palpation represents soft tissue weakness. The pathophysiology of the TMJ indicates that the weakest soft tissue element is the posterior ligament that originates on the external anterior wall of the external auditory meatus (including the deep anterior wall of the tympanic plate) and inserts on the posterior band of the TMJ meniscus. A healthy posterior ligament holds the meniscus in its proper position between the mandibular condyle and the articular eminence of the glenoid fossa. The TMJ meniscus held securely in its proper position effectively absorbs the forces of chewing. Another property of the meniscus is that it separates the osseous mandibular condyle from the osseous articular eminence, thus protecting the bones of TMJ articulation. Soft tissue weakness in the posterior ligament allows the meniscus to slip forward resulting in compromise of the meniscus-evoked protection from chewing forces. In addition, the posterior ligament (while still attached to the posterior band of the meniscus) thins out as it stretches forward, thus weakening its insertional attachment to the posterior band of the meniscus. Interestingly, as the posterior ligament abnormally stretches forward it occupies the location where the meniscus should normally be positioned. Such a forward 10

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MARCH 2014

PUBLISHED BY: SouthComm, Inc. FLORIDA MARKET PUBLISHER John Kelly johnkelly@orlandomedicalnews.com AD SALES: John Kelly 407-701-7424 Koreen Hart-Morales, 321-662-1660 Tony Smothers 407-247-1308 Brief digital palpation of the anterior wall of the external auditory meatus when opening and closing the mouth, provides valuable clinical information.

Rupture of the posterior ligament from the meniscus results in osteoarthritis changes.

LOCAL EDITOR Lynne Jeter lynne@medicalnewsinc.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com

Normal soft tissue morphology of the TMJ provides a strong connection between the posterior ligament and the meniscus.

position of the posterior ligament makes it vulnerable to normal chewing forces. Histologically, the posterior ligament is highly innervated and highly vascularized. When the posterior band abnormally stretches forward into the area where the vector of chewing forces operate, what follows is mechanical stimulation of the nociceptors of the posterior ligament leading to hyperalgesia. In addition, vascular plasma extravasation occurs due, in part, to the compromise of the integrity of the endothelial “tight junctions”. Taken together, nociceptive activation and the vascular damage leads to inflammation, injury and, pain or discomfort, when the posterior ligament is abnormally stretched forward allowing it to become susceptible to injury by the power of mastication. Discussion Resultant injury of the posterior ligament can end up with a negative result or a positive result. Untreated, negative sequelae progress from a minor stretch of the posterior ligament to mechanical injury – the dense fibrous connective tissue of the posterior ligament (that normally is securely connected to the posterior band of the meniscus) will rupture, thus separating, either partially or completely, the ligament from the meniscus. At this stage of deterioration, bone on bone contact occurs. Arthritis of the TMJ begins. With positive therapy, a favorable outcome is predictable. The TMJ can be saved from degenerative changes. Early treatment of early symptoms, i. e., painless noise or vibration can be appropriately treated in order to preserve the attachment of the posterior ligament to the meniscus.

Proper treatment preserves the posterior ligament-m­eniscus connection by forming an extension pad of collagen.

The initial inflammation and injury can be minimized and allowed to heal and maintain the posterior ligament-disc connection. It is common medical knowledge that when inflamed dense fibrous connective tissue is allowed to heal, scar tissue forms. Scar tissue is primarily collagen, free of nociceptive innervation and thus free of pain or discomfort. If the healed posterior ligament remains between the mandibular condyle and articular eminence, its collagen base can serve painlessly as the meniscus. The collagen base represents an “extension pad” of collagen continuous with the meniscus. This unique repair process can only occur in the TMJ because the meniscus of the TMJ is composed of collagen. All other synovial joints containing menisci are composed of fibrocartilage. The clinical relevance of the unique property of the TMJ that is composed of collagen, not fibrocartilage, is that early treatment of the posterior ligament allows healing with the goal of extending the collagenous meniscus to include more continuous solid collagen into the adjoining healed posterior ligament, thus replacing innervated and highly vascularized connective tissue. Mastication now functions on a solid painless collagenous support structure. Brian D. Fuselier, DDS is a member of the International Association for the Study of Pain, and the American Pain Society. Barry A. Loughner, DDS, MS, PhD is a member of the International Association for the Study of Pain, the American Pain Society, the American Dental Association, and the Ethics Committee of the American Association for the Study of Headache. Dr. Fuselier and Dr. Loughner are actively practicing at Central Florida Oral and Maxillofacial Surgery. This practice is unique as they have both Oral Surgeons and Facial Pain Specialists practicing together. For more information visit www.cforalsurgery.com

CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Lynne Jeter, Cindy Sanders, Jeff Webb —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. Suite 100 Nashville, TN 37203 615.244.7989 (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 Two years $78

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GrandRounds ICD-10 Cost Estimates Increased for Most Physicians The mandated implementation of the ICD-10 code set will be dramatically more expensive for most physician practices than previously estimated, according to an updated cost studyinitiated by the American Medical Association (AMA) and conducted by Nachimson Advisors. The 2014 study found that in some cases, the estimated ICD-10 implementation costs are nearly three times what had been predicted by a landmark 2008 study also produced by Nachimson Advisors. In the AMA’s continuing effort to urge the U.S. Department of Health and Human Services to make good on its commitment to improve the regulatory climate for physicians, the AMA sent a letter to Secretary Kathleen Sebelius asking her to again reconsider the ICD-10 mandate. In 2008 the predicted cost to implement ICD-10 ranged from $83,290 for a small practice, $285,195 for a medium practice and $2,728,780 for a large practice. Based on new information, the 2014 study found the following cost ranges for each practice size based on variable factors such as specialty, vendor and software. • Small practice: $56,639 - $226,105 • Medium practice: $213,364 - $824,735 • Large practice: $2,017,151 - $8,018,364 Two-thirds of physician practices are projected to fall into the upper range of current cost estimates that are considerably higher than the 2008 estimates. These practices are expected to incur major costs associated with software upgrades to accommodate the transition to ICD-10. In addition to software upgrades, the total costs include the expense of training, practice assessments, testing, payment disruptions and productivity loss for physicians. The 2014 estimates include much higher figures due in part to significant post-implementation costs, including the need for testing and the potential risk of payment disruption. The Centers for Medicare & Medicaid Services has estimated that claims denial rates could increase 100 to 200 percent in the early stages of coding with ICD-10. Costs are not the only challenge facing physicians in implementing ICD-10. Data shows that software vendor readiness for the new code set is significantly lagging. Few practices have therefore been able to conduct appropriate testing or implement workflow changes to ensure the new codes are working as intended. The AMA will continue to convey the significant financial and administrative burden that the ICD-10 mandate places on physicians to policymakers in Washington. In the meantime, the AMA is devoting considerable effort to educational programs, resources and guidance that will help physicians prepare for what is sure to be a very disruptive change.

Philanthropist and Orlando Health Foundation Board Member Pledges $300,000 Gift Bryce West, a member of the Orlando Health Foundation’s Southwest Community

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Board, has recently announced a $300,000 pledge to support Healing Arts at Orlando Health. His philanthropic gift will provide the resources needed to develop the Music Therapy program beyond what is currently offered for children at Arnold Palmer Medical Center, bringing it to patients at Orlando Health’s adult hospital facilities as well. West’s passion for the arts is well known in the Central Florida community. In addition to serving on the boards for the Orlando Philharmonic, the Dr. Phillips Performing Arts Center and the Orlando Shakespeare Theater, he has also made significant philanthropic gifts in support of these two organizations through his Bryce L. West Foundation, Inc.

MedMal Direct Announces Endorsement by Physicians’ Alliance of America Jacksonville-based MedMal Direct Insurance Company (MedMal Direct) announces its recent endorsement by Physicians’ Alliance of America. Physicians’ Alliance of America (“PAA”) is a national healthcare group purchasing organization dedicated to helping medical practices save money and improve their bottom line. PAA was founded in 1992 by a handful of physicians worried about the rising costs of operating a medical practice and has grown to approximately 35,000 physician members. As one of the fastest growing medical professional liability insurance companies in the nation, MedMal Direct is the only medical malpractice insurance carrier to exclusively offer its policies direct to physicians.

St. Cloud Regional Medical Center Offers Help Trying to Navigate the Online Health Insurance Marketplace For individuals who have had issues trying to sign up for health insurance on the online Marketplace, help is here, thanks to St. Cloud Regional Medical Center. The hospital invites anyone needing assistance to call the free help line at 407498-3737, where a Certified Application Counselor can help individuals navigate the insurance exchanges and selection process, enroll in the program and find a physician. Depending on household income, some individuals may qualify for subsidies toward the cost of the premium. Also, under this law, individuals who don’t have insurance by the deadline may be subject to penalties. The deadline for enrollment is March 31, 2014. Individuals who signed up before December 23, 2013, may have received coverage as early as January 1, 2014. Once coverage begins, individuals can schedule well visits with their new primary care physician, pediatrician, internal medicine specialist or family doctor. For more information, contact one of our Certified Application Counselors at 407498-3737

Central Florida Regional Hospital Officially Pursuing Hospital In Oviedo Central Florida Regional Hospital is

actively pursuing building an acute care hospital in Oviedo. Operating under the legal name Oviedo Medical Center LLC, the organization submitted a letter of intent to the State of Florida on Friday, January 31, informing them of plans to apply for a Certificate of Need. Central Florida Regional Hospital, based in Sanford, opened Oviedo ER, a free-standing emergency department, in November on 48 acres of land at the intersection of Red Bug Lake Road and Broadway Street (S.R. 426) adjacent to S.R. 417. Since opening, Oviedo ER has stayed busy caring for patients from east Seminole County and surrounding areas, which hospital officials believe is a strong indication of the need for more healthcare services in Oviedo. Oviedo Mayor Dominic Persampiere stated that bringing a hospital to the residents of Oviedo and eastern Seminole County has long been a priority for city leaders. The support for a hospital in Oviedo extends beyond the city limits. Seminole County Commission Chairman Bob Dallari said a hospital in east Seminole County would benefit the entire region

Fifth Third Bank Unveils ‘Pay to the Order of’ Campaign Driving Donations for Cancer Research Can a checking account help fight cancer? The “Pay to the Order of” campaign launched by Fifth Third Bank and agency of record Leo Burnett answers that question by using account openings to drive donations for cancer research. For each new customer who opens a checking account with direct deposit and makes three online bill payments, Fifth Third will give $150 to the customer and donate $150 to Stand Up To Cancer (SU2C). SU2C, a program of the Entertainment Industry Foundation and a 501(c )(3) charitable organization, is a groundbreaking initiative that supports scientific collaboration to accelerate innovative cancer research and bring new therapies to patients quickly. Fifth Third began working with SU2C in 2013 when the Bank launched the Fifth Third SU2C credit and debit cards, which direct donations to SU2C for every qualifying purchase made using those cards. Fifth Third Bank is the only card issuer to offer SU2C payment cards and contributed more than $534,000 to SU2C in 2013. The campaign spans radio, in-branch, online, out-of-home and social media as well as TV. Fifth Third is asking everyone who has been impacted by cancer to share their photos and stories by using the hashtag #PayToTheOrderOf via Twitter, Vine, Instagram and Facebook. Some stories will be featured on an interactive gallery at 53.com/SU2C. For additional information visit www.53.com/SU2C.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

A PROFESSIONAL ASSOCIATION

Wilbur M. Davis, Jr., DDS, MSD Andre U. Buchs, DMD Michael J. Langan, DMD, MS Brian D. Fuselier, DDS Barry A. Loughner, DDS, MS, PhD Daniel J. Crofton, DDS, MD Scott A. Wenk, DDS, MD Ramon L. Ruiz, DMD, MD Frankie M. Gomez, DMD, MD Bryan H. Adams, DMD, MD

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