Orlando Medical News May 2014

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May 2009 2014 >> $5 December

Medical School Milestone


Miles M. Landis, MD

UCF College of Medicine residents create internal medicine program to ease physician shortage in Central Florida



As a student, Ayden Cooper helped create UCF’s new College of Medicine. On Match Day 2014, she learned she’ll help create the school’s first residency program, designed to bring more primary care physicians to Central Florida. Sixteen medical school graduates who comprise its charter class of internal medicine residents will begin the new residency program in July, in partnership with the Orlando VA Medical

Happy Trails UCF College of Medicine celebrates 100 percent match rate for 2014 ... 5


SANS Cyberthreat White Paper Shows Dark Clouds on HIT Horizon Widespread security issues put systems, patients at risk By CINDy SANDERS

Consider yourself warned. A white paper released earlier this year by SANS, a global leader in cybersecurity research, training and certification, painted a bleak picture of where those in the healthcare industry currently stand in


Center and Osceola Regional Medical Center. “I feel incredibly honored to be a part of this,” said Cooper. “I was fortunate enough to be in the College of Medicine’s second class and am now so excited to be part of its new internal medicine residency program. I love building things.” The new residents were chosen from 2,546 total applicants and after 187 interviews.

terms of keeping protected information safe and secure. The report was created using healthcare-specific data provided by Norse, a live threat intelligence and security solutions firm, from September 2012-October 2013. The eye-opening results underscored the vulnerability of providers, payers, business associates and patients.

Authored by Barbara Filkins, a senior SANS analyst and healthcare specialist, the report detailed the widespread problem. In analyzing the Norse data collected during the 13-month sample, the intelligence found: • 49,917 unique malicious events, (CONTINUED ON PAGE 4)

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MAY 2014


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Miles M. Landis, MD Lake Mary Pediatrics By JEFF WEBB

LAKE MARY - Miles Landis has been in private pediatrics practice for 28 years, so he has adapted to many changes in the healthcare industry. But there are some trends that concern him now because they threaten the fundamental relationship between patients and physicians. “Everything now is outcome-measured. Are the asthmatics getting their pulmonary function tests as directed? Are the diabetics getting their blood tests at the right times?” Landis said, using only a couple of examples common in primary care. “That is all very important. But as far as patient interaction with the physician and happiness and attentiveness by the physician to the patient’s global needs, that is not something easily measurable or that we’ve even been asked to measure,” said Landis, 60. To maintain that connection with his patients, Landis and his colleagues at Lake Mary Pediatrics “still make our own rounds at the hospitals, which is very much a dying art in the primary care business,” he said. “We still see our own newborns and our own inpatients at the hospitals,” rather than using hospitalists, he said. “We want to keep that continuity,” whether it is at Orlando Health or Florida Hospital facilities, he said. Landis said he and others in his practice “have been on the other side of that hospital bed and we realize how important it is for a familiar face to pop their head in the door in the morning or evening. It’s extremely important. You want to keep that interaction going despite the fact there are pressures now not to have to do it, or even dissuade you from doing it,” he said. “I want to continue to practice pediatrics long enough to see that patient care is not sacrificed at the expense of the more global changes in the healthcare field.” Landis’ patients appear to be into his outlook. He founded Lake Mary Pediatrics in 1988, when Arnold Palmer Children’s Hospital was just opening up in Orlando, he said, “and I recognized the potential for excellent pediatric care coverage.” Landis now serves as senior partner and medical director for the practice, which has grown to about 50 employees, including six full-time and two part-time physicians, four Advanced Registered Nurse Practitioners and a physician assistant. Lake Mary Pediatrics now has three locations: Lake Mary, Orange City and College Park. Landis’ approach to patient care is fundamental. “First, listen closely to the parent. They many not know, but they are actually telling you what’s wrong with the child. The other thing is just talk with the children. I don’t care if they are just 2 years old. It sounds so easy and so simple, but a lot of people don’t do it. If you do, you will be in a better position to help the children and the parents,” he said. Landis also is involved “in many cliniorlandomedicalnews


cal trials, but it is the trials concerning children with autism that capture my greatest interest,” he said. “Many of these trials last for extended periods of time and I am able to get to know the children in a way that regular office visits would not allow. The first crying, scared, non-communicative patient often becomes a happy, smiling and sometimes talkative child when familiarity sets in,” Landis explained. Landis’ interest in becoming a physician goes back to his childhood in Brooklyn, N.Y His father, Victor, an attorney for the New York Supreme Court, died of a heart attack when he was just 44 years old. Landis was 13 and it impacted him greatly. “The greatest challenge of my life was the loss of my father … and the great economic difficulties that followed. Hard work, a strong sense of purpose and a strong family support system helped me overcome these challenges,” he said. He has a sister, Ilissa, who is 10 years younger and he was integral in her upbringing, he said. “I didn’t have much time in high school for many after- school activities. I worked in many odd jobs, from pedaling a large ice cream tricycle, to a ladies undergarment salesman,” which was “not my first choice in that department store,” he quipped. “But I was always extremely interested in all the sciences, particularly medicine and astronomy. I had my first telescope at age 7, but the Brooklyn sky was somewhat limit-

ing in what deep space objects I could view though from my apartment on the 21st floor. … I dabbled with chemistry sets and often visited the butcher shop to dissect the organs they were happy to sell me. I had a fetal pig delivered to my apartment and had the unusual hobby of preparing microscope slides of my dissected specimens using a hand microtome. I was strongly encouraged by my family and teachers,” he said. So, when Landis enrolled at Rensselaer Polytechnic Institute in Troy, N.Y., in 1972 to study biology, and then was accepted to medical school at the University of Buffalo, no one was surprised. “I am a child at heart and the choice of pediatrics was a natural one,” said Landis, who completed his internship and residency at Children’s Hospital of Buffalo. He spent two years in private practice in New Jersey before putting down roots in the Orlando area. Accompanying him was his high school sweetheart, Kate. He was 18 and she was 16 when they met, and have shared 35 years of marriage as they parented four children. Eldest daughter Victoria is a pediatric speech therapist married to a hematologistoncologist. Erica is entering a post-graduate program in Interpersonal Communication.

And identical twin sons Michael and Ian are graduating from college this year and wish to pursue careers in medicine, Landis said. “We’re a pretty tight-knit family. They all attended (the University of Central Florida) and stayed around. We still tend to do things as a family.” The same hands-on attitude Landis uses at work is a cornerstone at home. “I prefer to do odd jobs around the house,” he said. “If I’m off work I’m doing something around the house and getting my hands dirty. I’m not the type to see something wrong in the house and say ‘We better call someone to fix that.’ I do my best to fix it myself. The results sometimes are not there, but I give it the old college try,” he laughed. When he has time, Landis also dabbles in a flower garden and enjoys eating eastern European Jewish foods comfort foods like stuffed cabbage and blintzes. “It brings me back to my childhood and memories of the smells emanating from my grandmother’s apartment,” he said. And, in another throwback to the childhood of this successful children’s doctor, Landis said he has a new telescope for his older eyes. “It allows me to gaze at the same heavens I saw as a child, but with much better clarity.”

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SANS Cyberthreat on HIT Horizon, continued from page 1 • 723 unique malicious source IP addresses, and • 375 US-based healthcare-related organizations compromised … averaging about one a day. Filkins wrote, “The data analyzed was alarming. It not only confirmed how vulnerable the industry had become, it also revealed how far behind industryrelated cybersecurity strategies and controls have fallen.” Furthermore, the analysis made it clear that the threats aren’t unique to any one type of healthcare company, but providers are seemingly the most vulnerable. In looking at the sectors compromised by malicious traffic, healthcare providers led the way with 72 percent. Business associates accounted for 9.9 percent of the malicious traffic, health plans 6.1 percent, healthcare clearinghouses 0.5 percent, pharmaceuticals 2.9 percent, and other related entities 8.5 percent. Most alarming, noted Filkins, was the level of activity found in what was just a sample set. Speaking to Medical News from her California office, Filkins said ‘malicious events’ are defined as an outside threat or event that might have penetrated the system and could range from hijacking contacts to pushing sensitive information outward. She noted that many companies, practices and facilities have policies in place warning employees not to click on an unknown email or link. (And who hasn’t received a suspicious link under

the guise of coming from a friend or colleague?) Yet, she said, “People need to be looking at not only what comes into their network, but what goes out of their network.” To find and address malware typically requires a HIT professional. “A lot of times an attacker will use a very common protocol so it might look like someone is browsing the web, but you might have to dig a little deeper under the covers,” she noted of finding and locating problems. “A lot of these events continued not just for days … but for months,” she added. Locking the Front Door, Leaving the Back Wide Open Oftentimes the point of entry for attackers was not the main information system. Instead, those with malicious intent entered through peripheral surfaces like network printers, call contact software, routers, medical devices, and … ironically … security cameras. While the main system was securely locked and password protected, many times, Filkins said, the default password remains on these addon surfaces. Finding the admin password, she continued, is as easy as doing a quick Internet search for the device in question. “There are some very basic things that can be done to get started with protection,” Filkins noted. The most obvious … but clearly overlooked … is to change those default passwords. However, she

continued, changing to an easily deciphered password isn’t much help. Avoid using your children’s names, street address, pet names, combined physician names, name of the practice, or other easily discernable choices. The best passwords, Filkins said, include numbers and unique characters. Mobile devices can also cause headaches … in part because of unrealistic expectations and policies. “Everyone uses mobile devices,” Filkins stated. “Rather than trying to bury that and say, ‘oh, we never use mobile devices,’ maybe relax the punitive policies and instead say, ‘let’s get honest and figure out how to make them more secure.’” Measures to Improve Security “Know what’s on your network,” Filkins said. “Make sure your network is configured properly and devices are configured properly.” She added it’s important to know who is using what and how it’s being used. Having a strong password policy is critical to proper configuration. “Think like an attacker,” she continued. “And if you can’t do it, get someone who can.” There are numerous resources and companies that can help with this task. It boils down to being aware, Filkins noted. “It’s basic awareness but in a digital world.” She continued, “Know what your network pathways are for your organization.” Filkins said that often there’s an

emphasis on protection for “bad things coming in” … but if something does penetrate the system, there isn’t much monitoring of outbound traffic. Egress filtering is as important as ingress protection. The Cost of Failure The healthcare industry is particularly attractive to cyber attackers because of the type of information housed on servers. With medical identity theft, the victim is responsible for costs related to a compromised medical insurance record. A survey by the Ponemon Institute last year estimated that cost to be $12 billion in 2013. Security breaches also represent major costs to the compromised entity. Steep fines, incidence handling, victim notification, credit monitoring for victims, and potential legal action represent direct out-of-pocket expenditures. In addition, a data breach could also significantly harm reputation and future business opportunities. The greatest cost, however, is to a patient who winds up with inaccuracies in his medical record that could result in a misdiagnosis or wrongly prescribed medication. The Takeaway “Today compliance does not equal security,” Filkins wrote. “Organizations may think they’re compliant, but this data shows that they are not secure.”


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MAY 2014



Happy Trails UCF College of Medicine celebrates 100 percent match rate for 2014


On Match Day 2014, UCF College of Medicine administrators dangled 55 gold and black paper lanterns from palm trees on the medical school’s Tavistock Green, each holding a sealed envelope containing the student’s residency match. After the clock tower tolled 12 times at noon, students pulled a string on the lantern to free their envelope and learn where they would spend the next several years of residency training. It’s the first year the school celebrated a 100 percent match rate for 2014. Cheers, tears of joy, and the hugging of loved ones punctuated the ripping open of envelopes. Avianne Bunnell reached her hands up to the sky and said, “Thank you, God!” as she learned she would go to her first choice, the Medical University of South Carolina, to be a vascular surgeon. Bunnell’s husband, Brian, matched into a pre-doctoral program in clinical psychology at the same university about a week earlier. The couple approached Match Day unsure if they would be sent to the same location. “I’m absolutely thrilled,” Bunnell said. “I’m so, so blessed.” Jennifer Bazemore, a UCF biomedical sciences honors undergraduate, will complete her pediatric residency at Johns Hopkins. “I’m beyond excited,” she said, of landing her top choice at one of America’s premier programs. “I can’t stop crying.” This year, USF medical school seniors matched into residency programs across the country in specialties that included primary care, anesthesiology, dermatology and vascular surgery. In-state residency locations include Orlando Health, Florida Hospital, University of Florida, University of South Florida, Miami Children’s Hospital and the Mayo School of Graduate Medical Education in Jacksonville. National residency locations include Harvard’s Massachusetts General, Georgetown University and Stanford University. Deborah German, MD, vice president for medical affairs and founding dean of the College of Medicine, said she was “deorlandomedicalnews


lighted” with the Class of 2014 match, the second in the young school’s history. “As our students continue their training, they’ll care for patients throughout Florida and the nation,” she said. “They’re carrying on the legacy of our young medical school as UCF-educated physicians.” Omar Shakeel opened his match envelope standing near his mother and learned he’ll do his pediatric residency at Emory University, his first choice. “I love taking care of kids. They’re the future,” he said. “And right now, I’m remembering everything these people did to get me here.” Learning where they will pursue their

residencies is the final hurdle before the college’s second class graduates on May 16. This year, 34,270 applicants participated in the national match program. Many UCF students placed into primary care specialties – nine matched into internal medicine, eleven matched into pediatrics. Thirteen students matched in Orlando – 10 at Orlando Health, two at Florida Hospital and one at UCF’s new residency program. (Last year, only 10 UCF medical school seniors matched in-state.) Alvin Detorres, a Stetson University graduate, matched at Georgetown University for otolaryngology. “I’m very excited,”

he said. “I get to help people hear music the way I hear music.” Bobby Palmer matched into orthopedic surgery at his first choice, the University of Florida College of Medicine in Jacksonville. An emotional Palmer dedicated his match to his grandfather, who had died a day earlier. “I’m from a small town in South Florida, so Jacksonville felt like home to me,” he said, adding that he’s always been comfortable with tools, such as the ones orthopedic surgeons use. “I guess that’s because my granddad had a hardware store when I was growing up.”

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Medical School Milestone, continued from page 1 “As we were selecting residents, we asked ourselves, ‘Who would you love to work with every day?’ and ‘Who would you want to care for your family? They’re pioneers,” said Abdo Asmar, MD, associate director of UCF’s new residency program and a former chief resident at Chicago’s Cook County Hospital, one of the nation’s largest. “They want to establish a foundation of graduate medical education and build something together with us.” Born in the United States to an American father and Vietnamese mother, Cooper followed a nontraditional journey to medical school. She studied traditional Chinese medicine techniques like acupuncture and herbs in Vietnam and received a master’s degree – she holds two – from Georgetown University in integrated medicine. She worked for NASA, identifying whether healthy antioxidants in vegetables change in outer space. With a black belt in karate, her diverse experiences and world travels, she learned versatility and adaptability “so I can cater to my patients’ needs and be culturally sensitive in how I can help them,” she explained. Almatmed “Mo” Abdelsalam, another resident with UCF ties who will help build the new program, received his master’s degree in molecular biology from UCF’s Burnett School of Biomedical Sciences after completing medical school. He’s working in the laboratory of Saleh Naser, MD, who is researching better treatments for Crohn’s disease. The nation’s top residency programs provide medical school graduates with a diverse population of patients. UCF’s partnership program will offer residents the opportunity to care for those, includ-

ing military veterans and residents of Osceola County, one of Florida’s fastestgrowing and most diverse communities. Osceola has one of the state’s most rapidly sprawling Hispanic populations; roughly one in three new residents speaks Spanish as a second language. The Orlando VA Medical Center is among the busiest VA facilities nationwide, providing healthcare services to more than 100,000 Central Florida veterans. When it opens, the new Orlando VA Medical Center at Medical City will offer top-grade inpatient acute care for veterans. It’s been designated an emerging center of innovation and will emphasize a Patient-Centered Medical Home (PCMH) approach through interdisciplinary teams of healthcare professionals. That approach includes mental health services as part of all primary care offerings. Osceola Regional is undergoing several expansions and offers specialty programs such as its Central Florida Cardiac and Vascular Institute and Orthopedic and Spine Center. The center offers robotic surgery and continuity clinics that help patients acclimate to life and care when they leave the hospital. “The UCF College of Medicine and our partners are delighted with our first residency match,” said Deborah German, MD, vice president for medical affairs and founding dean of the UCF College of Medicine. “We’re looking forward to expanding the training and numbers of physicians who will practice in Central Florida.” UCF’s new program is accredited for up to 20 residents a year, for a total of 60, and will increase as the program grows.

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Scoring Well Ocala Health System highlights Central Florida’s presence on 2014 100 Top Hospitals list By LYNNE JETER

In Truven Health Analytic’s 2014 list of the nation’s 100 Top Hospitals, the South and Midwest represented the strongest growth in award winners. Two dozen list-toppers of the 21st annual study released in March are located in the Medical News market areas, with Illinois accounting for 9 hospitals, primarily centered on Chicago; Florida with six; and the balance spread among North Carolina (3), Georgia and Tennessee (2 each), and Louisiana, Missouri and South Carolina (1 each). Half the states had zero hospitals on the list, including Alabama, Arkansas, Kentucky, and Mississippi. Of those, Kentucky and Mississippi fell in the worst of five quintiles of state-level rankings, along with Connecticut, Maryland, New Jersey, New York, and Hawaii. Alabama, Arkansas, Louisiana and Missouri were ranked in the second worst quintile. Georgia and Tennessee landed in the middle quintile, while Florida and the Carolinas were ranked in the second best quintile. Best quintile states include Delaware, Indiana, Minnesota, Montana, Texas and Wisconsin.

The Scorecard The 100 Top Hospitals balanced scorecard measures hospital performance across 10 areas – mortality, inpatient complications, patient safety, and average patient stay, expenses, profitability, and patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia. The study has been conducted annually since 1993. “Employers and payers are increasingly seeking network hospitals that consistently provide demonstrated value — hospitals that deliver higher quality, higher satisfaction and lower cost. The 100 Top Hospitals have been objectively proven to provide high value, and the majority of them have

demonstrated year-over-year increased value, as well,” said Jean Chenoweth, Truven Health Analytics senior vice president, 100 Top Hospitals Programs. “The results show 100 Top Hospitals to be strong, wellmanaged hospitals with consistently high performance. This year,

59 percent of the 2014 100 Top Hospitals were winners last year. In 2013, 51 percent were repeat winners; in 2012, 42 percent were repeat winners.” Florida Truven Winners, with number of years making the list in parentheses: • Brandon Regional Hospital in Brandon (6) • Gulf Coast Regional Medical Center in Panama City (5) • Ocala Regional Medical Center in Ocala and West Marion Community Hospital in West Marion County (4) • Memorial Hospital West in Pembroke Pines (4) • Sacred Heart Hospital on the Emerald Coast in Miramar Beach (4) • Memorial Hospital Miramar in Miramar (2) Convergence Challenges The economics of healthcare delivery continue to evolve radically as hospitals face the challenges of the convergence of risk and care management, said Mike Boswood, CEO of Truven Health. “In the face of such pervasive changes, our objective and independent measurement shows that these winning hospitals have found ways to achieve excellent pa(CONTINUED ON PAGE 11)

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Better Operations from Better Compliance


The OIG has had compliance program guidance since the early 1990’s for Physician Group Practices and other types of providers such as hospital, DME. With the Healthcare Reform Act and Patient Protection Affordable Care Act, a Compliance Program is required since 2013. The required compliance program should follow the OIG Compliance Guidance for your physician practices. An effective compliance program will develop a risk assessment and audit protocol to monitor the business’ activity to prevent fraud and abusive activities. The program will also ensure contracts and relationships comply with federal Stark Law and Anti-kickback Statute. Keep in mind a physician practice has to maintain compliance for several areas such as HIPAA Privacy (2003) and HITECH security (2009) which also includes the Omnibus Rule (2013), OSHA standards, Human Resource Processes, licensing requirements and more. Each program has very specific elements that must be implemented to be “effective and active,” including a program manager(s), support from the top down, standards of conduct, policies and procedures, training, monitoring and more. As you can see there are many pitfalls that are possible. Without compliance the business operations will suffer one way or the other. HITECH Security is beyond your billing system. It looks to whether or not someone can hack open ports in your server, what employees are saving on their PCs and mobile devices and are the devices encrypted, who has access to PHI and e-PHI, are staff emailing PHI and more. This is a very intensive process of examining the IT infrastructure and does require knowledge and understanding of HIPAA and HITECH rules. The Office for Civil Rights (OCR) as well as the Office of Inspector General (OIG) will be auditing to ensure compliance with the HIPAA and HITECH provisions. Security audits include wrongfully attesting to Meaningful Use or not main-



taining meaningful use guidelines for the money a provider was paid for their Electronic Medical Records system and are prosecuted under the Federal False Claims Act which includes a treble damages penalty. HIPAA Audits are increasing mainly due to the number of breaches being reported and the penalties are steep considering the cost of monitoring in a proactive manner. A breach can be anything where PHI ends up in the wrong hands such as but not limited to stolen or lost mobile devices containing PHI. Omnibus Rules expands all the privacy and security rules to Business Associates. A business associate is anyone who may have potential access or need to see protected health information such as consultant, attorney, billing companies, etc. Providers must have a business associate agreement updated in 2013 with the new rules. Providers must keep a log of all business associates, date, and purpose at a minimum. OSHA rules for work place safety, signs as appropriate for your business must be maintained and training performed with staff. Human Resource Compliance ensures that you perform all verification prior to hiring, complete all the necessary forms, completed your new hire process and checklists, employee evaluations are performed, employees disciplined accordingly, consistency, and all must comply with federal and state laws. All the programs require the need for monitoring the processes to ensure they start and stay compliant. This auditing process will include reviewing billing revenue reports, selecting a sample of claims to ensure the documentation is sufficient to warrant the evaluation and management code billed and services provided, patient records for privacy acknowledgement and appropriate consent or authorization, if applicable, IT network and devices audit at least annually, meaningful use compliance, inspection of the OSHA items that are appropriate for your office, employee records to verify

they have been checked against the sanction provider databases, and all employee training has been completed. Keep in mind, if the audit results in problem areas that need to be corrected, ensure those issues are corrected and documented education is provided. Using compliance to improve your business operations is essential and will improve efficiency, cash flow, and keep your business “between the ditches.” Effective compliance programs will also ensure the company is meeting all federal and state laws, the coverage criteria for the services you provide which will reduce risk for overpayments in audits, reduce the provider’s risk for criminal charges and help keep penalties to a minimum. You can use the compliance program as a marketing point to referral sources because providers do not want to risk referral business to a company that is unethical or not compliant which may cause the “Badges” to show up at their office as a secondary investigation or even for questions. As a former compliance officer, I developed a compliance program that reflected the personality of the company and the executive team. This saved the company when we disclosed we had a rouge employee who violated federal law. I also focused on working closely with billing to ensure we all stayed current on education and changes with payers. Have you started on your compliance programs? The programs are required and upon audit or investigation, especially, the government is not giving lenience for not having put programs into place. Failing to have compliance programs in place could result in the government pursuing criminal charges, which sounds as painful and expensive as it really is unfortunately. Here is the good news, if you pull the OIG Compliance Guidance and work plan for 2014, this will help you outline a program if you need to do the program yourself. Office for Civil Rights has sample Privacy Notices and other forms. A consultant or your healthcare attorney can review what you have done as part of the independent audits of these programs to give you an assessment of your program. This will help your compliance or regulatory officer develop changes and improve the efficiency of the program. An efficiency and effective set of compliance programs will improve the company’s operations and reduce risk. Don’t look at compliance programs as “cost centers but rather “reward programs” for your company! Angela Miller, CMC, CHC, is president of Medical Auditing Solutions LLC. Contact her at www.MedicalAuditingSolutions.com


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MAY 2014



2014 Top 100 Hospitals Highlights Third Consecutive Appearance for Ocala Health System OCALA—Ocala Health System employees celebrated the hospitals’ fourth appearance – and third consecutive year – on Truven’s annual list of the nation’s Top 100 Hospitals. Ocala Regional Medical Center, a 200bed facility located in Ocala, and West Marion Community Hospital, a 70-bed hospital located in West Marion County, are part of the Hospital Corporation of America’s (NYSE: HCA) North Florida Division. “While hospitals are regularly evaluated against a broad range of performance standards, only 100 make this prestigious list—less than 2 percent of all the hospitals in the entire country,” said Randy McVay, CEO of Ocala Health. “This distinction is a clear testament to the hard work and dedication of our physicians, employees, and volunteers to delivering the highest quality

care to our patients and their families.” Three HCA properties comprise half the Florida list. Gulf Coast Regional Medical Center in Panama City is featured in the company’s North Florida portfolio, and Brandon Regional Hospital in Brandon represents HCA’s West Florida division. Ocala Health has several capital improvement projects in varying stages of completion. Earlier this year, Ocala Regional Medical Center hosted its facility rededication of a $9.2 million project that included a new façade, reconfiguration of the Emergency Services entrance, and the creation of a two-level parking garage. “For the last several years as the number of patients we serve has increased, accessibility to our campus became more difficult – for patients, their family members, visitors, physicians, and for our Emergency

Expansion at the West MarMedical Services teams,” said ion facility includes the addition McVay. “We needed to imof a cardiac cath/special proceprove access. The final result dures lab, a dozen medical/surwas worth the effort.” gical beds on the east wing of Expansion projects at both the second floor, and another Ocala Regional and West Mardozen medical/surgical beds on ion Community Hospital facilithe east wing of the third floor, ties total $45 million. for a net increase of 24 licensed On the Ocala Regional Randy McVay beds. Also, the existing lab will campus, plans involve buildexpand approximately 800 square feet, ing 56,000 square feet of new space, and doubling its current size. consolidating all current critical care beds “These plans are extensive; the financial into the new square footage. When cominvestment being made by HCA is signifipleted, 34 intensive care unit beds will be cant,” said McVay. “These projects reflect added, representing a net increase of 14 the confidence HCA has in the work we do licensed beds at the Ocala hospital. In adeach day, in the way we deliver quality padition, the post-anesthesia care unit and tient care to our community, and our ability pre-op area, along with pre- and post-cath to continue doing so.” lab areas, will undergo complete renovation and upgrade.

Scoring Well, continued from page 8 tient outcomes while maintaining financial performance,” he said. Boswood pointed out the hospitals making the list use evidence-based management, driven by objective data and analytics, to help prevent the acceptance of performance patterns that, while traditional, have proven to be unnecessary or detrimental to progress. “They evaluate all resources to drive new practice patterns in their category,” he said, “and set targets for performance improvement initiatives.”

Truven Health is not averse to rescinding recognition when necessary. Earlier this year, the company removed Desert Valley Hospital, a facility owned by the 20-hospital for-profit Prime Health Services, for 2012 and 2013. To conduct the 100 Top Hospitals study, Truven Health researchers evaluated 2,803 short-term, acute-care, nonfederal hospitals, using public information — Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data

from CMS Hospital Compare website. Hospitals do not apply for a spot on the list; winners don’t pay to market the honor. Collectively, the nation’s best hospitals have a lower mortality index considering patient severity, have fewer patient complications, avoid adverse patient safety events, follow accepted care protocols, have lower 30-day readmission and mortality rates, keep expenses low, send patients home sooner, and score better on patient satisfaction surveys.

“In fact, study projections indicate that if the new national benchmarks of high performance were achieved by all hospitals in the U.S., nearly 165,000 additional lives could be saved; more than 90,000 additional patients could be complication-free; $5.4 billion could be saved; and the typical patient could be released from the hospital a half day sooner,” said Boswood, noting that the analysis is based only on Medicare patients. “If the same standards were applied to all inpatients, the impact would be even greater.”


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MAY 2014



The Use of E.Q. to Overcome Healthcare Reform


On March 23, 2010, President Obama signed the Affordable Care Act into law, putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. Today, thanks to the Affordable Care Act, more than 7 million Americans have signed up for private health coverage. Now, 54 million Americans can receive a free preventive service, such as cancer screenings, through their private insurance plan. But are the healthcare leaders ready for these changes? The anxiety level of many healthcare leaders has been rise due to the uncertainty and drastic changes of the healthcare industry. Giving the assumptions that healthcare changes will continue in one form or another, it is important to find ways to mitigate these changes and lower the levels of anxiety that these may cause. For healthcare organizations to survive in

these increasingly challenging times, leadership must face mounting interpersonal skills. In today’s healthcare industry, the importance of interpersonal skills cannot be stressed enough. Whether the leader is forming relations internally or externally, interpersonal skills to create collaborative relationships are key to the success of the individual as well as the organization. Collaborative relationships are more likely than antagonistic ones to produce better and high quality services at a lower cost that will result in to a profitable organization. To achieve the collaborative relationship need to navigate through the turbulence water of healthcare leaders need to develop interpersonal skills thru emotional intelligence (EQ). Career experts agree that emotional intelligence is a better predictor of career success than IQ. Emotional Intelligence has been prove to be more important than cognitive intelligence. In 1995, psychologist Daniel Goleman drew widespread attention to the field of emotional intelligence with his best-selling book “Emotional Intelligence:

Why It Can Matter More Than IQ.” Goleman’s thesis that emotional intelligence -- or the ability to interpret others’ emotions and regulate one’s own -- was a better indicator of success than traditional cognitive intelligence set off a flurry of new research. Emotional Intelligence is a measure characteristics that research has confirmed are important to successful and enjoyable living. People with high EQ have control over their emotions and impulse, they are aware of their limits and abilities and have real view of their expectations and are able to adapt to changes quickly. Social and emotional abilities that previous research has shown to be linked to successful performance in the workplace. These abilities are grouped into five core areas: (a) self-awareness, (b) self-regulation, (c) motivation, (d) empathy, and (e) social skills. Healthcare organizations requires leaders with high EI. Many of the daily duties performed by the healthcare leaders can be classified under the five EI skill categories. • Self-Awareness – is no other than knowing and understand your emotions. These will help healthcare leaders to have confidence in making decisions about operations that can have an implication on burnout/ workaholic, personal values/selfworth and issues about control. • Self-regulations – is defined as the ability to manage your emotions.to be consider during ethical behavioral issues, temper/patience, objectiveness and multitasking/time management. • Motivation – is the ability to enjoy challenges and to be passionate toward work. Healthcare leaders need to maintain a positive attitude toward the Affordable Care Act changes that

cannot be avoided and may impact the organizational culture. • Empathy – is a social awareness skills and the ability to recognize the emotions in others, get our self in other’s shoes. Excellent to manage conflict, maintain a patient centeredness practice, manage patient/family interventions and subordinates problems. • Social Skills – supportive communication skills: ability to influence and inspire. Excellent communication, social and listening skills will drive organizational profitability wit negotiation competencies, governing board/ committee relations, employee engagement and patient experience. How the leaders completes those tasks will be shaped by the person’s emotional intelligence abilities. The healthcare leader needs to know their emotions and how to manage them. Assessing and evaluating an individual’s emotional intelligence can help understand areas of strength and weakness establish the need for targeted development programs and measures. This, in turn, can lead to dramatic increases in the person’s performance, interaction with others, and leadership potential. Career experts agree that emotional intelligence (EQ) is a better predictor of career success than IQ. But many healthcare executives do not have a clear idea of how their emotional intelligence measures up. With an Emotional Intelligence Assessment, you can measure your emotional intelligence quotient (EQ) and use the results to enhance self-awareness and achieve greater work/life balance. Healthcare organizations would be wise to incorporate an EI training program for their leaders. Equally important is for the developers of those programs to take into account the specific needs of the different members of their training audience. Beyond the scope of this article, yet critical to mention, is that the tailoring of any EI development program should directly involve employee participation. Having healthcare leaders with good EI skills will boost team productivity, increase organizational effectiveness – two conditions that are desperately needed in healthcare today. In any case, managers or leaders who allow themselves to become more emotionally intelligent, will improve not only their own personal qualities but also those of their organization. Remembered to be a great leader you should know how to manage yourself first. Wanda Bonet-Gascot PhD, MBA is a Doctor in Holistic Health and Portfolio Manager at DRW Life Skills Institute. Sheila Ortiz, DHA, MBA is the Corporate Program Director at DRW Life Skills Institute. They offer Emotional Intelligence Assessments and Training. Dr. Wanda can be reached at drw@ lifeskillsinstitute.net and Sheila can be reach at sortiz@lifeskillsinstitute.net . For more information www.DRWinstitute.org



MAY 2014




Florida Sober Homes Caught in a Perfect Storm

EMPLOYMENT OPPORTUNITIES MD’S, DO’S, ARNP’S, PA’S Physical medicine based urgent care with three locations throughout Greater Orlando is seeking a board certified or board eligible physician as well as a ARNP or PA to join this growing practice.


Presently we have multiple board certified MD’s who provide consultations for patients with soft tissue musculoskeletal based injuries. Treatment plans are then enacted which include physical therapy, diagnostics, pain management, and surgical intervention.


This group is growing due to the community’s rapid growth and development. The primary focus is on evidence-based medicine.


A confluence of forces brought about by lawmakers, insurance companies and regulators have caught sober homes in the eye of a perfect storm here in Florida. Senate Bill 582 proposes to mandate that Florida sober homes and their owners be registered, inspected and licensed; but really, that bill may not be necessary due to other factors. Florida’s Department of Children and Families (DCF) has been using Section 65D-30.007 of its Administrative Code to require that sober homes be licensed for Residential Treatment if any resident at that sober home is also a patient at a licensed treatment program owned by the same person or entity that owns the sober home. The actual language of the regulation exempts sober homes that provide only meals and minimal services at the home (i.e. no more than Alcoholics/Narcotics Anonymous groups), as long as the patient is not required to live in the sober home as a condition of receiving treatment in a licensed program owned by the same provider. DCF, however, now interprets the regulation more expansively so that a treatment provider that gives its patients the choice of living in its or any sober home is still required to obtain a Residential Treatment license and be regulated by DCF. The pressure placed on sober home operators by DCF’s expansive use of its regulation is compounded by the fact that market forces have driven sober home providers to get licensed and open their own treatment programs, which puts them squarely in DCF’s cross-hairs. Historically, sober homes have generated strong revenues by conducting CLIAwaived toxicology screens on their residents. Over the past year that revenue stream has been reduced to a trickle as a result of a drastic reduction in reimbursement for these types of toxicology screenings. When the reimbursement for the CLIA-waived toxicology screens was reduced, sober home operators flocked orlandomedicalnews


to also become licensed program operators and laboratory owners as a means of replacing the lost toxicology revenue. As a result there are fewer and fewer sober homes that are not owned by providers who also own treatment programs. The specter of regulation as a Residential Treatment facility under Section 65D-30.007 is not so bad, in and of itself, since it is the same review process that applies to licensed treatment program owners; however, the actual building must meet may be restricted from operating in certain neighborhoods by zoning laws. By using Section 65D-30.007 to require these “co-owned” sober homes to become licensed and regulated, DCF may have just obviated the need for Senate Bill 582 in large part. Providers are urged to contact their healthcare attorneys for advice as to how to structure, or restructure, their organizations to avoid triggering the licensure requirement of this regulation.

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MAY 2014



Is Testosterone Safe? By DANIEL THOMAS, DO

There’s been a recent concern about testosterone and heart disease. A study published in the New England Journal of Medicine in 2010 found an increased risk of heart disease in men over the age of 65 while taking testosterone; and a study published in PLOS One in 2014 found an increased risk of heart disease in men under the age of 65 while taking testosterone. These findings were unexpected, and run counter to the decades of research and hundreds of studies published on testosterone showing it to be beneficial to the cardiovascular system. So why the disparity now? Why were the results from these two recent studies so different from previous studies? There are 3 reasons for this: • Excess red blood cells: In some men, testosterone can stimulate the bone marrow to produce more red blood cells. While this is desirable for someone who is anemic, it is not desirable for someone possessing risk factors for heart disease including high cholesterol, high blood pressure, diabetes, smoking, excess weight, physical inactivity, and family history of early heart disease. Too many red blood cells—a condition known as erythrocytosis—can make the blood too viscous (thick) and potentially cause it to clump together and clot. Blood viscosity is measured by a routine lab test called hematocrit. Hematocrit measures the percentage of the volume of whole blood that is made up of red blood cells. Reference ranges vary slightly among laboratories, but in general, the full range is 40-54 percent. Unfortunately, in neither of the two studies cited above was hematocrit ever measured.

• Excess estrogen: Testosterone therapy can increase a man’s level of estrogen. Women synthe-size estrogen in their ovaries. Since men lack this part of the female anatomy, they produce needed estrogen through a biochemical process involving an enzyme called aromatase that converts a small portion of their testosterone to estrogen. Optimal levels of estrogen have numerous health-promoting benefits, however, excess estrogen has been linked to an increased risk of heart disease (not to mention prostate disease). Reference ranges for estrogen (estradiol) vary slightly among laboratories, but in general, the full range is 0-56 pg/mL. Unfortunately, in neither of the two studies cited about was estrogen ever measured. • Excess testosterone: In the two studies cited above, the primary treatment was transdermal (topically-applied) testosterone. It is assumed that when testosterone is delivered to the body topically with creams, gels, or roll-on liquids, only 10 percent is absorbed. It is also assumed that when testosterone is delivered to the body topically, the standard venous blood test accurately reflects how much testosterone is getting to the tissues throughout the body. Under these assumptions, the FDA has approved daily dosages of topical testosterone that are 10 times higher (50100 mg) than the daily amount healthy young men produce naturally in their testicles (5-10 mg). Unfortunately, both of these assumptions are wrong, and are causing millions of men to be overdosed from topical testosterone. This is because topical testosterone is

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transported primary by the lymphatic system and not the circulatory system. Short of a direct determination via tissue biopsy, the way to indirectly determine the tissue level of testosterone is to measure the level in capillary blood from a specialized finger-prick test. Capillary blood is more representative of the amount of testosterone at the tissue level whereas venous blood is not. This is because venous blood measures the amount of testosterone being car-ried away from the tissues, and capillary blood measures the amount of testosterone being car-ried toward the tissues. In healthy young men, the level of testosterone in the venous blood is equivalent to the level of testosterone in capillary blood. However, in many patients that are using topical testosterone, the level of testosterone in the capillary blood exceeds that of venous blood by as much as 10-20 times. At these extreme levels, testosterone itself may increase the risk of heart disease. When administered correctly, testosterone is very safe. The operative word is “correctly.” Testo-sterone therapy can be one of the most effective ways to reduce the signs of aging and regain more mental and physical vigor. Furthermore, numerous studies have shown that testosterone can help make men less vulnerable to heart disease, diabetes, Alzheimer’s, obesity, sarcopenia (loss of mus-cle), osteoporosis, depression, and even premature death. In short, testosterone can greatly improve a man’s health and well-being. And when combined with proper diet and the right type of exercise, the synergistic effect can be quite profound. Dr. Daniel Thomas, DO, MS is Medical Director of More T Clinics in Altamonte Springs. He is author of The Doctor’s Guide to Testosterone Therapy, and publisher of Healthy and Strong: The quarterly guide to living long and living well. In addition to a medical degree, he holds a Master of Science degree in Metabolic and Nutritional Medicine, and a post-Master’s Graduate Certificate in Metabolic Endocrinology, both from the University of South Florida College of Medicine.

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MAY 2014

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GrandRounds Orlando Foot & Ankle Clinic Announce New MLS Laser The Orlando Foot and Ankle Clinic is proud to announce that we now offer MLS Laser Therapy treatment for Podiatric pain. The MLS Laser is designed to relieve patients of their chronic foot or ankle pain. The procedure will initially be administered by out of our Kissimmee location. MLS Laser Therapy uses specific wavelengths of light that have a strong anti-inflammatory, anti-edema effect on tissues that are exposed to the laser. Painful conditions accompanied by swelling or inflammation benefit from this technology. Photons of laser energy penetrate deeply into tissue and accelerate cellular reproduction and growth. As a result of exposure to the MLS Laser, the cells of tendons, ligaments and muscles repair themselves faster. As inflammation is reduced, pain subsides very quickly. In simple terms, laser energy kick-starts the healing process, thereby speeding up recovery. Unlike some pharmacological solutions, there are no known negative side effects. Laser therapy is cleared by the FDA and is safe and effective. Laser Therapy is painless. Most patients report no sensation at all while receiving laser therapy. Treatments average 8 minutes. MLS is fast-acting; many patients in high levels of acute pain experience relief after the first or second treatment. Over 90 percent of patients experience positive results after the third treatment, with the average course of treatment being 7 to 10 sessions. In many cases, by the 3rd or 4th treatment, swelling is greatly reduced and there is a rapid relief of pain. The effects of MLS Laser Therapy are cumulative; therefore, expect to see improvement as you proceed through your Treatment Plan.

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St. Cloud Regional Medical Center Now Accredited Chest Pain Center St. Cloud Regional Medical Center announces that it has received Chest Pain Center Accreditation from the Society of Cardiovascular Patient Care (SCPC). SCPC is an international notfor-profit organization that focuses on transforming cardiovascular care by assisting facilities in their effort to create communities of excellence that bring together quality, cost and patient satisfaction. Hospitals that have received SCPC accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack. To become an Accredited Chest Pain Center, St. Cloud Regional Medical Center engaged in rigorous evaluation by SCPC for its ability to assess, diagnose, and treat patients who may be experiencing a heart attack. To the community served by St. Cloud Regional, this means that processes are in place that meet strict criteria aimed at: • Reducing the time from onset of symptoms to diagnosis and treatment • Treating patients more quickly during the critical window of time when the integrity of the heart muscle can be preserved • Monitoring patients when it is not certain that they are having a heart attack to ensure that they are not sent home too quickly or needlessly admitted to the hospital.

TVRH Names New Chief Clinical Officer Central Florida Health Alliance is pleased to introduce Mary Jane CurryPelyak, RN, MBA, Vice President and Chief Clinical Officer [CCO] at The Villages Regional Hospital [TVRH]. She

joined the TVRH team in May 2008 as the Chief Nursing Officer. With over 25 years of experience in nursing leadership, Mary Jane Mary Jane brings her experience Curry-Pelyak and strengths to both the clinical areas of TVRH as well as the general administrative side.

Florida Hospital Center for Thrombosis Research Celebrates 20th Anniversary Every year, up to 2 million Americans are diagnosed with deep vein thrombosis (DVT), and up to 300,000 of these will die. Although thrombosis (blood clots) claim more lives than breast cancer, AIDS and traffic accidents combined, many people have never heard of it. John Francis, Ph.D. founded the Florida Hospital Center for Thrombosis Research in 1994 with a goal to improve the diagnosis and treatment Dr. John of patients with bleeding Francis and clotting disorders. Recently, the Center for Thrombosis Research celebrated its 20th anniversary, making it the longest-standing laboratory research department at Florida Hospital. With a full-time staff of 21, the Center for Thrombosis Research offers the widest range of specialized blood coagulation tests available in the state of Florida. Their laboratory performs more than 50,000 tests for bleeding and clotting disorders every year, making it the busiest laboratory of its kind in the Southeast and is truly unique to The Center’s research focuses on understanding the relationship between the blood clotting system and

the growth and spread of cancer, assessing the risk of thrombosis, and new approaches to the diagnosis and treatment of blood clots.

Nemours Hires New Director of Fund Development Nemours has added a new leader to its fundraising team. Lesli J. Cearley, director of fund development for the Nemours Fund for Children’s Health, will build philanthropic support for the unique pediatric programs and services offered by Nemours Children’s Hospital in Lake Nona and Nemours Children’s Specialty Care locations in downtown Orlando, Lake Mary andViera. Prior to joining Nemours, Cearley was the director of development for the Military Child Education Coalition in Harker Heights, Texas. She also served as the director of fund development for McLane Children’s Hospital, a division of the Scott & White Healthcare Foundation in Temple, Texas. Cearley will manage all fundraising activities in Central Florida, including major gifts, corporate and foundation giving, annual giving and special events like the annual Nemours Gala. Cearley joins Nemours at a time of rapid growth when philanthropy has become more important than ever. The children’s health system just purchased five urgent care centers in Central Florida - now known as Nemours Children’s Urgent Care. In May, Nemours is set to open its eighth Nemours Children’s Primary Care location in Oviedo. 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.


YOU HAVE A CORPORATE RECRUITER, WHY SHOULD YOU CONSIDER US? Finding the right people that truly fit your criteria and culture requires going beyond typical methods of healthcare recruiting. We don’t rely on the inflow of applications; we are hunters that are out locally meeting with top professionals.

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MAY 2014



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