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PHYSICIAN SPOTLIGHT PAGE 3
Leslie W. Miller, MD ON ROUNDS
Preparing for the Alzheimer’s Burden Industry experts discuss challenges in research, legislative advocacy By LyNNE JETER
How to concoct a good exit strategy ... 6
The Move from Social Media Marketing to Social Business Strategies
At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. ... 9
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The statistics for Alzheimer’s disease in Florida are staggering. The sunshine state houses the nation’s second largest population of patients suffering from the devastating malady for which there is no cure. The University of Michigan Health System and RAND estimates it as the highestcost disease for care. A 2011 MetLife study estimated that wage losses incurred by care-
givers, who are usually in their prime earning years at the time they’re needed, average more than $300,000. “Cases of the disease have drastically increased and will continue to do so,” said Prem R. Shah, MD, who established in 2011 the 100-bed Bristol Court Assisted Living Facility in Tampa, the largest Pinellas Dr. Prem Shah
County site exclusively for Alzheimer’s and other memory-loss patients. “As the CEO of assisted living facilities specializing in this disease, we see a drastic need for additional funding and growth of facilities catering to this specialized population. I personally hear from my staff that families are keeping residents longer and longer at home. This is because families are forced to since many care facilities can cost families (CONTINUED ON PAGE 4)
MedEvolve ﬁnds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide was “preoccupied and disinterested,” and customer support was practically LITTLE ROCK – When Bill non-existent. “Our practice collecHefley, MD, was a junior partner tions soon approached zero. I knew at a Little Rock orthopedic practice there had to be a better way.” more than two decades ago, he was A hobbyist computer tasked with choosing a new informaprogrammer, Hefley devoted his tion technology (IT) system to replace Dr. Bill Heﬂey energies to filling the void in the an antiquated one. After completing marketplace. From it, he established due diligence on various options, he played MedEvolve as a truly collaborative it safe and purchased a new system from the industry partner to solidify the IT nation’s largest vendor. backbone of medical practices. “It was a complete disaster,” recalled The success of MedEvolve’s Hefley, noting the software was different practice management than the demonstration version, the trainer (CONTINUED ON PAGE 8) By LyNNE JETER
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Leslie W. Miller, MD Director, University of South Florida Heart Institute By JEFF WEBB
TAMPA - If you already are a renowned expert in heart failure and transplantation, and if you have already been involved in more than 100 clinical trials, and if you have a 75-page CV that shows you are one of the most creditably published cardiologists in the U.S., and if you are 66 years old, you might ask yourself “What’s next?” But Leslie W. Miller, MD (simply “Les” to many of his colleagues) is too busy with the next big thing to give it much thought. “The research I am pursuing now is, by far, the most exciting of my career. ... The field is moving faster than any other in my career,” said Miller, director of the University of South Florida Heart Institute. Miller’s latest enthrallment is regenerative medicine, which uses stem cells and targeted gene therapies to actually regenerate damaged or dysfunctional heart tissue and blood vessels. The possibilities of continued success in clinical trials have the potential to drastically change the landscape not only for cardiovascular medicine, Miller said, but may be applied to other organs in need of repair. After years of being a surgeon and involved most of his career in the areas of heart transplantation and mechanical support, Miller has been broadly in the field of treating patients typically who have advanced heart failure. “Those were the only two (solutions) we had for a growing number of people who have become unresponsive to conventional medical therapy,” Miller explained. “In that experience, neither of those options are perfect. There aren’t any perfect options. They come with expense and, with a transplant, of course, an irretrievable option.” But about 6 years ago, while at Georgetown University in Washington, D.C., Miller said, that through his use of mechanical devices “I became interested in the concept of ‘Couldn’t those devices help us recover heart function, and then people could have them taken out?’ Through molecular science we began to identify specific important proteins in the heart and the body that were really contributory (to cardiovascular disease). We looked for genes that correlated (to heart disease). We found a few and it really spawned my exposure in the area of stem cell therapy (and) using stem cells to most readily achieve, in a broad distribution in an economically doable process with limited toxicity, taking advantage of the body’s natural repair mechanisms,” he said. Miller has been at the forefront of this research for several years, and now it is “fair to say that USF is at the forefront,” he said. He is immersed now in a clinical trial, STOP-HF, which has 90 patients namedicalnews
tionwide, 10 of whom are active at Florida Hospital Pepin Heart Institute and the Dr. Kiran C. Patel Research Institute affiliated with the University of South Florida. Miller and Charles Lambert, MD, and medical director at Pepin, are collaborating to oversee the stem cell gene therapy research. Although furthering the funding and function of the USF Heart Institute is “my fundamental role” as director of the USF Heart Institute, Miller said, this clinical research with Pepin is “the opportunity to pursue regenerative medicine as a centerpiece for the kind of technology and new therapies we’re going to have.” The USF Heart Institute was awarded a total of almost $9 million last year to begin design on a 100,000-square-foot building that will be erected on the main campus. USF Health officials are hopeful the Florida Legislature will come through again this year in time to break ground on the project in July. (Editor’s note: The 2013 legislative session had not been adjourned when this article went to press, so the allocation request had not been approved yet.) Miller has been doing his part to lobby for funding of the facility he described as “somewhat unusual for the typical heart institute, in that it will be 90 percent science research and 10 percent delivering patient care in a clinical setting. That’s not the case in most heart institutes
around the country.” Miller said the heart institute will be three stories: One floor for genomic science that will use DNA to identify markers and predict what drugs work best; One floor for research on stroke, diabetes, metabolic syndrome and other factors that predispose patients to cardiovascular disease; and one he calls the “therapeutics floor,” where stem cells will be used for targeted gene therapy. Is this going to put USF Health at the forefront of fighting cardiovascular disease, the leading cause of death, and arguably the most important healthcare problem in the world? “I think it is fair to say that,” said Miller. “The goal is to develop new diagnostics and therapies that will change cardiovascular care around the world.” That farsighted confidence is music to the ears of Stephen Klasko, MD and CEO of USF Health, who recruited Miller in 2010 as director of the Department of Cardiovascular Sciences. Klasko’s oft-repeated mantra is that he expects USF Health “to be the place where tomorrow’s healthcare happens today.” With Miller and Stephen Liggett, MD, another nationally known
researcher who came to USF last year as vice-dean of Personalized Medicine and Genomics, Klasko said “it sends a signal to the world that we are serious about transforming cardiovascular medicine. ... Having them on board makes it a whole lot easier to make the pitch (for additional funding) and it makes it much easier to be a place that recruits the top people in the country,” he said. “Having Dr. Miller here will allow us to get some of the best young minds to be part of the heart institute.” Miller said he has little time outside of work, but when he can, one of his priorities is the Chain of Hope, a humanitarian charity run by his friend Magei Yacoub, MD, who organizes clinics in Egypt, Ethiopia and Qatar that cater mostly to children with congenital heart disease. Miller also has gone on several missions to Rwanda, he said. “It is an amazing challenge ... and the most soul-gratifying, life-changing experience I’ve ever had. Probably the best thing I’ve ever done,” said Miller, the sincerity in his voice inspiring the unsolicited addendum “so far.”
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Preparing for the Alzheimer’s Burden, continued from page 1 thousands of dollars monthly.” Earlier this year, the national Alzheimer’s Association published new recommendations for primary care physicians on how to assess cognition during the Medicare annual wellness visit. Soon after, the 2013 Alzheimer’s Disease Facts and Figures was released, revealing that one in three seniors dies with Alzheimer’s or another dementia in the United States. Even though deaths from other major diseases continue to experience significant declines, Alzheimer’s deaths continue to rise, increasing 68 percent in the first decade of this century. Without the development of medical breakthroughs that prevent, slow or stop the disease, analysts have anticipated the number of people with Alzheimer’s disease by 2050 could reach 16 million, and increased healthcare costs related to the disease could rise by 500 percent to $1.2 trillion. “Unfortunately, today there are no Alzheimer’s survivors. If you have Alzheimer’s disease, you either die from it or die with it,” said Alzheimer’s Association CEO Harry Johns. “Urgent, meaningful action is necessary, particularly as more and more people age into greater risk for developing a disease that today has no Harry Johns cure and no way to slow or stop its progression.” The burden of Alzheimer’s disease so strains the nation’s healthcare system
and government programs that President Barack Obama spoke of the need for “investments in science and innovation,” with specific reference to Alzheimer’s disease, in his inaugural second-term State of the Union address. “With baby boomers reaching the age of elevated risk, we don’t have time to do what we’ve always done,” said Robert Egge, vice president of public policy for the Alzheimer’s Association. “The National Institutes of Health needs to reset its priorities and focus its resources on the crisis at our doorstep, and Congress must fully Robert Egge fund implementation of the National Alzheimer’s Plan to solve the crisis.” Recently, Johns outlined a clear case for increased resources to address the Alzheimer’s epidemic at a hearing of the Subcommittee on Labor, Health and Human Services, Education and Related Agencies Committee on Appropriations. He pointed out that even though the National Alzheimer’s Project Act that was passed unanimously with bipartisan congressional support in 2010, the first National Alzheimer’s Plan has been developed and submitted to Congress — consistent with the goals established by the National Alzheimer’s Project Act, with the promise of important progress when fully implemented. However, to achieve the plan’s ambitious goal
to prevent and effectively treat Alzheimer’s disease by 2025, smart commitment of resources must be made. “Having a plan with measurable outcomes is important, but unless there are resources to implement the plan, we cannot hope to make much progress,” he said. “If we’re going to succeed in the fight against Alzheimer’s, Congress must provide the resources the scientists need.” Nationally, industry leaders have also discussed disappointment that the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel doesn’t believe adequate evidence exists to determine whether PET imaging of brain beta amyloid changes health outcomes, and urged the Centers for Medicare & Medicaid Service (CMS) to review the evidence and make a positive determination about coverage. In Florida at press time, state lawmakers were mulling a proposal to force more seniors into nursing homes. House Bill 1323 and Senate Bill 1748 would essentially restrict the use of Personal Services Contracts (PSCs) and inhibit a well spouse from continuing to pay living expenses when an ill spouse needs to enter a nursing home. For now, PSCs allow family caregivers to be paid by the ill relative because many family caregivers must leave jobs or reduce work hours. Placing unreasonable limits on payments would be a huge financial sacrifice, especially because many caregivers also must support their own families. SB 1748 calls for paying the minimum wage, which
in Florida is $7.79. “Presently, the lack of legislation and payment sources prevent families from placing residents from such facilities, as well as exorbitant costs in hospitals and nursing homes,” said Shah. “Advocates are beginning to urge legislators to focus on dementia since its burden is overwhelming many states including Florida. Studies have also shown that the treatment cost for Alzheimer’s tops any other disease, comparable to cancer or heart disease. With an aging population, costs toward healthcare in general will rise considerably and make up a large portion of the GDP (Gross Domestic Product).” Both bills would necessitate the caregiver to predict the number of hours spent taking a relative to the doctor or pharmacy, running errands and managing care, an almost impossible task to properly assess. These laws would essentially delete PSCs, which would require seniors to pay someone else for expensive professional care-giving or enter a nursing home, with Medicaid footing the bill, explained Ellen S. Morris, an attorney in Boca Raton who specializes in elder law. “I’m hopeful that continued awareness within the general public and legislators will bring some cure, treatment or solution to this devastating disease,” said Shah.
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Succession Planning How to concoct a good exit strategy By LYNNE JETER
In uncertain economic times, planning for the future – retirement, selling a company, or transitioning a family business into the next generation – is critical to maintaining financial stability in a medical practice. Despite industry projections reflecting that half the nation’s active doctors will reach traditional retirement age by 2020, and physicians typically live into their early eighties, very few practitioners are succession ready.
Plan years in advance to mitigate risks associated with succession planning. “The earlier, the better,” said Jim Weiss, senior vice president and commercial banking executive for Fifth Third Bank (Tampa Bay affiliate). “One to three years is short and the bare minimum. Sometimes, depending on the complexity of the issues at hand, it can be 5 to 10 years in the making.” Why? The legal, financial and tax implications of succession planning can be extremely complex, based on the organizational structure of the business, composition of ownership, and whether the business will be sold to employees, a third party, or transferred within the family. Trying to resolve issues just prior to
a sale or transfer is virtually impossible to do properly. There’s too much value at stake,” said Weiss. “You should start early and over the years make changes as the business evolves. It’s not unusual to start down one path and then course correct as conditions change. As an example, by starting earlier, you’re able to diversify the business, which can add significant value. And if competitive landscape changes, you can be prepared to move quickly … whether your goal is to sell, exit, acquire or grow. Without early planning, and on-going maintenance of that plan, it will be more difficult to achieve your goal.”
in the healthcare industry, for example, will help doctors better understand the process and may bring major players in the industry to the table to garner maximum dollars possible.”
Ask about the Money
Succession planning isn’t very expensive. Compared to the value created, the process becomes quite affordable. Succession Planning Involves Determining How One “Providing solutions could Will Transfer Wealth To The Future Generation. get expensive, but doesn’t need “That game plan changes frequently, depending on life events,” to be,” explained Weiss. “Imagexplained Jim Weiss, senior vice president and commercial banking ine having a lawn overgrown with executive for Fifth Third Bank (Central and North Florida affiliate). weeds and vines. The longer you “For instance, a 35-year-old with young kids should make sure they let it go, the tougher and more have very good insurance coverage. Once children are through college and the company matures, the focus should turn to the next expensive it’ll be to get it back step – succession planning. Anyone who owns a company should be into shape. But if you maintain thinking about the long-term position of their business.” it, the incremental investments are much smaller. Depending on how active you are with managin significant estate tax savings and help Find the Right Wealth ing personal affairs, it could be simple adjustavoid potential conflicts between family Management Advisor ments, but if we undo years of neglect, it can members,” said Weiss. “If the goal is to Accountants and attorneys often recpotentially grow into a complex and intensell the company, business owners need to ommend involving a wealth management sive project. The bottom line is start early work with someone savvy in their indusadvisor to the succession team to provide and maintain often – you won’t regret it.” try. This has many advantages, including critical financial planning advice prior to having the network and inside knowledge the business transition. Be Candid to take that business to the correct poten“A wealth advisor can identify and According to the Institute for Family (CONTINUED ON PAGE 10) tial buyers. Having a bank with specialty help rectify potential issues that result
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Pay or Play … What Makes Sense for Your Company? Preparing for the Affordable Care Act Implementation in 2014 By CHARLES EGERTON
When it comes to health benefits, the rules are about to change dramatically for companies with 50 or more full-time employees. The so-called “employer mandate” of the Patient Protection and Affordable Care Act (ACA) includes so-called “pay or play” regulations, which will soon begin imposing significant penalties on those who fail to offer “adequate and affordable” health insurance coverage.
Understanding the Penalties
After December 31, 2013, ACA provisions levy penalties on “applicable large employers” – those with more than 50 full-time workers – that don’t offer employees and their dependents the chance to enroll in a minimum essential coverage health plan. The fine for noncompliance is $166.67 per month per employee, except for the first 30 employees. For a business with 60 employees, the penalty would add up to $5,000 each month, or $60,000 each year, beginning in 2014. And a 600-person company that failed to comply with the law would be fined $95,000 a month,
or $1.14 million a year. Penalties are even less forgiving when it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from exceeding 9.5 percent of their household income. Employers that don’t offer a “qualified health plan” and premium assistance to employees to keep their cost below 9.5 percent will be subject to this penalty. The fine is $250 per month, multiplied by the total number of full-time employees who buy coverage through a Health Insurance Exchange (not just those in excess of the first 30, as with the other aspect of the law). In other words, if your company attempts to offer a plan, but it doesn’t measure up to federal standards – the penalty can be as much as $3,000 per employee. This second penalty cannot exceed the total amount of the first penalty. Both of the law’s penalty provisions will be adjusted for inflation each year. The ACA penalties that go into effect next year can represent a significant cost for a business of any size. But since offering health insurance is typically more expensive than that, some businesses are considering whether to simply pay the fines. As
Penalties are even less forgiving when it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from
exceeding 9.5 percent of their household income.
a financial professional, how should you advise your company … pay or play?
Evaluating Your Company’s Standing as an Employer
The first step is to determine whether the federal government will regard your organization as an “applicable large employer.” Your company is exempt from the law if it has less than an average of 50 fulltime employees. But defining a full-time employee is complicated; especially for companies that employ lots of part-time or seasonal workers. Simply put, according to the ACA regulations, a full-time employee is one
who works an average of at least 30 hours per week. This news won’t come as a shock to many human resources professionals, who have long used the 30-hour mark as a litmus test for determining whether an employee was considered full-time and eligible for healthcare coverage. But beginning in January 2013, companies must also take into consideration the average amount of hours logged by all workers within a calendar month. The statute requires businesses to determine their number of “full-time equivalent” employees. To get this figure, add the hours of all of your company’s part-time employees and divide by 120, or a month’s worth of hours for one full-time employee at 30 hours per week. This provision was included to prevent businesses from trying to circumvent the law by cutting their employees’ hours to less than 30. Similarly, the ACA prohibits companies from subdividing their business into separate companies to create the appearance of multiple employers with less than 50 full-time workers. The law was written so no matter whether companies “pay or play,” they must play fairly. (CONTINUED ON PAGE 9)
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IT Acceleration, continued from page 1 (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.
The Drawing Board
In searching for a better solution in the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Horsham, Pa., and a pioneer in the emerging field of electronic medical records (EMR). “Intrigued, I became an early investor and a development partner focused on orthopedic clinical content,” he said, noting that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development partner with NextGen in 1994, working on the development of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing computerized billing and scheduling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering support and customer service. I frequently heard my physician
friends and colleagues recount horror stories of flawed software systems with dismal support that were making it impossible to run their practices successfully. I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.” In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service. “My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We integrated our PM product with several specialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.” With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM. “Physicians were struggling with increasingly complex third-party payor systems, growing documentation requirements, mounting government regulations, and threats of audits, fines and imprisonment,” said Hefley. “Practices were searching for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of the ever-changing rules and regulations.
Health Reform Impact
With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry
– 97 percent firstpass claims success, 27 percent average increase in practice revenue and a 38 percent average reduction in
accounts receivable days…
- Bill Hefley, MD, President and CEO of MedEvolve.
Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.” MedEvolve developed an RCM division, acquired three small RCM companies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists. “With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers immediately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”
The 2009 American Recovery and Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system. “With the new criteria defined, MedEvolve saw a need for a modern EHR product designed from the ground up to meet Meaningful Use mandates and finally deliver on the industry’s promise of a cutting edge, customized solution that helps practices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.” Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excellent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature. As a result, employees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.” “In the software business, that means several operators are at the ready for periods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less support is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some detached, impersonal entity; we partner with the practice in achieving their goals.” Today, MedEvolve offers PM and EMR software and RCM services to physician partners, and also electronic prescribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitioners to practices with more than 50 physicians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide. By year’s end, MedEvolve will outgrow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion. “We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”
The Move from Social Media Marketing to Social Business Strategies By CINDy SANDERS
Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer Andrew Dixon for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular tool
being used today to do that is email, but email was never intended to be a collaborative tool.” In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business
Three Trends Driving Change
software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information (CONTINUED ON PAGE 10)
Three trends are driving change in the workplace – social, mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space. “It’s incredible how powerful each of these trends are alone, and they are all converging,” said Andrew Dixon of Igloo Software. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statistics. “All of their IT requirements will be outsourced and provided to them by the cloud.” Citing recent research from business and technology research
firms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.” Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Taking the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone professionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent. Furthermore, half of the tablet-owning doctors have used their device at the point of care.
Pay or Play … continued from page 7 Weighing the Options
If you establish that your company is affected by the ACA regulations, you must then weigh the consequences of either offering healthcare coverage that complies with the law or paying the penalties. From a fundamental business standpoint, many organizations would certainly save money by paying $2,000 per full-time employee rather than offering employee health benefits. But there are intangible considerations – such as employee relations, morale among workers and the company’s public image – which must be evaluated. The bottom line? This is a complex law and the stakes are high. Even the most experienced financial professional would benefit from legal counsel as they decide whether to “pay or play” in this new realm of healthcare regulation. Charles Egerton is a founding shareholder of Dean, Mead, Egerton, Bloodworth, Capouano & Bozarth, P.A., a commercial law firm that has provided full-service legal representation to businesses and individuals throughout Florida since 1980. Charles can be reached at CEgerton@deanmead.com.
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Succession Planning, continued from page 6 Business, about one-third of family businesses survive into the second generation. Roughly 12 percent remain viable into the third generation. Yet only 3 percent operate into the fourth generation or beyond! “From what I’ve seen, you usually have a founder with a strong entrepreneurial gene who has created an idea or product,” said Weiss. “They then build a company around it. In most instances, they hope and pray that the kids share the same entrepreneurial gene and want to continue the family business. However, that’s not always the case.” Even though it’s rare, sometimes children come into a family business with the energy and talent -- matched with an entrepreneurial gene – to improve it. “If handing the business off to a family member isn’t in the cards, you still have other options for the business to flourish,” said Weiss. “You can find talented components, such as hiring a professional CEO, and build the company/infrastructure around it. For some, this might be a better route, but then one must consider how to build an estate instead of counting on the business.”
Cover the Bases
Having business partners makes it even more important to have a plan in place so all parties are prepared for succession, noted Weiss. “With partners involved, it can be very complicated,” he said. “It’s incredibly important to have candid conversations with
them in a business to discuss what would become of a company if something unfortunate happened to one of its owners. Sometimes, the business has to be sold to cover estate taxes if a partner dies. Stakeholders in multi-physician practices need to be prepared. What happens if one of them leaves, dies or is injured?” Therefore, having the right insurance program, including life and disability coverage is a critical component to a succession plan. “Injury, as opposed to death, is a higher risk, higher probability scenario for many,” explained Weiss. “For instance, a surgeon who hurts his hand won’t be able to perform his job.”
“Have a realistic picture of what your company’s worth if you’re considering selling it,” said Weiss. “Going through an advisor can help develop a capital strategy plan based on the end goal. It’s important to get a true valuation of company. Business owners need experts to help maximize gains in these areas depending on your corporate goals – max dollars from a sale in three years – versus personal goals – wanting to maintain the company and minimize the estate gap.”
Pay Attention to Trends
Right now, hospitals are snapping up physician practices. “Physicians Associates recently sold to Orlando Health, an example of this (con-
solidation) trend playing out locally,” said Weiss. “I see this trend continuing and physicians should be proactive to maximize their transaction by starting to plan early. If practitioners are thinking about selling to a hospital and they haven’t gone through the process of succession planning and business positioning, they need to now.” “Clark & Daughtrey recently sold to Lakeland Regional Health Systems, an example of this (consolidation) trend playing out locally,” said Weiss. “I see this trend continuing and even expanding beyond hospitals to include other segments as well. Physicians should be proactive to maximize their transaction by starting to plan early. If practitioners are thinking about selling to a hospital and they haven’t gone through the process of success planning and business positioning, they need to now.”
Be a Good Client
Avoid the frequent phrase: “I’m too busy.” “Estate and wealth planning deserves high priority and can be very risky should you leave it uncared for,” said Weiss. “We help them think through it, but we bring solutions to the table so they don’t have to figure it out by themselves. Some might believe the process of facing one’s mortality and putting a plan in place is uncomfortable … but at the end, they’re always relieved.”
Creating Engaged Communities
Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also al10
lows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.
“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social
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The Move from Social Media, continued from page 9 outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.
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business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”
Avoiding Information Overload
Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said. However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.
The Bottom Line
With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”
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GrandRounds NurseLineMD Launches Anytime, Any Place, Any Device Efficient Medical Communications NurseLineMD is announcing the national launch of DoctorDirect, a new communication system for healthcare service. DoctorDirect by NurseLineMD improves office efficiencies and allows the medical staff to spend more time with patients. Patients can simply log-in to enter a message, and be notified immediately when a nurse or doctor replies. Likewise, doctors and nurses are alerted when a patient has an inquiry or urgent need. Created for use in various medical environments, DoctorDirect can be implemented and accessed simply, through the easy to use interface and cloud architecture. The system enables patients to communicate at their convenience about any medical or billing issue, as well as to notify medical staff of changes and updates to their personal information and insurance, eliminating many cumbersome administrative duties for the nursing staff. It also enriches the patient/provider relationship by enabling patients’ access to quickly and easily communicate with their provider at any time. The DoctorDirect solution was created out of a personal experience with a high risk pregnancy.
TGH Announces Two Promotions For Nursing Services Celeste Kallenborn J. Celeste has become the Vice Kallenborn President of Acute Care and Pam Sanders has been promoted to Vice President of Women and Children services at Tampa General Hospital. Kallenborn joined TGH in 2001 as the TrauPamela G. ma Program Manager, Sanders and was promoted to the Director of Medical Surgical Services in 2006. Kallenborn has been a key leader on multiple successful projects, and currently is co-leading the FMEA length of stay initiate. She has been a Registered Nurse for 22 years, with a Bachelor of Science in Nursing, a Master of Business Administration, and professional certification as a Nurse Executive. Sanders joined TGH as the Nurse Manager of the Neonatal Intensive Care Unit in 2000, and assumed additional responsibility for the Transition Nursery in 2008. She has been a Registered Nurse for 29 years, earning her Bachelor of Science in Nursing from the University of Tennessee, her Master of Science in Nursing from the University of Central Florida, and is currently enrolled in the Doctorate of Nursing Practice Executive Track at UCF. Sanders has earned two professional certifications, Neonatal Intensive Care Nursing and Nurse Executive. Pam was a critical leader in the design and development medicalnews
of the NICU expansion project, and has been influential with the perinatal quality and safety program.
Largo Medical Center receives American Heart Association’s Get With The GuidelinesHeart Failure Gold Plus Quality Achievement Award Largo Medical Center has received the Get With The Guidelines®–Heart Failure Gold Plus Quality Achievement Award from the American Heart Association. The recognition signifies that Largo Medical Center has reached an exceptional goal of treating heart failure patients according to the guidelines of care recommended by the American Heart Association/American College of Cardiology. This marks the 5th year Largo Medical Center has been recognized with a quality achievement award. Get With The Guidelines–Heart Failure helps Largo Medical Center’s staff develop and implement acute and secondary prevention guideline processes to improve patient care and outcomes. The program provides hospitals with a webbased patient management tool, best practice discharge protocols and standing orders, along with a robust registry and real-time benchmarking capabilities to track performance. The quick and efficient use of guideline procedures can improve the quality of care for heart failure patients, save lives and ultimately, reduce healthcare costs by lowering the recurrence of heart attacks. Following Get With The Guidelines– Heart Failure treatment guidelines, heart failure patients are started on aggressive risk-reduction therapies if needed, including cholesterol-lowering drugs, betablockers, ACE inhibitors, aspirin, diuretics and anticoagulants while in the hospital. Before discharge, they also receive education on managing their heart failure and overall health, including lifestyle modifications and follow-up care. Hospitals must adhere to these measures at a set level for a designated period of time to be eligible for the achievement awards.
St. Joseph’s Women’s Hospital’s Program Results In Fewer Early Deliveries A study published in Obstetrics & Gynecology shows that multistate, hospitalbased quality improvement programs, including the one at St. Joseph’s Women’s Hospital, can be remarkably effective at reducing early elective deliveries of babies. The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline. At St. Joseph’s Women’s Hospital, the Perinatal Safety Committee established scheduled delivery guidelines and their rate fell from 38.6 percent to
TGH Trauma Florida’s Only Nationally Verified Trauma Center Tampa General Hospital’s Level l trauma center for adults and children is the first and only program in the state of Florida to earn recognition from the American College of Surgeons (ACS) for the quality of its trauma care. This achievement, known as verification, recognizes Tampa General’s dedication to providing optimal care for both adults and children. Verified trauma centers must meet essential criteria that ensure top-notch trauma care capability and institutional performance, as established by the ACS. These criteria mean that the trauma center has demonstrated commit-
ment not only to patient care, but also to education, research, and community outreach. This designation as a nationally-verified level I trauma center confirms that Tampa General has demonstrated a commitment to providing the highest quality patient care, placing Tampa General in a class with the other leading trauma centers in the United States. The verification followed an extensive review by the ACS Committee on Trauma, which was established to improve all phases of patient care in trauma centers and to prevent injuries before they occur.
3.3 percent during 2011. The March of Dimes, which partly funded the initiative, says this is good news because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life. St. Joseph’s Women’s Hospital Perinatal Safety Committee identified two physician leads on the March of Dimes project. Dr. Jeffrey Angel, Medical Director of Maternal Fetal Medicine, and Dr. Richard Matthews, of Lifetime Obstetrics and Gynecology, were the ‘hard stops’, which meant
that any requests for a scheduled delivery outside of the guidelines had to go to them for review. Written guidelines and the involvement of these physicians were crucial to this culture change. Throughout 2012, the rate has decreased further to less than 1 percent. St. Joseph’s Women’s Hospital, part of BayCare Health System, implemented a toolkit called “Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age” to guide changes in early term delivery practices.
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Tampa Bay Area Physicians Jorge Ayub, MD
Sunil Gandhi, MD
Jeffrey L. Paonessa, MD
Jose Alemar, MD
Larry Gandle, MD
Janelle Park, MD
Rand W. Altemose, MD
Christopher B. George, MD
Y. K. Peter Park, MD
Jennifer L. Ball, DO
Vivian Griffin, MD
Hitesh Patel, MD
Gregoire Bergier, MD
Andrew E. Hano, DO
J. Andrew Peterson, MD
Sawsan G. Bishay, MD
Vu Tran Ho, MD
V. Upender Rao, MD
Rafael W. Blanco, MD
Nuruddin Jooma, MD, MPH
Mark S. Robbins, MD
Kerry E. Chamberlain, DO
Craig S. Kitchens, MD
Joseph Sennabaum, MD
Hafeez T. Chatoor, MD
Richard A. Knipe, MD
Ramesh K. Shah, MD, PA
Marion T. Chirayath, MD
Julio Lautersztain, MD
Shalin R. Shah, DO
Mamta T. Choksi, MD
Don D. Luong, MD
Gerald H. Sokol, MD, MSc, FCP
Julia Cogburn, MD
Joseph R. Mace, MD
R. Waide Weaver, MD
Michael Diaz, MD
Idelfia A. Marte, MD
David Wenk, MD
Robert L. Drapkin, MD
Arthur J. Matzkowitz, MD
David D. Wright, MD
Matthew A. Fink, MD
Edgar G. Miranda, MD
Gail Lynn Shaw Wright, MD, FACP, FCCP
Gustavo Fonseca, MD
Magda Melchert, MD
Lane D. Ziegler, DO
Tampa Bay locations Additional FCS locations
Tampa Bay Medical News May 2013