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PAGE 3

Nathalie Dauphin McKenzie, MD, MSPH

PHYSICIAN SPOTLIGHT

HEALTHCARELEADER

By PL JETER

Controversy swirled when the Florida Supreme Court ruled last month that the law limiting pain-and-suffering damages in medical malpractice cases is un-constitutional, effectively rejecting a debated change that lawmakers and then-Gov. Jeb Bush approved 14 years ago.

Jessica Hoehn of Danna-Gracey, the largest in-dependent medical malpractice insurer in Florida, called the decision “the final nail in the coffin of tort reforms enacted in 2003.”

“This Court action will hasten the anticipated hardening of the marketplace and doctors are sure to see higher prices for their coverage and fewer insurers bidding on their medical insurance (soon),” she said.

Justices were deeply divided on the ruling in the Broward County Case, with the four-member major-ity comprised of Chief Justice Jorge Labarga and

(CONTINUED ON PAGE 4)

A year in to the job and things are looking goodMark Marsh, President, Orlando Health Central

HEALTH INNOVATORSMedical Devices: The Equipment of Innovation & Training ... 7

CPA SPEAKWhat Does MACRA Mean to Your Practice? ... 9

The Value of MESHWhen most people think about independence in the context of aging, they connect it to issues related to medical diagnoses and treatment. ... 12

Supreme Court Knocks Down Caps on Noneconomic DamagesWhat to do now?

By PL JETER

OCOEE—When Mark Marsh was starting quarterback for the Western Ken-tucky University (WKU) Hilltoppers under Coach Jack Harbaugh, father of Jim and John, he reveled in the symphonic nature of collaborative teamwork.

“Sports taught me a lot about life as a quarterback, and I was always as good as the weakest link,” recalled Marsh, a native of Cin-cinnati, Ohio. “It was a great lesson in leader-

ship and the importance of good coaching.”

As a football player on a full scholarship from 1985 to 1989, Marsh had hoped to become a professional player. When the possibility of going to the next level seemed less than likely, he turned to mentors to determine his academic pursuit. A valuable role model was Tom Babik, longtime CEO of the Graves-Gilbert Clinic, a large multi-specialty practice in Bowl-ing Green, Ky., who was passionate about

sports and commu-nity improvement. For

example, before he relo-cated to Springfield, Mo., in

2007, Babik was involved with the Kiwanis Club, Boy Scouts, Christ United Method-ist Church and various charitable events. In fact, when a colleague asked Babik for the green light to nominate him for a local volunteerism award, Babik declined, say-ing politely that “performing community

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PHYSICIANSPOTLIGHT

Nathalie Dauphin McKenzie, MD, MSPHFellowship Director of Gynecologic Oncology, Florida Hospital

By PL JETER

On November 20, 2007 Nathalie McKenzie, MD, played a pivotal role in one of the first success stories of its kind between the University of Miami (UM) Infertility Center and Sylvester Compre-hensive Cancer Center.

Only McKenzie’s role wasn’t as a doctor that day. Instead, it was as the mother of a healthy baby girl.

Before that day, puzzled, because her family history had no sign of breast can-cer, McKenzie needed to quickly learn if a pea-sized lump she found in her breast was cancerous. After all, she and her husband of a year had talked about starting a family.

The diagnosis: invasive metaplastic ductal carcinoma, an aggressive form of breast cancer. The lump she felt was only the tip of a high-grade tumor. An MRI showed the cancer had not metastasized.

“I immediately starting thinking about my fertility,” said McKenzie, who had a mastectomy in October 2004. Before be-ginning treatment, McKenzie consulted with the UM Infertility Center, which had recently partnered with Sylvester Com-prehensive Cancer Center to seamlessly connect cancer patients with fertility pres-ervation counseling to simultaneously pro-tect their ability to have children.

“I was really lucky to have a discussion with an infertility doctor before I started treatment,” she said. “Some patients, un-fortunately, will lose their fertility. But if the possibility isn’t introduced as an option to a young woman with cancer at that critical time, then she may lose the option. So, the first thing (after a cancer diagnosis) is the surgeon and the infertility specialist need to get together and really sit down, brainstorm together and offer her all of the options that might, for which she as an individual, may be a candidate. Then, given her disease, or how progressive her disease is, what does she have time to do or not do.”

Instead of freezing her eggs, a move that would have delayed chemotherapy, McKenzie pursued fertility treatment with Zolodex to protect her ovaries. Three years after her double mastectomy, McK-enzie gave birth to Gabrielle.

“Now I have two beautiful, smart, amazing children,” said McKenzie, also mother to Nathan, 4. “I was able to con-ceive them … without any help … fairly quickly. The first month we tried for Gabby, we hit a home run.”

Since then, McKenzie, a board-cer-tified gynecologic oncologist, has become an award-winning physician known for her expertise in radical debulking proce-

dures for removing advanced tumors. She also specializes in scar-less hysterectomy, HPV-related neoplasia and patient-driven cancer treatment. Her most recent re-search project is ARIEL2, a phase II clini-cal trial that started last March to evaluate rucaparib for the treatment of women with relapsed, high-grade ovarian can-cer. The study was recently expanded to include patients with a minimum of three prior lines of chemotherapy.

It’s a surprising twist perhaps to learn that McKenzie worked on Wall Street be-fore turning to medicine. The daughter of a banker and United Nations finance ad-ministrator, McKenzie entered college in New York City with international business as her major focus. Quite unexpectedly, her mom had a brain tumor surgically removed. “Other experiences drew me to a hospital setting,” she said, “all of which culminated in my decision to want to care for people and use my talents in that way.”

McKenzie worked on Wall Street long enough to “rearrange things and go pre-med,” she recalled. After completing medi-cal school at the University of New York at Buffalo, McKenzie headed south for OB/GYN residency training at UM/Jackson Memorial Hospital and a Galloway rota-

tion at Memorial Sloan Kettering Cancer Center in New York . Nine months after Gabrielle was born, she began a fellowship, while concurrently earning an MPH (mas-ter’s degree in public health).

“I was (practically) sold on my spe-cialty,” she said, at the time she was diag-nosed with breast cancer. “My personal experience took away any guesswork.”

McKenzie relates well to patients and the medical staff in more ways be-yond being a physician and cancer sur-vivor. In 2015, Orlando Health honored McKenzie with the Exemplary Physician Colleague Award. She’s fluent in four lan-guages – English, French, (medical) Span-ish and Haitian Creole.

In addition to a busy practice, McK-enzie, who won student teaching awards for four consecutive years, has held three academic teaching posts since 2012 .

She has served as assistant professor of gynecologic oncology at UF Health Can-cer Center Orlando, University of Central Florida School of Medicine, and Florida State University School of Medicine.

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Supreme Court Knocks Down Caps on Noneconomic Damages, continued from page 1

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Justices Barbara Pariente, R. Fred Lewis and Peggy Quince finding that caps on noneco-nomic damages violated equal-protection rights. They also disputed the notion that a malpractice insurance crisis exists.

“We conclude that the caps on non-economic damages … arbitrarily reduce damage awards for plaintiffs who suffer the most drastic injuries,” they wrote. “We further conclude that because there is no evidence of a continuing medical malpractice insurance crisis justifying the arbitrary and invidious discrimination between medical malpractice victims, there is no rational relationship between the personal injury noneconomic damage caps … and alleviating this purported cri-sis. Therefore, we hold that the caps on personal injury noneconomic damages … violate the Equal Protection Clause of the Florida Constitution.”

In the decision, dissenting justices Ricky Polston, Charles Canady and Alan Lawson balked at the majority overstepping its role. “It is the legislature’s task to decide whether a medical malpractice crisis exists, whether a medical malpractice crisis has abated, and whether the Florida statutes should be amended accordingly,” they wrote.

At the center of the much-debated case is dental assistant Susan Kalitan, who entered surgery in 2007 for carpal-tunnel syndrome and departed with a perforated esophagus resulting from tubes inserted into her mouth

and esophagus during the administration of anesthesia. The 2008 lawsuit against the North Broward Hospital District and other defendants resulted in a jury award of $4 mil-lion in noneconomic damages. The amount was reduced to $2 million, based on caps in the law approved by state lawmakers and then-Gov. Jeb Bush in 2003.

Brian C. Lamb, a personal injury at-torney with Martinez Manglardi PA, in Orlando, said “the net effect of the recent Supreme Court decision is … nothing.”

“This decision was based on two areas of reasoning,” he explained. “First, the way the caps were defined in the statute, survi-vors in a wrongful death action in the same position could get radically different results based simply on the number of survivors that the victim of medical malpractice left behind. If they only had one survivor, that individual could get up to $1 million. If they had 10 survivors, then each individual would be limited to $100,000. The results were illogical under the cap and didn’t treat all survivors equally. The Court held that this illogical unequal treatment of similarly situated survivors was unconstitutional.”

Secondly, Lamb continued, the Court delved into great detail to review the rea-son for the caps.

“They determined that the caps were an inadequate way to address the crisis … and the purpose of the cap statute wasn’t rationally related to the stated purpose, to

make medical malpractice insurance more affordable,” he said. “The Court could find no empirical evidence that the caps had any effect in reducing the cost of medi-cal malpractice insurance.

“Given the dual result of unfair treat-ment of similarly situated survivors and the fact that there was no relation between the caps and the cost of malpractice insurance, the Court struck down this limit on noneco-nomic damages in wrongful death cases.”

In his dissent, Polston focused on what’s typically referenced as “a rational basis test.”

“Importantly, under the proper ra-tional basis test, it is immaterial that the majority of this Court disagrees with the Legislature’s evidence regarding whether there was a medical malpractice crisis in Florida,” he wrote. “It is also immaterial that a majority of this Court questions whether the Legislature’s policy choice of enacting a cap on noneconomic dam-ages has resulted in insurance companies passing along savings to their physician customers.”

Robert E. White Jr., senior vice presi-dent and regional operating officer of The Doctors Company in Jacksonville, noted the Court decision was mum on the con-stitutionality of the cap concerning non-wrongful death cases.

“This decision will significantly af-

fect the tort climate in Florida, and it’s ex-pected that it will increase the frequency and severity of claims,” he said.

Susan St. John, an attorney with Flor-ida Healthcare Law Firm in Tallahassee, warned that medical malpractice insur-ance premiums “will climb fast now that damage award limits are off.”

“It will be critical to re-evaluate medical malpractice coverage to ensure coverage is adequate,” she emphasized. “Keep in mind that medical malpractice insurance may pay out the upper end of liability insurance. However, this may not fully satisfy a judgment entered by a court against a healthcare provider, business or entity. Unsatisfied judgments against an individual or entity will remain recorded in public records until satisfied.”

Dan Reale, owner of Aviso Insurance LLC in Ruskin, said the Supreme Court’s decision will further pressure insurers.

“Malpractice insurers have reported flat or negative earnings over the past few years, but held off from raising premium rates to maintain business volume,” he explained, pointing out that physicians are paying approximately 50 percent less in premiums than a decade ago. “We’ll likely see smaller malpractice insurers fold, or be acquired by more established malpractice insurers who have weathered severe market changes.”

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5 Steps to Take NowWith more plaintiff attorneys returning their focus to medical malpractice cases because of the Florida Supreme Court’s ruling on the 2008 Broward County Case, doctors may need to consider revisiting ways to reduce risk in their medical practice.

• Review insurance coverage and deter-mine if the insurer is financially secure enough to last through some years of deteriorating financial results. “I pre-dict many of the A.M. Best unrated in-surers and small risk retention groups (RRGs) will fail in the next five years or be forced to sell to the larger insurers,” said Jessica Hoehn of Danna-Gracey. “For those insured with captives and as-sessable RRGs, I recommend you seri-ously now consider switching coverage to the more financially stable carriers.”

• Consider increasing policy limits of li-ability since there are now no limits on noneconomic damages that can be awarded in Florida.

• Get serious about risk management. “It works! Many insurers offer for free very comprehensive in-office assessments and a wide array of best practice recom-mendations, as well as astute articles on cutting edge ways to reduce your risk of being sued,” she said.

• Polish communication skills. “Poor skills lead to unhappy patients and lawsuits,’ said Hoehn. “Remember that patients don’t care how much you know until they know how much you care, as Sir William Osler so wisely said.”

• Review and update asset protection now, not after a lawsuit has been filed.

Source: Jessica Hoehn of Danna-Gracey, the largest medical malpractice insurance agency in Florida.

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HEALTHCARELEADER | Mark Marsh, continued from page 1

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service was reward enough for him.” “I knew as a kid … I had the type of

demeanor to want to be in a profession where I helped others,” said Marsh, who shadowed interns and learned the admin-istrative ropes via Babik. “I liked the multi-dimensional challenge in healthcare.”

After earning undergraduate and graduate degrees in healthcare administra-tion from WKU, Marsh declined the op-portunity to work with Harbaugh, who led WKU to a national championship in 2002. “Jack asked me if I wanted to coach or go into healthcare, and I said, ‘Coach, with all due respect, thank you. You’re great and I’d love to, but healthcare is my calling.’”

After serving as CEO of Gateway Med-ical Center in Clarksville, Tenn., a 270-bed acute care hospital, Greenview Regional

Hospital in Bowling Green, Ky., and Mar-shall Medical Center in Lewisburg, Tenn., Marsh relocated to the Sunshine State.

Last May, Marsh was named CEO of Orlando Health Central, a 400-bed healthcare system in Ocoee.

“There’s something quite unique about Orlando Health Central. There’s a great sense of family within the culture,” he said. “I see it from the teamwork and comradery, the result of the staff working together for a long time.”

Marsh’s diverse community involve-ment spans the American Heart Associa-tion, March of Dimes, Red Cross, United Way, and YMCA. He is a fellow in the American College of Healthcare Ex-ecutives and has been honored with the Regent’s Award and Young Healthcare

Executive of the Year in Tennessee. Perhaps the most important leader-

ship quality Marsh has learned during his 24-year administrative career: to honor the three Cs: care, compassion and com-mitment. “We’re in the business of the human element,” he said, “and people don’t care how much you know until they know how much you care.”

When Marsh strides down hospital corridors, he vigilantly seeks opportuni-ties to make a difference. “Patients com-ing here are at their most vulnerable and in the greatest need,” he said. “We like to also cure with kindness.”

Short term, Marsh continues striving toward his goal to expand Orlando Health Central into “the best hospital possible” in one of the nation’s fastest-growing areas,

“West Orange.” “A brand-new cancer center is getting

ready to kick off, also a new skilled nursing facility,” he noted.

Longer term, Marsh wants to see Or-lando Health Central land on the list of the Truven Top 100 Hospitals, a nation-ally recognized awards program based on patient outcomes and experiences.

“Our commitment is to become bet-ter every day,” he said. “I can hear first-hand how excited folks are about Orlando Health Central today. This is their hospi-tal of choice. We don’t want to stop there, though. We want to be the most patient-friendly hospital in Central Florida ... and Florida for that matter!”

West Orange Healthcare District and Or-lando Health join forces to improve healthcare in West Orange County with a $100 million project to expand the Health Central Hospital campus and bring services to Horizon West.

“We are extremely pleased and thankful for the District’s support and collaboration on this project,” said David Strong, President and CEO, Orlando Health. “West Orange County residents will soon be able to access more world-class healthcare services in their com-munities, close to home.”

Horizon West Emergency Department and Medical Pavilion

Construction of the project is planned to take place in two phases. The first phase is a 78,000 sq. ft. freestanding emergency depart-ment (ED). The ED will contain 12 patient exam rooms and additional four rooms that will be used for patient observation. Phase 1 is ex-

pected to be completed in the spring of 2018.The second phase will be the construction

of a six level, 214,000 sq. ft. medical pavilion, built to adjoin the freestanding emergency department. The phase 2 project will give the campus a facility that houses outpatient di-agnostics and laboratory services, as well as providing space for primary care physicians and specialists. Plans are to begin phase 2 in the spring of 2018.

Once fully operational, the Horizon West Medical Campus will create more than 750 new permanent healthcare jobs and attract other high-caliber healthcare businesses to the area.

Comprehensive Cancer CenterAdditions to the Ocoee campus include a

30,000-square foot comprehensive cancer center with expanded clinical programs and services for family, supportive and holistic care.

“Evidence proves that patients suffering from cancer have better results when they are treated closer to home,” said Mark Roh MD, president, UF Health Cancer Center – Orlando Health. “Each year, more than 1,200 residents living near Health Central are diag-nosed with cancer. The current facility, which opened in 2012, reached its expected five-year capacity in its second year. So this new facility is greatly needed.”

Skilled Nursing FacilityA new 100-bed skilled nursing facility will

also be coming to the Ocoee campus. The fa-cility will consist of a 60-bed rehabilitation unit and a 40-bed Alzheimer’s unit.

At the Horizons West location, construction continues on a 70,000-square foot building that will feature a freestanding emergency de-partment, outpatient diagnostics and labora-tory services, offices for primary care physicians

and specialists, and a human performance and wellness center.

“This facility will combine high-tech with high-touch to provide patients with the most advanced medical care available,” said Greg Ohe, Senior Vice President of Ambulatory for Orlando Health. “Through telemedicine technology, Horizon West residents will have access to additional pediatric and adult spe-cialists who may be located on any of our other campuses.”

Construction on the Ocoee facilities is ex-pected to be complete by the end of 2018. Construction on the Horizon West project is slated for completion by the end of 2017. The combination of both construction sites will generate more than 500 construction jobs. Once fully operational, the facilities will create more than 200 new permanent healthcare jobs and attract other high caliber healthcare busi-nesses to the area.

Capital Improvements Coming to Orlando Health – Health Central Hospital

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o r l a n d o m e d i c a l n e w s . c o m JULY 2017 > 7

HEALTH INNOVATORS

By KELLI MURRAy, CEO, MEdSPEAKS & CO-FOUndER HEALTH InnOvATORS

The medical device landscape is an

important one for many reasons - one of them being that it is a leading area for cap-ital investment. According to a recent re-port by CBInsights, global funding in 2017 is expected to reach $6.6B with over 700 funded deals, a 5 year high – with most of these transactions happening here in the U.S. Additionally, the range of market ap-plications for devices is extremely diverse and support a variety of specialty areas such as general surgery, cardiovascular and orthopedic to evolving areas such as neurology, urology, and ophthalmology.

From a “big data” perspective, emerging technologies such as Artificial Intelligence (AI) will become paramount as intelligent data and devices converge. The result aims to produce personal-ized pathways in terms of when and how health care is delivered. Additionally, ex-pect to see a fresh onset of new devices ranging from lifestyle management and monitoring, imaging and diagnostics, and, of course, wearables and they will forever change the way by which patients and physicians engage.

In June, The Nicholson Center at Florida Hospital Celebration was the very gracious host for our free Health Innova-tors community event focused on Medical Device innovation. The event brought to-gether nearly a hundred people, including 16 startup companies plus technologists, physicians, investors, incubators, ideators, economic development leaders, and sup-port providers of our ever-growing health-care ecosystem.

The forum moderator was Roger Smith, the Nicholson Center’s Chief Technology Officer. Roger is responsible

for establishing the technology strategy and leading health-tech research experi-ments at the Nicholson Center, and was the perfect guide for this conversation.

Our panel of experts were:• Jack Abid, Patent Attorney with

ADD&G, one of Florida’s oldest and largest law firms practicing intellec-tual property law.

• Errol Singh, MD, Urologist, Founder and CEO of PercuVision® LLC, inventor of a camera guided Foley catheter that reduces pain and complications from difficult catheter-izations.

• Vanaja Ragavan, MD, Endocri-nologist, CEO of Aviana Molecu-lar Technologies and expert in FDA regulations and medical affairs for global pharmaceutical and biotech companies.Many questions were discussed but

opinions varied when it came to the topic of what kind of impact and role tech gi-ants like Google, Apple, and Microsoft will have on medicine.

Roger: “Google, for example, in the robotics space, may emerge as a sec-ond-tier player by bringing big data and intelligence to match your case with a per-sonalized approach.”

Dr. Singh: “I believe these organiza-tions will be big players; predominately in terms of Artificial Intelligence in the use of medical procedures.”

Dr. Ragavan: “Augmented Reality (AR) is emerging from these companies – this is a big deal and very important in the healthcare space.”

Jack: “I have doubts about their stay-ing power. This (healthcare) is a different space and not as easily scalable. There are privacy issues…let’s face it, Google profits from a person’s data and this is a conflict

for the healthcare industry.”I pondered these opinions and de-

cided to dig into the giants to find out the latest on device invention and investment. Here’s what I found.

Google Ventures has taken the lead on the quantity of investments. The com-pany is hedging their risks by diversify-ing their (data) portfolio with a variety of healthcare companies ranging from life science and insurance to tech and wear-ables. Meanwhile Apple appears to be maintaining its focus on personal health and fitness data. Microsoft tried its hand in health care but sold its Health Solutions Group to GE last year. It’s now turned its focus towards its technology strengths in the Intelligent Cloud and leveraging grow-ing its AI and AR capabilities.

A few recent examples of device de-velopments for 3 of the top 5 tech giants (excluding Facebook and Amazon):

• May 2017, Google’s holding company, Alphabet. Inc., and its life science research arm, Verily, recently published a patent on a device worn on the wrist. The device contains a diagnostic method that uses contrast agents to identify blood particles such as specific proteins and antibodies.

• March 2017, Apple published a patent that measures intraocular (blood) pressure using sensors worn on the wrist. (Perhaps a new addition to Apple Watch technology.)

• Stryker is incorporating Microsoft’s HoloLens AR platform to enable remote planning of operating room designs without needing physical mock setups.Let’s cover Amazon for just a mo-

ment because there’s potential for a medi-cal device-like play here. It’s been widely

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By JOHn nOSTA, PRESIdEnT, nOSTALABS

Her presentations are as interesting as they are long. Kleiner Perkins Caufield & Byers Partner, Mary Meeker, devoted 31 pages of her information-packed Inter-net Trends Report to health technology. The title of the section set the tone: “The Healthcare Digital Inflection.” Meeker’s presentation—focused on internet trends—provides further evidence that health and technology are converging to offer new and important solutions in managing and untangling the complexities of health and

wellness. The focus was on internet trends, so many top-of-mind digital health issues such as AI, nanotechnology and robotics were off-topic for her presentation (www.kpcb.com/internet-trends). However, clear trends emerged, as technology is pushing many aspects of health and medicine into the 21st century. Here’s my top-line over-view. I encourage everyone to review the presentation, as it’s full of interesting data, graphics and insights.

Bold on digital. In just the years from 2000 to 2017, we truly arrived at a new century. From x-ray machines to sphygmomanometers to ECGs, we have become digital. Further, the rise of digital information and digital capture is growing rapidly. And perhaps most interestingly, these data are more freely shared by con-sumers. Meeker also asks if these changes in health technology can follow tech-like rapid adoption curves. Perhaps this sugges-tion is a bit of challenge or even a warning for what might be just around the corner.

Bold on data. The proliferation of health apps and the rise of empowering

data is in the hands of both patient and physician. The electronic health record (EHR) and rise of centralized medical in-formation are at the center of this trend. Also, the ability for hospital to provide ac-cess to digital data is on the rise—a sev-enfold increase since 2013. Yet Meeker also presents the tremendous increase in health data and references, a 48% year-on-year growth. And the growth of medi-cal knowledge is also rapidly growing. In 1950, medical knowledge doubled over 50 years. By the year 1980, that changed to seven years. In 2010, medical knowledge doubled in 3.5 years. Meeker’s presenta-tion of data suggests that data itself has the power to inform, educate and overwhelm the medical and consumer communities.

Bold on genomics. As genomics digitizes, it gets faster, better and cheaper. And the accumulation of the data lead to a tremendous growth in knowledge. Meeker suggests that this increase will lead to a di-rect increase in therapeutics into the mar-ketplace. Also, a sequenced genome can be leveraged by an ecosystem of partners

to provide a variety of services and prod-ucts. This will ultimately result in more informed and empowered consumers.

Bold on innovation. Drug devel-opment was another interesting aspect of the presentation. As development costs in-crease, it was suggested that innovations in genomics can help better select patient pop-ulations for drug trial, impacting success and speed to market. The dissemination of information within the scientific commu-nity—the breaking down of silos—can also drive collaboration and innovation.

Meeker calls it a healthcare digital inflection point. I agree. However, this inflection point is less a single point on a curve, but more a reflection of multiple factors converging at this point in time. Technology is empowering and challeng-ing. But the tsunami of change is upon us, and it’s less a question of “if” than a ques-tion of “when.” To get a sense of this, just look over your shoulder.

Follow me @JohnNosta for a more informed and healthy future. Originally published on Forbes.com.

By BETH RUdLOFF, CHIEF InnOvATIOn OFFICER, MEdSPEAKS

The Florida Hospital Nicholson Cen-ter is an important part of the medical de-vice innovation climate in Central Florida and is expanding its state of the art ser-vices to embrace simulation, consulting, education, research, as well as digital and audio/video services. With this expansion of services, the Nicholson Center has po-sitioned itself well as an industry leader for increasing the competence and skills of physicians and surgeons.

The Nicholson Center’s highest vol-

ume trainer is the da Vinci robotic surgi-cal device, but they also conduct training on other robotic systems and devices; in fact the Nicholson Center is the only ro-botic training facility in the country that trains on all major robotics devices. Ef-ficient robotic surgical devices and profi-cient training on how to use them remain an important and evolving industry inno-vation. Robotic devices provide the sur-geon with an up close and precise view of the internal operating site with very small incisions; and HD video means the sur-geon doesn’t have to guess at the anatomy as they do with laparoscopic surgery. The classic fields you would regularly associate with robotic surgery such as urology, tho-racic, and gynecology, continue to grow in volume, but newer areas of growth include spinal surgery, and total knee or

hip replacements. However, the type of explosive growth we’re seeing in robotic surgeries cannot be supported by the in-dustry without the types of in depth train-ings provided at the Nicholson Center.

There are interesting new advantages for robotic surgery that are just starting to be explored, such as Telemedicine. A surgeon in a remote area using robotic surgical device can transmit the images in real time to a more experienced surgeon assisting in dealing with any unexpected issues during surgery and assuring the best possible outcome. Big Data is another burgeoning advantage of robotic surgery, even attracting the attention of large IT companies like Google and Apple. The possibility of mass data collection from robotic surgeries for analysis of outcomes is just around the corner, and data scien-

tists everywhere are chomping at the bit to begin analyzing robotic surgery met-rics. Our event moderator, Roger Smith, thinks the eventual outcome will be simi-lar to the “Intel inside” for computers. He imagines that someday soon, there will be the second tier artificial intelligence for robotic surgery, possibly advising the surgeon during the procedure on the best possible approach from its data analysis of thousands of similar procedures.

As innovators, we are impressed with the range and effectiveness of the Nicholson Center. Clearly the medical providers that visit for seminars and trainings to improve their clinical expertise are benefiting, and their patients are as well. This increased level of competency ripples out across Cen-tral Florida and beyond, creating better outcomes for patients and consumers.

Medical Devices: The Equipment of Innovation & Training (Part II)

Mary Meeker Is Bold On Digital Health

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By dALIA CAnTOR, CPA

Many physicians just catching a breather after implementing systems for electronic health records (EHS) but an-other challenge is awaiting right around the corner.

In 2015, the bipartisan reform legis-lation called Medicare Access and CHIP Reauthorization Act (MACRA) was passed. The goal of MACRA is to help change Medicare payments from quantity to quality based. Changes begin to roll out in 2017, so physicians need to begin now to understand the new structure. MACRA will consist of two payment structures, Merit-based Incentive Payment System (MIPS) and Advanced Alternative Pay-ment Models (APM).

A new Advanced Care Information (ACI) performance score under MIPS takes away the old “all-or-nothing” scor-ing and makes up 25% of the MIPS score. The new ACI performance score is de-signed to make the requirements more simple, support patient care, and be flex-ible to meet the needs of practices. Physi-cians are able to select criteria to focus on for their practice and choose which mea-sures best suit their practice.

ACI is only one section of four within the MIPS scoring system. The other three

sections include clinical quality, making up 50% of the whole score in the first year; re-source usage, making up 10% of the score in the first year; and clinical practice im-provement activity, making up 15% of the score in the first year. Adding in the score for advanced care information, for 25% of the total score in the first year, physicians will receive a total score in 2017 that will be used for payments in 2019.

The physicians who perform best will also be qualified for bonus payments of up to 10% from 2019 to 2024. Physicians scoring below a certain threshold will see opposite changes to their payments. Pen-alties will range from a maximum 4% in 2019 to 9% in 2022 and beyond.

Independent health care practitioners are faced with many challenges in today’s ever changing environment. Changes in payment models and reimbursement

methods, competition with a large group of employed physician practices, and changes in patients’ insurance coverage can negatively impact practices’ bottom line if physicians do not stay focused on fi-nancial performance of their practices. In order to continue to be successful, prac-tices should commit to staying on top of new regulations and effective implementa-tion of them as well as using best practices for cash flow management.

Dalia Cantor, CPA, has been practicing as an accountant and tax advisor since 1997. She is a Certified Public Ac-countant in the states of Florida and New York, and graduated Dowling College with a Bachelor’s Degree in Accounting. Dalia is a member of the American Institute of Certified Public Accountants and the Florida Institute of Certified Public Accountants. Prior to establishing her own practice, Dalia worked in public accounting managing both domestic and foreign audit and tax clients. In private indus-try, she was involved in the regulatory environment, spe-cializing in technical accounting, internal controls, and SEC reporting for publicly held companies. She can be reached at Dalia@mycpasolutions.com

What Does MACRA Mean to Your Practice?

published that Amazon may take seri-ous aim at the multi-billion-dollar retail pharmacy market. (In case you missed it, in April, Japan was the first market where Amazon began selling Class I drugs online.). Knowing this, I can’t help but contemplate whether Amazon will jockey for partnership or acquisition with smart pill bottles such as Orlando-based company, SMRxT simply because it could fit squarely into Amazon’s auto-fulfillment and Dash platforms. Medica-tion adherence is a well-known, complex problem and it seems feasible that this approach could be a win particularly for senior care.

Speaking of senior care, one of my favorite quotes of the event came from Jack in regard to a question about what future opportunities exist in geriatrics. He said, “As baby boomers age, it’s all about the issue of scalability around mobility. Without enough doctors, we will literally be forced to change the way care is de-livered.” Dr. Singh comically opined, “If you live long enough, you’re going to end up in the hands of a urologist. Telemed (technologies) that keeps patients where they are instead of transporting them, is the future. The need is already here.” In response to a growing need to keep geri-atric patients in the home, Dr. Ragavan added that “mobile diagnosis of patients in their homes is imperative to early di-agnosis and treatment of things like infec-tions and strokes.”

When it comes to breakthrough in-novation, the ongoing dialog exchange is not only important among experts, but also young companies determined to drive change in an industry going through massive shifts in care and payment models. To see such talent congregating, learning, and building relationships is exactly the reason why Florida is poised for growth. It’s up to us to collectively build bridges and move the proverbial needle in supporting mean-ingful, tangible medical inventions.

Medical Devices (Part I), continued from page 7

Do you have an invention or a natural curiosity about new developments happening locally? If so, then now is the time to get involved. There are a host of opportunities to share your expertise, ideas, patents, tools and devices with a group eager to engage, connect and grow.

Join the movement at www.meetup.com/FLHealth%20%20 or email info@medspeaks.com.

10 > JULY 2017 o r l a n d o m e d i c a l n e w s . c o m

By SOndA EUnUS, MHA, CMPE, CPB

Orlando Medical News is pleased to present this first in a series of answers to questions from readers dealing with issues faced by practice managers in our health care community. We encourage readers to send questions they face in everyday practice to editor@orlandomedicalnews.com.

1. How will MACRA impact my practice?

MACRA (Medicare Access and Chip Reauthorization Act) reporting started on January 1st, 2017, and even though we are already halfway through the year, many Medicare providers and practices are still not familiar with its requirements and stip-ulations. Additionally, some providers do not understand the urgency of getting on board with the quality measures because they erroneously believe that MACRA does not come into effect until 2019. This confusion stems from the fact that the first significant Medicare payment adjust-ments for quality measures will take effect

in 2019 – but the reporting and measure-ment of quality measures has already been in effect since the beginning of 2017. Until 2019, providers will receive a 0.5% annual increase in Medicare reimbursement, and will then need to choose one of the two available payment tracks under MACRA.

The Merit-Based Incentive Payment System (MIPS) is one of the payment tracks, and will be the one that most pro-viders will qualify for—at least in the first few years. This payment model will be closer to the Fee-for-Service model, but will take into account quality as well as patient volume. Quality will be measured by resource utilization, EHR use, and clinical improvement practices, on top of the traditional quality measures that pro-viders were reporting on under PQRS, Meaningful Use, and Physician Value Based Modifier. All of these programs will be replaced by MIPS. Each year, payment adjustments will be made based on the provider’s performance. These ad-justments can range from +9% to -9% by 2022. Under MIPS, the payment in-creases made to high-scoring providers

will be offset by the payment decreases to low-scoring providers. Furthermore, the best-performing providers will also receive additional payment adjustments.

The second payment track under MACRA is the Alternative Payment Model (APM) track. This option is riskier for pro-viders because they are taking on greater financial risk and responsibility for the over-all well-being of their patients. However, this increased risk is also rewarded by a 5% annual lump sum bonus in reimbursement. Not all providers will be able to qualify for the APM track, as they must hit a threshold for the percentage of total revenue that they receive from qualifying APMs.

Smaller physician practices are ex-empt from MACRA reporting. The origi-nal threshold for exemption was less than $30,000 in Medicare revenue, or fewer than 100 Medicare patients. However, since the reporting process is so complex and time-consuming, there is a new rule that was proposed by CMS on June 20th which will move the threshold to $90,000 or less in Medicare revenue, or fewer than 200 Medicare patients. This will exclude

approximately 834,000 clinicians from MACRA quality reporting.

All Medicare providers should edu-cate themselves on MACRA and its two payment tracks, and allocate time and resources to quality measure reporting in order to avoid penalties in the near future.

2. What practice specialties are best suited for providing telemedicine?

Technology is transforming the way that health care has traditionally been deliv-ered, and telehealth is a hot topic that many practice managers are curious about. Tele-health, or e-visits, are becoming increasingly popular due to their flexibility and efficiency, both for the patient and the healthcare pro-vider. Patients appreciate not having to take off work, travel, and sit in the waiting room and wait for their doctor’s appointment, and enjoy the ease of access to healthcare services

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o r l a n d o m e d i c a l n e w s . c o m JULY 2017 > 11

Five Points Your Physician Employment Agreement Should Address Regarding Med Mal Coverage

By JESSICA HOEHn

Physician employment agreement clauses about complex issues regarding your med mal coverage often are muddled at best, and some even create more ques-tions than they would if they just didn’t deal with the important malpractice in-surance issues. Confusion and ambiguous wording in contracts creates lawsuits so fully understanding these five points will help immensely:

• Who will be purchasing what coverage? Most Physician employment agreements at least state if the employer or employed physician will be purchasing coverage. The issues go well beyond that, but most agreements only hit the broad brush basics.

• Retro coverage or not when joining a new practice? Will retroactive coverage be purchased for the employed doctor’s possible previous exposure? If not who will pay for the expensive “tail” coverage? If retroactive coverage is being brought into the new practice who will be paying the difference between the “mature” policy cost and a first year claims-made policy cost? Tail coverage allows a physician to extend coverage after the cancellation of a claims made policy. With tail coverage, if a claim is filed that reflects the period of the expired policy, coverage is provided even though the policy is no longer in effect. An important portion of the employment agreement should address any professional

liability insurance coverage that will be required, as well as which party will be responsible for acquiring and paying for the coverage. If the professional liability insurance is a “claims made” policy, then tail coverage needs to be addressed in the agreement as well in case of departure or termination.

• Liability limits: What limits will be required to be purchased? There are differing opinions on purchasing low or high liability limits so the physician employment agreement needs to address the limits issues, as well as situations in which the employed doctor might want higher limits than most in the group, which brings up if this will be allowed and, if so, who will pay for the increased costs of a higher limits policy.

• Quality of insurance company: To say the least, not all insurers are created equal and there are vastly different thoughts on the risks versus costs of purchasing coverage from a financially unstable insurer versus an A.M. Best top-rated insurer.

• Departing physician’s tail issues: Will a tail purchase be required or will it be acceptable to purchase continuing coverage, keeping the in-force retroactive coverage date for at least five years after leaving a group? Will the choice between those two depend upon termination with cause or not, and/or termination by which party? Since there is now a stand-

alone tail market, what quality of tail insurer is acceptable

and how long of a tail must be purchased,

since even one-year tails can be bought but do not begin

to offer relief for the much longer liability risk window?

The physician employment agree-ment should outline all of these terms on whether the group or the individual physi-cian is obligated to pay for and purchase these coverages. By clearly stating the ex-pectations and requirements in the em-ployment agreement there should be no question on what is expected surrounding the beginning, duration of, and termina-tion of the employment relationship. But remember, lawyers only write up what parties are agreeing to, so all parties to the employment agreement need to fully edu-cate themselves with a knowledgeable and experienced malpractice insurance expert to prevent unrealized expectations or lots of miscommunications about the key issues, both of which can lead to very costly legal actions, which does no parties other than the lawyers any good. Remember too that a misstep in this area can lead to cover-age gaps or coverage issues at a time when you are being sued and want top drawer defense, not more legal issues because of a misworded employment agreement.

Jessica Hoehn is a medical malpractice insurance specialist with Danna-Gracey, an independent insurance agency with a statewide team of specialists dedicated solely to insurance coverage placement for Florida’s doctors. To contact Jessica, email jessica@dannagracey.com.  

that telehealth provides in general. Addition-ally, these services are now being reimbursed by both private and government payers, and can be a great source of additional revenue for healthcare providers. Many employers are now providing telehealth insurance ben-efits to their employees in order to reduce expenses, and it has been forecasted that 90% of employers plan to cover telemedi-cine services by 2018.

One of the leading specialties cur-rently offering telehealth is psychiatry and mental health counseling. Many patients who may benefit from regular counsel-ing sessions may not be able to fit these sessions into their schedule. Telehealth makes it possible because these patients can attend their sessions from their living room, and still obtain the same profes-sional care that they would at the clinic. Dermatology is another specialty that has found telehealth services to be very useful, as have many others including infectious diseases and pain management. There has been a remarkably low number of mal-practice claims related to telehealth so far, although these statistics may change as the volume of telehealth visits increase. Pro-viders interested in providing telehealth services must ensure that their malpractice insurance policy covers the provision of such services. Furthermore, some special-ties such as cardiovascular disease, chronic disease management, and oncology carry a higher risk of negative patient outcomes from telehealth services, and may find it safer to stick to traditional visits.

FOR MORE INFORMATION, VISIT:

https://www.ajg.com/media/1700234/healthcare-telemedicine-march-2017.pdf 

http://blog.evisit.com/top-specialties- for-telemedicine 

http://liveclinic.com/blog/telemedicine/ top-10-telemedicine-specialties-2017/ 

http://www.the-dermatologist.com/ content/top-teledermatology-trends 

http://www.beckershospitalreview.com/healthcare-information-technology/survey-telemedicine-is-most-useful-in-these-10-specialties.html

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Sonda Eunus, Founder & CEO of Leading Management Solutions  has a background in managing a multi-location pediatric primary care prac-tice, and truly enjoys medical practice management. She holds a Master of Healthcare Management, and a BA in Psychology. She enjoys sharing her work experience and knowledge of

the healthcare field through her consulting work and her writing. She founded Leading Management Solutions, a healthcare management consulting firm, out of her desire to assist medical practice managers and physician owners in the successful management of their practices, by pro-viding services that she herself needed while managing her practice. Along with a team of experienced and knowl-edgeable consultants, Sonda aims to make Leading Man-agement Solutions a one-stop shop for medical practices by offering a variety of needed services that add great value to any healthcare organization. She can be reached at sonda@lmshealthpro.com

Overwhelmed Yet?, continued from page 10

PRACTICE MANAGEMENT Q&A

12 > JULY 2017 o r l a n d o m e d i c a l n e w s . c o m

By BILL THOMAS, Md

When most people think about inde-pendence in the context of aging, they con-nect it to issues related to medical diagnoses and treatment. In fact, the experience of in-dependence in later life is defined primarily by and through function. The relationship between function and independence was first explored by Dr. Sidney Katz and his team at Cleveland’s Benjamin Rose Hos-pital more than half a century ago. His team analyzed data on treatments, clinical progression, and patient outcomes gath-ered from older people under their care. Although they began their work with the expectation that clinical diagnoses would be the best predictor of outcomes, they found that it was seemingly ordinary abilities like bathing, eating, mobility and hygiene that tracked most closely with the ability to live independently.

This insight has never been more important than it is today. A 2009 report on Medicare beneficiaries showed that 25 percent self-reported difficulty with at least one ADL. Although overall chronic disability among older age groups has decreased in the last few decades, man-agement of disability and maintenance of functional independence among elders has never been more important. According to a review performed by the Brookings Insti-tute, a person’s functional status continues

to be a significant predictor of “admission to a nursing home; use of paid home care; use of hospital services; living arrange-ments; use of physician services; insurance coverage; and mortality.”

During my decades in clinical practice it became clear to me that while our health care system’s ability to diagnose and treat acute conditions is unparalleled, the tools we need to help elders safeguard and ex-tend their function and independence are too often missing or unavailable. This is disheartening because practical determi-nants of function are exceptionally simple. People, especially people who are older and unwell, need to move, eat, sleep and

heal. We can see the truth of this simple as-sertion in Dr. Harlan Krumholz’s analysis of what he termed “post-hospitalization” syndrome. In an editorial, published in the NEJM he wrote, “During hospitalization, patients are commonly deprived of sleep, experience disruption of normal circadian rhythms, are nourished poorly, have pain and discomfort, confront a baffling array of mentally challenging situations, receive medications that can alter cognition and physical function, and become de-condi-tioned by bed rest or inactivity.”

Whether they are in the hospital or at home, elders benefit greatly when we en-able them to do the simplest and most vital

things. We should help elders 1) MOVE by emphasizing physical activity and strength maintenance or improvement, 2) EAT by promoting good nutrition while addressing nutritional deficiencies, 3) SLEEP to enhance the body’s ability to rest and recover while minimizing pain and stress so they can 4) HEAL. We are truly healed only when are able to move forward and find our new normal. Doing so would radically transform the experi-ence of hospitalization and, as Dr. Krum-holz concludes, “Shorter lengths of stay put an even greater premium on prepar-ing patients for a successful convalescence from the first day.”

Combatting “post-hospital” syndrome is important but what about the vast major-ity of older people who are not in the hospi-tal or receiving care of any kind? A survey of offerings currently available to elders liv-ing at home are skewed toward “care” and essentially assist elders with closing the barn door after the “horse” of independence is already gone. What older people and their families need and too often cannot gain ac-cess to are specific strategies, tools and tech-niques that can help them master the art of moving, eating, sleeping and healing in their own homes and on their own terms. Older Americans, despite their many dif-ferences, are united on this point. They

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treasure the ability to live in the place and manner of their own choosing and want to do so for as long as possible. Who can blame them?

There can be no doubt that the health care system will continue to contribute vitally to the well-being of older Americans. In the not too distant future, however, doctors and nurses will be joined in this effort by new and deliberately non-clinical technologies, strategies and enterprises dedicated to help-ing millions of older Americans get the sim-plest things (move, eat, sleep and heal) right. These innovations should be welcomed by the health care professionals who are dedi-cated to safeguarding the health and well-be-ing of their older patients. The ability to help elders improve their strength and well-being will do much to disrupt the conventional nar-rative of aging and craft a new story based on strength, purpose and belonging. We all deserve a new—and better — old age.

Dr. Bill Thomas, a graduate of Harvard Medical School, has dedicated his life to working with older populations. He’s spearheaded initiatives to change the way we treat our elders: The Eden Alter-native, which matches care according to the individual; the Green House Project to construct small, home-like environ-ments where people can live a full and interactive life; and Milo, a service that helps people thrive at home by focus-ing on well-being. Thomas is the author multiple books, most recently Second Wind: Navigating the Passage to a Slower, Deeper and More Connected Life (Simon & Schuster).

Social Customer Service and the Big Reason It Matters to Your Practice

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Just when you think you’ve finally gotten your head around why you need to be on social media, and what you need to be doing on Facebook and Twitter (shar-ing, educating, interacting with followers, etc.), the rules go and change again.

That’s right, social media is evolving yet again; and it’s imperative for you to keep up with the times by putting your best foot forward with social customer service.

So, what is social customer service? Consider it like a marriage - the joining together of social media and customer service (without the tax benefits). Not only are your patients able to ‘Like’ you on Facebook, but now they’re encouraged to share everything they may dislike about you as well. Oh, and the offspring of this perfect union?

Your online reputation.

The State of Social Customer Service and Reviews

Worldwide, there are nearly 2 billion active users on Facebook including 1.28 billion who login daily and spend an aver-age of 35 minutes on the social platform. Twitter, although significantly smaller, has 328 million users. The firm Social-Bakers suggests that more than 80 percent of customer service requests on social are happening on Twitter.

Whether you like it or not, Facebook encourages patients to make recommen-dations and post reviews. Just like visit-ing an online dating site to connect with a potential partner, your patients are actually doing something very similar in

peeking around on Healthgrades, Vitals, RateMDs, Yelp and Google before they book their first appointment. Heck, once you’ve been on your first ‘date,’ more often than not, patients are discussing how things went to their friends and even rating the experience online, especially on Facebook and Twitter. If you’re really unlucky, they’ll even tell their distant rela-tives about the experience (these are the typical online physician review sites you know and love).

You’ve Got a Following and Reviews. Now What?

Listen and respond. It’s important to pay attention to what your patients are saying online. Common, recurring com-plaints could be symptoms that something is actually in need of improvement at your practice; or, the patient could just be upset

and is venting. Either way, in most cases, it’s important that you respond because no response is still a response.

Considering 92 percent of all con-sumers admit to allowing online reviews to shape their purchasing and service deci-sions, patients are paying attention to your negative reviews and it’s impacting your ability to attract new patients.

The Most Common Complaints Aired on Facebook About Medical Practices

• Long wait times• Front office staff• Poor follow-up• Unnecessary tests• Physician/staff not listening • Differing of opinion (commonly

shows up something like: ‘The doctor doesn’t know what he’s talking about’)

Who Should Manage the Online Review Process at Your Office?

Managing your medical practice’s so-cial media presence generally falls to the marketing department (or outside con-sulting agency), but responding to online reviews and managing customer service inquiries should include somebody with an operational role within your practice to review the patient’s records and inves-tigate what actually happened with staff and, sometimes, the physician.

The relationship between marketing and customer service has very quickly gone from casual to an official marriage. The process will be different for every practice but it’s vital to actually have a process when the reviews come in - and they will. This marriage isn’t ending anytime soon.

Jennifer Thompson serves as President at Insight Marketing Group. She founded the medical marketing company in 2006 after an unsuccessful run for political of-fice (which she went on to win in 2010 & 2014). Jennifer has two decades ex-perience in marketing in the areas of technology, retail and medical for small businesses and Fortune 100 companies. For more, email Jennifer at Jennifer@InsightMG.com or visit InsightMG.com.

The Value of MESH,

continued from page 12

14 > JULY 2017 o r l a n d o m e d i c a l n e w s . c o m

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Social Customer Service and the Big Reason it Matters to Your PracticeBe prepared to get on the fast track and learn the latest and greatest in current trends in Social Media and Marketing.

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DATE/TIME: August 9, 2017 - 3:00- 5:00

LOCATION: Winter Park Community Center

GrandRoundsMissy Chaves Named Commercial Banker at Synovus Bank of Florida

Synovus Bank of Florida has announced the appointment of Missy Chaves as com-mercial banker. Chaves was previously with Surety Bank for nearly five years, most recent-ly as vice president, business relationship manager. She is located at the Synovus Bank of Florida Orlando office at 450 South Orange Boulevard.

“Missy is a deeply experienced banker with a wealth of personal knowledge of industries, companies and economic de-velopment opportunities in Orlando,” said Don Gaudette, Synovus Orlando market executive. “Customers will be in great hands with Missy, and we are thrilled to have her on board.”

Chaves’ 27 years in the banking industry include experience in commercial lending, treasury management, residential mort-gage, merchant, payroll and all other busi-ness banking services. She is a native and current resident of DeLand, and serves as president of the Deland Breakfast Rotary as well as assistant chair of the Economic Development Committee for the City of Deland. Chaves also serves on the Volusia County Fair Board and the Halifax Hospice of Volusia County Board.

Arnold Palmer Hospital Named a “Best Children’s Hospital” in 5 Specialties

U.S. News & World Report has ranked Arnold Palmer Hospital for Children in its 2017-2018 Best Children’s Hospitals rankings published online today. It is the only hospital in Orlando to be given this designation.

The hospital was ranked in five pediatric specialties:

· #21 in diabetes and endocrinology· #34 in orthopedics

· #36 in pulmonology· #43 in cardiology and heart surgery· #45 in urologyU.S. News introduced the Best Chil-

dren’s Hospitals rankings in 2007 to help families of children with rare or life-threat-ening illnesses find the best medical care available. They are the only comprehen-sive source of quality-related information on U.S. pediatric centers.

“We are pleased to learn that Arnold Palmer Hospital been ranked as a Best Children’s Hospital for the eighth consecu-tive year,” said Kathy Swanson, president of the Arnold Palmer Medical Center, which includes Arnold Palmer Hospital. “It’s an honor for our team to be recognized for the high-level of care we provide for our patients every day.”

The 11th annual rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties, including cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gas-trointestinal surgery, neonatology, nephrol-ogy, neurology and neurosurgery, orthope-dics, pulmonology and urology.

The Best Children’s Hospitals rankings rely on clinical data and on an annual sur-vey of pediatric specialists. The rankings methodology considers clinical outcomes, such as mortality and infection rates, ef-ficiency and coordination of care delivery and compliance with "best practices.” Sur-vival rates, adequacy of nurse staffing, pro-cedure and patient volume, availability of programs for particular illnesses and con-ditions and much more can be viewed on http://health.usnews.com/best-hospitals/pediatric-rankings.

This year’s rankings will be published in the U.S. News & World Report’s “Best Hos-pitals 2018” guidebook, available on news-stands September 12.

Free Back-to-School Physicals for Uninsured Children

Back-to- school physicals are a summer-

time ritual for school-aged children and their families. But, for the estimated 27,000 chil-dren in Orange and Seminole counties who are uninsured, this annual rite of passage can be out of reach. For the fourth consecu-tive year, Shepherd’s Hope, in partnership with Nemours Children’s Health System, is offering free back-to-school physicals and other medical services for local uninsured and underinsured families at three locations between July 31 and August 10.

The free back-to-school physicals will include general health assessments and sports physicals (minus immunizations) as well as vision and hearing screenings with a Nemours specialist. In addition, mam-mogram screenings will be available for women accompanying their children at the Longwood Shepherd’s Hope Health Center location in conjunction with the Florida Hos-pital for Women Mobile Wellness Coach.

To qualify, children must be under age 18 and uninsured. The required Florida Department of Health form (DOH 3040) will be issued following completion of the physical examination which meets the Florida state requirement for enrollment in public or private school. Appointments must be scheduled in advance.

Physicals will be conducted at the fol-lowing Shepherd’s Hope health clinic loca-tions. Appointments can be made by call-ing (407) 876-6699, ext. 243:Longwood Shepherd’s Hope Health CenterThe Sharing Center Plaza, 600 N. US Hwy 17-92, Suite #124, Longwood, FL 32750

Monday, July 31 | 9 a.m. to noonThursday, August 3 | 9 a.m. to noon Wednesday, August 9 | 9 a.m. to noon

Downtown Shepherd’s Hope Health CenterOrange County Medical Clinic, 101 S. Westmoreland Drive, Orlando, FL 32805

Wednesday, August 2 | 6 p.m. to 9 p.m.Dr. Diebel, Jr. Memorial Shepherd’s Hope Health CenterSamaritan Resource Center, 9833 E. Colo-

o r l a n d o m e d i c a l n e w s . c o m JULY 2017 > 15

FREE CONSULTATIONLEARN MORE 407-785-6200 X160

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It’s about People, not Machines.

INS is a different kind of IT Group. They are very responsive to your calls for assistance and are always available regard-less of the size of your company. INS is a family owned and operated company and you feel like they are family. You are confi dent that whatever the issue, they will solve it.

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Tuesday, August 1 | 6 p.m. to 9 p.m.Thursday, August 10 | 6 p.m. to 9 p.m.“Uninsured children deserve to get the

same start to their school year as their peers, and in partnership with Nemours, we are able to provide compassionate free health care to some of our youngest, most vul-nerable, neighbors,” said Marni Stahlman, president and CEO of Shepherd’s Hope.

Florida Hospital Partners with Panaceutics to Explore Use of Edible Gel Instead of Multiple Pills

Florida Hospital is partnering with pre-cision-medicine manufacturer Panaceutics to test an innovativesolution to the prob-lem of medication adherence, focusing on patients with cardiovascular disease.

According to the American Heart Asso-ciation, research shows that 24 percent of patients who suffer a heart attack do not fill their medications within seven days of dis-charge, and 34 percent of heart attack pa-tients with multiple prescriptions stop tak-ing at least one of them within one month of discharge. Lack of medical adherence is a factor in patients’ quality of life and con-tributes to the rising cost of health care.

But with Panaceutics’ proprietary compounding technology, rather than remembering to take a handful of pills, patients would have the option of taking their medications in a single, personal-ized, edible dose.

Panaceutics, which is based in the Re-search Triangle area of North Carolina and has business ties in Orlando, this month signed an agreement with Florida Hospital’s Cardiovascular Institute. The agreement is a first step in exploring how to bring this inno-vation to Florida Hospital’s patients.

“We are focused on the cardiovascular space because it’s such a large population, and we believe our automation technol-ogy will allow us to personalize and get benefit out of generic compounds,” said Pharmaceutics Chief Science Officer and co-founder L. Staton Noel III. “Our goal will be to show that with our method, ad-herence improves significantly. And when adherence is improved, outcomes go up for patients.”

Janis Moysey, Director of Alliance Inno-vation Development for Florida Hospital, said the Panaceutics agreement is an im-portant step in advancing Florida Hospi-tal’s mission to find innovative solutions to pressing health-care challenges.

Dr. Duane Davis, director of the Cardio-vascular Institute at Florida Hospital, said he looked forward to exploring the options offered by Panaceutics’ technology.

Florida Hospital to Begin Using Risk-predicting Software for Angioplasty Patients

Florida Hospital, part of Adventist Health System, will soon begin using ePRISM®, a technology platform from Health Out-comes Sciences (HOS) that automates calculations of risk and appropriate use for individual patients receiving angioplasty.

ePRISM software digitizes and makes ac-

cessible research data that previously may have sat unused for years. Using this assem-bled data, ePRISM will bring predictive risk modeling into the workflow, allowing clinical teams the opportunity to better understand the specific risks of individual patients, and will assist the physicians in making more in-formed and confident clinical decisions.

“Florida Hospital is always looking for new technologies that will allow us to pro-vide exceptional care to our patients,” said Kimberly Bell, assistant vice presi-dent of the Florida Hospital Cardiovas-cular Institute. “By working with the team from Health Outcomes Sciences and their ePRISM platform, we will be able to deliver precision medicine at the bedside.”

ePRISM will allow Florida Hospital clini-cians to gauge patients’ risk for PCI bleed-ing, acute kidney injuring, restenosis and mortality, and to decide appropriate use of coronary revascularization, prior to the start of the procedure.

Florida Hospital will serve as a reference site for Health Outcomes Sciences and will also help develop new models of care de-livery in cardiology. Specific areas of focus include interventional cardiology, cardio-thoracic surgery and electrophysiology.

ePRISM will first be deployed at Florida Hospital Celebration Health, and will then be put into use at Florida Hospital locations across Central Florida over the next year.

Groups: Mobility & Liberty of Amputees At Risk If Changes Shrink Coverage

Many of the two million Americans who are amputees – including military veterans, accident victims, and older Americans – could lose care and the mobility and liberty that comes with that care if federal health care reform is not crafted to avoid three key “pitfalls,” according to the American Orthotic & Prosthetic Association (AOPA) and the Amputee Coalition.

As outlined by the groups in a recent news conference, the “big three” priority

Local residents came together for the Jess Parrish Medical Foundation (JPMF) “Fran Gerrett Memorial Golf Classic” on Friday, April 21 at La Cita Golf & Country Club and The Great Outdoors Golf Club. The event was presented by the law firm of Zumpano Patricios & Winker, P.A. and raised more than $65,000 for The Chil-dren’s Center (TCC) in Titusville.

“The success of the Fran Gerrett Me-morial Golf Classic rests on the wonder-ful support from the community for the work of TCC. We believe in continuing the foundation’s mission of providing healing experiences to families through-out Brevard County and helping make a difference for the next generation,” said Joseph I. Zumpano, shareholder at Zum-pano Patricios & Winker, P.A.

More than 220 golfers and volunteers participated in the two-course tournament with all proceeds benefiting TCC, a ser-vice of Parrish Healthcare, which provides families with special needs and/or typically developing children with numerous health,

therapy, education and child development programs in a single location. The annual golf tournament lives on as a tribute to Fran Gerrett’s longtime dedication to our community and his favorite charity. Fran, a former Parrish Medical Center Materials Management director, was famous for say-ing, “It’s all about the kids!”

The committee secured 53 sponsor-ships from numerous community mem-bers and organizations. Gold sponsors include Susan Morse, Senior Vice Presi-dent and Steve Soltesz, Financial Advisor, Indian River Wealth Management Group. Silver sponsors include Berkeley Research Group, LLC; Boggs Gases; Medline Indus-tries, Inc.; RUSH Construction, Inc.; and The Watauga Company.

“We’d like to thank all our sponsors, golf-ers, committee members and volunteers who helped us reach our goal and make this event a huge success for the children in our community,” said Gene Sego, chair of the Jess Parrish Medical Foundation Board of Directors.

Jess Parrish Medical Foundation Golf Classic Drives Results Exceeding $65,000 for The Children’s Center

With months of preparation and planning, the Fran Gerrett Memorial Golf Classic was a huge success.

(CONTINUED ON PAGE 16)

16 > JULY 2017 o r l a n d o m e d i c a l n e w s . c o m

GrandRounds

issues for amputees are as follows: (1) no cuts to Medicaid that would turn back the clock on the limb-loss/mobility impaired community in terms of access to needed treatment and state-of-the-art devices; (2) no waivers as to rehabilitative and ha-bilitative services (an essential health ben-efit) that could be used to deny access to care and treatment for amputees; and (3) no changes to authorize higher premiums with respect to amputation as a pre-exist-ing condition that could interfere with cov-erage access. (See details below.)

AOPA President Michael Oros said: “For amputees, loss of affordable health insur-ance not only means a loss of care, it also means a loss of independence and liberty in the form of the mobility that the care makes possible."

Dr Jeff Cain, head of advocacy program of the Amputee Coalition, a Denver physi-cian, and former president, American Acad-emy of Family Physicians, said: “Arms and legs are not a luxury … I have three con-cerns about the current health care reform that could severely limit people with ampu-tations: #1) If fewer people have insurance, fewer people can afford health care, and that means fewer amputees will be able to afford a leg to stand on … second, not mandating essential health benefits, includ-ing habilitative and rehabilitative services, would mean that the cost to insure those people would rise dramatically. If you can’t afford an insurance policy, you can’t afford a leg to stand on … and third, we cannot afford to go back to the pre-ACA world of pre-existing conditions, which prevented amputees across the country from being able to afford a leg to stand on.”

More details about the three areas of concern for AOPA and the Amputee Coali-tion are detailed here:

* Medicare cuts. Orthotics and prosthet-ics provided through Medicaid to millions of individuals are at risk within the current framework of healthcare legislation reform.

In 2013, around the time the Medicaid expansion was in full effect, the recorded number of amputations (upper and lower extremity) was 154,000 and 14% of those where paid by Medicaid as compared to 18% by private payers. Since the majority of amputations are between the ages of 45-64, the time before someone becomes eligible for Medicare, and the fact that not all private payers cover prosthetics, the loss of Medicaid expansion could be det-rimental to patients facing limb loss and already suffering from limb loss.

* Essential health benefits. Removing of certain essential health benefits from insurer plans may cause individuals to face the possibility of not having coverage for orthotics and prosthetics (bracing and ar-tificial limbs), or be faced with unrealistic annual limits or artificial lifetime caps. Or-thotics and prosthetics are considered an essential health benefit under the rehabili-tative and habilitative services and devices category; in part because it was included in 70-75 percent of private payer plans. If essential health benefits are removed we could return to 25-30% or more of private employer plans not covering orthotics and prosthetics, and possibly even an increase in the number of non-employer based plans not including O&P coverage.

* Pre-existing conditions. Amputations which are traumatic or caused by an acci-dent, may not always be considered a pre-existing condition, however if the amputa-tion and all follow-up care is required as a result of a disease (non-traumatic); then it could be considered as a pre-existing con-dition. For example, diabetes may be cur-able but can also be a long-term illness and lead to an amputation; and cause insurance companies to declare the amputation as a pre-existing condition. A large number of individuals have been affected by the burdens caused by diabetes, in 2010 29.1 million individuals were diagnosed with diabetes and in 2010 60% of non-traumatic lower-limb amputations among adults were attributed to people with diabetes. There are also several conditions (e.g. cerebral palsy or multiple sclerosis) currently listed

as pre-existing, and life lasting, which may result in some type of limb impairment and require the use of an orthosis.

LRMC Part of Baby Friendly Project

Leesburg Regional Medical Center (LRMC) is a participant in the 2017 Baby Steps to Baby Friendly project to increase breastfeeding initiation and duration rates in Florida. A growing body of evidence points to breastfeeding as critical to im-proved health outcomes for mothers and babies, and beneficial to the families and communities in which they live. The goal of this project is to implement and enhance hospital maternity care practices that sup-port and promote breastfeeding.

LRMC recently completed each of the mandated steps in the Baby Steps to Baby Friendly program. “Completing the proj-ect means that we have earned a $20,000 grant from the state of Florida to be used for staff education and required projects for the final Baby Friendly designation,” says Sandra Mullin, Director of LRMC’s Ma-ternal Child Health Unit.

The hospital will now move on to the designation phase with the goal of com-pleting the Baby Friendly survey in Au-gust of 2018.

As the hospital strives to promote breastfeeding, LRMC will celebrate World Breastfeeding Awareness Week in a big way this year with its annual Mom-To-Be Expo Tuesday, August 1 from 2 to 4 p.m. in the hospital’s lobby. This free community event is for women who are pregnant or planning to become preg-nant and who want to learn more about what the hospital has to offer.

“Guests at the Mom-To-Be Expo will be able to learn more about preparing for their baby, childbirth, and breastfeed-ing,” continues Mullin. “Tours of the la-bor and delivery suites will be included as well as giveaways, raffle prizes, re-freshments and more.”

To register for the Mom-To-Be Expo, vis-it www.LeesburgRegional.org/MomToBe.

Tavistock Development Company, a diversified real estate firm owned by Ta-vistock Group, announced that Certara®, the global leader in model-informed drug development and regulatory science, is opening a new office in Lake Nona Medi-cal City in a 3,526-square-foot (SF) space on the second floor of the GuideWell In-novation Center.

An established innovator, Certara® uses model-informed drug development, regulatory science and knowledge inte-gration to enable superior drug develop-ment decision-making and optimize R&D productivity, commercial value and patient outcomes. With 19 offices on four conti-nents, Certara’s portfolio spans the discov-ery, preclinical, clinical and post-marketing phases of drug development. Certara’s cli-ents include 1,200 commercial companies,

250 academic institutions and numerous regulatory agencies around the world.

“There is a growing global demand for scientists who are skilled at using model-ing and simulation to improve decision making throughout the drug development process,” said Certara Chief Executive Officer Edmundo Muniz, MD, PhD. “The University of Florida’s Center for Pharma-cometrics and Systems Pharmacology in Lake Nona is doing an excellent job of training the next-generation of pharmaco-metricians. In fact, Certara just established an endowed professorship to support their work further. We are looking forward to expanding our offices, building upon our successful partnership with the Center for Pharmacometrics and Systems Pharmacol-ogy, and establishing new relationships with other tenants.”

Located within the innovation campus of Lake Nona’s health and life sciences cluster, a global destination for healthcare innovation in Orlando, Florida, the Guide-Well Innovation Center is an ideal location for companies that are creating game-changing diagnostic, treatment, and moni-toring solutions that help improve health. Opened in March 2016, the 92,000 SF facil-ity is uniquely designed to accommodate

both office and wet lab space, meeting the needs of companies of a variety of sizes and stages of development.

Certara joins existing innovation cam-pus anchor tenant, GuideWell Innova-tion’s Collaborative Resources Ecosys-tem (CoRE). For leasing inquiries, contact Ginger Vetter at gvetter@tavistock.com or (407) 816-6686.

Certara Opening Office in Lake Nona Medical City

Groups: Mobility & Liberty of Amputees, continued from page 15

Powering Medical City

LAKE NONAEVENTS

Breakfast Connections are the 2nd Wednesday of each month. Business Luncheons are the 4th Friday of each month

MONTHLY BUSINESS LUNCHEON FRIDAY JUL 28, 2017 11:30AM - 1:00PM EDT Ronald McDonald House, Nemours Children’s Hospital13551 Nemours Parkway, Orlando

Our Business Luncheon Event has been designed to promote strong connections, business opportunities and fun through education! 

BREAKFAST CONNECTIONS @LAKEHOUSEWEDNESDAY, AUGUST 9, 2017 8:00AM - 9:30AM EDTLakehouse 13623 Sachs Ave., Orlando

For more event info contact Elaine Vail at administration@lakenonacc.org

Refer patients with sprains, strains and breaks to our Orthopaedic Injury Walk-in Clinic and they’ll receive immediate care

without an appointment from an orthopaedic specialist.

THE EMERGENCY ROOM VISIT. THE INCONVENIENT WAIT TIMES.

THE HASSLE WHEN YOU’RE INJURED.SKIP

Save Time. Save Money. Immediate Access.

N O W O P E N

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