Robert Hirschl, MD

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By LyNNE JETER

TALLAHASEE – In mid-December, the Florida Medical Association (FMA), Florida Osteopathic Medical Association (FOMA) and the American Medical Association (AMA) joined forces to oppose Aetna Inc.’s appli-cation to acquire Humana Inc., in Florida.

Aetna, the fourth-largest insurer, announced July 3 that it plans to buy Humana, the largest insurer of Medicare Ad-vantage, for $37 billion to form the largest Medicare Advan-tage insurer in the state.

“We believe that high insurance market concentration is an important issue of public policy because the anticompetitive effects of insurers’ exercise of market power poses a substantial risk of harm to consumers,” according to the joint letter. “Our analysis of data related to the proposed merger reveals signifi cant concerns with respect to the impact on con-sumers in terms of healthcare access, quality, and affordability.”

The trio of associations sent a letter Dec. 17 to the Florida Department of Financial Services’ Offi ce of Insurance Regulation (OIR), concerning the poten-tial combination of Aetna and Humana.

Physicians Displeased with Aetna/Humana Proposed Merger ProcessAMA, FMA, FOMA Claim Florida’s OIR Provided Insuffi cient Information

By LyNNE JETER

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The affi liation expands Osceola Regional’s existing team of pediatric ER physicians, neonatologists and local pediatricians. Doctors from Nemours now provide on-site care at Osceola Re-gional’s 13-private room pediatrics unit.

Also, when Osceola Regional completes construction on its $7 million, 6-room pediatric intensive care unit (PICU) this summer, and expansion of its existing Pediatric Inpatient Unit and Neonatal ICU Level II, Nemours will staff the unit with pediatric intensivists

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Clinical CollaborationNeurosurgery Program Adds Robert Hirschl’s Expertise

By JEFF WEBB

ORLANDO - When Robert Hirschl makes a new acquaintance, the 38-year-old frequently receives a well-intentioned, but awkward, compliment. “Most people who meet me say ‘I can’t believe you are a neurosurgeon. You seem so normal!’” he said.

Or, a quip along the lines of “Well, it’s not exactly brain surgery,” might fol-low. “That gets old, but it’s always in good fun,” said Hirschl.

To a layman, Hirschl’s expertise might appear unlikely. But to his col-leagues and patients, it is anything but unexpected. Hirschl is medical direc-tor for the University of Florida Health Neurosurgery Clinic at Orlando Health, headquartered at Orlando Regional Medical Center. Hirschl also is associate chairman and associate professor of neu-rosurgery at UF’s College of Medicine in Gainesville.

Hirschl’s arrival in August 2015 added depth to the existing surgical team, which now includes five neurosurgeons and one endovascular neurologist, said William Friedman, MD, professor and chairman at UF Health Neurosurgery. “We are thrilled to have him in our de-partment,” said Friedman. “He is a very experienced neurosurgeon with exper-tise in endovascular, cerebrovascular and minimally invasive spine neurosur-gery. He is also an experienced leader,” Friedman said.

Hirschl gained a good deal of that leadership experience in his previous post at Mercy Medical Center in Des Moines, Iowa. He was the architect of the neuro-surgery department at the hospital, which was the “biggest and busiest hospital in the state. I was lucky to be in a situation where I could build the program, which I really enjoyed,” said Hirschl. “But I missed the academics,” an area in which he had ex-celled during his neurosurgery residency and neuro-interventional endovascular fellowship at his medical school alma mater, Ohio State University. During residency, Hirschl said, he was awarded attending privileges at the Ohio State Uni-versity Medical Center, the only time that has ever happened.

So, “When Dr. Friedman offered me the position I just couldn’t pass it up,” said Hirschl. The clinical collaboration be-tween UF and Orlando Health has been “phenomenal. … First class. And the (ORMC) staff is incredible. It has been a great experience,” he said.

As medical director of Florida Health Neurosurgery at Orlando Health, Hirschl said he spends two days a week in clinic and two days in the operating room. Another day is devoted to “catch-ing up” and administrative chores, he said. “I split most of my time between

minimally invasive spine surgeries and endovascular work,” said Hirschl, adding that trauma and emergent cases demand “a large portion of our time because we are the only Level 1 trauma center in the area.”

There also is a hands-on teaching component for Hirschl at Orlando Health. “There’s a chief resident rotation, so the chief residents at UF in Gainesville come down and rotate, usually for 3 months at a time. There’s always one here. Occasion-ally we will have med students from UF as

well as Florida State (University’s) medical school,” he said.

Hirschl’s accomplishments reach be-yond his leadership, academic and surgical skills; he also is an accomplished inventor.

“I started tinkering when I was an undergrad, but it really was when I was a resident that I got serious about invent-ing,” he said. “I’ve always enjoyed com-ing up with solutions to problems. Trying to make minimally invasive spine surgery more effective and safer is something I’ve been passionate about, so most of my in-novations have been surrounded by that.”

“A lot of it was done on my own. I’d either sell the IP (intellectual property) to private industry, and then have my own company develop instrumentation,” he said.

Hirschl described his current pat-ent project: “One of the main challenges of minimally invasive spinal surgery is decreased fusion, or bone healing, due to lack of exposure. I have invented and am studying a novel spinal implant … to promote bone healing and increase fusion rates.”

That’s lofty terrain for a young man who grew up in gritty Youngstown, Ohio, the youngest of three children and the only son of a high school science teacher and stay-at-home mom. Hirschl said he didn’t even consider a career in medicine until his sophomore year at Youngstown

State University. “I realized that at some point I needed to figure out what I would do with my life,” he recalled. “There was a flyer on a bulletin board about a shadow-ing rotation for general surgery and car-diovascular surgery. I went and l loved it. I knew then (surgery) was what I wanted to do.”

By then, Hirschl had met the love of his life, Erica, a fellow chemistry major with whom he found his element. “We’ve been together ever since,” he said. The couple married in 2001, and eight years ago son Issac joined the family.

Making time to accommodate his personal and professional lives is a prior-ity, Hirschl said, and it requires a team effort. “It’s really about being around people who are understanding. I married well (with) my wife being very understand-ing and not expecting a lot of my time in terms of being home when most people would be home. That certainly helps. But it’s always tough to have work-life balance, and we certainly try. I work more than I probably should; it’s just what we do.”

For those who encounter Hirschl and wish to avoid the perils of the “You-seem-so-normal-for-a-neurosurgeon” conversa-tion, try this: Last year, before he left Iowa and at the urging of his friend and col-league Pat Hood, Hirschl skydived. He’s glad he did it, but he won’t do it again.

“Once was enough,” he said.

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By ANN BITTINGER

Leo Tolstoy once wrote that “Ev-eryone thinks of changing the world, but no one thinks of changing him-self.” In this era of great change in the healthcare industry, stakeholders point fingers at CMS, at the Obama admin-istration, at the payers, at the hospitals. The successful individuals, however, look at themselves. Physicians will sur-vive in these changing times if they look at changing their own practice settings, their groups and their relationships to fit the times.

I have spent the last 17 years work-ing with physicians organizing their individual practices and internal corpo-rate group structures and aligning them in the greater healthcare market to lay the proper foundation and structure – legally – for my physician group clients to flourish. In this three-part series, I will share ways that practices in Florida are adapting to the changing market. These are structures that you can learn from, and modify to fit your own needs and goals.

Alignment This first article will address the

issue of alignment. Alignment and consolidation are not the same thing. As more and more physician groups

sell their companies to hospitals and become hospital employees, the dis-tinction between alignment and con-solidation is important. A group can consolidate into a hospital system but never truly align. Reciprocally, a group can align with a hospital without con-solidating with it (or selling out to the hospital). An experienced healthcare attorney can help you restructure your practice and align it within a loosely-integrated delivery system without the sacrifices that becoming an employee involve.

Incentives to stay Independent When a physician sells a practice

and becomes a hospital employee, that physician sacrifices a number of im-portant things. First, long term profits from his or her direct and indirect labor become profits of the hospital. Recent cases involving hospital excessive pay-ment to physician employees have put great pressure on health systems to pay very conservative salaries to employed physicians. The Halifax case made hos-pitals very wary of giving physicians any type of bonus based on profits from his or her division or subspecialty. Other cases have impacted the industry such that many hospital systems are not pay-ing physician employees any bonus unless it is directly tied to his wRVUs.

Astute physicians know that they are not going to get ahead in life if all they are earning is based solely on the direct patient care they provide. Employed physicians cannot be paid for work they refer to the hospital without violating the Stark Law. Employed physicians cannot be paid for diagnostic work, lab work, prescriptions, and therapy that goes through their practice setting with-out violating the Stark Law.

The fact of the matter is that even though physician groups are selling out to hospitals in epidemic proportions, there is great incentive for physicians to retain their own groups. Not only are there financial benefits, most physi-cians agree that their practices are more effective in patient care when they are operated by physicians rather than mid-level hospital administrators.

So how does a physician group sur-vive without selling out to a hospital? Let’s take a look. First, I guide clients through a process of identifying what is their biggest threat and what strengths and power they have in the market.

Reimbursement If the self-evaluation process reveals

that reimbursement rates are the biggest threat, I ask my client to look closely at that. It seems that it’s a knee jerk reac-tion for my physician group clients to

say “I’ll make $20 more per 99214 if I join the hospital.” This is a very nar-row way to look at things. First, sure the hospital contracts with payers may be better than the group’s payer con-tracts, but what about collections? Can the hospital properly capture the work, bill for it, and collect on it as effectively as the physician group? I’ve been in-volved with a number of groups who consolidated with a hospital with bet-ter payer contracts, only to find that the hospital wasn’t collecting well, which impacted the physicians’ collections-based bonuses.

IPAsInstead of consolidating with a hos-

pital by selling outright, many of my cli-ents examine ways to align with other providers – including ancillary provid-ers. If there’s one mantra that’s true in 2016 in healthcare it is: “what’s old is new again.” HMO enrollments are on the rise, for example. Another example, in the alignment arena, is the IPA, for Independent Physician Association. IPAs are loose (but not too loose) asso-ciations of independent practices that organize to negotiate contracts with the payers.

Integrated GroupsThe IPA concept could take a

tighter approach by actually merging groups together in some degree. One approach is to join already-existing physician groups together by way of a jointly-owned parent company. We form the parent company as an um-brella company, owned by individual physicians. The existing physician groups become subsidiaries of the new umbrella company. The umbrella com-pany has the volume in terms of physi-cians that the payers want in order to give good reimbursement rates. And the physicians still operate somewhat independently in their individual sub-sidiaries in terms of the day to day op-erations.

These are just a few of the many variations that alignment can take to re-tain a good amount of independence for the physicians from the hospitals. Next month’s article will explore ways that are a little closer to integration of the hospital and group without constituting a full-fledged sale of the practice.

The Times They are A-Changing

Ann M. Bittinger specializes in advising healthcare entities in their business transactions.  Her particular expertise is in legal relationships between hospital systems and physicians or physician groups, such as co-management agreements, joint ventures, clinical integration arrangements, practice acquisitions and employment agreements. Board certified by The Florida Bar in health law in 2005, she is in particular demand from companies located outside Florida that are expanding their businesses into Florida.  She has serviced client companies headquartered in Dallas, Nashville, Boston, New York City, San Francisco, Los Angeles and London, U.K. She can be reached at Ann@bittingerlaw.com.

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“We’ve analyzed the likely competitive effects of this proposed merger both in the sell-side market for insurance and the buy-side market for physician services,” accord-ing to the joint letter. “We’ve considered data on competition in health insurance in recent studies on the effects of health insur-ance mergers, and the testimony of Aetna’s executives and expert, Dr. Thomas R. McCarthy of NERA Economic Consult-ing. We’ve reviewed this matter from our long-standing perspective that competi-tion in health insurance, not consolidation, is the right prescription for health insurer markets. Competition will lower premiums, force insurers to enhance customer service, pay bills accurately and on time, and de-velop and implement innovative ways to improve quality while lowering costs.

“Competition also allows physicians to bargain for contract terms that touch all aspects of patient care.”

Monopsony ConcernsThe result, medical association lead-

ers emphasized, will be detrimental to consumers.

“The merger would create, enhance or entrench monopsony power in Florida markets for the purchase of physician services,” said Thomas L. Greaney, a na-tional leading antitrust expert, Chester A. Myers Professor of Law, and co-director of the Center for Health Law Studies at the Saint Louis University School of Law in St. Louis, Mo.

“The lessons of oligopoly are perti-nent here: consolidation that would pare the insurance sector down to less than a handful of players is likely to chill the en-thusiasm for venturing into a neighbor’s market or engaging in risky innovation. One need look no further than the airline industry for a cautionary tale.”

Northwestern University’s Leemore S. Dafny, PhD, a professor of strategy, the Herman Smith Research Professor in Hospital and Health Services, and direc-tor of Health Enterprise Management at

the Kellogg School of Management, explained in recent Senate testi-mony on the merger that monopsony is “the mir-ror image of monopoly; lower input prices are achieved by reducing the quantity or quality of ser-vices below the level that is socially optimal.”

Dafny also noted that “if the past is prologue, insurance consolidation will tend to lead to lower payments to health-care providers, but those lower payments will not be passed on to consumers. On the contrary, consumers can expect higher in-surance premiums.”

Impetus of the Letter The Dec. 17 letter was prompted by

questionable actions by the OIR that oc-curred nearly a month earlier. On Nov. 20, the Friday before Thanksgiving, the OIR published in the Florida Register no-tice of a Dec. 7 public hearing on Aetna’s application for the proposed acquisition of Humana. Even though physicians practic-ing in Florida have substantial interests that would be affected by the OIR’s de-cision on the application, the OIR didn’t serve a copy of the notice to the FMA or FOMA. The notifi cation and scheduling snafu made it unlikely for those impacted by the decision to conduct due diligence on the issue to adequately participate, ac-cording to the joint letter.

In addition, a submission of com-ments by Dec. 17 had been hampered because the OIR “has been dilatory in producing requested application-related documents, such as Aetna’s competitive analysis, which the OIR still hasn’t pro-duced,” according to the joint letter.

Politico Florida’s report described the OIR hearing as “oddly lacking the par-ticipation of anyone except Aetna and Humana executives and witnesses for the companies,” according to the joint letter,

adding the report characterized the hear-ing as a mere gesture inconsistent with im-portant public policy issues at stake.

“At the capital on (that) Monday, no critics appeared to oppose the merger, which would impact about 2.4 million people spanning four licensed Humana insurance companies in Florida,” accord-ing to the report.

The Fallout The mega-merger’s impact would

exceed federal antitrust guidelines and be presumed to enhance market power in three Florida metro areas: Jacksonville, Sarasota-Bradenton-Venice, and Tampa-St. Petersburg-Clearwater, the joint letter read.

According to the U.S. Department of Justice, “a merger enhances market power if it’s likely to encourage one or more fi rms to raise price, reduce output, diminish in-novation, or otherwise harm customers as a result of diminished competitive con-straints or incentives.”

The AMA analysis, continued the joint letter, also shows the proposed merger would raise signifi cant competi-tive concerns in an additional four Florida metro areas, including Fort Lauderdale-Pompano Beach-Deerfi eld Beach, Lake-land-Winter Haven, Miami-Miami Beach-Kendall, and West Palm Beach-Boca Raton-Boynton Beach.

“Physicians charge that Aetna has yet to address fi ndings showing the nega-tive competitive effects of the proposed merger,” according to the joint letter. “Physicians noted to Florida insurance regulators that Aetna hasn’t met its bur-den of proof to show the merger wouldn’t substantially lessen competition, or tend to create a monopoly in Florida’s commer-cial health insurance market.”

Bottom line of the joint letter: Physi-cians believe that Florida is at a critical de-cision point on the Aetna-Humana merger and urged state regulators to reject Aetna’s application to acquire Humana.

Aetna/Humana’s TakeIn an Aetna/Humana joint press re-

lease, company leaders said the comple-mentary combination brings together Humana’s growing Medicare Advantage business with Aetna’s diversifi ed portfolio and commercial capabilities to create a company serving the most seniors in the Medicare Advantage program and the second-largest managed care company in the United States.

“The combined entity,” according to a company press release, “will help drive better value and higher-quality health-care by reducing administrative costs, le-veraging best-in-breed practices from the two companies — including Humana’s chronic-care capabilities that measurably improve health outcomes for larger popu-lations — and enabling the company to better compete with more cost effective products.”

Aetna CEO Mark T. Bertolini put it bluntly: “The acquisition of Humana aligns two great companies and will sig-nifi cantly advance our strategy of more effectively serving members in a rapidly changing healthcare industry.”

Humana CEO Bruce D. Broussard summed up the transaction as “a testa-ment to the accomplishments of Humana associates and an outstanding outcome for our shareholders, who will receive an im-mediate premium and the opportunity to

Physicians Displeased with Aetna/Humana Proposed Merger, continued from page 1

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participate in the growth potential of the combined organization.”

Next Step If approved, Aetna has said it doesn’t

anticipate closing on the Humana acquisi-tion earlier than mid-year.

In the meantime, association leaders asked the OIR to grant a 30-day continu-ation of the hearing to allow critics of the proposed merger to have timely access to documents and to testify before the hear-ing panel.

Florida law places the “burden of proof” on Aetna to show “the effect of the acquisition wouldn’t substantially lessen competition or wouldn’t tend to create a monopoly.”

“In other words, Aetna must produce the evidence and carry its burden of per-suasion that the merger wouldn’t substan-tially lessen competition,” according to the joint letter. “Accordingly, this statement will begin by examining the evidence pre-sented by Aetna through its expert, Dr. McCarthy.”

The proposed merger, they say, vio-lates NAIC competitive standards and federal antitrust merger enforcement stan-dards.

Perhaps the greatest obstacle, associa-tion leaders pointed out, is the so-called chicken-and-egg problem of health insurer market entry: health insurer entrants need to attract customers with competitive pre-miums that can only be achieved by ob-taining discounts from providers.

“However, providers usually offer the best discounts to incumbent insurers with a significant business—volume discount-ing that reflects a reduction in transaction costs and greater budget certainty. Hence, incumbent insurers have a durable cost advantage,” according to the joint letter.

AMA pointed to the presence of sig-nificant entry barriers in health insurance markets that was demonstrated in the 2008 hearings before the Pennsylvania In-surance Department on the competition ramifications of the proposed merger be-tween Highmark Inc. and Independence Blue Cross. In a report commissioned by the Pennsylvania Insurance Department, consulting firm LECG Corporation con-cluded it was unlikely that any competitor would be able to step into the market after a Highmark/IBC merger.

Another wrinkle: According to a re-cent New York Times article, the Obama administration will pay only 13 percent of what insurance companies were anticipat-ing to receive through “risk corridors” that were expected to help insurance compa-nies with too many sick people and too lit-tle cash to operate in the first years under the health law.

“There have been reports that Unit-edHealth Group Inc. may leave the mar-ketplaces,” according to the joint letter. “Moreover, only two for-profit companies that weren’t already health insurers have entered the state marketplaces.”

One company is Oscar, touted by Bertolini as an example of successful entry in his testimony before the Senate Judiciary Committee. However, Oscar estimated in a regulatory filing that it lost about $27.5 million in 2014, roughly half its revenue. The CEO of Oscar, one of the very few new companies to even attempt entry, described the task as “quite daunt-ing.”

Rejecting the MergerAMA, FMA and FOMA leaders

noted that any remedy short of reject-ing the merger application wouldn’t ad-equately protect consumers, and that a divestiture wouldn’t protect against the loss of potential competition that occurs when one of the largest health insurers is eliminated. Also, divesture could be highly disruptive to the marketplace and cause harm to consumers, especially in Medi-care Advantage markets where the elderly

would be faced with a new insurer. “As a practical matter, the over-

whelming number of markets adversely af-fected by the proposed merger, along with the barriers to entry to health insurance, makes unlikely that the OIR could find proposed buyers of assets that could sup-ply health insurance at a cost and quality comparable to that of the merger parties in the huge number of affected markets,” according to the joint letter. “Moreover, any qualified purchaser able

to contract with a cost competitive network of hospitals and physicians, if found, would likely already be a market participant, and a divestiture to such an existing market participant wouldn’t likely return the market to even pre-merger lev-els of competition.”

Accordingly, association leaders have urged the OIR to reject the parties’ ap-plication to merge so consumers are pro-tected from premium increases, lower plan quality and a reduction in the quantity and quality of physician services.

“Physicians strongly believe that any remedy short of rejecting the merger wouldn’t adequately protect Florida’s con-sumers,” according to the joint letter. “A divestiture wouldn’t protect consumers against the loss of potential competition that would occur when one of the largest health insurers is eliminated from the mar-ketplace.”

At press time, Orlando Medical News was unable to reach the OIR for com-ment.

Physicians Displeased with Aetna/Humana Proposed Merger, continued from page 6

The American Medical Association analysis, according to the joint letter, also shows the proposed merger would raise significant competitive concerns in an additional four Florida metro areas, including Fort Lauderdale-Pompano Beach-Deerfield Beach, Lakeland-Winter Haven, Miami-Miami Beach-Kendall, and West Palm Beach-Boca Raton-Boynton Beach.

o r l a n d o m e d i c a l n e w s . c o m FEBRUARY 2016 > 9

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John Kelly, Karen Dicembre &the Orlando Medical News Family Welcome You!

By CINDy SANDERS

When two wellness giants joined forces in 2013, the hope was that mil-lions of people would benefit. Nearly three years later, the partnership between Dean Ornish, MD, and global well-being improvement company Healthways con-tinues to expand, bringing evidence-based lifestyle programming to ever-increasing numbers of individuals across the nation.

Based in Franklin, Tenn., Healthways is a provider of well-being and health im-provement solutions to nearly 68 million people on four continents. The company entered into an exclusive agreement with Ornish in July 2013 to operate and license his Lifestyle Management Programs, which included interventions addressing early-stage prostate cancer, type 2 diabe-tes, and heart disease.

A cornerstone of the partnership is Dr. Ornish’s Program for Reversing Heart Disease™ (Ornish Reversal Program), which is scientifically proven to not only treat … but also to reverse … the progres-sion of heart disease through comprehen-sive lifestyle changes.

“What’s different about it is recogniz-ing lifestyle is a viable treatment alterna-tive for cardiac disease that can actually reverse the disease at its root cause,” said

Robert Porter, managing director of the Ornish Reversal Program for Healthways.

He added integral parts of the pro-gram focus on diet and nutrition, exercise, stress management and group support. “One of the unique things about the program is that it is of-fered to people in cohorts of eight to 15,” Porter said. “The reality is we

are social animals. We’ve discovered the power of that group support and commu-nity in helping individuals make and sus-tain a behavior change.”

Each small group participates in 18 four-hour interactive sessions. In addition to learning new strategies and techniques from a staff leader, participants also use group time to share suggestions and prac-tical solutions to incorporating new habits into daily ‘real’ life. During a session, the group might share a meal, practice yoga

together, work on stress reduction exer-cises and learn how to choose wisely from restaurant menus. “They don’t just learn what they should do … they actually do it,” Porter said. “They’re actually living the program during those 18 sessions.”

He pointed out the support system functions in much the same way as having a workout buddy, mixing social interac-tion with a degree of accountability. “It’s a really powerful way to provide support, a bond and a covenant among the group that helps them build (program elements) into their new lifestyle,” he explained.

Porter added the bond is so strong that participants formed alumni groups to continue to foster encouragement and maintain interaction. The Ornish Rever-sal Program website (ornishspectrum.com) states 87.9 percent of participants continue to get together regularly after finishing the 72 hours of active programming. In fact, Porter noted, some of the participants from the early research studies, which go back decades, continue to keep in contact.

“Dr. Ornish, over 30 years, has done the most rigorous research you can imag-ine,” Porter said of the science behind the program. Starting with the notion that it’s easer to turn off the faucet than to mop up the floor, Ornish began formulating ideas

Prevent, Protect, ImproveHealthways Continues Expansion of Ornish Heart Disease Reversal Program

Robert Porter (CONTINUED ON PAGE 13)

10 > FEBRUARY 2016 o r l a n d o m e d i c a l n e w s . c o m

Join us Wednesday, February 17th for cocktails and dinner in the Mills Memorial Hall on the Rollins College Campus. After dinner we will take a leisurely stroll to the

Annie Russell Theatre to enjoy the play Expecting Isabel.

Proceeds will benefit the Orange County Medical Society Foundation and its mission.

5:30 PM - 7:30 PM Cocktails and Dinner Rollins College, The Galloway Room in Mills Memorial Hall,

1000 Holt Avenue, Winter Park, FL 32789

8:00 PM Annie Russell Theatre "Expecting Isabel"

$150 Individual includes cocktails, dinner, and theatre ticket

$275 Per Couple includes cocktails, dinner, and (2) theatre tickets

$1200 Table sponsor includes cocktails, dinner, and (8) theatre tickets plus table signage.

$75 of your individual ticket and $600 of a table purchase represents the charitable contribution to the OCMS Foundation and is tax deductible for charitable purposes.

To register please visit www.ocms.org

Orange County Medical Foundation, together we are making a difference.

Orange County Medical Foundation, Inc. was founded by the Orange County Medical Society in September of 1988. The Foundation is the philanthropic arm of the Orange County Medical Society and is organized exclusively for charitable, educational and scientific purposes.

Join us WEDNESDAY, FEBRUARY 17TH

for cocktails and dinner in the Mills Memorial Hall on the Rollins College Campus.

After dinner we will take a leisurely stroll to the Annie Russell Theatre to enjoy the play Expecting Isabel.

Proceeds will benefit the Orange County Medical Society Foundation and its mission.

5:30 PM - 7:30 PM Cocktails and Dinner

Rollins College, The Galloway Room in Mills Memorial Hall,

1000 Holt Avenue, Winter Park, FL 32789

8:00 PM Annie Russell Theatre"Expecting Isabel"

$150 Individual includes cocktails, dinner, and theatre ticket$275 Per Couple includes cocktails, dinner, and (2) theatre tickets

$1200 Table sponsor includes cocktails, dinner, and (8) theatre tickets plus table signage.

$75 of your individual ticket and $600 of a table purchase represents the charitable contribution to the OCMS Foundation and is tax deductible for charitable purposes.

TO REGISTER PLEASE VISIT WWW.OCMS.ORG

Orange County Medical Foundation, together we are making a difference.

Orange County Medical Foundation, Inc. was founded by the Orange County Medical Society in September of 1988. The Foundation is the philanthropic arm of the Orange County Medical

Society and is organized exclusively for charitable, educational and scientific purposes.

By GENE LANIER

If you have a web site and no video, you are missing one of the best opportuni-ties available on the Internet. Today it is all about video. You can take a deadly dull website and bring it alive with just a few short videos.

Do you have a few pages of instruc-tions for patients to prepare them for an upcoming procedure? Consider using a video explaining the same material except you are delivering the message. This does two things; it is clearer for the patient and it creates more trust because the patient feels he knows you a little better. Videos like this are an eyeball-to-eyeball experi-ence and second only to actually being there.

Many websites include testimonial sections but most of those are written. It is a known fact that people much prefer video to having to read something.

We often hear people say they only use word-of-mouth advertising. However, when we look closer we find that word of mouth advertising doesn’t always work. In fact, it is such a small percentage of suc-cessful advertising that it hardly shows on the radar. The reason is simple; people who want to use word of mouth don’t want to put any money into it and so by not promoting word of mouth advertis-ing, it doesn’t happen very often. Look at

it yourself. Let’s say you have dinner at a new restaurant and really enjoy the expe-rience. You have been there. You have had that experience. How many people did you tell about the restaurant? How many did you tell a week later? It’s just something we don’t do.

Now, how would you like to have your patients telling people about how much they like and respect you, your staff and how satisfied they are with the care they received? How would you like hav-ing those people doing eyeball to eyeball with other people twenty four hours a day – every day?

To that end, we have developed a program that will work for you and is not expensive. Let’s use tracking of a virus to show you how this works.

As you know, a virus begins with an agent of infection that moves out and be-comes a contagion; the contagion spreads and we eventually have an epidemic. And that is why we call this program an en-demic epidemic because this program will create an epidemic for you.

Step one is to select your target. You may have one or many, depending on the nature of your practice. If you were a bookseller you would have a lot of dif-ferent targets: children’s books teenager books, adult books, books on different subjects. If your practice is limited to one particular area, that’s one target. If not, it

will have more than one target.After you have found your target(s),

you have to design an agent of infection. This will be your website coupled with email, as a secondary agent. Next comes the virus. This is very important because it is the part that sells. The virus must be very positive and very contagious. An ex-ample would be a dentist who specializes in dentures. Is he selling teeth? No, he is selling a smile, the ability to chew again. Maybe it’s just about making you feel good about yourself. You don’t sell soap, you sell cleanliness. Now, we have to get the virus ready to go. So, what is the virus? Your patients and their enthusiasm.

The question arises, how do we de-liver the virus? This is really simple; we get your patients, the ones who will volunteer to do this, to come in and just talk to us on camera about why they like you as their physician. We talk with the patient for a few moments to get them warmed up and then ask them one simple question: why do you prefer this doctor for your health-care? Then, we shut up and let them talk. The interesting thing we have learned, having done a little over 1200 of these, is that this method we use produces a tes-timonial that is so believable. We do not script these testimonials nor do we prac-tice. We warm them up with light conver-sation and let them talk right off the top of their heads. Interestingly too, is that the

average person will only talk about 45 to 60 seconds, which is perfect timing to hold a person’s attention.

When we have finished, we process the video and send HTML code to your webmaster so it can be imbedded on your website. We also send you links to your videos so you can send them out to pro-spective patients, current patients and anyone else you wish to see them.

To increase the epidemic and speed the virus along, ask patients and friends to email the testimonials to friends close by. Since we are dealing with video links, it is really simple to email any video.

At this point, to create contagion, we begin to drive people to your website using blogs, social media and email. If someone inquires about your practice, send a testi-monial along with any other information you normally send.

Gene LaNier is a native of North Carolina and a graduate of The University of North Carolina at Chapel Hill. He continued his education with postgraduate studies at New York University and the University of Central Florida.

He is listed in Who’s Who in Public Relations, Sixth Edition, 1992. He was named one of the “world’s top public relations professionals” in the book, The Pro Challenge, 1994. He is accredited by the Public Relations Society of America.

He is currently CEO of My Marketing Group, Inc., a virtual company with affiliates in India, New Zealand, Hong Kong, North America, the United Kingdom, Germany, Sweden and Romania. Visit www.mmgfla.com

Use Video to Attract More Patients

and neonatologists, who work closely with primary care providers and other pediatric specialists at the 318-bed, Trauma Center Level II Osceola Regional, including those in the hospital’s pediatric emergency de-partment.

“Osceola County is one of the na-tion’s fastest-growing counties, and our community has needed greater access to specialized pediatric care for years,” said Bob Krieger, CEO of Osceola Regional Medical Center. “We’ve now added the expertise of Nemours physicians and are finalizing the construction of our state-of-the-art PICU, slated to open this summer. Our experts are well-equipped to treat children dealing with a range of health is-sues, from minor illnesses to acute injury or disease.”

The agreement also includes Nemours CareConnect, a technological link that remotely brings pediatricians who specialize in rare conditions from Nemours into Osceola Regional Medical Center. It allows the specialists to visually assess a patient in Kissimmee through an iPad.

“When our physicians have the op-portunity to put their eyes on a patient, it will provide an added level of com-munication that you just cannot get over the phone,” said Robert Bridges, CEO of Florida Operations for Nemours Chil-dren’s Health System. “We think Nemours CareConnect allows care teams to better determine the safest and most necessary care for the child and family.”

Osceola Regional CNO Rick Naegler said working with Nemours “allows us to combine the best of what they do – spe-cialty pediatric care – with the best of what we do as a full-service community hospital. This partnership also increases continuity and coordination of care by helping to ensure that patients see the same medical experts throughout their stay in our hos-pital.”

In addition to pediatric care, Osceola Regional offers the only NICU Level II facility in Osceola County, which pro-vides special medical care for newborns and is adjacent to the recently-renovated $1.6 million Baby Suites for birthing mothers.

Tawni Price, administrative direc-tor of Women’s and Pediatric Services for Osceola Regional, said when families come to Osceola Regional to deliver their babies, “they can rest assured knowing that our experts are prepared to handle any medical scenario. “And as their chil-dren grow up, we will continue to serve as a trusted resource for these families.”

The financial bottom line for both in-stitutions likely prompted the partnership. According to WMFE News, “Nemours was only 37 percent occupied in 2014, and lost $54 million on operations. Osceola Regional made $42.3 million in net income in the same year.” Reporter Abe Aboraya called the deal “interesting in part because Osceola Regional’s par-ent company is for-profit HCA, while Nemours is owned by a charity.”

Osceola Regional, continued from page 1

o r l a n d o m e d i c a l n e w s . c o m FEBRUARY 2016 > 11

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By LyNNE JETER

PHILADELPHIA, PENN. – Thomas Jefferson University’s College of Popula-tion Health is once again serving as the exclusive academic partner for the nation’s leading forum on innovations in population health in the City of Brotherly Love.

Slated March 7-9, the 16th Popula-tion Health Colloquium will be held on-site at the Loews Philadelphia Hotel or via webcast with 24/7 access for six months. Co-sponsored by the Population Health Alliance, the 3-day conference will bring together industry stakeholders – healthcare providers, payers, pharmaceuticals, lead-ing technology and solutions companies, academia and government – to share best practices, case studies, expert insights and industry trends in the quickly-growing field of population health.

Conference 2016 highlights include two special dinner programs. On Sunday, March 6, Stephen K. Klasko, MD, MBA, president and CEO of Thomas Jefferson University (TJU) and Jefferson Health, will engage in an extended conversation with conference participants to share his unique vision regarding innovation and transfor-mation. The interactive session – moder-ated by David B. Nash, MD, MBA, dean of the Jefferson College of Population Health,

the nation’s only degree-seeking school of its kind – will also include a special guest to discuss how a traditional academic medi-cal institution is transforming to reimagine healthcare, health education and discov-ery, and also detail Jefferson’s journey to-ward its transition into a consumer-centric healthcare enterprise. On Tuesday, March 8, a dinner and panel discussion will be held focused on population health analyt-ics and featuring dozens of exhibitors.

A March 7 morning preconference symposia will highlight population health management projects and best practices nationwide for integrated delivery systems and large medical groups that are strug-gling to adapt. The session will show how three very different entities are making it work: a Midwest academic medical center that implemented a $12 million Medicare/Medicaid innovation grant to improve rural cardiovascular health; a state medi-cal society that developed cutting-edge an-tibiotic stewardship programs; and a West Coast community’s program to combat childhood obesity. Speakers represent PYA Analytics: CMO Kent Bottles, MD, and Principals James Michael Keegan, MD, and Martie Ross, JD.

Day 1 begins after lunch, with a key-note presentation and discussion of the healthcare landscape by Peter Orszag,

Citigroup’s vice chairman of corporate and investment banking and chairman of its fi-nancial strategy and solutions group.

Day 2 begins with Klasko presenting the inaugural winner of the Hearst Health Prize for Excellence in Population Health, who will receive a $100,000 cash prize in recognition of outstanding achievement in managing or improving population health. Following the presentation, Julie Gerberd-ing, MD, MPH, Merck’s executive vice president of strategic communications for global public policy and population health, will discuss the case for a new population health protection agenda.

Other second-day topics on the agenda: accelerating change toward a bet-ter healthcare system; population health in the era of cognitive computing; and inno-vative provider collaborations and enable-ment strategies. Afternoon mini-summits sponsored by Accenture, Evolution Health, athenahealth, and Sage Growth Partners/WellCentive, involve achieving the promise of data exchange; shortening the ROI in population health; driving results in the ac-countable care era; and creating a platform for care transformation in value-based care environments.

A special evening dinner program – What’s Inside the Data? – features popu-lation health experts sharing insight, using

case studies to illustrate how healthcare or-ganization are using analytics tools to sup-port and implement successful population health management programs. Participat-ing experts include Nathan Gunn, MD, president of population health for Valence Health; Gregory G. Kile, CEO of Populyt-ics and senior vice president for insurance and payer strategies for the Lehigh Valley Health Network; Sally Okun, RN, MMHS, vice president of advocacy, policy and pa-tient safety for PatientsLikeMe; Jonathan Ware, MD, medical director of population health management for Phytel, an IBM company; and Adrian Zai, MD, PhD, chief medical informatics office with SRG Tech-nology, and clinical director of population informatics with the computer science labo-ratory at Massachusetts General Hospital.

Day 3 features presentations on the crit-ical role of community in population health; controlling the rising costs of specialty drugs; and perspectives from an ACO.

Within the conference for attendees wanting to take a deeper dive into the Col-loquium’s subject matter is Jefferson’s Pop-ulation Health Training Program. Also, the conference has been approved for up to 20.85 NASBA CPE credits for account-ing professionals.

For full program information, go to www.populationhealthcolloquium.com.

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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 FEBRUARY 2016 > 13

Orlando Health Announces Three New Executives

Orlando Health today, announced the addition of three new senior vice pres-idents. The new executives will join CEO David Strong’s executive cabinet.

R. Erick Hawkins is the new Senior Vice President of Strategic Management. Mr. Hawkins most recently served as chief fi nancial offi cer and vice president of heart and vascular services for University of North Carolina REX Healthcare in Raleigh. In that position, he was the executive re-sponsible for the organization’s strategic innovations. Other leadership positions Mr. Hawkins has held include President of the Board of Directors for Hospice of Wake County, member of the Executive Leadership Team for the American Heart Association’s Triangle Heart Ball, and member of the Leukemia & Lymphoma Society’s Triangle Light the Night Walk’s Executive Leadership Council. He re-ceived a bachelor’s degree from Yale Uni-versity and a MBA from Duke University’s Fuqua School of Business.

Greg P. Ohe, FACHE, is the new Se-nior Vice President of Ambulatory. Mr. Ohe, will transition over the next few weeks, from his current position as presi-dent of Orlando Health’s Health Central Hospital. In addition to having oversight over the 171-bed hospital, Mr. Ohe also oversees Health Central Hospital Park, a long-term care and rehabilitation facility, Express Care, an urgent care walk-in clinic, and a state-of-the-art surgery center. Mr. Ohe is a Fellow in the American College of Healthcare Executives and is a mem-ber of the Healthcare Financial Manage-ment Association. He has served as the President of the Central Florida Health-care Executive group and as a member of Community Advisory Committee for the Health Services Administration program at the University of Central Florida. He has functioned as a mentor for young profes-sionals associated with the University of Central Florida and Xavier University. Mr.

Ohe has served on numerous health-care committees throughout Florida and the Southeastern United States. He has a Bachelor’s Degree in Chemistry and a Master’s Degree in Hospital and Health Administration from Xavier University in Cincinnati, Ohio.

Andrew J. Snyder is the new Senior Vice President of Marketing and Commu-nications. Mr. Snyder most recently served as vice president and chief marketing offi -cer for AMITA Health in Arlington Heights, Illinois where he oversaw all aspects of marketing, brand management, and web/social media strategy. Mr. Snyder is a frequent presenter at industry events and universities such as the Harvard/Chan School of Public Health, Loyola University, the Society for Healthcare Strategy and Market Development, and the Forum for Healthcare Strategies. Other leadership positions Mr. Snyder has held include Board Member of the Elgin Symphony Orchestra, the Chamber of Commerce of St. Joseph County, AIDS Ministries of Northern Indiana and United Way of Por-ter County. He received a Bachelor’s De-gree in Biology from Wabash College in Crawfordsville, Indiana.

about how to improve health while he was still in medical school. By 1978, Ornish and colleagues at the University of Cali-fornia, San Francisco showed heart dis-ease could be reversed after only 30 days, as demonstrated by improved blood fl ow to the heart, in a pilot study that utilized the tenets of the Ornish program.

Based on nearly four decades of on-going research, which has been widely published in peer-reviewed journals, the program was approved for Medicare reimbursement under the category of ‘Intensive Cardiac Rehabilitation’ begin-ning in 2011. In addition to nationwide reimbursement through Medicare, com-mercial payers in 17 states also cover the program for heart disease.

“As the evidence grows, as we gain experience, the science would seem to predict there is the possibility for this pro-gram to expand to a larger number of chronic diseases,” said Porter. He added a few payers have extended the criteria for coverage to include those with diabetes and early-stage prostate cancer.

The core program, however, is cur-rently focused on heart disease. With the exception of congestive heart failure, which Porter said he hopes will be added in the near future, the program is ap-proved under Medicare for the same diag-noses as traditional cardiac rehabilitation. The six qualifying conditions are:

• Acute myocardial infarction in the preceding 12 months,

• Coronary Artery bypass surgery,• Current stable angina pectoris,• Heart valve repair or replacement,• Percutaneous transluminal coro-

nary angioplasty or coronary stent-ing, and

• Heart or heart-lung transplant.A focus on lifestyle modifi cation and

prevention has increasingly become more mainstream in healthcare, but transform-ing the delivery system remains an ongo-ing challenge.

Phil Newbold, CEO of Beacon Health

System in Indiana, which launched the program in August 2015, noted, “If you look at the mission and vision statements of most hospitals and health systems, the word ‘health’ is all over them … but if you look at where we spend our resources, about 99 percent goes to the medical side of things and very little actually focuses on health. When we looked at the Ornish Reversal Program, we saw that it was the best way for us to really embrace health in a scien-tifi c way and better align ourselves with our mission of creating a healthier community.”

Echoing the sentiment, Porter said, “I think our whole healthcare system was built around passively waiting to treat people when they presented with a problem. We’ve found that is unsustain-able. It’s unsustainable fi nancially, and we’re not optimizing the health status and qualify of life for people.” He continued, “The best way for us to promote health is to adopt a healthy lifestyle that prevents the onset of chronic disease.”

The Ornish Reversal Program is rapidly gaining a foothold in the medical community since rolling out nationally about 18 months ago. At the end of 2015, four new partner sites were announced in Texas, Florida, North Carolina and Vir-ginia. At press time, Healthways had im-plemented the program in 22 sites across 14 states with two more programs in the process of being launched and numerous others in the discussion phase.

While Porter said it was too early to have hard fi nancial fi gures in terms of sav-ings to the health system, he noted early indicators have been impressive. “We’re certainly seeing incredibly solid clinical results,” he said. “Based on those clinical results, the predictive variables would indi-cate we expect to see solid results in other outcomes like readmissions and costs.”

Physician groups and hospitals inter-ested in learning more about the program and research behind it should go online to ornishspectrum.com or call Healthways at 877-888-3091.

Prevent, Protect, continued from page 9

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14 > FEBRUARY 2016 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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• What is a QCDR and is this the answer to full alignment now & in the future

Speaker: Leslie Witkin, Physicians First, Inc.

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UF Health Cancer Center - Orlando Health Opens At South Lake Hospital

South Lake Hospital, in affiliation with Orlando Health, has added a new col-laborative cancer center to its growing medical campus. The new center, which will provide radiation oncology services, will be managed by UF Health Cancer Center - Orlando Health and Integrated Oncology Network (ION) and give patients in and around Lake County local access to the cancer center specialists, vast resources, leading-edge treat-ments and ongoing medical trials.

The 4,800 square-foot practice will be staffed by UF Health Cancer Center-Orlan-do Health radiation oncologists and an ad-vanced nursing team, providing comprehen-sive cancer care.

The center’s tech-nology - provided by ION - will offer break-through technologies, including Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radia-tion Therapy (IGRT). IMRT is the most technologically advanced and most precise method of external beam radiation therapy available. IGRT takes this technology one step further. Daily imaging assures the radiation is delivered precisely to the treatment area while sparing sur-rounding tissue. Treatment may be able to be delivered in as few as 1 to 5 treatments. These advanced radiation technologies provide cancer treatment more precisely, with less risk, and are beneficial for many different types of cancer.

ION has been focused on expanding its networks across the United States of more than 250 multispecialty oncology-focused physicians to affiliate with larger pro-viders and healthcare systems in their market to provide quality and cost-efficient pa-tient care.

From left Randy Sklar, Senior Vice President, Integrated Oncology Network; John Moore, President, South Lake Hospital; Mark Roh, MD, President, UF Health Can-cer Center – Orlando Health; Tomas Dvorak, MD, radiation oncologist, UF Health Cancer Center – Orlando Health.

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Jess Parrish Medical Founda-tion Partners with TD Bank to Support Healthcare Initiatives

Jess Parrish Medical Foundation re-cently received a cash contribution from TD Bank, America’s Most Convenient Bank®, through the bank’s Affinity Mem-bership Program.

Jess Parrish Medical Foundation re-

lies on support from community partners, like TD Bank, to raise funds that sustain and enhance healthcare services offered by Parrish Medical Center.

TD Bank’s Affinity Membership Pro-gram helps non-profit organizations raise money by receiving an annual cash contri-bution from TD Bank based upon the par-ticipation of qualified member accounts.

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GrandRounds

o r l a n d o m e d i c a l n e w s . c o m FEBRUARY 2016 > 15

Introducing Fresh

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bioACTIVENaturally

42 Days of ViabilityProprietary Storage System

Durable and Flexible

The Affinity Allograft Advantage

References: 1. Niknejad H, Peirovi H, Jorjani M, et al. Properties of the Amniotic Membrane For Potential Use in Tissue Engineering. Eur Cell Mater. 2008(15):88–89. 2. Wolbank S, Hildner F, Redl H, van Griensven M, Gabriel C, Hennerbichler S. Impact of human amniotic membrane preparation on release of angiogenic factors. J Tissue Eng Regen Med. 2009;3(8):651–654. 3. Gruss J, Jirsch D. Human amniotic membrane: a versatile wound dressing. Can Med Assoc J. 1978;118(10):1237–1246.

Contact NuTech at 800-824-9194

Learn more about how Affinity fresh allografts are transforming regenerative medicine:

info@nutechmedical.comwww.nutechmedical.com

Announcing a breakthrough in regenerative medicine: Affinity fresh amniotic allografts. NuTech’s breakthrough proprietary preservation system, AlloFreshTM, maintains the integrity and viability of fresh amniotic tissue. For the first time, surgeons can take full advantage of this unique tissue’s strength, flexibility, and healing potential. Affinity provides a natural solution for regenerative healing.1–3

© 2015 NuTech Medical, Inc. NuTech name and logo are registered trademarks, and Affinity is a registered trademark of NuTech Medical, Inc. AlloFresh is a trademark of NuTech Medical, Inc. All Rights Reserved.

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