november 2017 > $5 combating mocbw-31b5b7b61bc03a158c3c602c6ce6489b-bwcore.s3.amazonaws.c… ·...

1 > NOVEMBER 2017 o r l a n d o m e d i c a l n e w s . c o m

PRINTED ON RECYCLED PAPER

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

PROUDLY SERVING CENTRAL FLORIDA

November 2017 > $5

ONLINE:ORLANDOMEDICALNEWS.COM

ON ROUNDS

PAGE 3

Bethany Ballinger, MBBS

PHYSICIANSPOTLIGHT

RADIOLOGY INSIGHTSPatient Radiation in Diagnostic Imaging ... 9

CPA SPEAKYour Accountant is Your Partner; Choose Wisely ... 8

HEALTH INNOVATORSNew Technology Boosts Cancer Diagnosis and Treatment ... 7

December Bonus SectionCENTRAL FLORIDA PHYSICIAN’SLUXURY SPORTS CAR

What resonated in 2017?… the Future?

Combating MOC"Professional self-regulation is under attack"

By PL JETER

Physicians are outraged about plans by the American Board of Medical Spe-cialties (ABMS) and its 24 specialty boards to overhaul once again the Maintenance of Certification (MOC) requirements they say have already become too time-consuming, expensive and clinically irrelevant.

“The MOC controversy is a David v. Goliath story that may be the most sig-nificant corruption story ever uncovered in the history of U.S. medical education,” said Westby Fisher, MD, a cardiac elec-trophysiologist from Illinois and author of the “Dr. Wes” blog.

Under ABMS’s MOC requirements, physicians are assessed every other year, and must pass a re-certification exam in their specialty every 10 years. Here’s the rub: MOC is legally considered voluntary

and not a requirement to practice medi-cine in the U.S.

The ABMS, doctors insist, has an unfair near-monopoly on the MOC re-certification process based on long-term partnerships with insurance companies and hospitals, who often mandate MOC recertification, a brewing problem for the swelling number of hospital-employed physicians. Medicare, the standard bearer for coverage in the American healthcare system, does not.

“I’ve seen the forensic accounting on this … it would stop your heart,” said Marni J. Carey, executive director of Or-lando-based Association of Independent Doctors (AID). But “then you might need a cardiologist, who won’t be available because (of) studying for recertification. MOC is a hoax and needs to stop.”

In a grassroots rebellion against unfair

MOC mandates, AID is among many or-ganizations across the country, including the American Association of Physicians and Surgeons (AAPS), Practicing Physicians of America (PPA), and the recently physician-formed National Board of Physicians and Surgeons (NBPAS), that oppose the ABMS initiative launched Sept. 25. A month be-fore the announcement, 33 national medi-cal societies and 41 state medical societies sent the umbrella organization a letter pro-posing a meeting with certifying medical boards to address their concerns “regard-

ing the usefulness of high-stakes exams, the exorbitant costs of the MOC process,

and the lack of transparent communication from certifying boards (that have led to) damaging the MOC brand, and creating state-level attacks on the MOC process.” The societies also want participation in planning a solution.

The ABMS initiative, “Continu-ing Board Certification: Vision for the Future,” was launched anyway. ABMS CEO Lois Nora, MD, insisted the con-cept had been brewing for months, noting that “concerns … stimulated our thinking about the commission.”

“The best step the ABMS can take is to assure us that MOC is voluntary,” said AAPS spokesperson Jane Orient, MD.

Anup Patel, a plastic and reconstructive surgeon who established Orlando Plastic Sur-gery Institute, completed his MD/MBA de-grees at Yale University. He received his plastic surgery training at Yale University followed by a fellowship in hand and microsurgery at the New York University and Mount Sinai.

In a lifetime marked by excellence, Patel graduated as the valedictorian of his class at the University of Florida, majoring in economics, biochemistry and molecular genetics and vale-dictorian of his high-school class at Lake High-land in Orlando, Florida.

Dr. Patel maintains a commitment to serv-

ing society. He co-founded Cents of Relief, a 501(c)3 nonprofit, that seeks to help victims of human trafficking. The foundation has devel-oped a partnership with Operation Smile to deliver burn care to indigent victims and de-veloped a comic book that teaches burn safety to children. He has been on panels with global health leaders such as NBA Global Ambassador Dikembe Mutombo and Partners in Health’s co-founder Dr. Paul Farmer for his work on reducing the global surgical burden of disease. Dr. Patel’s healthcare efforts have been fea-tured in the New York Times best-seller Half

HEALTHCARELEADER

The Gift of Being a PhysicianAnup Patel, MD, endeavors to provide surgical access to the underserved on an international level

(CONTINUED ON PAGE 14)


http://orlandomedicalnews.com/

http://orlandomedicalnews.com/index.php

http://orlandomedicalnews.com/webform.php?ViewForm=1


ChoseNChoseNAGAIN#1 HOSPITALIN ORLANDO

17-SYS

TEM-05286

Florida Hospital is recognized by U.S. News & World Report as one of Florida’s best hospitals in 14 types of care.

FloridaHospital.com/USNews

https://www.floridahospital.com/usnews/


PHYSICIANSPOTLIGHT

Bethany Ballinger, MBBS, is the Pro-gram Director for the University of Cen-tral Florida College of Medicine (UCF COM), Emergency Medicine Residency Program at Osceola Regional Medical Center in Kissimmee, Florida, and Asso-ciate Professor of Emergency Medicine at the UCF College of Medicine.

She hails from England, where she attended medical school at the Univer-sity College London School of Medicine, followed by a 3-year emergency medi-cine residency and then by a fellowship/specialist registrar posting in Emergency Medicine at Oxford University Teaching Hospital. After several years of practice in England, Dr. Ballinger moved to America and did a second emergency medicine residency at Orlando Regional Medical Center. She was then recruited as an in-augural faculty member for the EM resi-dency at Florida Hospital.

Dr. Ballinger's zeal to educate phy-sicians of tomorrow to excel in today's digital world, led to her recruitment at the University of Central Florida College of Medicine (UCF COM). UCF COM's program epitomizes innovation, high-tech learning tools and a pioneering spirit to educate young doctors and scientists in a new and better way for the 21st century. Dr. Ballinger was one of the founding fac-ulty for the medical college, and the col-lege's mission reflects her vision.

As a founding faculty member of the UCF COM, she had the vision of devel-oping the new medical school's GME component. Specifically, a residency that would combine excellence in clinical skills with the humanity of the compassionate physician to produce outstanding patient centered care. She was thus naturally cho-sen to lead the new EM residency for the UCF COM, based at Osceola Regional Medical Center.

Dr. Ballinger is renowned for her experience in evidence based medicine (EBM), clinical informatics and patient safety. Her passion for EBM blossomed while she was still at Oxford. Committed to promoting emergency medicine inter-nationally, Dr. Ballinger took this exper-tise around the world. Notable endeavors include the creation of a "Virtual Health Sciences Library" at the Hue College of Medicine and Pharmacy, in Hue, Viet-nam, and launching the "Practising Evi-dence Based Medicine" course there. One of the American Association of Medical College's (AAMC) current initiatives is "Best Practices for Better Care," a multi-

year initiative to improve the quality and safety of health care.

As an early proponent of patient safety education, Dr. Ballinger implemented the LCT in patient safety at UCF COM, be-cause she is passionate about educating doc-tors who take the entire patient experience into account. Under her leadership, the UCF COM was one of only 10 schools in the world to participate in the World Health Organi-zation's implementation study of the Patient Safety Curriculum. Integrating technology into medical education, Dr. Ballinger's has successfully taught students to be proactive in looking for possible safety hazards in real time such as dangerous drug interactions using their iPads. Her research and innovations are frequently highlighted at the national AAMC and American Council of Graduate Medical

Education (ACGME) meetings.Dr. Ballinger is active in organized

medicine. At the regional level, she is a founding member of the Florida State Com-mittee on Patient Safety Education, and on the academic affairs committee of the Flor-ida College of Emergency Physicians Educa-tion. At the national level, she holds the post of American College of Emergency Physi-cians (ACEP) Ambassador to the United Kingdom. She is a member of the ACEP International section's education commit-tee, and also serves on the communications committee of the International Federation of Emergency Medicine.

Dr. Ballinger is a beloved educator and not surprisingly has been recognized by numerous awards, including the Fac-ulty of the Year for the Emergency Medi-

cine Residency Program, and the Florida Hospital Compassion and Excellence in Medical Care Award, for which she was chosen amongst a group of over 2500 qualified physicians.

And in September, "National Women in Medicine Month," the American Medi-cal Association honored Dr. Ballinger as one of the nation's most inspirational women in healthcare. This year's AMA celebration carries the theme, "Women in Medicine: Born to Lead," and honors 80 physicians who have offered leadership, mentoring and support to increasing the number of women in medicine.

For our forum this month, Dr. Ball-inger shares her passion for developing women healthcare leaders and helping them find the balance for success.

Bethany Ballinger, MBBS, AFRCSEd, FFAEM, FACEPEducating healthcare leaders with an accent on women

Growing up in rural England in the 1970s, I told everyone I wanted to be a doc-tor – just like the kind man who came to our country home whenever I was sick. People just looked at me, patted me on the head and said, “Yes, of course you do, dear.”

At that time, all of our community’s physicians were men. That’s changed. Today, half the students in medical schools

are women. Yet females make up only about 15 percent of the leaders in healthcare. The question is why? And just as importantly, what are we doing to change those facts?

My specialty – Emergency Medicine – has always been male-dominated. I still have patients who ask, “When is the doctor coming in?” when I enter their exam room. When I joined Osceola Regional Medi-

cal Center in 2014, I was the only female full-time emergency physician. But that’s changing – because many of us worked to-gether to make it so.

Today, I lead the ER residency pro-gram at the hospital, a partnership between

IN OTHER WORDS with Bethany Ballinger, MD

Fast CarsFast CarsPhysicians, Food, Fellowship and

Porsche of Orlando9590 South Hwy 17-92

Maitland, FL 32751

HORS D’OEUVRES <<<

ADULT BEVERAGES <<<

DOOR PRIZES <<<

PORSCHE ACCESSORIES <<<

Wednesday

Feb 76:00pm-8:00PM


http://orlandomedicalnews.com/news.php?viewStory=1444


“We need options.”

CASH COWThe seismic shift of MOC from life-

time to time-limited board certification has been a major cash influx to non-profit ABMS member boards. For example, the American Board of Internal Medicine (ABIM), the largest of the member boards, reported $27 million in MOC fees on their IRS form 990 three years ago.

The MOC re-certification process began innocently enough. The program was originally created when the (ABIM) and the American College of Physicians (ACP) were searching for clever ways to perpetually fund their activities and mem-ber salaries. In the late 1970s, the ABIM tried on for size a voluntary ongoing phy-sician recognition program, “Continuous Professional Development,” as an addi-tional board certification. The plan failed because physicians didn’t find the CPD valuable to their practices.

Taking a page from the playbook of the American Board of Family Medicine (ABFM) that only offered time-limited board certification, ABIM leaders imple-mented a similar program, reasoning that physicians “needed to keep up” or face “uncertain circumstances,” noted Fisher.

“Before 1990, ABMS’s ‘board certi-fication’ was a well-respected voluntary lifetime physician credential that served as a practical assessment of a physician’s ad-equacy to practice their specialty following residency training,” Fisher explained.

In the 1990s, the ABMS board imple-mented a MOC program requiring doctors under a certain age to obtain re-certification throughout their careers. The move appeased older physicians, who were grandfathered in via previous lifetime certification guidelines. As the “grandfathers” retire, MOC fees just for ABIM “will certainly top $50 million,” said Paul Teirstein, MD, who formed the physician-led National Board of Physicians and Surgeons (NBPAS) in 2015 to create a competing recertification program.

In a bold move to ensure their place at the table, the ABMS trademarked MOC in 2005. To sell MOC to the pub-lic, ABMS promoted the process as show-ing how doctors are staying abreast of their specialty while also honing their clin-ical skills. Over the next nine years, while doctors were distracted by ever-increasing federal government mandates, the ABMS quietly increased its coffers.

By 2014, MOC costs had increased 244 percent since 1999. MOC fees average $3,000 or more, excluding calculation for time lost caring for patients. An independent study showed that MOC-related fees add nearly $6 billion every decade to the already burdened American healthcare system.

That’s not the only fallout. Accord-ing to ABIM, 13 percent of physicians fail their initial MOC exam, an outcome doc-tors say is unfair to an unproven system and is “especially inappropriate when doc-tors are already in short supply and suf-fering from record levels of burnout and suicide,” noted Fisher.

The creation of NBPAS (NBPAS.org), which has gained 6,000 members in less than two years and is on target to hit the 10,000 mark by the end of 2018, was in response to unreasonable MOC mandates. The ar-gument: ABMS lacks significant evidence to support their reasoning of increased public safety to increase MOC mandates.

“We’ve been lobbying for change for over two years, but the ABMS member boards still require physicians (to) prepare for tests that have little relevance to their practice and result in well over $100 million in fees to board members,” said Teirstein.

In an analysis of 33 MOC studies de-termining whether re-certification improves patient safety and outcomes, roughly half reported a significant association between certification and positive outcomes while nearly half found no association. Three surveys found a negative association.

“There’s no evidence to support their claim to this end,” said Judith Thompson, MD, a general surgeon from Houston.

“Never has a patient outcome been related to the MOC product. Where’s the public outcry for recertification? Show us the data.”

STATE-BY-STATESo far, 17 states have proposed leg-

islation to ban mandatory MOC require-ments, but powerful industry lobbyists quashed Oklahoma’s anti-MOC legisla-tion passed in 2016. The Right-to-Care law, the first of its kind in the nation, in-tended to eliminate MOC as a stipulation for physicians to receive hospital privileges and licenses. But various loopholes in the language allowed hospitals to mandate MOC as a requirement.

In Tennessee, lawmakers were only able to remove MOC requirements for medical licenses. Aggressive anti-MOC bills in Arizona, Kentucky and Michigan legislatures died quietly.

In the 2017 session, a Florida anti-MOC bill languished in committee. The move was expected, since Gov. Rick Scott made millions as a hospital industry ex-ecutive and was tied to Columbia/HCA, which eventually became the nation’s larg-est private for-profit healthcare company. However, on Oct. 25, Sen. Denise Grims-ley (R-26th District), a registered nurse, filed Senate Bill 628, “prohibiting the Boards of Medicine and Osteopathic Medicine, re-spectively, the Department of Health, cer-tain healthcare facilities, and insurers from requiring physicians and osteopathic phy-sicians to maintain certification or obtain recertification as a condition of licensure, reimbursement or admitting privileges.”

Other states are making headway on the MOC issue. In an Oct. 11 hearing, Fisher, who has 17,000 Twitter follow-ers, testified to the Ohio Health Commit-tee that “hundreds of Tweets and emails I receive each year speak to the reality of the tremendous negative effect (MOC has) on decent, highly respected colleagues too embarrassed to go public with their failure, many of whom quietly leave medicine.”

Georgians embraced the first successful

state-implemented MOC legislation. In May, lawmakers successfully removed MOC man-dates at some hospitals for doctor privileges, medical licensure and payer membership.

“The battle in state legislatures is an effective first step, but could be side-stepped if ABMS (et al) ‘rebrands’ the MOC program to a new product. As such, the most effective deterrent will be a ruling by the Federal Trade Commis-sion (FTC) that (their MOC program) is a monopoly and violates anti-trust laws,” said Fisher, noting the American Medical Society (AMA) has lobbied since 2015 to keep at bay an anti-trust lawsuit filed in the Northern District of Illinois.

“ABMS is now desperate to rebrand the MOC® program that funds as much as 47 percent of some ABMS member-board annual revenues in an attempt to pivot to a new, clever revenue stream that’ll still permit cash to flow to this consortium of unaccountable private non-profit corpora-tions to continue,” said Fisher.

FAIR & BALANCED?To compile a commission of roughly

two dozen members to manage MOC changes, the ABMS has said it will include a diversity of industry representatives. When asked if the commission would in-clude physicians, including representa-tion from unpaid NBPAS members, Nora dodged the question, adding that members appointed to the commission will be deter-mined by the ABMS planning committee.

“Physicians should insist their hos-pital Medical Executive Committee rec-ognize NBPAS as an equal alternative to participation in MOC,” said Fisher. “Both boards require initial board certification, but NBPAS recognizes the Accredita-tion Council on Continuing Medical Education (ACCME), vetted Continuing Medical Education credits, as valid for documentation of ongoing lifetime certi-fication without having to commit to sign-ing a HIPAA business agreement.”

Combating MOC, continued from page 1

It’s important to understand what “accepted” or “recognized” means with respect to these types of organizations.

For hospitals, NBPAS acceptance usually means the hospital’s Board of Di-rectors will accept NBPAS certification in-stead of ABMS member board (or AOA) certification for hospital privileges. The process for gaining acceptance usu-ally starts with an interested physician making a presentation to the hospital’s Medical Executive Committee (MEC), where they vote to recommend the hos-pital’s Board of Directors accept NBPAS as an alternative. There are currently

over 60 U.S. hospitals that either accept NPBAS certification for privileges or have eliminated MOC requirements from their bylaws. We are fighting to increase hos-pital acceptance/recognition by: provid-ing advocacy materials on the Advocacy Center tab of our website, engaging our 400-volunteer physician Advocacy Com-mittee, lobbying (within the limits allowed by law) state legislators to pass anti-MOC bills, and meeting with the Federal Trade Commission to consider the anti-compet-itive aspects of MOC.

For payers (insurance companies), NBPAS acceptance means the insurer will

contract with physicians whose ABMS or AOA certification has expired but who have current NBPAS certification. Accep-tance by payers is critical for widespread growth of NBPAS, and no insurer that we know of currently accepts NBPAS. It has been very difficult to get the attention of insurance company’s management on this issue. While currently frustrating, we be-lieve our continued growth and political activity will win over the payers. We es-pecially believe passing anti-MOC bills in many states will be very helpful to our goal of gaining acceptance by insurers.

For state medical boards, accep-

tance is usually irrelevant. State medical boards do not require board certification or MOC as a requirement for initial li-censure or MOL (maintenance of licen-sure). One important function of NBPAS is to bring awareness of this controversy to the state medical boards, which will help deter any efforts to make MOC a requirement for MOL in the future. However, there is one caveat we are aware of. A few states, including California and Texas, have laws requiring ABMS (or AOA) member board, or equivalent certification if a physician ad-vertises they are a “board-certified special-ist.” These laws define “equivalent” very restrictively, so as the laws currently stand, NBPAS would not qualify. As NBPAS gains more widespread growth, we believe these laws will be changed.SOURCE: NBPAS.org.

Physicians are jumping on the bandwagon of the newly formed National Board of Physicians and Surgeons (NBPAS), which offers an alternative MOC certification program. The San Diego, Calif.-based organization has accrued 6,000 members since its inception in 2015, and is on target to reach 10,000 members in 2018. According to the NBPAS.org website, here’s the most common question physicians have about the organization:

Is NBPAS accepted or recognized by hospitals, insurance companies, and state medical boards?


Connecting practices to

EMERGING TRENDS.We’re taking the mal out of malpractice insurance. In an ever-evolving healthcare environment, we stay on top of the latest risks, regulations, and advancements. From digital health innovations to new models of care and everything in between, we keep you covered. And it’s more than a trend. It’s our vision for delivering malpractice insurance without the mal. Join us at thedoctors.com

6292_FL_OrlandoTampa_WFI_Oct2017.indd 1 8/30/17 12:45 PM

http://www.thedoctors.com/


It’s Not “Just” GERD

By FARID GHARAGOZLOO, MD

There has been much discussion around why esophageal cancer has in-creased by more than 600 percent in the U.S. since 1978. I strongly believe that the increase may be related to esophageal reflux and hiatal hernias. Medical therapy of acid reflux using proton pump inhibi-tors has not decreased the incidence of esophageal cancer, and in fact may play a role in increasing the numbers. There are hypotheses as to why this is, one being that esophageal cancer may not be caused by acid at all. Yes, we can shut off the acid with medicines, but what if the acid was making things harder on cancer cells all along? Other theories as to risk factors in-clude bile salts and bacterial overgrowth due to backed up food that has liquefied in the esophagus, causing pain and burning. Many doctors, confronted with a patient who presents with “heartburn” pain, will give stronger and stronger medications for acid reflux, not realizing the patient is actually experiencing esophageal (as op-posed to gastroesophageal, GERD) reflux caused by a hiatal hernia.

In a normally functioning esopha-geal hiatus, the esophagus goes through the hiatus opening in the diaphragm where it joins the stomach in the abdo-men, forming a gastroesophageal valve – not a sphincter, as it is often called. I explain to my patients that if their hiatus gets bigger, even by two centimeters, the valve will no longer work. The wider the opening, the more the stomach can move through the opening, like a napkin pulled through a ring.

HIATAL HERNIAS SHOULD BE TAKEN SERIOUSLY

Hiatal hernias are more than just un-comfortable bulges. A larger hiatal hernia becomes an obstruction of the esopha-gus, and in addition to concerns around esophageal cancer, a hiatal hernia of that

size can cause a host of other preventable disorders.

When a hiatal hernia patient lies down, digested liquid can flow into airways causing labored breathing. Believing they have chronic sinus problems, they make visits to the ENT, who can discover no real cause for the infection present. When this hernia gets bigger, as the stomach migrates into the chest, it can compresses the vena cava, preventing the heart from filling with blood. Patients begin com-plaining of low energy. They can’t exer-cise because they can barely breathe, not due to the hernia compressing the lungs, but due to heart failure. They think it’s all because they’re getting older and gaining more weight, causing poor circulation. When I speak to my patients about this, suggesting that hernia repair can alleviate these symptoms, they often cry with relief.

The truth is, our understanding of hiatal hernias has grown. Medicine is like a big ship – it’s hard to turn it fast enough, especially when it comes to the super-specialized area of upper GI. But as an estimated third of our local population has this problem, we must be vigilant in

diagnosing and treating it correctly.

ADVANCED ROBOTIC SURGERY FOR HIATAL HERNIA

Advances in robotic surgery have com-pletely transformed the treatment of hiatal hernia. In the not-so-distant past, patients avoided having the procedure because the methods available made the treatment risk-ier than the disease. Laparoscopy, though better than open surgery, didn’t allow the visibility or flexibility needed.

Things have changed. Robotics allows us to use wrist-like action, with 3D cameras giving the full view necessary to see in the space to reconstruct the hiatus. This tech-nology has changed the game, allowing highly successful results with almost non-existent hernia recurrence rates.

ROBOTIC SURGERY FOR ACHALASIA

The many benefits of robotic surgery make it an excellent solution to treat many thoracic and esophageal disorders, includ-ing achalasia. Patients present with pain on eating and difficulty swallowing. Most achalasia patients we see have been cop-ing with the disorder for many years. Their esophagus have become damaged, causing many problems to occur, including aspira-tion and choking.

Patients who have trouble swallow-ing should see a specialist who focuses on esophageal medicine for a proper diagno-sis. The sooner achalasia can be treated, the better – and not with dilation. Physi-cians have been searching for ways to treat achalasia since the 1700s, at one point using a whale bone to open the esopha-geal valve. But dilation, whether it’s done with a whale bone or endoscopy, doesn’t work as a long-term solution. In the past, as with hiatal hernia surgery, patients wanted to avoid open techniques. Lapa-roscopy, while better, is still not sensitive enough to allow the muscle to be cut and avoid putting a hole in the esophagus.

Laparoscopic myotomy, where the muscle of the lower esophagus is cut in a longitudinal fashion on the front of the esophagus, can be effective, but is associ-ated with an increased incidence of reflux, which necessitates a partial fundoplication, also decreasing long-term benefit. Robotic Lateral Heller Myotomy eliminates the need for fundoplication. Using this tech-nique, the muscle of the esophagus is cut longitudinally on the left side. Cutting the muscle on the left side of the esophagus pre-serves the normal gastroesophageal valve, which prevents reflux and removes the need for a fundoplication. Robotic Lateral Heller Myotomy procedure without fun-doplication is associated with 98 percent benefit, without any reflux.

These results have been superior to that of all previous procedures. The ro-bot’s 3D visualization allows the depth of visibility needed. It’s an elegant surgical strike! The patient wakes up and can eat.

LEADING THE NEW WAY Minimally invasive procedures using

medical robotic tools help us operate with more precision and efficiency at the Center for Advanced Thoracic Surgery. Thanks to the assistance of the revolution-ary robotic technology, positive patient outcomes are dramatically increased, while blood loss, pain, hospital stay and risk of infection or death are drastically de-creased. In most cases the use of the robot allows us to access afflicted areas with minimal incisions and increased visibility for greater success.

Farid Gharagozloo, MD, FACS is board certified in general surgery and thoracic surgery, and specializes in provid-ing the latest robotic surgery options to treat thoracic, esophageal, gastrointestinal, and lung diseases and can-cers. He is an esteemed physician and is the founding surgeon of the Center for Advanced Thoracic Surgery at Florida Hospital Celebration. His role at Florida Hospital’s acclaimed Global Robotics Institute establishes him as one of a handful of internationally recognized physicians at the leading edge of robotic surgery. To learn more about the Center for Advanced Thoracic Surgery or to refer a patient, contact the practice at (407) 303-4877.

Robotic Surgery Plays a Major Role in Successfully Treating Esophageal Disorders, Including Hiatal Hernias that Cause Damaging, Dangerous Esophageal Reflux

http://www.eocc.org


By JOSHUA BOWMAN, INTERN, MEDSPEAkS

Change. It’s the inevitable force that transpires throughout life. Change happens in several ways. We are all familiar with it. When we observe change on a macro scale, such as government policies and regulations, we can see the impact it has on entire in-dustries, and the trickle-down effect it has on businesses. In this case - health insurance.

Here are the facts: payers are pouring more money into investing and acquiring businesses than ever before. This is true for all types of companies, especially tech companies. Investing in or acquiring tech companies has a multitude of benefits for payers, but what was the cause of this in-vestment boom? What changed?

It’s true that big health insurance com-panies aren’t only investing in tech compa-nies. Payer/provider relationships are an example of this, focusing instead on evolv-ing care models and cutting costs. Payers have interests in investing in technology for obvious reasons. Whether it’s for data management or information security, it just makes sense. But where things get really interesting is when you consider how tech investments have exploded in recent years.

A study done by CB Insights shows that between Q1’12 and Q1’17, 141 trans-actions (investments and acquisitions) took place. Blue Cross Blue Shield Ventures had the most activity with 42 deals. Sixty-three of the 141 transactions were in digital health. Again, BlueCross Blue Shield led the way with investments in 19 unique digi-tal health companies during this time (CB

Insights). Clearly health insurance companies

are investing more

than ever before, so let’s examine the cata-lyst for this change.

When the Affordable Care Act passed, specific mandates were put into place to motivate health insurance com-panies to invest. One of those mandates, which is probably the biggest driver of the investment boom, is known as the medi-cal loss ratio rule. According to Centers for Medicare and Medicaid Services, The Affordable Care Act requires health insur-ance issuers to submit data on the propor-tion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards.

The Affordable Care Act requires insurance companies to spend at least 80 percent or 85 percent of premium dollars on medical care, with the rate review pro-visions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers (CMS). Since health insurance issuers are required to spend premium revenue on quality im-provement, they have chosen to spend revenue in a way that offers return on in-vestment. At the same time, they can meet ACA requirements and strategically invest. It’s good business and it makes sense.

This trend has payers investing not in technology giants, but instead in smaller startups. According to Fortune, in 2014 Blue Cross Blue Shield of Florida (Florida Blue) started an accelerator for healthcare

HEALTH INNOVATORS

By JAVIER ROJAS, MEDSPEAkS

In a world where a growing number of people are diagnosed with some form of cancer each day, the hope for a cure also grows. Recent statistics from the Ameri-can Cancer Society show that:

Every MINUTE three new cases of cancer are diagnosed in the United States.

This is an astonishing number since, in a year’s time, that will equal roughly 1.6 million new cases and there seems to be little we are able to do about it…yet. Though the hope of finding one magi-

cal cure for cancer still seems to be far off, there are a few companies that have decided to take an innovative approach against this deadly disease.

Targeting early detection of cancer, DermaSensor is a Miami-based startup. A device resembling the shape of an over-sized digital thermometer can quickly and easily detect possible skin cancers by press-ing the sensor against suspected cancerous skin tissue, which will display the results on the device’s screen in seconds. The device, which actually started out as desktop device resembling an old school computer, works by using ‘Elastic Scattering Spectroscopy technology’ along with learning algorithms

to effectively differ-entiate cancerous skin tissue from healthy tis-sue. Though it is still going through testing in clinical trials, the company aims to first sell their device to physicians and retail clinicians, but ul-timately the real goal is to source it to the average consumer at an affordable price. If successful in their mission, DermaSen-sor could make screening for skin cancer as easy as taking your temperature.

Another company taking an innova-tive approach in oncology is a University of Central Florida sponsored company, SegAna. They are employing a clever

solution to solve the problem of complica-

tions that occur during ra-diation of the lungs or when

surgery is necessary. They have developed a unique 3-D printer that can produce an exact structural duplicate of a patient’s lung. This will then allow the sur-geon to practice their radiation or surgery on this ‘Phantom’ lung, as SegAna calls it, which greatly reduces the risk of error and generally improves the patient’s outcome. Currently, the prototype is ready, and they are producing a demonstration to show the

New Technology Boosts Cancer Diagnosis and Treatment

PUT GAMERS TO THE TEST! Put gamers, geeks, and artists to the ultimate “test” by submitting challenges and/or ideas to engage patients. The best ideas will be pitched at Florida’s first MeGa Jam event which will converge medicine with video gaming technologies to create MEDICAL GAMES! [email protected]

Sponsorship packages are now available as are mentor registrations. Mentor Roles with Clinical and Executive level experience are needed to rally around teams, discuss and define clinical problems. www.megahealthjam.com.

Payer-Tech: Does it Really Exist?

MedSpeaksTM showcases the most exciting experts, events and innovations in Central Florida by bringing together the state’s largest community network of Health Innovators. We have converged over 1,400 healthcare professionals including clinicians, entrepreneurs, and technologists to discuss and promote the problems facing healthcare today and the innovations reshaping the future. www.medspeaks.com

GET INVOLVEDTECHSTARS STARTUP WEEKEND November 17 from 6:30p until November 19 at 9p http://bit.ly/2z6MunK

HEALTH INNOVATORS: NEW MODELS IN MEDICAL TRAINING & SIMULATION NOVEMBER 28 | 6:30PMOrlando, FL | www.meetup.com/FLHealth

IHI’S INSTITUTE FOR HEALTHCARE QUALITY IMPROVEMENTDECEMBER 10-13, 2017 Orlando, FL | www.ihi.org

FEATURED INNOVATORS:

Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements. All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.

HEALTHCURE is a unique environmental-tech company with a novel approach to thwart healthcare associated infec-tions (HAIs). The solution, Goldshield, uses a proprietary water-based technology to provide safe, non-toxic prophylactic protection on fabrics and hard surfaces against gram-positive and gram-neg-ative bacteria, as well as mold and mildew for 30 days. The company offers Goldshield - at cost - for healthcare institutions, LTC facilities, schools and other public and private facilities in hurricane crisis areas, such as Florida and Puerto Rico. www.healthcure.biz

AUXADYNE, based in Key Stone Heights, Florida designs and manufactures a patented auxetic polyurethane foam padding. Ini-tially used for sports helmets and padding, the company is expand-ing its application to innovate prosthetic socks, medical braces, and military and first responder protec-tive equipment. Unlike traditional foams, Auxadyne increases impact absorption by 600x and reduces pressure point stress by 50 percent. Investment Opportunity Available www.auxadyne.com

VIOLET DEFENSE TECHNOLOGY, based in Cel-ebration, Florida recently launched a new anti-microbial prod-uct line that combines broad spectrum UV and violet-blue light with artificial intelligence (AI) to kill MRSA, E. coli, Salmonella and Norovirus, from as far as three meters away. The ‘whole room’ unit disinfects a standard size room with various automatic cleaning modes that activate when the room is unoccupied and can be pre-programmed based on a facility’s specific operational needs. www.violetdefense.com



http://www.megahealthjam.com

http://bit.ly/2z6MunK

http://www.meetup.com/FLHealth

http://www.ihi.org

http://www.ihi.org

http://www.healthcure.biz

http://www.auxadyne.com

http://www.violetdefense.com

http://www.healthcure.biz

http://www.auxadyne.com

http://www.violetdefense.com

http://www.megahealthjam.com

mailto:kelli%40medspeaks.com%20%0D?subject=Put%20Gamers%20to%20the%20Test%21


By DALIA CANTOR

Our profession has evolved vastly over the years and today we are more than just bean counters and tax pre-parers. A good CPA can be your com-pany’s financial partner for life and will help you with decisions from day to day operations to strategic plan-ning. So how do you find the right CPA for your business?

Like any other partner you choose to be by your side, you need to go through the vetting process. The first step in setting the stage for a successful search is to know what services you need and/or want. Given the level of fees you are prepared to pay, you must decide where your responsibility stops and where the ac-countant’s begins.

You should plan to interview three to five candidates and evaluate each potential candidate based on these criteria – services, personality and fees. You will notice that I am not mentioning professionalism and competence because that should be a given fact amongst the candidates of your choos-ing. The best place to start your pickings are your referral sources such as business partners in your industry, your attorney, or your banker.

SERVICES Most accounting firms offer tax and

bookkeeping services. But what if you need payroll, management consulting, budgeting and forecasting, estate plan-ning? Will the accountant help you design and implement financial information sys-

tems? Other services a CPA may offer is assistance for loans and financing; mergers and acquisitions related services; manag-ing investments; and representing you be-fore tax authorities.

Although smaller accounting firms are generally a better bet for entrepre-neurs, they may not offer all these ser-vices. Do your homework and find out if the firm has what you need. In addition to services, make sure the firm has experi-ence with your size of business and with your industry.

PERSONALITYI am talking about long term relation-

ships here so the personality and like mindedness does mat-ter. Is the accountant’s style compatible with yours? Excel-lent organization skills, high de-gree of precision, focus on the client, extreme trustworthiness,

creativity and collaboration are basic skills that a suc-cessful and competent CPA should possess. What about your vision? Can you see this person working side by side with you in achieving your goals?

Be sure the people you are meeting with are the same

ones who will be handling your business. At many accounting

firms, some partners handle sales and new business, then pass the ac-

tual account work on to others.

FEESAsk about fees upfront. Most ac-

counting firms charge by the hour; fees can range from $100 to $275 per hour. However, there are some accountants who work on a monthly retainer. Figure out what services you are likely to need and which option will be more cost-effec-tive for you. Try to get an estimate of the total annual charges based on the services you have discussed but don’t base your decision solely on cost. Remember that often you get what you pay for.

You should ask your potential CPA candidates questions such as:

• Do you deliver timely services?• How soon do you respond to an email

or a phone call?• What other clients do you have in the

same industry?• What other services do you offer

beyond usual reporting?• Is your firm tech-savvy and how do you

use the latest technology for efficiency?• What kind of credentials do you have?• Who in your firm I will be interacting with?• How are your fees calculated?• What can I do to help with your work

to keep your fees lower?• Why should I use your firm?

You should also pay attention to the questions CPA asks you. You know your finances, but the CPA doesn’t, so are they asking enough questions to understand your entire financial situation?

Accounting books provide a basis for business decisions and measure the finan-cial health of your company so naturally you want someone on your team that under-stands your business, is reliable, precise, and is as passionate about your business as you are!

Dalia Cantor, CPA, has been practicing as an accoun-tant and tax advisor since 1997. She is a Certified Public Accountant 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 manag-ing both domestic and foreign audit and tax clients. In private industry, she was involved in the regulatory en-vironment, specializing in technical accounting, internal controls, and SEC reporting for publicly held companies. She can be reached at [email protected]

CPASPEAK in partnership with

SEEING BEYOND THE NUMBERS

Responsive, Proactive & Focused on Client Needs• Bookkeeping, payroll & financial statements

• Tax planning & preparation

• Practice management

• Practice valuations, sales & acquisitions

[email protected]

/CPASolut ions.com

MYCPASOLUTIONS.COM

C O N V E N I E N T LY L O C AT E D O F F I C E S I N D O W N T O W N O R L A N D O & A V A L O N P A R K

NEW LOCATION! CELEBRATION 6 1 0 S Y C A M O R E S T. , S T E 1 5 0 , C E L E B R AT I O N , F L 3 4 7 4 7

advantage and practicality of the technol-ogy for surgeons and oncologists.

The definition of an innovator is, “to do something in a new way” and that is exactly what the Tampa-based company, Cvern-genx is doing. Cverngenx is focused on ra-diation therapy, which is anything but new in cancer treatment, except they have taken the current treatment style and revolutionized it by using a patient’s genome to develop per-sonalized radiation treatment. This seems like a pretty simple idea realizing that every person is different and will require a differ-ent treatment plan, but currently most can-cer patients are being treated with the same radiation treatment across the board. They have developed a ‘Precision Genomic Radia-tion Therapy platform’ or ‘pGRT™’, which is able to mathematically suggest radiation parameters that would best fit that particular patient. Being able to effectively predict how each patient will react to his or her radiation will not only save time and money but could improve or save that person’s life.

Cancer cases are only continuing to grow over the years and until we develop a cure, the best we can do is develop new ways to detect it early on or find more ef-fective ways to treat it once it develops.

New Technology,continued from page 7

HEALTH INNOVATORS

Your Accountant is Your Partner; Choose Wisely

http://www.mycpasolutions.com/


By DR. WILLIAM F. SENSAkOVIC

Wilhelm Roentgen serendipitously discovered x-rays in 1895. Scientists and physicians, eager to improve patient care, immediately applied the new technology to imaging the human body. By 1897 reports began to surface of hair loss and skin redden-ing and in that same year it was confirmed that x-rays induce biological changes when they were used to treat nevi (hairy moles) on the back of a 5 year old girl.

Extensive research over the last cen-tury using animal models and epidemio-logical data from events such as the atomic bombings of Hiroshima and Nagasaki and Chernobyl has improved our understand-ing of radiobiological effects. This research has definitively demonstrated that radia-tion may cause cancer, epilation, sterility, cataracts, erythema, desquamation, tissue necrosis, and death. Further, radiobio-logical effects are of particular concern for children and pregnant women. Research has demonstrated that children are more sensitive to radiation induced cataracts, hy-pothyroidism, thyroid nodules, and many forms of cancer. An irradiated embryo/fetus is at risk for miscarriage, childhood cancer, growth retardation, organ malfor-mation, and intellectual disability.

These severe radiobiological effects coupled with the ubiquity of medical imag-ing are often a source of anxiety for both patients and physicians. Add in damning exposés in the news, exaggerated journal ar-ticles, and a general lack of education about radiation and it creates a hysteria that may cause both physicians and patients to avoid essential imaging.

To understand the effects of radiation and gauge its danger one needs to under-stand how we measure radiation. Though the field is vast, for our purposes it will suffice to say that tissue radiation absorbed dose is measured in Grays (Gy). All radiobiological effects, except cancer, require a minimum dose (threshold) before they occur.

Computed tomography (CT), nu-clear medicine, and fluoroscopy typically give the highest radiation absorbed doses (up to 0.1Gy to tissue and up to 0.03Gy fetal). The lowest dose that produces non-cancerous biological effects is 0.25Gy in adults and 0.1Gy in utero. Thus, a typical diagnostic scan will not cause biological tissue effects in adults or a fetus. It should, however, be noted that interventional procedures and radiotherapies can that approach a level of concern.

Radiation dose measurements are modified to account for the varying poten-tial of cancer induction in different tissues. This modified dose is called the effective dose and is measured in Sieverts (Sv). CT typically delivers the highest effective dose (~0.002-0.01Sv) with radiographs and fluoroscopy below that. Though there is some controversy, currently accepted models assume any amount of radiation may induce cancer. That being said a

0.01Sv CT scan increases a typical person’s cancer risk from ~40% to ~40.1%. Similarly, a pelvic CT of a pregnant woman in-creases the fetal risk of child-hood cancer from ~0.3% to ~0.5%. Thus, the risk from imaging is very low. However, given the ubiquity of scan-ning and the possibility of multiple scans on the same patient, it is recommended that radiation is lim-ited to what is diag-nostically necessary.

Given the small risk of cancer it would be ideal if we could minimize dose; however, this is not possible. Although the exact relationship is complex, image qual-ity generally decreases as dose decreases. Thus, minimizing dose would result in non-diagnostic image quality. Instead, manage-ment of patient radiation should follow the principles of justification and optimization.

Justification states that an exam should only be performed if it does more good than harm. A good mnemonic is .DAM (dot DAM): Don’t Order Tests that Don’t Af-fect Management. The physician looking for guidance on appropriate imaging should refer to The American College of Radiol-ogy (ACR) Appropriateness Criteria®. These are “evidence-based guidelines to as-sist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical con-dition.” By ordering the lowest-dose exam that still conveys relevant clinical informa-tion the referring physician can play a large

role in reducing patient radiation dose.Optimization entails ensuring that

modern technology is utilized and that im-aging protocols are set such that excess ra-diation is not delivered to the patient. New technology such as iterative reconstruction and automatic exposure control when prop-erly used create images of sufficient quality at reduced dose. How that technology is implemented is determined by the scanning parameters, which have a tremendous im-pact on image quality and patient dose. The protocol that describes these parameters should be periodically reviewed by a team consisting of, at a minimum, a radiologist, qualified medical physicist, and technolo-gist. The radiologist reviews image quality, the physicist reviews the technology and dose, and the technologist reviews workflow integration and implementation feasibility. Many resources exist to guide optimization. These include journal articles, ACR practice parameters, and publications from Image Wisely, Image Gently, and the American

Association of Physicists in Medicine. This information can help a practice provide the best care for their patients

by ensuring that patient radiation dose is As Low As Rea-

sonably Achievable (ALARA).

The radiation delivered during im-

aging is essential for di-agnosis, but brings with is a small risk to the patient. It is important

that physicians keep this risk in mind, but also in perspective when ordering imaging studies and perform-ing patient scans. Diagnostic imaging

exams, when performed correctly, should not induce non-cancerous effects. The prob-ability of inducing cancerous effects is also quite low to negligible. Qualified Medical Physicists are experts in the application of radiation in healthcare and should be con-sulted when optimizing protocols, imaging vulnerable populations, and when questions related to dose and image quality arise.

Dr. William F. Sensakovic received his undergraduate degrees and PhD from the University of Chicago. His research focused on image processing, computer-aided detection, and imaging biomarkers. He is certified by the ABR for Diagnos-tic Medical Physics and by the American Board of Magnetic Resonance Safety (ABMRS) as a MR Safety Expert. He is

Chair of the AAPM Imaging Physics Curricula Subcommittee and task group on establishing an image quality registry, edi-tor for the physics section of both RadExam and Radiology As-sessment and Review (RADAR). He is president-elect for the State of Florida AAPM, the ACR councilor-at-large for Medical Physics, a board member for the ABMRS, and on the board of associate editors for Medical Physics. He is currently a Medical Physicist at Florida Hospital.

Patient Radiation in Diagnostic ImagingRADIOLOGY INSIGHTS sponsored by

601 East Rollins St. Orlando, FL 32803 (407) 303-8178 | FloridaHospitalRadiology.com

å

Dedicated to ServeRADIOLOGY SPECIALISTS OF FLORIDA

Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully dedicated to providing our community with excellent medical imaging services.

WE PROVIDE• 24/7 Reads and accessibility• Continuity of care• State of the art technology• High Image quality• Lowest Levels of Radiation• Trusted Florida Hospital Radiology

17-RSF-03539 RSF Radiologist Informational Flyer.indd 1 7/18/17 3:40 PM


å






å





601 East Rollins St. Orlando, FL 32803

(407) 303-8178FLORIDAHOSPITALRADIOLOGY.COM



https://www.floridahospitalfri.com/


Direct Support For Patients & Families

• Lynx Single Ride Option Bus Passes and gas cards to make

reaching our health centers easier

• Publix, W almart or Target Gift Cards

• Videos and DVD’s, Coloring books & crayons, and games for

children who wait to see the provider

• Financial contributions to support patient visits and medical services

Direct Support of Our Health Center Managers

• Kleenex and Multi-Fold Paper Towels

• Hand Sanitizer

• Disinfectant Wipes

• AA and AAA Batteries

• Tall Kitchen Garbage Bags

• Non-Latex Medical Gloves

• Forever Mailing Stamps

• White Copy Paper

• Plain White Mailing Envelopes (Size #10, 9” x 12” and 10” x 13”)

• Automatic Blood Pressure Cuffs

• Wall-Mount Flat Screen Television for Volunteer Trainings

t For Patients & Families

of Healinggifts

olunteer Trainings

Shop AmazonSmile.com Volunteer

Give a Gift!

and double your donation. Selected items are shipped

directly to Shepherd’s Hope.

Volunteer your time at a Shepherd’s Hope Health Center.

For more information, visit ShepherdsHope.org/Volunteers

Every $ Makes a Difference: Visit ShepherdsHope.org/DonateNow

Call 407-876-6699 Ext. 230.










• Hand Sanitizer











of Healinggifts

olunteer Trainings


Give a Gift!






Call 407-876-6699 Ext. 230.










• Hand Sanitizer











of Healinggifts

olunteer Trainings


Give a Gift!






Call 407-876-6699 Ext. 230.










• Hand Sanitizer











of Healinggifts

olunteer Trainings

Give hopeShop

AmazonSmile.com VolunteerGive

a Gift!and double your donation. Selected items are shipped





Call 407-876-6699 Ext. 230.

www.ShepherdsHope.org

By MARk LANTON

You know that HIPAA is manda-tory, and you know the significance of complying with HIPAA. But, do you re-ally know what all HIPAA commands of you? I use the word “command” because of the heavy hand of the government and the serious consequences, even if due to a simple infraction on the physician’s part. This may surprise you, but according to the government, more than 70 percent of all physician practices are NOT compli-ant. You have to ask yourself the ques-tion, “is my practice in compliance?” And if you think you are, how do you know?

Not knowing for sure if you are completely in compliance is like playing Russian Roulette with your practice. For instance, a three-physician dermatol-ogy practice in Massachusetts was fined $150,000 because an office employee backed up patient records on an unen-crypted thumb drive that was stolen. This was not an intentional HIPAA violation, but not paying attention to details are the cause of a significant number of HIPAA violations nationwide.

Another example of a HIPAA blun-der was an employee at the University of Iowa Student Health Center who had noticeably displayed her surprise when she learned the results of a high-profile athlete’s pregnancy test. Even though the employee had compliance training, this employee made a supposedly virtuous remark in wishing the young couple well. The employee was “thinking out loud,” but was overheard by other employees who reported her statement. The em-ployee was then fired.

I can go on-and-on with examples of HIPAA violations that were easily pre-ventable. It is reported that there have been more than 27,000,000 medical re-cords disclosed in the past three years. That number is more than the popula-tion of many nations around the globe. Doctors, nurses, office managers and healthcare professionals all share in the confusion that is linked to HIPAA.

Who is responsible for following HIPAA?

Every covered entity (CE), physician practice must appoint a Compliance Of-ficer within the practice. A Compliance Officer can be the Office Manager or physician. The Compliance Officer car-ries a heavy load on their shoulders be-cause the fate of the practice can depend on the quality and thoroughness in main-taining compliance. If you are responsible for maintaining the compliance in your practice, your employment, finances and freedom can be all at risk. Fines can range in the neighborhood of $50,000 or more. Recent legislation has increased the gov-ernment’s ability to audit and penalize

to the fullest extent. If your Officer Man-ager or in-house biller is undercoding or unbundling codes, the possibility of being audited is greatly increased. It has been shown that outsourcing to billing/coding companies have proven to dramatically decrease government audits, and increase a practice revenue.

What happens to a practice that is not found in compliance? Several things can happen, depending on the violations. In the case of a data breach, in addition to the hefty fines by HHS, the HITECH Act also gives the State Attorney General authority to impose civil penalties for violations. A practice can also run the risk of receiving negative publicity. Here’s how. If there is a breach in protected health information (PHI) of more than 500 patients, the cov-ered entity (CE) is required to notify each affected patient, and also report the data breach to the media. There will be various additional sanctions on this practice as a result of the data breach. A scenario like this can certainly cause significant prob-lems to a practice, and patient trust in this practice will be minimal.

What can you do to secure a compliant practice?

You have to follow the rules. How do you know what rules to follow? By having security and privacy procedures in place that will protect PHI. Although you can do it yourself, it is proven that using a pur-chased product, such as an independent medical revenue management company to identify the compliance and security “pain points” of a practice has been highly ef-fective. Solutions can then be formulated, which will result in increased practice ef-ficiency and compliance.

The HHS has clearly communicated their goal in strict enforcement of HIPAA. Don’t let your practice become a bad ex-ample. You can be publicly censured by the government for unintentional infrac-tions. You can be subject to enormous fines, loss of patients and possible impris-onment. The reality of being forced to do the figurative “perp walk” of shame because of something that was prevent-able, is easy as accidentally forgetting to lock your computer when you leave the office for lunch. We want your practice to thrive and focus on giving great patient care instead of dealing with insurance companies, complicated paperwork and the over-bearing government. Take an in-ventory of your practice and ask yourself this question. When was the last time your practice had a checkup?

Mark A. Lanton, CMRM, is founder/CEO of Lanton Consulting, LLC., Specializing in increasing physician practice efficiency, compliance and cashflow via Practice Management, Revenue Cycle Optimization and Pri-vate Practice Business Support. Visit www.LantonConsulting.com or email [email protected]

Is Your Practice HIPAA Compliant?

http://www.LantonConsulting.com

mailto:[email protected]


By kATIE BLAyLOCk & PATRICk DUDLEy

Medical professionals are looking to staffing agencies to help staff their offices and hospitals with high quality temporary employees more and more. Utilization of staffing agencies used to be an option of last resort, but now staffing agencies provide a strategic advantage and financial benefits. While there are many advantages of work-ing with a staffing agency, how do you find the right one? You start by clearly outlining your specific needs and then identifying the staffing agency that can work with you as a partner to meet your objectives.

By working with a staffing agency, the hiring manager can ensure temp employees possess the necessary skills, education, and experience to meet their needs. Here are a few reasons a staffing agency can help.

LOWER COSTSBy employing temporary staff through

staffing agencies, the employer eliminates many tasks and cost associates with gener-ating payroll. There are no employee tax or benefit costs. No liability insurance cover-ing employee actions. No paid time off for holidays or vacation. No payroll withhold-ings or deductions to pay or report.

STAFFING FLEXIBILITYThere are three major types of jobs

that staffing agencies help companies fill: • temporary – the employer can work

with a candidate for a set time• temp to hire – the employer can

work with a candidate for a time to ensure they are a fit before offering a permanent position

• direct hire – the employer uses the staffing agency as a recruiter for a permanent position within the company

By working with the agency, you can determine the job and the best way to fill that position which offers you staffing flexibility.

YOUR TIME Wouldn’t it be nice to actually work

on things that will benefit your company rather than always dealing with turnover? With the improving job market, the hir-ing process is longer and more difficult for many companies. The staffing agency can assist in the process. An experienced staffing agency has access to a greater tal-ent pool including both active and pas-sive candidates. Convincing a person who is not considering an opportunity takes more time than recruiting someone who is anxious to leave. Most corporate recruit-ers spend their time with active candidates because they know the position needs to be filled. They simply don’t have the time to invest in passive candidates. They understand real job needs, so they hire people who can hit the ground running

Part of being a strong industry spe-cific staffing agency is understanding the real job needs, as well as the hiring man-ager needs. While corporate recruiters could certainly do this, they rarely get the chance. As a result, too many corporate recruiters over-rely on skills, experience and compensation to filter candidates, eliminating high potential and diverse candidates from consideration.

NEED TO KEEP PERMANENT HEADCOUNT DOWN

During hiring freezes, managers are not allowed to hire permanent employ-ees. At this time, temporary employees become a valuable resource. They can

become permanent employees when the hiring freeze is over.

• Medical office managers know there are many advantages to using temporary staff, but how do you take the risk out of outsourcing those positions? Many managers are shifting their perspective from simply locating staffing agencies to developing relationships with strategic partners.

• The difference is more than semantics. The thought of using temp labor for critical services may be unnerving because you feel you could lose control and connectivity. By working with a strategic partner, those services should have a

different feel and result. Although a contract is involved, a strategic partnership is relationship based.

Working with an agency as a strategic partner, the focus is placements not activity

Some external recruiters might sub-mit as many candidates as they can and hope one sticks. By working with an agency as a strategic partner, you work together to identify the job and candi-date needed to fill that position. The best agency will present fewer high-quality candidates and will help manage the pro-cess from beginning to end.

Cancer/Specified-Disease • Initial Diagnosis Benefi t • Hospital Confi nement Benefi t • Radiation and Chemotherapy Benefi ts • Cancer Wellness Benefi t, plus more

Accident • Emergency Treatment Benefi t • Accidental-Death Benefi t • Initial Hospitalization Benefi t • Hospital Confi nement Benefi t, plus more

Short-Term Disability • Selection of: • Monthly Benefi t Amount • Elimination Period • Benefi t Period • Guaranteed-Renewable to Age 75

Hospital Confinement Sickness Indemnity • Physician Visits Benefi t • Initial Hospitalization Benefi t • Major Diagnostic Exams Benefi t • Surgical Benefi t • Hospital Confi nement Benefi t

M2080V2

A�ac is an extra measure of �nancial protection.

When you’re sick or hurt,

A�ac pays cash benets directly

to you, unless otherwise assigned,

to help you and your family

with unexpected expenses.

For more information about

policy bene�ts, limitations,

and exclusions, please call

your A�ac insurance agent:

Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. For more information about One Day PaySM, visit a�ac.com/OneDayPay. Worldwide Headquarters | 1932 Wynnton Road | Columbus, Georgia 31999

7/15

Juan Lopez-Cortes

(407) 802-8715

[email protected]

Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. For more information about One Day PaySM, visit a”ac.com/OneDayPay. Worldwide Headquarters | 1932 Wynnton Road | Columbus, Georgia 31999

Got Your Attention?Policy – Benefi ts - Limitations - Exclusions

Juan Lopez-Cortes; PrincipalDOC Offi ce Support, LLCAn Independent Afl ac [email protected] ac.com

M2080V2

A�ac is an extra measure of �nancial protection.

When you’re sick or hurt,

A�ac pays cash benets directly

to you, unless otherwise assigned,

to help you and your family

with unexpected expenses.

For more information about

policy bene�ts, limitations,

and exclusions, please call

your A�ac insurance agent:

Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. For more information about One Day PaySM, visit a�ac.com/OneDayPay. Worldwide Headquarters | 1932 Wynnton Road | Columbus, Georgia 31999

7/15

Juan Lopez-Cortes

(407) 802-8715

[email protected]

Bonus… Improved Employee Recruiting & Reduced Employee “Churn”

Independent Physician’s RX for “Extra” Financial Protection

Why Companies Should Use Staffing ServicesBy working with a staffing agency, the hiring manager can ensure temp employees possess the necessary skills, education, and experience to meet their needs. Here are a few reasons a staffing agency can help.


mailto:juan_lopezcortes%40us.aflac.com?subject=Responding%20to%20OMN%27s%20November%20ad


By SONDA EUNUS, MHA, CMPE, CPB

Orlando Medical News continues this series of answers to questions from readers dealing with issues faced by practice managers in our healthcare community.

We encourage readers to send questions they face in everyday practice. Use the subject Practice Manage-ment Challenges to [email protected]

Questions selected for inclusion in the next edition will receive a complimentary 300 x 600 pixel ad with animated gif on our website.

1. WHAT ADDITIONAL SERVICES CAN PRIMARY PRACTICES OFFER TO GENERATE MORE REVENUE?

There are various ways that a prac-tice can generate additional revenue from ancillary services and products. For exam-ple, a primary care practice may choose to offer allergy testing and immunotherapy services by partnering with an allergy test-ing lab (ex. BioTek Labs). This is an easy partnership in which the practice physi-cians refer patients for the testing, which is then done onsite. Many other types of lab testing can also be implemented. An-other way to generate additional revenue would be to have an onsite pharmacy, so that patients are able to fill their prescrip-tions immediately. All of these options are

convenient for the patients, and profitable for the practice. Some practices have also greatly profited from offering new ser-vices by leasing medical equipment that they did not have the capital to purchase. These are only a few examples of ways to implement additional revenue sources, it is up to each practice to determine which services would be the most appealing to their patient base.

2. WHAT CAN OUR PRACTICE DO TO RECRUIT MORE PHYSICIANS?

Physicians, as most employees, are motivated by much more than just finan-cial compensation when considering a job offer. They want to join a team with a vision that they can buy into, with lead-ership that is honest, fair, ambitious, and passionate about the success of the prac-tice. Physicians want to work with nurses and other ancillary staff who enjoy their jobs and anticipate their physicians’ needs. Aside from creating a great work culture, there are several other ways that a practice can become more appealing to a physi-cian candidate. Tuition reimbursement is greatly appreciated by physicians, as they frequently have large sums of outstanding

student loans. Some medical practices can qualify to become a loan forgiveness site, and be able to offer tuition reimbursement at no cost to the practice (https://nhsc.hrsa.gov/loanrepayment/). Health insur-ance is usually desired by candidates, and smaller practices may find that the costs of offering group health insurance are very steep. Additionally, the plans offered usu-ally come with a high share of cost for the employee as well. One way to bypass this challenge is to offer health insurance re-imbursement, in which an employee ob-tains their own health insurance plan, and the practice then reimburses an agreed-upon percentage of the premium. Finally, compensation packages are usually most effective when a base salary is combined

with a productivity and quality incentive system, which motivates physicians to see more patients, while still maintaining the practice’s standard of quality.

Sonda Eunus, Founder & CEO of Leading Management Solutions has a background in managing a multi-location pediatric primary care practice, 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 providing services that she herself needed while managing her practice. Along with a team of experienced and knowledgeable consultants, Sonda aims to make Leading Management 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 [email protected]

407.674.1916 | LMSHEALTHPRO.COM4 7 0 0 M I L L E N I A B LV D , S T E . 1 7 5 | O R L A N D O , F L 3 2 8 3 9

A Medical Practice Leader’s ResourceSERVICES OFFERED: • Management Consulting & Employee Training• Health IT Consulting & Implementation• Billing, Credentialing, & Marketing

L E A D I N G M A N A G E M E N T S O L U T I O N S

PRACTICEMANAGEMENT

Overwhelmed Yet?

orlandomedicalNews.comSubscribe Today at

fastNEWS MOVES

NO SPAM, NO FLUFF ... JUST NEWS.

Get weekly headlines that affect you and your business sent straight to your device, twice a week.

http://lmshealthpro.com/


http://lmshealthpro.com/

https://orlandomednews.bondwaresite.com/profile.php


Payer-Tech: Does it Really Exist? continued from page 7

HEALTH INNOVATORS

startups. As stated earlier, Blue Cross Blue Shield is among the most active investors. The accelerator, which is run by Healthbox, has invested in 47 healthcare startups.

Why tech startups? Prevention is a major emphasis of Affordable Care Act. A healthier person means less spent overall on healthcare and can drive costs and spend-ing down. Prior to the Affordable Care Act, the focus on prevention wasn’t what it needed to be. So now we have the focus on prevention. A wonderful example of the added focus on prevention is no cost pre-ventive care. Add in the medical loss ratio rule to this equation and you get the an-swer. With so much thought being put into health and wellness, the number of startups with this focus is astounding. Payers have taken notice and jumped at the many op-portunities to invest.

For example, Florida Blue has invested in a company by the name of ROSTR. ROSTR offers scouting and talent evalu-ation services to high school athletes who seek college scholarships for their potential sport. Through mobile technology, student athletes can track and view performance sta-tistics and vital statistics. Potential scouts can view the data on what is known as a Ros-trcard. This investment by Florida Blue is in-teresting because it is a good example of how

payers are investing in tech startups that are outside the realm of direct healthcare, but is still a medium for people to focus on health and wellness through technology.

Ultimately, since the implementation of the Affordable Care Act, there has been a huge emphasis on cutting healthcare costs. Through mandates such as the medical loss ratio rule, payers have started investing in tech companies that can at the same time help keep their members healthy and offer a return on investment. As technology ad-vances and payers put a higher emphasis on health and wellness, investments in tech companies will continue to rise.

Healthcare is early in its ever-chang-ing journey and with the potential repeal of Obamacare, new trends and forces may arise. If repealed, many of the mandates currently in effect could no longer exist, which would lead payers to re-think busi-ness strategy. It remains to be seen what effect this could have on the current invest-ment trend.

the UCF College of Medicine and Osceola Regional. And half of the core physician faculty in our graduate medical education program are women. Dr. Jennifer Waxler serves as the emergency department’s re-gional medical director and Dr. Larissa Dub is the department’s assistant medical director. Osceola Regional has made it a priority to diversify its leadership. That’s something we all can and must do.

The lack of women healthcare lead-ers is a nationwide problem. Recent stud-ies show that women make up only about one-third of the nation’s full-time medical school faculty positions. Only 15 percent are department chairs. Only 16 percent are medical school deans. The most com-mon leadership position for women across the nation is medical director. There are very few women leaders at the top of the healthcare arena. As physicians caring for an increasingly diverse community, we must look at why more women are not in leadership positions. Half of the country’s newly graduated MDs are women. That means half of the residents in our hospitals are female. So what happens to women physicians along the way? Why don’t they become leaders after they finish their train-ing? What are their concerns and decision points? Where do we lose them? Work-

family balance may be one of the concerns. Can our workplaces – hospitals, clinics, out-patient surgery centers – work to help accommodate those concerns? Have we, as leaders, done everything we could to men-tor young female physicians on work-life balance? I am the mother of a 14-year-old son. I hope my journey can be an example to other physicians – both female and male – of being a healthcare leader while raising a family. Each of us is a role model for oth-ers. We need to start acting that way and sharing our experiences.

I have a responsibility to highlight women physicians who are leaders and to encourage qualified women to take on lead-ership positions. I have the responsibility to work within my hospital to develop and promote women leaders. And I have the responsibility to show women doctors they have every opportunity available to them. We are only limited by our imaginations.

We have come a long way since my childhood in England. But we must do more. As women, we have unique traits that serve us well as care-givers. Those same characteristics make us strong lead-ers. We just have to work together to make more of those opportunities happen.

Bethany Ballinger, continued from page 3

PHYSICIANSPOTLIGHT

Social Media Strategy, Facebook Advertising, Online Marketing Materials, Web Development

Reach out to more than 1 million Orlando residents on Facebook!

Social Media Strategy, Facebook Advertising, Online Marketing Materials, Web DevelopmentOnline Marketing Materials, Web Development

Reach out to more Reach out to more than 1 million Orlando residents on Facebook!

It’s time to go social,

Doc!

Trish Murphy 863-899-3703 | TridentOrlando.com C H U C K H O L L I S , C C I M | V I C E P R E S I D E N TO 4 0 7 . 6 7 9 . 2 2 1 4 | M 3 0 9 . 3 0 3 . 4 4 6 6 | W W W. P E N N I N G TO N - A S S O C . C O M

Thank you to Florida Hospital Fish Memorialand RS&H Architects for including

Pennington & Associates, Inc. in the recently completed Fish Memorial Executive Offi ce Project

http://tridentorlando.com/

http://pennington-assoc.com/


the Sky: Turning Oppression into Op-portunity and on the NBC Tonight Show Starring Jimmy Fallon.

For our “In other words…” forum, Dr. Patel talks about Cents of Relief and his ef-forts to sustain the benefits to those it serves.

IN OTHER WORDS from Dr. Anup Patel

Dressed in a gaudy, orange sari to go with her fiery-red lipstick and cheap jewelry, a terrified woman whose facial disfigurement and burn contractures re-veal the violence she endured as a sex-trafficked victim in the notorious red-light area of Sonagachi. That summer of 2003 volunteering in India’s red-light area as an undergraduate, I witnessed a plethora of medical conditions these victims sustained from the abusive sex-trade without ac-cess to healthcare. The time in Mumbai and Kolkata proved to be the catalyst for co-founding Cents of Relief (CoR) that endeavors to empower victims of human trafficking through healthcare and edu-cation. The experience engendered my passion to become a physician, and, ul-timately, a plastic surgeon with the ar-mamentarium necessary to tackle the overwhelming craniofacial and hand pa-thology found in these areas. The unique ability of plastic surgery to restore both form and function, as well as the special-ty’s capability to provide healthcare on the international level attracted me to the field when I was a medical student.

Today, I find myself spending my time working to treat patients in the greater Or-lando area, while working to expand and raise awareness about human trafficking via CoR. The former means working with medical stu-

dents and residents to treat cosmetic, oncologic, and traumatic issues from head to toe for pa-tients of any age. For example, in one day, our clinic may have patients needing carpal tunnel surgery, reconstruction of a facial skin cancer, or aesthetic rejuvenation. Many patients dur-ing their visit inquire what led me to the path of medicine which inevitably brings up the CoR story and a discussion about human traffick-ing. Moreover, in the fall, Rina, my wife and co-founder of CoR, and I spend the evenings working on the logistics for our annual charity’s golf tournament in Orlando.

This golf tournament brings the jour-ney from volunteering in India to becoming a plastic surgeon to returning back to Or-lando full circle. The funds directly proceed the victims of human trafficking supported by CoR’s projects with many teams formed by friends in the area, including many of whom have been those inquisitive patients asking me what was the impetus for becom-ing a doctor. Many Lake Highland, Univer-sity of Florida, and Yale alums and current students as well as medical professionals not only play, but also volunteer during the weekend tournament. At the end, the tour-nament serves as a professional networking event with altruistic-minded members of the community getting to know each other better.

The surgical training obtained at first to provide an underserved area of India now pays dividends to treat the plastic and reconstructive needs of Cen-tral Florida with many of those patients joining the CoR crusade of giving back to the underserved areas of our globe.

Dr. Patel practices at the Orlando Plastic Surgery Institute and at Orlando Hand Surgery Associates. He can be reached at dranupprsATgmail.com

Dr. Anup Patel, continued from page 1

HEALTHCARELEADER

Staffing Services, continued from page 11

Good strategic partners are more consultative than transactional which means their candidates take the job for the right reasons

These external recruiters build rela-tionships with candidates. By understand-ing the needs of both the hiring company and candidate, the recruiter can find the right fit for your company. Understanding it takes more time to build these relation-ships, the recuiter can hire a person who will be more successful in the long run be-cause they understand what both parties are wanting. Where do you start looking for a strategic partner? It begins with trust. Trust is built through proven integrity, capability, and commitment.

INTEGRITY Choose a partner with a long history of

integrity; not just in appearance, but built into its value system and exemplified in its

leadership.

CAPABILLITY Partners who consistently perform well

have the experience to provide quality hires to your organization.

COMMITMENT Having a desire to excel and determi-

nation to overcome all odds are character-istics that all winning teams share. There are open lines of communications of what is needed and what is supplied.

Is the provider you currently use will-ing to learn your culture and embrace those characteristics in the candidates they pres-ent? Identify that provider, and you may have revealed your strategic partner.

Katie Blaylock, Manager of Marketing and Communications, and Patrick Dudley, Managing Director, of SourceMaster Search | Staffing | MatchabilityTM. Patrick has over 20 years’ experience in the staffing industry including owning his own agency since 2001. Patrick can be reached at [email protected]. Learn more about SourceMaster Search | Staffing | MatchabilityTM on their website, www.source-master.com.

By ROSE M. ROMERO

In an effort to navigate through the many complex aspects of running a pri-vate practice, you have likely measured your documentation practices, workflows, and staff productivity. However, you may be surprised to learn that those fundamen-tal measures of practice operations are not the only factors that directly impact your bottom line.

The reality of healthcare today is that the effort you apply on the front end of patient care is only as good as the at-tentiveness and accuracy that goes into your billing practices on the back end. After all, if the claims you send to insur-ance companies are inaccurate, there is a hundred percent chance that you will ex-perience a delay in your reimbursement. In fact, according to an article in Health-care Finance, claims errors can double the amount of time it takes for your claim to be processed. Think of it this way, how likely is a piece of mail going to get to its intended recipient without the correct address? That mail will continue to be returned until it contains everything the post office needs to process it appropri-ately. With that said, your practice’s cash-flow depends entirely on the optimization of your billing workflow; sending out clean claims – the first time, every time. But be-fore you can optimize your billing work-flow, you have to understand the entire process of revenue cycle. So where does the work start?

Believe it or not, your front office staff have the most impactful role in your revenue cycle. Their ability to collect and enter your patient’s demographic data with accuracy and completeness is just as important as the physician’s responsibility

to assign the appropriate ICD-10 and level of service to an office visit. Even the small-est of errors like a misspelled name, wrong date of birth, or a transposed insurance ID number can lead to a claim denial and ultimately slow your practice’s cash flow - not to mention, it could also lead to inac-curate patient records.

What if I told you that it costs your practice $15-$25 per claim error- and that almost 80% of those errors were due to registration mistakes? The first step to op-timizing your billing workflow is collect-ing information over the phone when a patient calls to schedule an appointment, known as preregistration. This will help to identify if your practice accepts the patient’s insurance plan and also inform the patient if they should expect to pay a copay at the time of service. In addition to point of service collections, gathering identification and insurance cards, and validating the information entered estab-lishes your revenue cycle process.

As healthcare continues to evolve and become more complex, establishing a comprehensive revenue cycle processing will certainly help you continue to navi-gate through those changes. The truth is, everyone in your practice has some skin in the game and spending time to ensure the accuracy of your claims is a step toward improving efficiency and optimizing your billing workflow.

Rose M. Romero is the founder/ CEO of Accredited Medical Billing Associates, a leading revenue cycle management company based in Altamonte Springs, Florida. For over 30 years, she has helped medical practices create customizable busi-ness solutions to optimize practice revenue, enhance cash flow and profitability, and increase efficiency. Visit www.AccreditedMedical.com or email Rose at [email protected]

Optimizing Your Billing Workflow

Leverage Medical New’s Physician Audience w/ Facebook Advertising

$200 Introductory Promotion

1X $50 ACCOUNT ESTABLISHMENT

FEE PROVIDING SETUPCAMPAIGN DESIGN | AD DESIGN | ANALYTICS

[email protected] [email protected] 407.702.1210

CO-BRAND WITH ORLANDO MEDICAL NEWS

Print | Digital | WebINCLUDING FACEBOOK

Facebook Advertising withHealthcare Professionals

Dominant Brand



http://www.source-master.com

http://www.source-master.com

http://orlandomedicalnews.com/webform.php?ViewForm=1


Did You Know?• Companies advertise on podcasts to

promote business, or position “top-o-mind”

• Podcast listeners are affl uent, educated consumers

• Popular Podcast listening locations; #1 Home, #2 Vehicle

15 MINUTE PODCAST DELIVERING• Planning and Production

• Script Development

• Recording Equipment

• Recording & Editing

• Uploading to Host Site

ORLANDOMEDICALNEWS.COM

CONTACT JOHN KELLY | 407-701-7424 | [email protected]

mailto:johnkelly%40orlandomedicalnews.com?subject=Medical%20News%20podcast


By: RON FRECHETTE

Thanksgiving is the time of year when we gather around the dinner table with our family, friends and loved ones to re-flect on the past year’s events and share the things we are thankful for in our lives. This is when family traditions we have established and practiced for years come to life. The savory smell of stuffed turkey and the sweet smell of pumpkin pie in the oven tickles our senses creating a continu-ous flow of water in our mouths as we wait in anticipation for all the family to arrive. It is truly a favorite time of the year for many of us here in America!

So what does Anti-Virus Protection and The Truth about Thanksgiving have in common? I’m sure if we dig deep we could find many parallels. My objective for this month, however, is to arm you with some facts about each of these topics that will be sure to enlighten and impress everyone around the Thanksgiving Day dinner table.

There are two main types of anti-vi-rus protection in the market today. Let’s examine both…

Blacklist Anti-Virus ProtectionBlacklisting software works by compar-

ing files against a list of known threats. If a file is on the list, then it won’t be allowed to execute, thus keeping our computer devices from being infected. You may know them as McAfee and Norton by Symantec. The challenge we face with blacklisting is that it can only protect against “known threats”. In recent years, cyber criminals have developed and deployed more sophisticated forms of malware that have been able to outsmart blacklisting software and wreak havoc on millions of people and businesses who con-

duct most of their communication and busi-ness on the World Wide Web (WWW).

It is estimated that there are about 500,000 new malware variants being launched onto the WWW EVERY DAY. They now come in the form of browser hijackers, ransomware, keyloggers, back-doors, rootkits, trojan horses, worms, ma-licious LSPs, dialers, fraudtools, adware, spyware… and the list keeps growing. Recently we are discovering other forms of cyber threats such as infected and mali-cious URLs, spam, phishing attacks, on-line banking attacks, social engineering techniques, advanced persistent threats (APT) and botnet DDoS attacks which we talked about in last month’s article. How can we protect ourselves with half a mil-lion new malware variants being launched into cyberspace on a daily basis? By add-ing a whitelist solution to our cybersecu-rity defense-in-depth strategy…

Whitelist Anti-Virus ProtectionWhitelisting works the opposite of

blacklisting by approving a list of trusted files and applications that can run on your network. If a file tries to execute that is not on the list, then it is rejected. Whitelist-ing has been around for quite some time. The challenge with this technology until recently has been limited functionality of business operations. Today’s whitelisting solutions have been able to overcome these challenges and allow a business to function both efficiently and much more secure.

Whitelisting also decreases the risk of human error and unplanned security is-sues. Any malware falsely clicked will not run. This new technology is providing more peace of mind to those in charge of main-taining the security of a business in addi-

tion to private users. Fact is most security breaches are due to impulsive clicking or lack of cybersecurity knowledge. Whitelist-ing reduces the fear and danger that users with a low level of security knowledge can be protected. I highly recommend learn-ing more about this new technology. A full list and overview of whitelist solutions can be found at: https://www.gartner.com/doc/1582715/application-control-whitelisting-endpoints

The Truth About ThanksgivingEnglish explorers began coming to

the shores of Massachusetts in the early 1600s. The earliest explorers would cap-ture the Indians and ship them back to England to work as slaves. Once word got out about the paradise they discovered in The New World, the Pilgrims began showing up… literally in boatloads.

The early Pilgrims who first arrived in America did not do very well. Many died during the winter due to sickness and lack of food and proper shelter. The following Spring, the Pilgrims were confronted by a tribe of Indians called the Wampano-ags. Among them was an Indian named Squanto who had been sold into slavery and eventually escaped by way of a friendly English explorer, Captain John Weymouth. Captain Weymouth taught Squanto how to speak English so he could communicate with the newcomers. Squanto and his fel-low tribesmen saw that the Pilgrims were in rough shape. They began to teach them how to survive. They brought them meat, furs for clothing, and taught them how to farm the land and build proper shelter.

When the Fall season came, thanks to the help of Squanto and the Wampanoags, the Pilgrims were in much better health,

had plenty of food, and had built houses that would keep them warm and protected through the winter. The Pilgrim’s leader, Captain Miles Standish invited the Wam-panoags to celebrate and give thanks. They were overwhelmed by the number of In-dians that showed up and quickly realized they did not have enough food. Squanto and the Wampanoag leader ordered their men to go back to their village and bring more food. The Indians ended up supply-ing most of the food and they celebrated the First Thanksgiving in peace for three days.

Soon after, the Puritans began migrat-ing to the New World to avoid persecution from the English. The white man even-tually outnumbered the Indians and no longer needed their help to survive. The Puritans began to condemn the Wampa-noag’s religious beliefs and customs which were based on giving charity to the help-less and hospitality to anyone who came to them with empty hands. A generation later, the children of that first Thanksgiving Day celebration began killing each other which became known as King Philip’s War.

At the end of that conflict most New England Indians were either annihilated, fled north among the French in Canada, or they were sold into slavery in the Carolinas by the Puritans. The trade of Indian slaves became so successful that several Puritan ship owners in Boston began invading the Ivory Coast of Africa for black slaves to sell to the colonies of the South, which marked the beginning of the African American-based slave trade.

In closing, combining both a blacklist and whitelist anti-virus strategy will dramati-cally mitigate your risk of becoming a vic-tim of a cyber-attack. As for the truth about Thanksgiving and how it relates to Anti-Virus Protection, I welcome your feedback.

Wishing you all a Secure and Happy Thanksgiving!!

Anti-Virus Protection and The Truth About Thanksgiving

Ron Frechette, Co-Founder & Manag-ing Partner of GoldSky Security is a cybersecurity and healthcare entre-preneur who over the last several years dedicated his career to helping enterprise companies reduce the risks of cyber-attacks. Ron left the enter-prise security world in 2015 and co-founded GoldSky Security, LLC. Ron’s vision is to build cybersecurity firms across the US that exist to help small-midsize businesses implement afford-able cybersecurity solutions. Ron can be reached at (321) 296-3527 or [email protected]

Sources: top10bestantivirus.com/free-antivirus-software

gartner.com/doc/1582715/application-control-whitelisting-endpoints

webcache.googleusercontent.com/search?q=cache:http://www.manataka.org/page269.html

en.wikipedia.org/wiki/Antivirus_software

https://www.gartner.com/doc/1582715/application-control-whitelisting-endpoints



https://www.source-master.com/en

https://www.top10bestantivirus.com/free-antivirus-software


http://webcache.googleusercontent.com/search?q=cache:http://www.manataka.org/page269.html

https://en.wikipedia.org/wiki/Antivirus_software


By KIM HATHAWAY, MSN, CPHRM

The last 90-day reporting period for the Medicare Access and CHIP Reautho-rization Act (MACRA) in 2017 began on October 2. Physicians and practices who are still interested in avoiding the negative penalty must act promptly. Practices that have not yet developed their MACRA plan face great urgency to complete it—and those who have started may be feeling overwhelmed. Regardless of the reporting stage, these steps can help guide practices to succeed:

1. Review past performance in quality measures such as the Physician Quality Reporting System (PQRS) or specialty measures that your practice has reported. These are strong indica-tors of how your practice will do in the future. Align activities and quality measures with what you are already doing in your practice and determine how to make capturing the needed data part of your team’s workflow. Educate and engage the entire work-force about what you are trying to ac-complish and why. Ask for input from the frontline of your practice about the most efficient ways to collect the necessary data elements. Even if you participated in PQRS in the past, there are differences that will require a team effort to be successful. Don’t try to do it alone. Consider making quality measurement part of the an-nual review for employees. 2. Study the specifications for measures you are reporting to bet-ter understand its value. For claims or registry reporting, go to Qual-ity Payment Program website and choose the appropriate file under “Documents and Downloads.” If you are reporting through your electronic health record (EHR), the vendor can be very helpful in choosing your mea-sures. In fact, not all EHRs will re-port all measures and there are some that collect data but don’t report to the Centers for Medicare and Medic-aid Services (CMS). Clarify with the EHR vendor when and how the doc-umentation is captured and counted toward the measure. The same ap-plies to the various registries. Be sure to do your homework and know about pricing and any requirements related to system compatibility. 3. Monitor your data on a weekly or bi-weekly basis. Compare the reports that you run in your office to those generated by your EHR or registry. Investigate any discrepancy so that it can be corrected now by coaching the team on documentation or timeliness of reporting. Don’t wait until the end of the reporting period to look at your performance data. There may not be time nor the ability to correct it later. 4. Understand that the scoring

process for the quality measures is very different than it was in PQRS. Under PQRS, if you reported the measure enough times, you received credit. And if you reported on one patient, you would get a pass.

Under the PQRS scoring process (based on 100 patients):

• Provider 1: 95 patients’ performance met, 5 patients’ performance not met = PASS

• Provider 2: 5 patients’ performance met, 95 patients’ performance not met = PASS

Under the quality measure, your rate will determine your score (based on 100 patients):

• Provider 1: 95 patients’ performance measure met, 5 patients’ performance not met = 95% Performance Rate

• Provider 2: 5 patients’ performance met, 95 patients’ performance not met = 5% Performance Rate

On top of the change in how much you report versus the performance rate, the scores will be determined based on national benchmarks, with the highest performing deciles receiving a greater point value.

5. Review the Quality Resource Utilization Report (QRUR) to fully understand how the practice performs in quality and cost. Use the 2015 or 2016 QRUR (publishing fall 2017) to identify potential weaknesses and address them before cost returns as a scored category in 2019—because cost will carry a weight of 30 percent toward the Merit-based Incentive Payment System (MIPS) composite score. This is a complex report that requires familiarity to truly under-stand its content. The biannual report

outlines the quality and cost data from PQRS and compares it to a national benchmark. Costs are determined by claims data. There are no reporting requirements for the cost category in 2017. CMS will provide feedback on cost for the 2017 performance period, but it will not be counted in the final composite score for 2017 or 2018.

Groups and solo practitioners may access their QRUR through the CMS Enterprise Portal. The person who ac-cesses this report for the group will need to create a login at CMS’ Enterprise Iden-tity Management (EIDM) system. This is a very secure site. It contains questions to verify and confirm the identity of the person registering, as well as information about specific providers in the group. Se-curity is very strict around these reports because they include patient health infor-mation so that groups may identify which patients may be attributed to them. For help with interpreting the information on your QRUR, consult the CMS website regarding QRUR analysis and payment.

You will find additional resources and links to the EIDM System and what to do if you believe your QRUR is not accurate.

If you would like to know how to participate in MIPS and avoid a penalty, consult with the Quality Payment Pro-gram CMS website. For additional in-formation, visit The Doctors Company’s MACRA Resource page.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regard-ing the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Kim Hathaway is a Patient Safety Healthcare Quality and Risk Consul-tant at The Doctors Company. She has more than 25 years of experi-ence in healthcare administration, nursing, and progressive leadership experience. Her extensive experi-ence also includes the areas of qual-ity performance improvement and healthcare regulation. Her e-mail ad-dress is [email protected].

It’s Not Too Late! Five Best Practices to Meet MACRA Requirements by the End of the Year

WWW.NEWREVNET.COM | [email protected] | 407-710-0014WWW.NEWREVNET.COMWWW.NEWREVNET.COM

• Reduce Payroll• Claim Submissions Less than 48 Hrs.• Shorten Reimbursement Periods• Reduce Claim Denials & Rejection

• NO Additional Software• NO Additional Staff• No Equipment Purchase• Improved Profi tability

Click Here for Complimentary Analysis & Dinner

Fewer Headaches- More Profi tabilityAllowing Patient Centered Practice!

https://qpp.cms.gov/about/resource-library

https://qpp.cms.gov/about/resource-library

https://portal.cms.gov/

https://portal.cms.gov/

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2015-QRUR.html

https://qpp.cms.gov/

https://qpp.cms.gov/

http://www.thedoctors.com/KnowledgeCenter/PatientSafety/articles/MACRA-Resources-for-Medical-Practices

http://www.newrevnet.com/


GrandRounds

Parrish Healthcare Names Andrew Waterman VP Ambulatory Services

Andrew (Drew) Wa-terman, an experienced healthcare executive, is Parrish Healthcare’s new vice president of ambula-tory services.

Waterman comes to Parrish from Providence Health Northeast in Colombia, S.C., one of the Providence Hospitals group, where he served for 12 years, most recently as vice president and chief administrative officer of the hospital’s orthopedics program.

“Andrew’s multi-faceted healthcare background fits perfectly with our nationally certified integrated care approach and our mission of providing healing experiences for everyone all the time,” said George Mikitarian, president and CEO Parrish Med-ical Center | Parrish Healthcare.

“Integrated care means that everyone throughout our healthcare system is com-municating and coordinating care with the patient and one another to eliminate un-necessary duplication of services, improve clinical quality and patient safety, and re-duce healthcare costs,” Mikitarian added. “Drew’s experience is a plus and we’re de-lighted to have him join us.”

Waterman’s roles since 2005 at Provi-dence Hospitals included managing or directing departments that include labora-tory; radiology; respiratory therapy; physical and occupational therapy; imaging; inpa-tient services; and orthopedics.

“Parrish has an amazing national repu-tation for the high quality of care, safety, and patients’ experiences,” Waterman said. “It’s an honor to be part of the Parrish Health-care team of care partners who are making such a tremendous difference in lives of the people and communities served, and I look forward to contributing to the system’s con-tinued success.”

As Ambulatory Services vice president Waterman will lead:

• Parrish Health & Fitness Center,• Parrish Healthcare Centers (Port Ca-

naveral, Titusville, Port St. John, Suntree/Melbourne),

• Parrish Medical Group, north Bre-vard’s largest network of primary care physi-cians and specialists, and

• The Children’s Center, a childhood development resource center.

Waterman will also oversee Ambula-tory (outpatient) Services for Parrish Health-care, a regional network formed by PMC to improve patient care service integration. Parrish Healthcare is made up of hundreds of patient and family-centered healthcare providers and in 2016 earned America’s first certification as an integrated care network from The Joint Commission, the nation’s premier healthcare accrediting organiza-tion. The Joint Commission annually sur-veys and accredits more than 21,000 health-care providers and programs.

Waterman attended Ashford Univer-sity, based in San Diego, Calif., where he earned his bachelor’s and master’s degrees

in healthcare administration and manage-ment. He is a retired U.S. Army veteran.

St. Cloud Regional Medical Center Recognized for Excellence with ACC Chest Pain Center Accreditation

The American College of Cardiology has recognized St. Cloud Regional Medical Center for its demonstrated expertise and commitment in treating patients with chest pain. St. Cloud Regional Medical Center was awarded Chest Pain Center Accredi-tation in August based on rigorous onsite evaluation of the staff’s ability to evaluate, diagnose and treat patients who may be ex-periencing a heart attack.

Hospitals that have earned ACC Chest Pain Center Accreditation have proven ex-ceptional competency in treating patients with heart attack symptoms. They have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate post-discharge care and recommendations and assistance in patient lifestyle changes.

“ACC Accreditation Services is proud to bestow Chest Pain Center Accreditation on St. Cloud Regional Medical Center,” said Abraham Joseph, vice president of ACC Accreditation Services. “We commend St. Cloud Regional Medical Center for its demonstrated commitment to providing St. Cloud and its surrounding communities with excellent cardiac care.”

Hospitals receiving Chest Pain Cen-ter Accreditation from the ACC must take part in a multi-faceted clinical process that involves: completing a gap analysis; examining variances of care, developing an action plan; a rigorous onsite review; and monitoring for sustained success. Im-proved methods and strategies of caring for patients include streamlining processes, implementing of guidelines and standards, and adopting best practices in the care of patients experiencing the signs and symp-toms of a heart attack. Facilities that achieve accreditation meet or exceed an array of stringent criteria and have organized a team of doctors, nurses, clinicians, and other ad-ministrative staff that earnestly support the efforts leading to better patient education and improved patient outcomes.

“I’m so proud to be a part of the team that works together every day to maintain St. Cloud Regional Medical Center’s accred-itation for chest pain patients,” said Rodolfo Aldir, M.D., FACC, FCCP, board-certified cardiologist with St. Cloud Medical Group Cardiovascular Clinic. “The integration of evidence-based science, quality initiatives, clinical best-practices and the latest medical guidelines into our cardiovascular care pro-cesses will ensure our patients consistently receive state-of-the-art care. “

St. Cloud Regional Medical Center pro-vides comprehensive heart care, offering ad-vanced diagnostic equipment in the Cardiac Catheterization Lab. The experienced clini-cal cardiologists use a wide range of cardiac procedures to diagnose heart disease and

Heart of Florida Regional Medi-cal Center broke ground on the new-est addition to the Four Corners area: Four Corners ER. With shovels in hand, dignitaries, EMS, and local leaders from Osceola, Orange, Polk and Lake Coun-ties joined Heart of Florida to “turn the dirt” on the northwest corner of US 192 and Avalon Road for the new freestand-ing emergency department.

Four Corners ER will be equipped to treat patients with illnesses and injuries that require a higher level of care than ur-gent care facilities offer. It will function as a department of Heart of Florida, mean-ing it will be a fully-operational emer-gency room with the immediate support of a hospital setting for any patient, 24 hours a day if needed. Many emergency services can be effectively managed at freestanding emergency departments without the need for transfer to a tradi-tional hospital setting.

The features of Four Corners ER will include:

• Over 12,000 square feet• Separate ambulance entrance• On-site laboratory• On-site radiology, including CT, x-ray and ultrasound• Around-the-clock emergency services

• Pediatric emergency care• Boarded emergency physicians• 13 private exam roomsFour Corners ER is being built from

the ground up and designed to support future development. “This investment into Four Corners demonstrates Heart of Florida Regional Medical Center’s commitment to offering expanded ser-vices to the area,” said Ann Barnhart, Chief Executive Officer at Heart of Flor-ida Regional Medical Center.

Michael McHale, MD, Medical Di-rector of Heart of Florida’s Emergency Department said, “For years, residents and visitors have had to choose which direction to travel to get emergency services – which county to travel into for care. Now, with Four Corners ER, there is no more need to travel. People in the Four Corners area will have a local place to receive quality healthcare – because emergencies can’t wait.”

Construction on the multi-million dollar facility is expected to be complet-ed in spring 2018. More than 40 new jobs will be created to serve patients at the emergency room, including registered nurses and lab, imaging, admitting and environmental services staff. As the open-ing approaches, jobs will be posted at www.HeartOfFlorida.com.

Pictured are, from left, Representative Sam Killebrew, Florida House of Representa-tives; John Newstreet of Kissimmee-Osceola Chamber of Commerce; Betsy Cleve-land of Haines City-NE Polk Chamber of Commerce; Michael McHale, MD, Medical Director of Emergency Services at Heart of Florida; Randy Spivey, Director of Emer-gency Services at Heart of Florida; Michael Willis of Gresham, Smith and Partners; Ann Barnhart, CEO at Heart of Florida; Matt Valentine of Wehr Constructors; Nicole Hendricks, COO at Heart of Florida; Gloria Ceballos, CNO at Heart of Florida; Dep-uty Chief Keith Cartwright of Reedy Creek Fire Department; Asst Chief James Bates of Orange County Fire Rescue

Heart of Florida Regional Medical Center Breaks Ground on New Freestanding ER for Four Corners Community



recognize heart failure in patients.The ACC and American Heart Associa-

tion are collaborating to offer U.S. hospitals like St. Cloud Regional Medical Center ac-cess to a comprehensive suite of co-brand-ed cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These ser-vices are focused on all aspects of cardiac care, including emergency treatment of heart attacks.

Florida Hospital Opens Newest Sports Medicine and Rehabilitation Location

Florida Hospital is pleased to announce the relocation of its Sports Medicine and Rehabilitation office location in Kissimmee.

Located at 2400 N. Orange Blossom Trail, Florida Hospital Sports Medicine and Rehabilitation offers a unique care option for patients with common muscle sprains, strains, neck and back pain, and recurring injuries.

Patients can utilize the “Direct Access” program, which allows physical therapists to administer treatment without a physician re-ferral for certain conditions and injuries. By going straight to physical therapy, the over-all cost of care to the patients is reduced.

The center is now open for patients.Florida Hospital Sports Medicine and

Rehabilitation has 18 locations across Central Florida. To learn more, visit FHSportsMed.com.

New Drug Enables Infants with Genetic Disorder to Live Longer, Gain Motor Function

Infants with the most severe form of spi-nal muscular atrophy (SMA) were more likely to show gains in motor function and were 47 percent more likely to survive without per-manent assisted ventilation support when treated with a new medication, according to a study published today in the New England Journal of Medicine. The drug, nusinersen, performed so well that the study was stopped early and the treatment was approved shortly thereafter by the U.S. Food and Drug Admin-istration (FDA) for all patients with this pro-gressive neuromuscular disorder.

"This is transformative for children with SMA," said Richard S. Finkel, M.D., the chief of neurology at Nemours Children's Hospi-tal in Orlando and lead author of the study. "Babies with this debilitating and deadly disease were destined to have a short lifes-pan and limited motor function. This study shows nusinersen is life-altering for families touched by this genetic disorder."

SMA Type 1 occurs in infants who have mutations in a gene responsible for pro-duction of a protein required for muscle development. Infants with this form of the disease, which usually presents between birth and 6 months of age, have progressive muscle weakness, and are never able to sit without help. Trouble breathing and swal-lowing leads to frequent lung infections, and a majority of babies fail to survive to 2 years of age without a feeding tube and artificial ventilation support. Other, less se-vere, types appear in older children and in adults. SMA affects 1 in 11,000 newborns, with approximately 60% having the most

severe type 1 form, and an estimated one in 40 adults is a carrier of the genetic defect.

Before nusinersen, no targeted drug treatments were available for SMA. This treatment modifies the SMN2 gene with an antisense oligonucleotide (ASO), a tiny fragment of synthetic DNA, injected directly into the spinal fluid. The DNA gets ab-sorbed into nerve cells of the spinal cord to increase production of the protein required for neuromotor development.

The study included 121 infants with SMA Type 1 from 31 centers in 13 countries. Patients were randomly assigned to receive injections of the drug into the spinal fluid, or a control group known as "sham" treat-ment. Physicians and family members were unaware of which patients received which treatment. This double-blind, randomized study design is considered the gold stan-dard in medical research, although often dif-ficult to achieve with rare diseases like SMA. Researchers overcame many obstacles to achieve this standard through a global re-search protocol that allowed broader patient recruitment. In addition, special procedures were developed to ensure researchers evalu-ating patient progress remained "blinded" and did not learn which patients received medication through a spinal injection.

Over the 13-month study period, 41 percent of the nusinersen-treated infants showed improvement on a scale of motor function, and several infants began develop-ing motor skills such as kicking, head control, rolling over, sitting, and standing, while none of the untreated infants in the control group made progress. The risk of death was 63 percent lower for those treated with nusin-ersen, and treated patients were less likely to require permanent assisted ventilation. The injections were also generally well tolerated by patients, with no serious safety concerns following administration of the drug.

In December 2016, after reviewing an analysis of interim data from the study, the FDA quickly approved nusinersen, now avail-able under the brand name Spinraza, for use in patients of all ages and with all types of SMA. This new therapy is the first FDA-approval for use of an ASO in infants, and demonstrates the life-saving possibilities of "precision medicine" for patients with devas-tating chronic or even fatal, diseases.

Following the conclusion of the study, all participants were enrolled in another trial evaluating the longterm impact of the treat-ment. The drug is also being tested in other trials. One study is evaluating nusinersen in older children with SMA Type 2, which also demonstrated a benefit in motor function, while another is testing it in pre-symptom-atic infants who were found to have SMA through a genetic test at birth.

Dr. Finkel and colleagues are also spearheading an effort to have SMA in-cluded in the Health Resources and Ser-vices Administration's Recommended Uni-form Screening Panel, a newborn screening panel of conditions that warrant immediate identification. If included, infants with SMA could be diagnosed routinely and treated before symptoms appear.

The study was funded by Biogen and Io-

nis Pharmaceuticals, which markets Spinraza

All Orlando Health Hospitals Receive Top Grades for Patient Safety

Orlando Health’s Dr. P. Phillips Hospital, Health Central Hospital, Lakeland Regional Health Medical Center, Orlando Regional Medical Center (ORMC), South Seminole Hospital, and South Lake Hospital in affilia-tion with Orlando Health have all received “A” hospital safety grades by The Leapfrog Group, an independent national nonprofit organization operated by employers and other large purchasers of health benefits. Grades are based on a point system that assigns – then calculates – numerical scores of nearly 30 healthcare measures includ-ing communication between clinicians and patients, implementation of processes and protocols to promote safe patient care that have been established by the National Quality Forum, and a hospital’s culture.

“In today’s rapidly changing health-care climate, hospitals must decide where to prioritize their energy and resources,” said Thomas Kelley, MD, chief of quality and clinical transformation, Orlando Health. “Some organizations have elected to focus on strengthening their economic position at the cost of lower quality outcomes. An "A" rating for every hospital in Orlando Health is a clear indication that we have invested heavily in the assurance of high quality care and that we value the safety of our patients.”

Orlando Health has developed a ro-bust system-wide structure to attain and maintain the safe delivery of care to patients. Major initiatives include the implementation of infection prevention bundle protocols, clinical standardization to assure best prac-tices are followed, and custom education modules called “Testing with a Purpose” that encourage teamwork between nurs-ing assistants, nurses and physicians. “Our entire team has worked very hard to reach this goal and we are extremely proud,” said David Strong, president and CEO, Orlando Health. “But the ultimate winner today is the patient, who can use this information to help them decide where they want to go to receive safe, high quality care.” To view Orlando Health’s Leapfrog scores, visit the Hospital Safety Score website at www.hos-pitalsafetyscore.org.

Parrish Medical Group Welcomes Homi S. Cooper, MD, FACOEM

Parrish Medical Group, with offices in Titusville, Port St. John, Suntree/Melbourne and now Port Canaveral, wel-comes Homi Cooper, MD, FACOEM, as its newest board-certified physician in Occupational/Environmental Medicine.

He received his medical degree from Grant Medical College at the University of Bombay in India, and completed residen-cies in neurology and internal medicine in India and the U.S. He completed a fellow-ship in Occupational/Environmental Medi-

cine in 1997. He is a Fellow of the American Association of Disability Evaluating Physi-cians and American Board of Quality Assur-ance and Utilization Review Physician Fellow of the Institute of Health Care Quality as well as a Diplomate of the American Board of Preventive Medicine in Occupational/Envi-ronmental medicine. He holds certification in workers’ compensation, managed care, risk management and case management by the American Board of Quality Assurance and Utilization Review Physician.

Dr. Cooper joins Parrish Medical Group from Space Coast Orthopedics in Merritt Is-land. In addition to practicing in Florida, Dr. Cooper has practiced medicine in Louisiana and Pennsylvania.

Dr. Cooper is conveniently located in the Parrish Healthcare Center at 390 Chal-lenger Rd., Cape Canaveral and is currently accepting Medicare, Medicaid, and most insurances.

Florida Hospital for Children Partners with Children’s Hospital of Pittsburgh of UPMC to Develop Pediatric Liver Transplant Program

In order to make lifesaving liver trans-plants available throughout central and north Florida, Florida Hospital for Children is part-nering with Children’s Hospital of Pittsburgh of UPMC to develop a comprehensive pe-diatric liver transplant program. This will be the first program of its kind in Orlando, the second in Florida, and is expected to start ac-cepting patients in January.

Florida Hospital is one of the largest not-for-profit hospitals in the country. The organization’s range of nationally and in-ternationally recognized services includes transplant, pediatrics, cardiology and ad-vanced surgical programs. Florida Hospital for Children’s flagship hospital in Orlando is the heart of a children’s network that in-cludes primary care pediatricians, specialty clinics, emergency departments and Kids Urgent Care.

“There is a critical need for children across our state to have access to a liver transplant program that is close to home,” said Regino Gonzalez-Peralta, M.D., direc-tor of pediatric gastroenterology, hepatol-ogy and liver transplantation with Florida Hospital for Children. “This partnership brings the experience of one the nation’s best pediatric liver transplant programs to central Florida. The Florida Hospital and Children’s Hospital of Pittsburgh of UPMC’s partnership is not only a win for our patients, but all of Florida.”

The teams will work in partnership with Florida Hospital’s Transplant Institute, which offers kidney, liver, kidney/pancreas, lung and heart transplants.

“Florida Hospital has been committed to saving lives through our transplant pro-grams for more than 40 years, and it is our goal to provide the same level of advanced and compassionate care to infants and chil-dren in our community in need of liver trans-plants,” said Thomas Chin, M.D., director

GrandRounds



Robotic-arm assisted hip and knee replacement has the ability to offer those suffering from osteoarthritis in their knees and hips almost immediate relief.

It is estimated that 15 million Americans suffer from osteoarthritis (OA) in their knees. The U.S. Census Bu-reau estimates that the 55 and older age group, who are peak knee replacement candidates, will reach 96 million by 2020. That age group is also the most susceptible to suffer from Degenerative Joint Disease (DJD) of the hip as well.

Abhijit Manaswi, MD, a specialist in joint replace-ment surgery, knows his robotic-arm assisted hip and knee replacement offers a solution to OA and DJD sufferers.

Heart of Florida Regional Medical Center, where Dr. Manaswi is the director of the Joint Replacement Center, is the only hospital in Polk County where the robotic arm joint replacement surgery is performed.

Dr. Manaswi uses a robotic arm interactive orthope-dic system to map the area that will be operated on. Using a computer guided robotic arm, Dr. Manaswi can easily and quickly remove the osteoarthritis from the healthy bone and replace the knee or hip joint with the new joint.

“There is a smaller, less invasive incision than tradi-tional surgery, and only the arthritic portion of the joint is removed, preserving the healthy bone and tissue,’’ Dr. Manaswi said. “There is less scarring, minimal hospital-ization time and a more rapid recovery time.’’

When patients start having symptoms of DJD in the hip, for example, they notice they start limping to avoid putting weight on the affected hip, and that pain radi-ates down to the lower back, or thigh to knee. They also notice that pain medication is also no longer helping.

That is when the robotic arm joint replacement sur-gery provides the most relief.

“By using the robotic arm system to remove the damaged bone, I can reduce the risk of leg length dis-crepancy and improve the post-operative range of mo-tion. There is also a rapid relief of pain and a quicker return to daily activities,’’ Dr. Manaswi said.

How It WorksIt all starts with a personalized plan. After a CT scan

of the joint is taken a 3-D virtual model of area is gener-ated. That model is loaded into the robotic arm system software and a personalized pre-operative plan is created.

During surgery, Dr. Manaswi uses that plan to

prepare the bone for the implant and the system guides him within the pre-defined arthritic area and keeps the machine from moving outside of the defined area for treatment. This helps provide a more accurate place-ment and alignment of the implant.

After surgery, the goal is to get the patient back up and moving around as soon as possible. At the Joint Re-placement Center at Heart of Florida, the patients will be up and doing physical therapy within a few hours of the surgery. They also participate in group therapy with others who have had the surgery as well.

Patients also return home sooner than after tradi-tional knee and hip replacement surgery.

Potential Benefits• Improved surgical outcomes• Optimal implant positioning • Smaller incision, less invasive• Minimal hospitalization• Less scarring• More rapid recovery• Ligaments remain intact for a more natural

feeling knee and hip• Ability to return to an active lifestyle quicklyDr. Manaswi offers several procedures including:

robotic arm assisted total hip replacement, computer as-sisted total knee replacement, robotic arm assisted partial knee replacement, revision knee replacement, and revi-

sion hip replacement.To find out more about the robotic arm joint re-

placement surgery, call Dr. Manaswi’s office today to make an appointment and come see how the robot-ic-arm assisted joint surgery can help your patients get their active lives back. For patients who would like to learn more about the surgery, please call Dr. Manaswi’s office at 863-419-8922.Disclaimer: Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks and benefits of each treat-ment can help you make the best decision for your individual situation.

Member of the medical staff at Heart of Florida Re-gional Medical Center. Heart of Florida Regional Medi-cal Center is owned in part by physicians.

Surgeon Specializes in Robotic-Arm Assisted Joint Surgery

Original knee.Robotic-arm joint replacement. Hip presentation Robotic-Arm Hip Replacement

BEST PRACTICES

3-D map of knee for robotic-arm joint replacement surgery.

3-D map of hip for robotic-arm hip replacement surgery.

Abhijit Manaswi, MD, MS, FCPS, DNB, MNAMS, FRCS

Board Certified | Fellowship Trained Total joint Surgeon Director, Joint Replacement Center

http://www.heartoffloridaphysiciangroup.com/doctors-providers/manaswi-abhijit-md--2682


PUBLISHERJohn Kelly

[email protected] ——

AD SALESJohn Kelly, 407-701-7424

——

EDITORPL Jeter


CREATIVE DIRECTORKaty Barrett-Alley

[email protected]

——

SOCIAL MEDIA DIRECTORTrish Murphy863-899-3703


FSU INTERNCorrin Hardin

——

[email protected]

——

CONTRIBUTING WRITERS

Dalia Cantor, PL Jeter, Javier Rojas, Joshua Bowman,

Farid Gharagozloo, MD, William F. Sensakovic, MD,

Kim Hathaway, Ron Frechette, Rose M. Romero, Sonda Eunus, Katie Blaylock & Patrick Dudley,

Mark Lanton

——All editorial submissions and press

releases should be emailed to [email protected]

——

Subscription requests or address changes should be emailed to


Orlando Medical NewsPO Box 621597

Oviedo, FL 32762 ——

Orlando Medical News is published monthly by

K&J Kelly, LLC.

©2016 Orlando Medical News. All Rights Reserved.

Reproduction in whole, or in part

without written permission is prohibited. Orlando Medical News

will assume no responsibility unsolicited materials.

All letters to Orlando Medical News

will be considered Orlando Medical News property and therefore unconditionally

assigned to Orlando Medical News for publication and copyright purposes.

orlandomedicalnews.com

GrandRounds

of the Florida Hospital Transplant Institute’s liver transplant program. “We are honored to partner with Children’s Hospital of Pitts-burgh of UPMC and bring our world-class programs together.”

In order to offer these transplants to families in the Florida area, the hospital will work with the Hillman Center for Pediatric Transplantation at Children’s Hospital of Pittsburgh of UPMC, which has performed more than 1,800 pediatric liver transplants – more than any other center in the United States, according to the United Network for Organ Sharing, with patient survival rates consistently higher than national averages.

“We are grateful for this opportunity to now expand our services and expertise in pediatric liver transplantation to families in the Florida area,” said George V. Mazar-iegos, M.D., chief of pediatric transplanta-tion at Children’s. “Our extension of exper-tise will provide the best possible care and make transplant a life-saving treatment for local families and help them to achieve a better quality of life.”

In 1981, Children’s Hospital of Pittsburgh of UPMC opened the country’s first compre-hensive pediatric transplant center under the guidance of transplant pioneer Thomas E. Starzl, M.D., Ph.D. According to the 2017 data released by the Scientific Registry of Transplant Recipients, the pediatric liver transplant program at Children's ranks num-ber 1 out of 62 pediatric liver transplant cen-ters in the United States for one-year overall patient and graft survival when comparing hazard ratio estimates. The program remains at the leading edge of expertise, innovation, and patient- and family centered care for transplant patients from all over the world.

Members of the transplant team from Children’s Hospital of Pittsburgh of UPMC will participate in the management of pa-tients in Florida. Transplant surgeons, medi-cal specialists and nurses from Florida and Children’s Hospital of Pittsburgh of UPMC will perform pediatric liver transplant surger-

ies together at Florida Hospital for Children.The pediatric liver transplant partner-

ship with Florida Hospital is the second program of its kind for Children’s Hospital of Pittsburgh of UPMC. In 2016, Children’s Hospital became the first and only pediat-ric liver transplant program to expand the geographic reach of its expertise through a partnership with the University of Virginia Children’s Hospital in Charlottesville. Today, Children’s pediatric liver transplant network extends from Pittsburgh to Virginia, and now Florida.

Federation of State Medical Boards Launches Blockchain Pilot Program

The Federation of State Medical Boards (FSMB) has become the first profes-sional membership organization to issue official documents to the blockchain. The FSMB issued sample verifications of under-graduate and graduate medical education credentials as part of a pilot of the Learning Machine blockchain records issuing system.

“The FSMB is dedicated to support-ing the work of its member state medical boards in their efforts to ensure that only qualified and capable physicians practice medicine,” said Michael Dugan, Chief In-formation Officer at the FSMB. “Verifica-tion of medical education and related cre-dentials is a critically important endeavor, and we are hopeful that the continued suc-cess of this pilot may provide the level of certainty needed to implement blockchain technologies in the medical licensing and credentialing process.”

Traditionally, verification of medical ed-ucation has relied upon the maintenance of physician profiles by credential verification organizations such as the FSMB. These pro-files are then shared with third parties, such as hospitals and state medical boards upon request, and are often maintained in a re-dundant manner. Anchoring official records such as degrees, transcripts, and verification

forms to the blockchain allows physicians and other practitioners to maintain their own private profiles of medical competency, which they can share as they see fit. In short, blockchains combine fraud protection with individual custodianship of official records.

Physician ownership of their official qualifications is possible through the block-chain certificates open standard ("Block-certs"). As a result of this standard, profes-sionals can hold and share their records using a credential wallet, a free mobile app. The Blockcerts Wallet serves as a us-er-owned portfolio to which no vendor or issuing institution has access. Behind the scenes, it seamlessly manages the user’s public and private blockchain addresses so that the process of owning one’s digital as-sets is radically simplified. Any vendor or in-stitution can build a Blockcerts-compatible wallet using the open standard. The open source Blockcerts Wallet is also available in the iOS and Android app stores.

“Blockcerts was built to serve as a foun-dation for recipient ownership of digital as-sets,” said Natalie Smolenski, VP of Business Development for Learning Machine. “That is the great promise of blockchain technol-ogy: now individuals can own their digital property without reliance upon trusted in-termediaries to serve as custodians of that property. However, many blockchain-based applications still put vendors at the center, diluting that promise. Learning Machine is building a social infrastructure that will out-last any company or issuing institution. We are building for the long-term future.”

The Blockcerts standard provides ven-dor and issuer independence. Should any issuing institution or platform vendor issuing Blockcerts cease to operate, the recipient still owns their records and can share and verify them in perpetuity.

FREE CONSULTATIONLEARN MORE 407-785-6200 X160

We are very pleased with the friendly and effi cient service we receive from INS. Requests for changes to our website are processed quicker than I would expect and they are always there to answer our questions and offer suggestions. A huge thank you to their staff!

Marjorie L., Chief Financial Credit Union

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.

Tina Blount, Marketing & Social Media ManagerEast Orlando Chamber of Commerce

On call 24/6 - No hourly fees! FREE Phone System … Ask How? Network & IT Solutions since 1987

http://www.insflorida.com

Downtown OrlandoCasselberry • Winter Garden

Save Time. Save Money.Immediate Access.

Open Monday - Thursday 8am - 8pm,Friday 8am - 4pm and Saturday 9am - 1pm

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

without an appointment from an orthopaedic specialist.

8 Convenient Locations Offering Same Day, Next Day AppointmentsOrlandoOrtho.com (407) 254-2500 DOWNTOWN ORLANDO | WINTER PARK | SAND LAKE | LAKE MARY | OVIEDO | LAKE NONA | CASSELBERRY | WINTER GARDEN

http://www.orlandoortho.com