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Three Ways to Lose a PatientAs the New Health Economy forces physicians to become patient-centric, customer service moves to the forefront

In a rural area with few specialists, patients waiting to see an orthopedist often spend unnecessary time in the waiting room. They know the drill: take plenty of material to keep busy ... 4

Help Wanted: Older PhysiciansA decade ago, Tony Stajduhar recruited a well-experienced specialist from the Cleveland Clinic to a rural intermountain community ... 5

By LyNNE JETER

Five years ago, Edith Pena was diag-nosed with thyroid cancer. After having the diseased thyroid gland and connected lobes removed, she has been cancer-free. Today, she’s a staunch supporter of Stand Up to Cancer (SU2C), as is her husband,

Jose Pena, senior vice president and head of retail banking for Fifth Third Bank (NAS-DAQ: FITB), North Florida.

“At Fifth Third, we’re part of a big cul-ture with strong core values, and our team wanted to know how we could make a dif-ference to the communities we serve,” said

Fifth Third Brings Back Successful Campaign“Pay to the Order of” benefi ts customers and Stand Up to Cancer

(CONTINUED ON PAGE 10)

By LyNNE JETER

Nearly 5 million patients were affected by the Chinese-led data breach targeting Franklin, Tenn.-based Community Health Systems Inc. (NYSE: CYH), the nation’s largest hospital group by number of beds.

Florida patients represented the largest group of cyber theft victims. The state has the most CHS hospitals, with 26 centering primarily on Orlando and Tampa Bay markets and cities nearby.

CHS reported that hackers bypassed the company’s security mea-sures, probably in April and June, according to a statement the company fi led with the Securities and Exchange Commission (SEC).

“It’s certainly one of the larger breaches, and certainly one of the bigger (ones) in healthcare space,” Crowdstrike CEO George Kurtz told Bloomberg. “It’s just another indicator of what we see on a daily basis, just how active the Chinese have been in targeting companies in the U.S. This breach is a little bit different because they’re targeting healthcare information and user information, as opposed to just stealing intellectual property, which they’re very good at.”

CHS contracted FireEye Inc’s Mandiant forensics unit to help with damage control. According to the company, data affected in the breach

Exposing VulnerabilityCHS is latest in line of data breaches, this cyber theft affecting nearly 5 million patients spanning last fi ve years


Jose Pena

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PhysicianSpotlight

By JEFF WEBB

ORLANDO - Impatience was a virtue for Javier Perez.

It was his first year at the Uni-versity of Puerto Rico School of Medicine in San Juan and Perez had learned over a beer with a buddy, who was a helicopter pilot in the U.S. Army, that if he signed up for the Health Professionals Scholarship Program he could have his medical school subsidized in exchange for an active duty commitment upon completion.

“I went to the Army recruit-ing station. I waited 30 minutes and no one talked to me. I said ‘Screw this!’ and left. I walked into the Navy recruiting station and in less than a minute they asked ‘How can we help you?’” Perez recalled. “They gave me the paperwork and I thought about it for a few weeks” before sign-ing up and being commissioned an ensign whose only job for the next three years, he said, would be to fin-ish medical school and do a few weeks of military training in the summers.

“Almost immediately” after enlisting, Perez said, “9/11 happened.” The ter-rorist attack that changed the world also had a lasting impact on how his career in medicine and the military would unfold.

After earning his medical doctorate in 2004 Perez was assigned to a one-year transitional internship at the National Naval Medical Center in Bethesda, Md. It was there that he decided to claim oph-thalmology as his specialty. “I remember it like it was yesterday,” he said. The Fal-lujah offensive was on and there were a lot of casualties (in Iraq). Marines would be injured in combat there, transferred to Germany and flown (to Bethesda) within 48 to 72 hours. Their injuries were hor-rible and when I was doing trauma I saw a lot of the doctors working with (patients who had) very severe eye injuries. That was the first telling moment about my in-terest in ophthalmology,” said Perez.

After a year at Bethesda, Perez was accepted into a rigorous 6-month train-ing course to become an undersea/diving medical officer, which took him to Gro-ton, Conn., and Panama City, Fla. “It was very competitive because it was so physi-cal. It was the most difficult thing I had ever done. There were times I thought I was going to die,” said Perez, but when he completed the challenge in December 2005, he was medically qualifying Navy divers and elite special operations SEAL team members.

The next three years included “a wonderful assignment and experience” at Pearl Harbor, Hawaii. “I was going div-

ing every Thursday and getting paid for it. It was fantastic,” said Perez, who was released from active duty in 2008 but con-tinued to serve as a Navy reservist while he completed his three-year ophthalmology residency at the University of Florida in

Gainesville. A one-year fellowship in glaucoma took Perez to Emory University in Atlanta, but he said there was never much doubt that he would return to Florida.

While at Gainesville, he had met Lindsay Koss, a med student who was on a rotation when he was an ophthalmologic resident. She’s a “full-blown Gator” who grew up in Sarasota, earned her undergraduate and medical de-grees at UF, and has just com-pleted her residency there, Perez said. Koss will join the OB/GYN group Contemporary Women’s Care of Orlando this fall, but for now she has a higher priority: Caring for the couple’s 2-month-old twins, Lucas and Alden.

Being a new dad and running his recently opened solo practice, Orlando Eye Specialists, is a “a lot of work,” Perez said, but “I’m doing the best I can. I always wanted to be my own boss and own my own practice.”

For now, it is just he and his recep-tionist, Laura Baez, so he handles “ev-erything from the start to the end of the patient encounter … and I still have to bring home work at night … but in a few months I may be able to hire a techni-

cian,” he said. Perez also works about two days a week at the Orlando VA Medical Center, where he is the go-to surgeon for glaucoma patients, he said.

Perez said his patient base is increas-ing for several reasons. One, he is bilin-gual and “there is a huge need for that in Orlando,” he said. Another is that “there is not a ton of glaucoma specialists. It’s sort of a niche market.” And luck has something to do with it, too, he said. “I just opened in May and the closest oph-thalmology practice to me just closed. They had been open forever and sold their practice to a corporation that went bank-rupt. So, all those patients are now looking for (an ophthalmologist) and I just happen to be in their region. …. that is helping,” said Perez, 36.

Between practicing medicine and parenthood, Perez said some of his active pastimes have suffered. “When I was in the military I used to do half-marathons, and a lot of trail running in Hawaii. It was good for my health, but it also was a good way to have time to yourself,” he said. And his wife Lindsay indulged his love of diving, he said, by becoming SCUBA cer-tified so they could share the experience on vacations they enjoyed in Cozumel and Belize.

But these days “my main hobby is changing diapers,” he laughed.

Javier Perez, MDOrlando Eye Specialists


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By LyNNE JETER

In a rural area with few specialists, pa-tients waiting to see an orthopedist often spend unnecessary time in the waiting room. They know the drill: take plenty of material to keep busy. A scan around the overflowing space shows people of all ages and disabilities hovering over smartphones, iPads, magazines and books, even knitting projects. New patient caregivers frequently shift their weight in the too-small, uncom-fortable plastic seats, unaccustomed to the ordeal. Perusing the stack of clinic-provided reading material shows dated magazines with torn edges and worn binders.

At the one-hour mark, a middle-aged patient emerges from the door separating the labyrinth of exam rooms and offices from the waiting area, victoriously waving a shoulder sling in the air before tossing it into the trash on his way out. The audi-ence provides a smattering of applause as he departs, uncertain if it’s a hurrah for an orthopedic problem solved or the end of the appointment.

At some point of the waiting game, patients usually weigh the option of leav-ing and perhaps rescheduling, but they know the co-pay was grabbed at check-in. They’re stuck. Besides, most have waited more than a month for the appointment.

Every few minutes, someone ap-proaches the humorless receptionist with the same question: “How much longer?” The pat answer: “Soon.”

After finally being ushered to an exam room at the 1-hour, 40-minute mark, and waiting another 20 minutes after vitals are taken, the very rushed orthopedist races into the room, mumbling “Sorry for the wait,” to the 88-year-old patient seeking a knee replacement consultation. In less

than five minutes, the physician exits the room, efficiently handing off the patient to a nurse.

“The doctor stays so busy,” remarks the nurse, shaking her head. “He sees 60 patients today, so he can leave by 2 p.m.” Why? No answer is given.

Fortunately, the Florida markets of Or-lando and Tampa aren’t rural, though sparsely populated pockets linger between both major cities, and the lack of respectful attention is a shared senti-ment among patients.

“Perhaps more than ever, physicians need to be focused not just on attract-ing more patients, but also on not losing the patients they have,” said Nick Hernandez, MBA, FACHE, CEO of ABISA LLC, a Florida-based healthcare consulting firm that specializes in solo and small group practice management. “National attention has been placed on patients as consumers, and that attention hasn’t gone unnoticed. Indeed, patients are educated healthcare consumers, and many are tired of being treated poorly.”

Aside from physician-specific interac-tion, Hernandez emphasized three areas of attention for practices, to prevent losing current patients:

Disrespectful Staff. “The correla-tion between respect and patient safety has been well-documented, but a disrespect-ful staff can also impact the health of your practice,” said Hernandez. “Whether it’s absent-mindedness or plain unprofessional behavior on behalf of your staff, these poor attitudes will lead to lost patients.

No matter how small the staff, most practices could use a primer or refresher on customer service. Using words please, thank you, and you’re welcome can go a long way.”

Dreary and Dull Office Ap-pearance. “There are many things your practice can do to overcome this without spending a lot of money on remodeling,” said Hernandez. “Does your staff straighten magazines and tidy up throughout the day? How old is your reading material in the lobby and waiting areas? It’s a good rule to never have magazines that are a year old.” (Nick, I can use the original ‘ton’ instead of ‘lot.’)

Hernandez noted other small changes to make a big difference.

“When’s the last time your lobby re-ceived a fresh coat of paint? If you have a small operation and don’t have janitorial service nightly, then on the days without service, have your receptionist run a vac-uum through the lobby area at the end of the day.”

Office Delays. “Scores of data from patient satisfaction surveys show that pa-tients are extremely frustrated when their appointment time is delayed significantly,” Hernandez pointed out. “While patient care is certainly not as programmed as an automated manufacturing line, many prac-tices could run much more efficiently if they scrutinized the operational flow of the prac-tice.”

Sometimes, common sense and good manners should prevail.

“As time-impacting issues arise dur-ing the day, communicate that to your pa-tients,” he encouraged. “They’ll be much more forgiving if they’re aware of the sched-ule. Remember, it’s highly unlikely this ap-pointment to your office is the only thing they have on their agenda for the day.”

Especially in the age of social media, word about poor service travels at lightning speed.

“Patients still tend to assess provider quality in terms of service and access,” said Hernandez. “It’s the wait time, the rude staff, and the inability to stick to a schedule that anger patients. The key is to not have patients leave the practice because of poor office policies or simple misunderstand-ings.”

PROJECT NAME

Three Ways to Lose a PatientAs the New Health Economy forces physicians to become patient-centric, customer service moves to the forefront

‘‘ It’s the wait time, the rude staff, and the inability to stick to a schedule that anger patients.

The key is to not have patients leave the practice because of poor office policies or simple misunderstandings.’’– Nick Hernandez, MBA, FACHE, CEO of ABISA LLC.

Nick Hernandez


Disrespectful Staff. “The correla-tion between respect and patient safety has been well-documented, but a disrespect-ful staff can also impact the health of your practice,” said Hernandez. “Whether it’s absent-mindedness or plain unprofessional behavior on behalf of your staff, these poor attitudes will lead to lost patients.

No matter how small the staff, most practices could use a primer or refresher on customer service. Using words please, thank you, and you’re welcome can go a long way.”

Dreary and Dull Office Ap-pearance. “There are many things your practice can do to overcome this without spending a lot of money on remodeling,” said Hernandez. “Does your staff straighten magazines and tidy up throughout the day? How old is your reading material in the lobby and waiting areas? It’s a good rule to never have magazines that are a year old.” (Nick, I can use the original ‘ton’ instead of ‘lot.’)

Hernandez noted other small changes to make a big difference.

“When’s the last time your lobby re-ceived a fresh coat of paint? If you have a small operation and don’t have janitorial service nightly, then on the days without service, have your receptionist run a vac-uum through the lobby area at the end of the day.”

PROJECT NAME

By LyNNE JETER

A decade ago, Tony Stajduhar re-cruited a well-experienced specialist from the Cleveland Clinic to a rural in-termountain community. The physician was looking for a place where he could raise horses and enjoy the last phase of his career. The new job fit the bill.

“On my latest visit to the commu-nity, I was happy to see that he’s still there working full-time and is an integral part of the program and community,” said Stajduhar, president of Jackson & Coker, a national permanent physician place-ment firm, based near Atlanta.

Older physicians, overwhelmed by federal mandates complicating the practice of medicine and considering retirement as their only option, may be much more marketable than originally considered in the post-Affordable Care Act (ACA) era.

For starters, the supply/demand curve is in their favor. According to the American Medical Association (AMA), nearly 1 million physicians practice medicine in the United States. Roughly 36 percent are 55 years or older. Of those physicians, pulmonologists and psychiatrists comprise two of the largest percentage categories.

A frightening statistic: up to 76 per-cent of pulmonologists and critical care specialists are in that age group.

“Older physicians are very mar-ketable,” said Stajduhar. “Even though clearly, nobody should be discriminating … in a perfect world, hospital admin-istrators would like to bring in doctors fresh out of residency, who could work there for 25 to 30 years. That’s utopia. In the real world, we know that when doctors complete their residency pro-grams, more than half of them leave within three years after making their first (placement) decision. That’s a huge percentage! Just because they’re young doesn’t mean they’ll stay.”

On the other hand, practitioners in their fifties, for example, who are con-sidering making a change realize it’s probably their last career move and are more motivated to make it permanent, said Stajduhar.

“Then it’s just a matter of asking: ‘how long are you willing to practice?’ Perhaps they’re 59, and say they want to work as long as their health holds out. When they’re upfront with the hiring client, you have a very marketable phy-sician.”

Surprisingly, hospital administra-tors rarely ask if qualified candidates are tech-savvy, noted Stajduhar, which quells one worry among older physicians.

“It doesn’t seem to be a concern at this point,” he said. “The older recruit may move into a hospital system that makes it fairly easy for them to adapt. For example, they may assign a nurse or

nurse practitioner to the physician, who can plug notes into an electronic medi-cal record (EMR) system as the physi-cian tends to the patient.”

After the ACA kicked in, most physicians with 25 or 30 years under their belt considered retiring. Unfortu-nately, it was signed into law less than 18 months after the stock market crash of September 2008, when many physi-cians watched in dismay as their retire-ment funds withered.

“Many would’ve retired then, if they could have,” said Stajduhar. “The ACA, out of the gate, scared the heck out of older physicians. If there’s a signif-icant continued uptick in the economy, I wouldn’t be surprised to see the retire-ment rate of that age group accelerate over the next five or six years. But then we’ll have a huge problem with special-ties being in critical shortage areas.”

If that happens, older physicians who opt not to retire sooner will be in even more demand, particularly if they’re open to moving to a different location, which melds with another emerging physician employment trend: The best jobs aren’t necessarily in rural areas, defined as a population of 40,000 or less.

“We probably have more primary care needs in urban areas than ever be-fore,” said Stajduhar, noting the great-est demand is internal medicine. “Yet we still have many unmet needs in rural areas, especially those areas we know are very rural. Older physicians have more opportunities than perhaps they realize.”

The passage of time since the ACA took effect has also softened the attitudes of older physicians, adding to their mar-ketability.

“Physicians, as a rule, have been fiercely independent,” said Stajduhar. “They didn’t want people telling them how to practice medicine from a hospi-tal level. When it became imminently clear that we’d have a different indus-try in five to 10 years, that revelation became the impetus of the dramatic change in the hiring process. Now those physicians are seeing the benefits of being employed by a hospital or health system, perhaps in another location. They’re in an age group where most are empty nesters, and being confined to a school district or a place to settle down isn’t holding them back. Only caring for aging parents may play a role in their ability to relocate.”

An employment contract for the older physician is a win-win for both parties.

“Administrators know the move is probably the doctor’s last hurrah,” he said. “That’s where they’ll retire. Then at a minimum, the client will have six or seven years from a good, experienced physician with a great track record on staff.”

Help Wanted: Older Physicians


By GRETA WEIDERMAN

In early June, pharmacy benefits manager giant Express Scripts announced that it was dropping coverage of more than 1,000 compound drug ingredients. Patients must now choose between switch-ing medications or paying up to $1,000 for a single prescription.

The St. Louis-based company, which manages pharmacy benefits for 90 million Americans, is the most recent in a string of pharmacy benefits managers to restrict access to compound drugs.

The use and costs of compound medi-cations have skyrocketed in the past two years. For Express Scripts’ clients, those costs increased 511 percent from $28 mil-lion in the first quarter of 2012 to $171 million in the first quarter of 2014, ac-cording to Brian Henry, Express Scripts’ spokesman. He said the average cost per compound prescription per patient in-creased from $90 in the first quarter of 2012 to $1,100 in the first quarter of this year.

The policy change will reduce costs of compound drugs for Express Scripts’ clients by 95 percent, Henry said.

“There was a 30 percent increase in demand from 2011 to 2014,” he said. “At the same time, costs have gone up 1,000 percent.”

The cost increases were due to new billing standards by the National Coun-cil on Prescription Drug Programs. The change was implemented Jan. 1, 2012. Starting then, compounding pharmacies were permitted to charge for each com-ponent in a compound medication and for the labor involved in making it. Previ-ously, pharmacists frequently lost money on compound medications because they were only able to charge for the most expensive ingredient, according to A.J. Day, PharmD, the director of pharmacy consulting at Professional Compounding Centers of America (PCCA), a chemical wholesaler to independent compounding pharmacies.

David Miller, RPh, chief executive

officer of the International Academy of Compounding Pharmacies (IACP), lik-ened the billing changes to pharmacists previously billing just for the meat in a hamburger, but now charging separately for the meat, bun, cheese, pickles and on-ions.

Express Scripts and other pharmacy benefit managers have responded to the cost hikes by eliminating or reducing coverage of compound medications.

According to Ex-press Scripts’ Henry, there are other FDA-approved medications that are less expensive and just as effective as compound medica-tions. He also noted that compound medi-cations are not regulated by the FDA. But ac-cording to Miller, many drugs that are prescribed today predated the FDA and haven’t been FDA approved either. Some include aspirin, Codeine and morphine, he said.

Henry acknowledged that some com-pound medications, such as liquid forms of pills, are necessary for patients who have difficulty swallowing pills. According to Day, of PCCA, compound medications are also vital for children with autism, patients with allergies to fillers, dyes and inactive ingredients in other medications, patients receiving hormone therapy and as alternatives to highly addictive opiate pain medications, like OxyContin and hy-drocodone.

Compounding pharmacies also offer patients access to medications that manu-facturers have discontinued.

“The implications of this are very broad,” Day said.

The coverage changes are causing headaches for physicians and pharmacists, as they are now communicating back and forth to find suitable alternatives for pa-tients who can’t afford to pay the retail

cash price for compound drugs.“People that are not involved in pa-

tients’ care have set up processes that pre-vent patients from receiving medications they need,” IACP’s Miller said.

PCCA has reached out to meet with Express Scripts officials, but Express Scripts has canceled three meetings with the company, according to Aaron Lopez, PCCA’s spokesman.

The coverage change “puts patients in very, very difficult positions,” Day said.

He said physicians should encourage patients to talk directly with their employ-ers about opting out of programs that ex-clude or reduce coverage of compound medications.

The new coverage restrictions are hurting business for QmedRx, a com-pounding pharmacy based in Orlando. The pharmacy has seen coverage rates for prescriptions it receives drop from 65 percent to 45 percent in the past year, said Blake Powers, the company’s chief operat-ing officer.

The industry also suffered a setback in October 2012 when the New England Compounding Center, based about 20 miles west of Boston, was shut down after an outbreak of fungal meningitis traced to the facility killed 64 people. The incident brought scrutiny on the fact that the com-pounding pharmacies are not regulated by the FDA.

Powers, however, said the industry is closely regulated by states that do surprise inspections at his facility.

“We’re regulated by every single state Board of Pharmacy that we ship to,” he said. The company ships to 49 states.

Can topical pain medications prevent opiate overuse and addiction?

Compound pharmacists say they can provide topical painkillers as alternatives to highly addictive opiate painkillers like OxyContin and hydrocodone. The num-

ber of annual overdose deaths from pre-scription painkiller was 14,800 in 2008, up 300 percent from 4,000 in 1999, accord-ing to the Centers for Disease Control and Prevention.

In the 1990s, a handful of studies sug-gested that opiate narcotic prescription painkillers weren’t as addictive as previ-ously thought, and physicians started pre-scribing them more frequently.

“I can tell you when I went to medical school, the one thing they told me about pain was if you give a patient in pain an opiate painkiller, they will not become ad-dicted, and that was completely wrong. We have a real need to better understand and ensure we use these only when neces-sary,” said Tom Frieden, director of the Centers for Disease Control and Preven-tion, during a press briefing last year.

The drugs were developed to treat pain in late-stage cancer patients, but physicians began prescribing them for all types of chronic pain, and the studies sug-gesting they weren’t all that addictive were later debunked.

In 2012, healthcare providers wrote 259 million narcotic prescriptions, enough for every American to have a bottle of pills, according to a Centers for Disease Control and Prevention report.

Forty percent of U.S. narcotic pre-scriptions in the United States in 2011-2012 were written by only 5 percent of opioid prescribers, according to an Ex-press Scripts study.

Now, in order to avoid the chance of abuse and addiction, or of unwanted side effects, physicians are prescribing topi-cal compound medications to treat pain. Those are not covered by the plans that Express Scripts administers.

Cuts in Compound Prescription Coverage Cause Headaches

Other pharmacy benefit managers reducing coverage:

In June, pharmacy benefit manager Catamaran Corp. launched a program to hep its clients reduce the increasing costs of compound medications. The Chicago-based company said in a statement that its annual expenses for compound medications had increased five-fold due to a jump in use and cost.

OptumRx, the pharmacy benefits manager of United Health Group, also recently dropped coverage of some compound ingredients. Officials said it has seen a 35 percent increase in the use of compound drugs among its members over a 12-month period from 2012 to 2013. The number of compounding pharmacies has also grown from 2,500 in 2009 to 7,500 in 2012, according to the company.

CVS Caremark, Harvard Pilgrim Health Care and some Blue Cross Blue Shield organizations have also restricted coverage for compound medications.

A.J.Day

David Miller

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TAMPA – Lexington Market-East End, a mini-market located in a histori-cally black “food desert” neighborhood in Kentucky, was once considered an eye-sore and unsafe place to shop. Now, it’s the centerpiece of a community driven by new and updated businesses and a stellar example of effective community-based prevention marketing (CBPM) for policy development.

The successful overhaul, resulting from The Good Neighbor Store initiative, exemplifies only one project from an im-pressive track record that helped the Flor-ida Prevention Research Center (FPRC) at the University of South Florida’s (USF) College of Public Health garner $4.35 million in federal funding over a five-year cycle from the Centers for Disease Con-trol and Prevention (CDC) to conduct in-novative public health prevention research among populations experiencing health disparities.

“We’re thrilled to receive funding for this particular grant, especially this go-round, because the field was highly competitive,” said Carol Bryant, PhD, distinguished USF Health professor and director of the prevention research center. “Congress cut the funding level signifi-cantly for this cycle, dropping the number of recipients from 37 to 25. When we saw the recipient list, there were quite a few surprises. Harvard didn’t make it. Neither did the University of Michigan, which has a very strong program. The University of Texas, an original recipient with a ter-rific program, didn’t make it. This time, we competed against the University of Florida for the first time… such a stellar university.”

The list of 25 academic institutions in 25 states became 26 when, at the last minute, the CDC added a second Penn-

sylvania system, making an exception not to award two academic institutions in the same state. These prevention research centers will partner with communities to translate research results into effective public health practices and policies that avoid or counter the risks for chronic ill-nesses, including heart disease, obesity and cancer.

“We worked tirelessly to have a very good proposal,” said Bryant, noting team members skipped vacations last summer and worked nights and weekends to fine-tune it.

USF, whose FPRC program has been continuously funded since 1998, was the only Florida academic institution to make the final list. The USF center’s specialty niche: social marketing.

The award “helps USF reinforce its brand equity as a leader in community-based social marketing and gives us the credibility that allows us to be more effec-tive,” said Bryant.

Specifically, the FPRC’s award – $750,000 for the first year – will support research to promote colorectal cancer screenings among underserved popula-tions initially in Hillsborough, Pasco and Pinellas counties, with plans to later ex-pand to other regions of the state.

The project to promote colorectal cancer screenings among the underserved, selected by the Florida Department of Health, begins in October, Bryant ex-plained.

“This will be our first time for the center to work very closely with research colleagues at Moffitt Cancer Center, and state, regional and local partners, includ-ing the state health department, American Cancer Society, and many other commu-nity-based organizations in Tampa Bay’s tri-county region,” said Bryant. “Those partnerships will give us a fabulous in-terdisciplinary team. We’ll learn together how to think about applying social mar-keting to colorectal cancer screening by looking at the entire system.”

The USF center will identify groups at high-risk for the disease that are most likely to respond to prevention marketing strategies with changes in behavior and therefore benefit from the tests that can find colorectal polyps or cancer.

Colorectal cancer screening is the sec-ond leading cause of cancer deaths among men and women in the United States, said

Julie Baldwin, PhD, professor of commu-nity and family health, who will become the FPRC co-director with Bryant this month as Bryant transitions to retirement in 2016.

“Building upon established part-nerships, we plan to identify, tailor, implement, and evaluate a multilevel in-tervention to increase colorectal cancer screening using community-based preven-tion marketing for systems change,” Baldwin said. “We’re very fortunate to draw upon our team’s expertise in social marketing and community-based participatory re-search, and our experience in developing and evaluating effective colorectal cancer interventions.”

Conducting Innovative Public Health Prevention ResearchUSF’s Florida Prevention Research Center garners $4.35 million in CDC funding for projects among population health disparities

2014 CDC-Funded Prevention Research Centers:

University of Alabama at Birmingham

University of ArizonaUniversity of Arkansas for Medical

SciencesUniversity of California, San

FranciscoCase Western Reserve University,

OhioDartmouth College, New

HampshireUniversity of Illinois at ChicagoUniversity of IowaJohns Hopkins University, MarylandUniversity of KentuckyUniversity of Massachusetts

Medical SchoolMorehouse School of Medicine,

GeorgiaUniversity of MinnesotaUniversity of New Mexico Health

Sciences CenterNew York University School of

MedicineUniversity of North Carolina at

Chapel HillOregon Health & Science UniversityUniversity of PennsylvaniaUniversity of PittsburghUniversity of Rochester, New YorkUniversity of South Carolina at

ColumbiaUniversity of South FloridaTulane University, LouisianaUniversity of WashingtonWest Virginia UniversityYale University, Connecticut

For more information on Prevention Research Centers nationwide, visit http://www.cdc.gov/prc.

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Healthcare providers are charged with healing the sick and sustaining wellness, while healthcare financial ex-ecutives are charged with maintaining a healthy balance sheet. The impact of the Affordable Care Act on the revenue side of the balance sheet remains an unknown variable. The scramble to organize into comprehensive accountable care organi-zations can result in increased access to services for patients and potential mon-etary impact to providers for keeping pa-tients healthy. But the initial investments, including such items as diagnostic equip-ment and electronic health and medical record systems, require capital. Shoring up the balance sheet may be achieved by adding additional points of entry for pa-tients.

For example, physician offices and hospitals often refer patients to other providers for diagnostic imaging, dialysis and laboratory services to name just a few services. Outsourcing these services was preferred to purchasing the equipment or technology for an in-house option. As the cost of technology declines, and pro-cedures become more reliable, provid-

ers may be poised to selectively bring once outsourced services back in-house. How can that be done without breaking the bank? The answer may be in equipment financing.

The initial cost of entry plus ongoing costs for upgrades are often big barriers for healthcare providers. The dilemma is not unlike a personal decision to purchase higher-priced household items – do you pay cash or finance? What type of financ-ing is best? Budget decisions and benefits to consider include:

• No (or low) Money Down – One hundred percent financing can preserve precious capital and budget dollars. Also,

with a lower initial investment in new ser-vice lines, leasing can allow your new of-fering to become profitable faster.

• Improved Cash Flow – Negoti-ate customized terms with an affordable monthly payment plan that fits your bud-get. Ask about flexible end-of-contract op-

tions. • Upgrade to New Technology Every

Few Years – Flex-ible structures, such as leases and

structured loans, can allow you to pay for

what you use rather than tying up capital in a rapidly depreci-

ating asset. The owner carries the burden of depreciation, not the lessor. Equip-ment financing also provides possibilities for early replacement and changes where traditional financing can fall short or add significant expense.

Generate Long Term Revenue – The new services/capabilities can be put to work for you. While offering the service to your own patients, it may provide an additional source of revenue by welcom-ing patients from other nearby providers without the same capability.

Equipment finance is not just a fi-

nance structure. It is a plan that supports the need of healthcare providers to remain on the leading edge of technological ad-vancements by acquiring the necessary assets in the most cost-effective manner. Equipment financing offers an oppor-tunity to add a new revenue stream to improve the overall well-being of your balance sheet.

Once you determine that equipment financing to fund additional services or capabilities is a viable alternative to in-crease revenue, choosing the right finan-cial institution is critical. An appropriate financial resource must demonstrate capi-tal strength, broad product offering and, perhaps most importantly, depth in expe-rience within the healthcare sector.

Stop Sending Patients Away: In-House Pathway to Healthy Balance Sheets

Ralph Swanson is senior vice president of PNC Healthcare in Florida and can be reached at [email protected].

This content has been prepared for general information purposes and is not intended as legal, tax or accounting advice or as recommendations to engage in any specific transaction, including with respect to any securities of PNC, and do not purport to be comprehensive. Any reliance upon any such information is solely and exclusively at your own risk. Please consult your own counsel, accountant or other advisor regarding your specific situation.


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Pena, based in Tampa. “Like me, many team members have experienced cancer in some form – themselves or a loved one – and for the same reason, cancer really resonated with employees and customers.”

Noting that one in two men, and one in three women, will be diagnosed with some form of cancer in their lifetime, Brian Lamb, president and CEO for Fifth Third Bank (North Florida), echoed Pena’s senti-ments. “We’ve all been affected by cancer in one way or another,” he said. “We look forward to further partnering with Florid-ians to help raise awareness and funds for the fight against cancer.”

After a successful first quarter run that helped to raise more than $2.3 million in donations to SU2C, Fifth Third brought back its unique “Pay to the Order of” cam-paign, which runs through Oct. 17. Less than two weeks into the renewed cam-paign that started July 28, the cumulative total had reached $2.6 million.

Originally launched in January, the bank’s “Pay to the Order of” campaign leverages new checking accounts to help drive donations to support collaborative cancer research programs. For every new customer who opens a checking account with direct deposit and makes three online bill payments, Fifth Third will gift $150 to the customer and donate $150 to SU2C.

SU2C, a charitable program of the non-profit Entertainment Industry Foun-dation, is a groundbreaking initiative that raises money to accelerate innovative can-cer research, enabling scientific collabora-tion to quickly connect new therapies to cancer patients.

Fifth Third began working with SU2C in 2013 when the bank rolled out exclusive SU2C credit and debit cards, which gener-ate donations to SU2C for every qualify-ing purchase made using those cards.

Specifically, SU2C receives the $10 annual fee associated with the debit card, plus $0.005 per net retail purchase made with the debit card. SU2C receives $5 for every active SU2C credit card, plus 0.2 percent for every net retail purchase made with the credit card.

Fifth Third’s marketing campaign deftly mixes humor and heart to make its point. In one ad, “Replacements,” featur-

Fifth Third Brings Back, continued from page 1

The renewed “Pay to the Order of” campaign benefitting Stand Up to Cancer (SU2C) ties in with Fifth Third Bank’s Decoding Healthcare events being held in Orlando and Tampa throughout the year.

In October, a distinguished group of panelists will share innovative ideas in response to the changing landscape of the healthcare industry and how it may impact business and personal lives.

Friday, Oct. 24, 7:30-9:30 am, in a location to be determined.

24OCT

SAVE THE DATE

ing the Fifth Third SU2C MasterCard, a seemingly mischievous schoolboy is shown as a champion when his motive becomes clear: he’s seeking help to fund a cure for his school pal with cancer.

“We’re thrilled not only with the tremendous support we’ve received from Fifth Third and its customers, but also the enthusiasm with which Fifth Third em-ployees have embraced the cause,” said SU2C co-founder Rusty Robertson. “To-gether, through initiatives like the ‘Pay to the Order of’ campaign, we can continue to fund the most promising research and help more people diagnosed with cancer become long-term survivors.”

The “Pay to the Order of” campaign also engages consumers by asking them to upload a photo at 53.com/SU2C or use the hashtag, #PayToTheOrderOf, to share the loved one for whom they’re fighting. For every eligible photo shared using the hashtag on Twitter, Facebook, Instagram and Vine, Fifth Third donates $1 to SU2C.

“The stories that surfaced and the connections made have been inspira-tional and beyond what we could have ever hoped for,” said Maria Veltre, se-nior vice president and CMO of Fifth Third. “We’re excited to bring this cam-paign back and drive additional funding for SU2C’s cutting-edge research.”

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was non-medical: no credit or debit card in-formation was derived. However, the theft included sensitive information – names, addresses, birthdates, contact information and Social Security numbers – of patients who were referred or received services from doctors affiliated with the company since 2009.

Vectra Networks CEO Hitesh Sheth cautioned that data breaches are more common than most people believe.

“More and more devices are getting connected, and the reality is if you’re con-nected, the odds of being hacked are pretty good,” he told Bloomberg. “Every network is breached. Against this backdrop, what’s really interesting about what Community Health Systems has done: they’re talking about bolstering their defenses ... acquir-ing the services of (Mandiant) to do some-thing on the forensic front. Really, what we should be focused on is not only defending ourselves, which we should, not just wor-rying about what happened after the fact, but we can identify attacks as they’re hap-pening and understand where they begin real time, so we can take preventive steps to limit the damage.”

Specifically, the CHS information breach resulted from the Heartbleed in-ternet bug, a major glitch in OpenSSL encryption software that’s commonly used to secure website and technology products including cell phones, data center software, and telecommunications equipment.

Systems are vulnerable to data theft by hackers, who can attack them without leaving a trace. Recently, the bug had been used to steal nearly 1,000 social insur-ance numbers from the Canada Revenue Agency website, prompting the govern-ment agency to shut down online tax filing for days during tax season in April.

TrustedSec CEO David Kennedy told Reuters that Juniper Networks’ equipment was used by hackers to seed the Heartbleed bug.

Tom Turner, an executive at Bit-Sight Technology, which published a 2014 cybersecurity report highlighting the healthcare industry as one of the worst at protecting against breaches, said patients whose records have been hacked should remain vigilant about opening fishy emails with suspicious attachments.

“Any time you’re offering any type of information you consider personal, pri-vate or sensitive, you have to be aware that the minute you provide it to a third party, you’re reliant on them to protect it,” said Burnette. But, he quickly added, “if you’re in need of life-saving medical care, you’re not going to stop and say, ‘Hey, before you start to operate, can you tell me if you’re going to protect my information?’”

The very public cyber attack hit CHS just as it resolved a Department of Justice in-vestigation, and announced second quarter net operating revenues of nearly $5 billion.

Last year, CHS acquired dozens of hospitals from distressed Health Manage-ment Associates, including Bayfront in St. Petersburg and community hospitals in west central and southwest Florida.

Exposing,continued from page 1


By RACHEL SMITH

Recently, I attended a local presen-tation for professionals in the medical in-dustry. A topic that was discussed included the concern over the upcoming changes, and how it will affect business. It was men-tioned that it may be a growing trend to have products available for purchase di-rectly at the doctor’s office. The reality of losing mass amounts of patients has many medical professionals scrambling to come up with different avenues to generate rev-enue. However, there is a simple solution to consider before adding a new product line to the office: customer service. Creat-ing a customer service policy isn’t enough; you have to have the right staff in place to implement it.

Gone are the days when patients ac-cept that they will have a long wait before they see the doctor. They are no longer understanding of a nurse’s less than cheer-ful disposition (even if it’s because the nurse is working through lunch, again). Today’s patients expect customer service, even when they are being seen by medical professionals. Not having the right team in place, or being understaffed can have damaging effects on patients remaining loyal to your practice.

Many dental offices have adopted a customer service approach to caring for their patients as a way to keep them com-ing back in for treatment. It is not a secret that most patients don’t look forward to going to the dentist. Understanding that oral health is vital to a patients overall health, conscious actions need to be taken to keep new and existing patients coming into the office for treatment. Dentist and their staff tend to cater to patient’s needs and spend time developing trust. They rely heavily on keeping patients positive by ensuring that the patient comes first. That typically starts with limiting the amount of time patients wait to be seen. As a former dental assistant, I have heard first hand from nearly every new patient that there was a drastic difference between waiting at the doctor’s office, and waiting at the dental office. Of course, this is not to say that dental offices do not have flaws, and there are not medical offices that have put similar measures in place. Rather, it is intended to highlight that the customer focus approach is a tool that can be eas-ily transferred to a medical office. In any situation unexpected events occur; some-one calls out sick, there is an emergency, a procedure did not go as planned, but it’s the overall consistency of the practice that patients will notice.

What we need to keep in the fore-front of our minds is, when a patient has a bad experience, they will tell oth-ers. This used to be a concern that did not have an immediate effect; it took some time to develop a poor reputation. Now, in addition to telling their friends, relatives, neighbors, and coworkers, that

disgruntled patient can post a review of a doctor, the staff, the office condition, and so forth on line. The first thing most people do before making a decision on a service or product is to read the reviews on line. That bad review can be seen by potential patients. We know that this is a trend that will not disappear. It is be-coming increasingly utilized when decid-ing where to go for medical treatment. There are apps and web pages specifically dedicated to rate, and review healthcare providers, and facilities. This allows users to give also leave detailed comments re-garding their experience. Reputation from patients and in the community is a leading factor when a choosing where to go for medical treatment. The most ef-fective way to avoid overwhelming nega-tive reviews is to have staff on board that shares a common passion for quality and efficient patient care. The effort placed on patient care will radiate throughout the practice, and that word also spreads quickly.

Proving excellent patient care isn’t the only goal that medical professionals need to reach. Practices need to be profitable to continue to operate. Before considering any alternative, invest in your staff, and that is guaranteed to generate revenue.

Creating the right team, which in-cludes having a sufficient number of team members, is crucial to the success of the practice. Not having one or both can sig-nificantly affect your bottom line and it doesn’t take long to feel the effects. The idea of implementing customer service by hiring the best team possible may not be the first thought that comes to mind. It may seem overwhelming to add in cus-tomer service on top of every other day-to-day task it takes to run a busy practice. However, medicine is a business, and if there are no customers, eventually there may not be a practice.

In addition to the detrimental effects staffing issues can have on business, this also causes major internal issues. Insuf-ficient staffing raises the stress level of all existing team members. Being in the recruiting industry, it is necessary to ask every candidate what is the motivating factor for looking for a new position. The most common answer we hear for job dis-satisfaction is emotional exhaustion as a result of not having enough staff to care for patients. Ensuring that your practice has adequate staff reduces the likelihood of employee burnout and will improve the quality of care that your patients receive.

The process of hiring, training and firing employees is costly. It is imperative that candidate selection is handled ap-propriately the first time, and significant efforts are made toward employee reten-tion. It is not likely that the perfect addi-tion to your team will come knocking on your door, or will happen to come across your job posting. A proactive approach to

The Wrong Staff Can Hurt Your Practice



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By TOM MURPHy

Over the past year, we have seen a number of high-profile cases involving privacy breaches that included personal health information (AvMed), credit-card data (Target), and Social Security num-bers, as well as other important personal information.

Cyber, or privacy, breaches are be-coming a daily occurrence and quickly rising to the top of the list of risk expo-sures for medical practices and corpora-tions alike. These breaches can come in a number of ways, including hackers who penetrate seemingly safe systems as well as stolen equipment such as computer lap-tops, tablets, or smartphones.

The results of these breaches can be devastating and very expensive for a prac-tice or corporation that does not have the proper cyber/privacy insurance coverage in place. Most physician medical-liability policies contain only minimal coverage that offers very little protection and does

not cover fines and penalties. This cover-age is insufficient for most breaches that we have seen up to this point

Most recently, AvMed agreed to set aside $3 million for a breach of thousands of its customers’ personal health informa-tion that was exposed when laptops con-taining unencrypted data were stolen. This is the first settlement in which vic-tims of the data breach will be compen-sated without having to show they suffered any losses from the theft of their personal health information.

Cyber liability is rapidly becoming a major concern for anyone who stores or transmits personal information as part of their medical practice or business. We rec-ommend that you speak with your profes-sional liability specialist.

Cyber Breach: The Dark Side of Technology

Tom Murphy is a workers’ compensation and medical-malpractice-insurance-specialist agent with Danna-Gracey in downtown Delray Beach. He can be reached at wlmailhtml:[email protected].

By KAREN ARLICK

As a seasoned veteran in the Real Es-tate Industry, I am consulted frequently when life guides people through significant changes. Life changes include happy times such as marriage, births, and graduations, even relocation and promotions! We often work with first time home buyers; move up home buyers, and luxury home buy-ers. All of these types of home purchases involve helping the new homeowner co-ordinate everything necessary to ensure a smooth transition. Everyone experiences the happy times in life when buying a home is part of life’s change of seasons.

We also help coordinate major life events in respect to real estate events when life makes other seasonal changes too. Such events can include the loss of a spouse, parent, or family member, or a home sale due to imminent foreclosure or the need to short sale due to illness or other distress. Other life events may also include selling a home and moving into an assisted living facility due to age and mobility concerns.

When do you know when it’s time to help a friend, family member, client or neighbor take that next step? Choosing to move to an assisted living facility takes care-ful consideration. The following checklist can help determine if the time is right.

• Is maintaining a home and yard difficult?

• It is hard to keep up with housekeeping and laundry?

• Are you living in only a small

portion of your home?• Do you find yourself eating and

cooking less?• Do you worry that you are taking

your medications correctly?• Do you worry about driving?• Are you worried about being

alone?• Are you worried about what would

happen in an emergency?• Do you find you see people less?• Do you worry that you are a

burden on your family or others?If the answers to these questions are

“yes”, then it might be time to consider as-sisted care facilities and selling your home-stead. We have many assisted care facilities we can recommend. When you are ready, we’ll help coordinate your home sale as well, so you have less to worry about, care for and maintain. You’ll get help and guidance throughout the whole process.

Only you know when the time is right. When you are ready, call me and we’ll discuss your options. I’m not just a Realtor®. I’m here to help you navigate through all of the real estate decisions you must make (or help others to make) in their lifetime. I’m here to help determine if now is the time for you (or a loved one) to take the next step.

When to call your Realtor®

Karen D. Arlick, PA, is a 14 year veteran in the real estate industry. She has lived in Central Florida 32+ years. Karen is a member of the Citrus Club, ORRA, FAR, NAR, and is currently studying for her real estate Brokers License. She can be reached at [email protected] or visit www.MyFlaLifestyle.com.


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By KEVIN FRITZ

In the United States, there are mil-lions of victims of human trafficking; Florida ranks third in the nation in calls to the human traffi cking hotline. Attor-ney General Pam Bondi is out to change that, making Florida a zero-tolerance state for human traffi cking by using the eyes and ears of local emergency medi-cine professionals who will be trained by the Orlando-based Emergency Medicine Learning & Resource Center (EMLRC).

“We can save lives doing this,” Bondi announced at an Orlando press confer-ence presenting the state’s “Human Traf-fi cking Overview for Emergency Medicine Personnel,” and its partnership with the EMLRC. “We have to be proactive and creative to combat human traffi cking.”

The EMLRC, which received an Emergency Medical Services State Match-ing Grant to provide education on recog-nizing the signs of human traffi cking, will begin training emergency medicine per-sonnel this fall.

“EMLRC’s Human Trafficking and Emer-gency Medicine Project will focus on educating our emergency room professionals on the identifying signs and in-jury patterns of victims, as well as the proper approach for care,” says Beth Brunner, CAE, EMLRC CEO and executive director of the Florida College of Emergency Physicians (FCEP), which shares the Orlando facility that houses the EMLRC. She says local and state resources will be provided to emer-gency medicine professionals for distribu-tion to suspected victims .

Emergency personnel may also play a role in identifying traffi ckers as well.

“We are seeing prolifi c trends of vic-tims being brought to emergency rooms many times by their traffi ckers,” says Terry Coonan, executive director of the Center for the Advancement of Human Rights at Florida State University. He has worked closely with Bondi’s offi ce in developing this initiative.

Brunner says emergency room pro-fessionals play a vital role since they are among the only people likely to encounter a victim while still enslaved. Coonan’s re-search shows that victims of human traf-fi cking have very little contact with anyone in the public eye except health care provid-ers. Because of that, training for emergency medicine professionals is vital to put a stop to this human rights crime.

According to the Family Violence Prevention Fund, 28 percent of traffi cking survivors in one study said they came into contact with a healthcare provider during the traffi cking situation—and were not rec-ognized.

This type of training does work, as is evident locally in the Orlando area. Or-ange County Undersheriff Rey Rivero

says 30 people have been arrested for sex traffi cking in the county as of July 25 since deputies underwent similar training. Prior to training, only seven arrests were made

in 2013. “But victims are scared

of local law enforcement,” Rivero says. “That’s why it is important to train others.”

EMLRC is the ideal institution to spearhead

this initiative since it delivers education and lifesaving training

techniques to more than 5,000 of the na-tion’s emergency care providers each year.

Over the past 30 years, EMLRC has pro-vided lifesaving education to nearly one million lifesavers.

“I look forward to eradicating this scourge in our state,” says Michael Lo-zano, Jr., MD, FACEP, FCEP president. “We are all poised to pick up on these red fl ags.”

After training has been implemented locally, Bondi and Brunner expect to take this initiative nationwide.

Among the general indicators of traf-fi cking for emergency room professionals to watch for in victims are:

• Lack of identifi cation documents. They may claim to be “just visit-

ing.”• No fi xed address or may be unable

to identify where he or she is living.• Under the control of another—pos-

sibly the person accompanying him or her.

• Exhibiting fear, hyper-vigilance, depression, submissiveness, or acute anxiety (PTSD).

• Typically not be in control of their own money or identifi cation docu-ments.

• Unable or reluctant to explain the nature of an injury.

• A third party may attempt to speak on behalf of the victim.

Human traffi cking victims generally fall into two categories: U.S. citizen chil-dren, usually ages 11-13, who have been recruited into a life of prostitution; and foreign nationals for sex trade and forced labor. The latter group knows they are il-legal and are reminded of it daily.

The U.S. State Department released its 2014 Traffi cking in Persons Report (TIP Report) in June, noting it is unclear how many actual human traffi cking victims there are in the United States or abroad. The Department’s report states that it is a “clandestine crime and few victims and sur-vivors come forward for fear of retaliation, shame, or lack of understanding of what is happening to them.”

“This is the signature human rights issue of our century,” says Coonan. “Our task is to abolish modern-day slavery and this is a major step in that direction.

Florida Fighting Human Traffi cking With Orlando’s EMLRC

“EMLRC’s Human Trafficking and Emer-gency Medicine Project

identifying signs and in-jury patterns of victims, as well as the proper approach for

in 2013. “But victims are scared

of local law enforcement,” Rivero says. “That’s why it is important to train others.”

institution to spearhead this initiative since it delivers

education and lifesaving training

The National Human Traffi cking Hotline’s number is 888.373.7888.

Danyelle Redden, MD, MPH, Orlando Emergency Medicine Professional; Michael Lozano, Jr., MD, FACEP, President, Florida College of Emergency Physicians; Pam Bondi, Florida Attorney General; Beth Brunner, CAE, CEO, Emergency Medicine Learning and Resource Center & Executive Director, Florida College of Emergency Physicians


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By JOSEPH TERRANOVA, DC

Of the many attractions within Cen-tral Florida and throughout Orlando, the fun of the outdoors is a major draw for residents and vacationers alike. For golf and tennis players, the area’s semi-tropical beauty is an ideal place to enjoy 18 holes on the links or three to five sets on the courts, respectively. Indeed, many profes-sional athletes call Orlando home for this very reason. It is an ideal destination to play sports, competitively or recreation-

ally, with a climate suitable for year-round activity.

But a large number of these same people, including some of the world’s most celebrated athletes, cannot achieve peak performance – they cannot swing or serve with their customary swiftness – because of pain, excess scar tissue and limited mobility. Restoring range of mo-tion, and doing so without surgery, is thus a high priority among all people who want to be fit, busy and healthy.

I write these words both from ex-perience, as a chiropractor who treats a diverse group of patients in the Greater Orlando Area, and as someone who seeks to provide non-surgical solutions to in-crease a patient’s range of motion, break apart scar tissue, and reduce discomfort or pain in general. In practical terms, that means – for the golfer formerly sidelined by back and shoulder injuries, or the ten-nis player unable to serve or volley without severe strain – there is an opportunity to restore the fullness of their posture and the symmetry of their game.

Remember, too, that these muscle tears and knee, joint and elbow problems are not exclusive to athletes; nor are these challenges the sole domain of people who wear their tennis whites or tread the grass with their spiked golf shoes. Many patients may have the same or similar injuries from job-related stress, or from pre-existing (but misdiagnosed) conditions.

Regardless of the cause or the prior treatment, the important thing to consider – and the advancement worth celebrating – is that new technology is now available to potentially resolve these musculoskel-etal symptoms. At a minimum, individu-als should evaluate all their options before committing to surgery, physical rehabilita-tion and a slow recovery – with no guar-

antee of success.Please also note that I have no brief

against surgeons or surgery. On the con-trary, surgeons often perform lifesaving work, in the battles against cancer and heart disease, and oversee transplant op-erations of unbelievable sophistication. I salute them, much in the same way I applaud the engineers responsible for a breakthrough like Acoustic Compression Therapy (ACT), which relieves musculo-skeletal pain – without the need for sur-gery and prescription medications.

A Reason to ACT: Relieving

Pain, Lessening the Intensity of Scar Tissue and Increasing Quality of Life

In citing the emergence of ACT, which is a treatment available in our clinic, there is much good news to report.

First, the union between documented, peer-reviewed scientific discovery and revolutionary technology is a reality. This combination is often elusive because it may take years or decades for the technol-ogy to emerge, which will validate a con-cept or some speculative idea.

Secondly, ACT (which is a form of WellWave technology) is a major mile-stone for the soon-to-be mainstream adoption of this application. Based on the science of lithotripsy and the use of high-energy sound waves to break up stones in the kidney, bladder or ureter, those fea-tures now address a variety of musculo-skeletal conditions.

These benefits, which I can confirm, and for which there are numerous, unso-licited testimonials, include improved cir-culation (which mitigates pain and muscle tightness) and healing. And, at the risk of repeating myself, ACT breaks apart sub-stantial amounts of scar tissue that may

cramp nerves and blood vessels. These damaged areas may then restrict physical movement and proper physiological func-tioning.

This pain is akin to the way a bulg-ing or herniated disc can exert pressure on a nerve. Bottom line: Everyone has some degree of scar tissue, and, depending on the scope and intensity of the affected area(s), ACT can potentially relieve this pain and pressure.

With three to five treatments, and no side effects, many patients experience dramatic results (sometimes after only one 10-minute treatment), starting with im-proved mobility.

The rewards associated with ACT, complemented by the comprehensive and sound research of distinguished scientists, is a declaration to options; the most im-portant of which is the option to postpone or forgo surgery, thus avoiding the ordeal of months of physical therapy, healing, scarring (ACT can minimize this effect, too) without any promise of success.

Non-Surgical Options for Enhanced Mobility and Improved Range of Motion

Joseph Terranova, DC, is the co-owner/founder for the Injury Health Center. He has a bachelor of science degree from Excelsior college in New York. Dr. Terranova earned his doctorate degree from Life University in Marietta Georgia in 1999. Visit www.injuryhealthcenter.com.

seeking out the most qualified candidates results in greater long term satisfaction in your employees.

With the uncertainty and changes medical professionals are facing, there must be a plan to avoid what can be avoided. Patients aren’t faced with limited access to medical care, they have options. People buy from people they like and trust. Medical care doesn’t have to be any different. Patient satisfaction and quality care will build a stronger, profitable prac-tice, and both start with a qualified staff. Not providing that combination to your patients can be a detriment to future suc-cess.

Wrong Staff, continued from page 13

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GrandRounds

Dr. Deborah German Receives Alma Dea Morani Award

The Foundation for the History of Women in Medicine is pleased to announce the recipient of the 2014 Alma Dea Morani, M.D. Re-naissance Woman Award, Deborah German, M.D., Vice President for Medi-cal Affairs and Dean of the College of Medicine at the University of Central Florida College of Medicine.

Dr. German was appointed Founding Dean of the University of Central Florida College of Medicine in December 2006. She also serves as UCF's Vice President for Medical Affairs.

As such, she oversees both the Medi-cal Education (M.D.) program and the Bur-nett School of Biomedical Sciences.

The College of Medicine is a founding tenant of Medical City, located just minutes from Orlando International Airport. The life sciences cluster is expected to generate more than 30,000 jobs and $7.8 billion in an-nual economic development by 2017.

Deborah German earned her under-graduate degree in chemistry at Boston University and gained her M.D. from Har-vard Medical School. She was a Resident in Medicine at the University of Rochester in New York. After her residency, she became a Fellow in Rheumatic and Genetic Diseases at Duke University in Durham, North Caro-lina. She was appointed to the faculty at Duke University Medical School and worked in the Howard Hughes Medical Institute, studying adenosine metabolism. She was also Director of the Duke Gout Clinics and Associate Dean of Medical Education while maintaining her own private practice of In-ternal Medicine and Rheumatology.

In 2005, Dr. German spent a year at the Association of American Medical Colleges in Washington, D.C. as a Petersdorf Scholar in Residence. She studied the leadership of academic health centers framed in the con-cepts of chaos theory and complex adap-tive system science.

Many communities have recognized Dr. German for her contributions. The city of Nashville honored her with the Athena Award and she was inducted into the YWCA Academy for Women of Achievement. She is the recipient of the AAMC Women in Medicine Leadership Development Award. Dr. German was named a Local Legend of Medicine in the National Library of Medi-cine.

Physician Associates to Expand to Lake Nona

Physician Associates, one of the largest multi-specialty healthcare groups in Cen-tral Florida and a part of Orlando Health will soon be offering its services in the Lake Nona area. The new office expects to open in January, 2015 in the Lake Nona Village. Alix Casler, MD; Daniel Goddard, MD and Norman Lamberty, MD will practice at the new location providing pediatrics, adult medicine and obstetrics and gynecologic

services respectively.Physician Associates will relocate its

physicians and staff from the Vista Lakes office on Chickasaw Trail to the Lake Nona location. With the opening in Lake Nona, the group will have 28 offices in four Central Florida counties: Lake, Orange, Seminole and Osceola. Drs. Casler and Lamberty will practice full-time at the Lake Nona location. Dr. Goddard will divide his time between the Lake Nona location and the Water’s Edge office in Edgewood.

Physician Associates, which is one of very few local practice groups that has been recognized as a Patient-Centered Medical Home by the National Committee for Qual-ity Assurance (NCQA), currently consists of 97 physicians. The group’s specialties in-clude family medicine, internal medicine, pediatrics, obstetrics and gynecology, pe-diatric gastroenterology, orthopedics, po-diatry and neuromusculoskeletal medicine.

Family Practice Clinic Opens In New Smyrna Beach

Bert Fish Medical Center welcomes Raman Ashta, M.D., to the medical staff. Dr. Ashta has opened her new practice, Coro-nado Health Partners – Primary Care in New Smyrna Beach. Dr. Ashta is Board Certified in Family Medicine and will begin seeing patients in her convenient location on Sep-tember 2nd.

Dr. Ashta has been in private practice since 2009 and is experienced in a full spec-trum of family medicine including adult medicine, pediatrics, office gynecology and psychosocial medicine.

Dr. Deborah German

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Medical Media Holds Training SessionMedical Media USA held a sales training meeting addressing all legal issues regard-

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AADM Recommends Medical Practices Prepare for Disasters

September is National Preparedness Month. The American Academy of Disaster Medicine (AADM) recommends medical practices, that could be called upon to help treat injuries − or even to save lives − es-tablish and maintain a comprehensive, up-to-date plan to ride out a disaster or wide-spread community emergency.

While every practice is unique, there are several general steps every physician or office manager can take once the potential serious risks have been identified:

1. Prioritize the practice’s operations on the basis of what will be maintained throughout the duration of the emergency and determine how those operations will be maintained.

2. Assign team members to relevant tasks, preferably in keeping with their every-day duties.

3. Create an inventory, with photo-graphs and receipts, of every item in the office.

4. Make a list of emergency contacts and keep it in an easily accessible place.

5. Create a document, preferably digi-tally and in print, providing all the details of the disaster plan.

Other factors should be taken into ac-count as well. In fact, the number one con-sideration during a disaster situation is the safety of staff members and patients. An evacuation route should also be planned, in case the immediate vicinity becomes unsafe. It also is vital to establish guidelines for recovery ahead of time, keeping them as general as possible to suit the particular emergency or loss.

Holiday Charity Ball set for November 22nd

The Holiday Charity Ball has been an important tradition in New Smyrna Beach since 1996. We are pleased to announce that this year’s Charity Ball will be held Sat-urday, November 22, 2014, 7:00 p.m., at the Brannon Center, New Smyrna Beach, FL 32168. This 18th annual event will be the fi-nal event held at the Brannon Center build-ing before renovations begin.

The Charity Ball fundraiser was origi-nally started by Kaye Walker in 1996. It is now being coordinated through the Bert Fish Medical Center Foundation with Walk-er’s guidance and assistance. She is also a Foundation board member. Monies raised from the evening will be dedicated to pa-tient services at Bert Fish Medical Center and improving the health of the Southeast Volusia community.

The fun filled evening features danc-ing, a silent auction, open bar, and other activities, along with a wide variety of food items contributed by area restaurants. Tick-ets are $75 per person and available through the Bert Fish Medical Center Foundation Office. Tickets may also be purchased by credit card by calling 386-424-5015. Only 400 tickets will be available this year and the event is expected to sell out quickly. Corpo-

rate sponsorships are also available. For additional information, please visit

website www.holidaycharityball.com, or contact the Foundation office at 386-424-5015 with any questions. Let’s all come to-gether to make this a “Ball” to remember!

Cardiovascular Interventions Offers Total Heart Health Programs in a Single Facility

Cardiovascular Interventions (CVI) of-fers a state-of-the-art total cardiac health facility and staff. Founded by Dr. Pradip Jamnadas, who recently received recogni-tion as a “Top Doc” in Central Florida by Castle Connolly Medical Ltd., the practice continues to grow.

The following procedures are chang-ing the way patients can utilize services at a private facility:

Cardiac catheterization (heart cath) – CVI patients have the convenience of out-patient services for diagnostic coronary and interventional peripheral procedures. All procedures are same day discharge and are performed by a friendly, well-trained team of professionals.

External Counter Pulsation (ECP) – This non-invasive, FDA approved, outpatient therapy helps them address the persistent symptoms of chest pain due to blockages in the coronary arteries. ECP quickly stimu-lates the formation of collateral blood ves-sels to help create a natural bypass around narrowed or blocked arteries to improve coronary blood flow with no significant side effects.

Dr. Jamnadas has performed 15,000 procedures in the cath lab and over 10,000 quality interventions and thousands of pacemakers and ICDs. CVI’s 12,000 sq. ft. facility houses a variety of state-of-the-art technological advancements and equip-ment that aid in the diagnosis/treatment of cardiac conditions and assists in developing the most sophisticated cardiac treatment plans.

Richard J. Lee, MD Joins Central Florida Cancer Care Center

Central Florida Cancer Care Center is proud to announce that Dr. Richard J. Lee has joined the practice as their newest Ra-diation Oncologist.

Having worked in one of the nation’s most prestigious facilities, with arguably some of the best physicians in his field, Dr. Lee brings along with him an innovative clinical approach to radiation oncology. This knowledge, combined with his com-forting and friendly demeanor, will make him a noticeable addition to the Central Florida medical community.

Dr. Lee attended the University of Michigan, as well as Boston Medical School, and completed his residency, as chief resi-dent, at the Mayo Clinic in Jacksonville, FL.

Dr. Richard J. Lee will be treating pa-tients at both of Central Florida Cancer Care Center’s locations in Sanford and Or-lando.


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Orlando Medical News Sept 2014