Tampa Bay Medical News November 2015

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PHYSICIAN SPOTLIGHT

Vilma Vega, MD

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Largo Medical Center Forges New Palliative Care PartnershipFor David Weiland, MD, chief medical offi cer at Largo Medical Center, palliative care has come a long way in general acceptance in the medical community. In fact, palliative care was not even a term in the early 2000s. Today, it’s a bona fi de recognized specialty with widespread acceptance ... 4

Mercy Launches World’s First Virtual Care CenterST. LOUIS, MO — Last month, Mercy unveiled the world’s fi rst Virtual Care Center in the heartland of America ... 8

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By DANIEL CASCIATO

Pancreatic cancer is one of the deadliest cancers worldwide - currently the fourth leading cause of cancer-related deaths in the United States. It is predicted to become the second leading cause by 2020. Today, there are no accurate methods to diagnose pancreatic cancer early when a patient may be eligible for surgery to remove the tumor and hopefully survive longer.

In a recent ‘proof of principle’ study published in Aug. 27 issue of Can-cer Prevention Research, Moffi tt Cancer Center researchers hope to improve pancreatic cancer survival rates by identifying markers in the blood that can pinpoint patients with premalignant pancreatic lesions called intraductal pap-illary mucinous neoplasms (IPMNs).

“To beat this disease, early detection is key, and our team has dedicated efforts to studying pancreatic cancer in its precancerous state because we be-lieve that the identifi cation and treatment of precancerous pancreatic lesions offers a promising strategy to reduce the number of people losing their lives to this disease,” said Jennifer Permuth, PhD, assistant member in the De-partments of Cancer Epidemiology and Gastrointestinal Oncology at Moffi tt Cancer Center.

Detecting Pancreatic Cancer EarlierResearchers Developing Blood Test to Identify and Characterize Precursor Lesions

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Editor’s Note: “Accelerating Telehealth” is the second of a two-part series about the upcoming Florida TeleHealth Summit. In this edition, Medical News highlights the agenda lineup.

Pushing telehealth to the forefront of Florida politics will top the agenda at the second annual Florida TeleHealth Summit, slated Dec. 2-4 at The Alfond Inn in Winter Park. The Southeastern Telehealth Resource Center, Florida State University (FSU) College of Medi-cine, and Florida Partnership for Telehealth are sponsoring the statewide event.

Florida Telehealth Summit Slated for OrlandoDec. 2-4 Event Will Take Place at The Alfond Inn

2 > NOVEMBER 2015 t a m p a b a y m e d i c a l n e w s . c o m

t a m p a b a y m e d i c a l n e w s . c o m NOVEMBER 2015 > 3

By JEFF WEBB

SARASOTA - When Vilma Vega talks about balancing, it is not an act; it’s an avocation. And if things go as planned, that avocation may morph into another full-fledged vocation.

After two-decades of caring for mostly HIV-afflicted patients in private practice, Vega is making her mark as a mentor who is motivating colleagues to free themselves of conventional expectations and pursue a lifestyle that is both professionally and personally holistic. That effort has mani-fested itself in Vega Consulting, where the 50-year-old has developed two self-help programs: “Transition MD” and “Blue-print to a Balanced Life.”

Both concepts are outgrowths of Ve-ga’s love of medicine, humanitarianism and a desire to meld her experience and faith to inspire others.

Vega’s journey to medicine and mis-sion work began when she was a little girl growing up in Chicago, the oldest of four children born to Peruvian emigrants. “When I was 5 my mother was diagnosed with a brain tumor. That changed my whole destiny. I watched her go through surgery. … I wasn’t sure whether my mom was going to live or die. When she came home she had a lot of bandages on her head. That very day I told my dad I wanted to be a doctor so that I could take care of my mommy. I wanted to help people like my mom. That was a turning point in my life,” said Vega.

And that was just the first of a trio of childhood epiphanies. “At 7, I was watch-ing TV shows about the Greenpeace and the Peace Corps. I remember saying I wanted to serve in other countries. I re-member thinking you had to be a nun to be a missionary, but my father said no (and) guided me toward being a doctor,” she remembered. By the time she was about 13, Vega said she “knew for sure that someday I would be a missionary doctor.”

She excelled at science in high school, which earned her a four-year scholarship to Loyola University, where she com-pleted a bachelor’s degree in biology, with a minor in theology and philosophy. She enrolled at the University of Illinois Col-lege of Medicine in Rockford, graduating in 1990. It was there she developed an interest in her specialty. “These doctors were my mentors. They took me under their wings and I realized that infectious disease specialists were the brainiacs of medicine,” she said.

For her internship and residency in internal medicine, Vega went to Jackson Memorial Hospital at the University of Miami, and stayed there for a fellowship in infectious disease. “I got involved full blast in the HIV/AIDS program. I started my HIV clinical research at that time. I

worked with the best of the best,” Vega said.

Her job search led her to Sarasota and a position at Infectious Disease Asso-ciates, where she spent the next 20 years and also served 10 years as medical direc-tor for the Community AIDS Network. Soon, Vega said, she will be working full-time at the Comprehensive Care Clinic in

North Port. That move will “allow me to do exactly what I love, which is to practice prevention in an outpatient clinic setting to help HIV patients, which is what I am very well known for,” said Vega. “I’ll be an independent contractor.”

Vega doesn’t just cherish the freedom to command her own schedule, she needs it because she is involved in so many ven-tures.

In 2005, she co-founded Hearts Afire, a not-for-profit group that has grown from three people to “about 2,000 in our da-tabase now,” said Vega. Hearts Afire has taken trips all over the world to provide humanitarian relief – medical, ministerial and other types – to areas that are in need because of natural disasters and poverty. She remains active as president emeritus and a board member, and regards helping that group to become financially sustain-able as one of the biggest challenges of her life.

The second-biggest challenge went “hand-in-hand with Hearts Afire,” Vega said. Her life was “out of synch” seeing patients day-in and day-out and working up to 80 hours a week. “I was leading an unhealthy life at 207 pounds, with a vari-ety of other disease patterns creeping in, including high blood pressure, blood sugar elevation and sleep apnea. I knew I had to completely balance my life, which meant making tough career choices and difficult

health choices,” she said.The career choice was to divest her

partnership at Infectious Disease Associ-ates and not work so many hours in clinic. “It was the best growth decision I’ve ever made. Financially it seemed crazy, but from a quality-of-life standpoint it was like the MasterCard commercial – priceless!” she said.

But Vega’s choice about her health was the opposite of growth; she shed 65 pounds. “It changed my life. Now I am able to help people all around the world by providing medical and spiritual sup-port for the underserved. I also am able to promote a more preventive method of practicing medicine for my patients, as well as myself, which brings me to my new career,” said Vega.

That new career is “Blueprint to a Bal-anced Life,” a curriculum-based program she conceived to help others make “trans-forming changes in their lives … and by giving them principles and methods which will help balance their lives,” said Vega, who is presenting it as a final project as she nears completion of her bachelor’s de-gree in ministry. Balanced Life Blueprint centers, she said, “will address all aspects of wellness, not just physical health. They also will focus on spiritual, mental, social and financial health.”

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By DANIEL CASCIATO

For David Weiland, MD, chief medi-cal officer at Largo Medical Center, pallia-tive care has come a long way in general accep-tance in the medical com-munity. In fact, palliative care was not even a term in the early 2000s. Today, it’s a bona fide recognized specialty with widespread acceptance.

“We all need to get better at helping people cope with the aftermath of a serious ill-ness,” Weiland said.

To back up this statement, late this past summer, Largo Medical Center, in partnership with the non-profit hospice provider Empath Health, began providing patients inpatient palliative care services focusing on relieving the pain, symptoms and stress that result from serious illnesses. Comprised of board-certified physicians, licensed counselors and chaplains, Largo and Empath’s palliative care team coordi-nates care with doctors while offering emo-tional and spiritual support to patients and

their family members.“We have become more family-fo-

cused than ever and palliative care’s focus puts the patients and the families in the middle,” said Weiland. “Our goal is to understand our patient’s wishes and work toward the goal of how we can improve the patient’s quality of life while they are cop-ing oftentimes with debilitating symptoms – and to do this in a team-based format. This service can be well-integrated into our typical care in most acute care hospitals.”

During his six-year tenure as medical director for Suncoast Hospice, now known as Empath Health, Weiland was responsi-ble for creating and working with palliative care teams in the community. After joining HCA Healthcare, which owns and oper-ates Largo Medical Center, he reached out to his former Empath colleagues so HCA could expand palliative care into Largo.

“It was a real opportunity for us to leverage our community partnership be-tween Empath, our sole provider of hos-pice services, and Largo Medical Center,” explained Weiland. “As healthcare systems continue down the path toward the model of integrated care, palliative care is some-thing that should be integrated into the care

treatment of patients with any chronic, de-bilitating illness.”

Through these inpatient palliative care services, the palliative care team can:

• Treat pain and symptoms such as fa-tigue, nausea, anxiety and depression

• Help patients maintain the most comfortable, independent and active life-style possible

• Coordinate care and treatment with a patient’s doctors and care team

• Provide guidance, emotional and spiritual support to patients and their fam-ily members when they are facing difficult medical decisions

• Identify support services to help pa-tients

From its customer satisfaction assess-ments, Largo Medical Center has long dis-covered that what dissatisfies families the most during a hospital visit or stay is when they feel they have not been communicated with effectively. A palliative care physician can act as a bridge in that circumstance to try to meet a patient’s level of understand-ing and ensure they understand what was explained to them about their situation.

With the assistance of Empath Health, Largo Medical Center educated its physi-

cians on the role of a palliative care phy-sician, added Weiland. “These physicians will be working with families in ICU and will have earnest conversations with fami-lies. We’re not talking about end-of-life de-cisions, but rather, hard choices one needs to make, such as should a loved one have or not have a feeding tube. These are conver-sations that families need to sit down and have with specialists to help them make in-formed decisions on difficult choices. This is a role palliative care does well.”

According to Weiland, palliative care is best if it’s introduced early, alongside cu-rative treatment and helps during all stages of serious illness.

“Patients should always feel empow-ered to ask for other forms of therapy or treatment that may help them in their jour-ney with their illness or disease,” he said. “Palliative care is just another tool in the toolbox. It doesn’t replace the oncologist, cardiologist, or general practitioner. Pal-liative care can help manage that debilita-ting pain that is really affecting a patient’s quality of life. So we’re really focusing on making lives comfortable and more livable, truly, and not just fighting the disease state as much as acute care does.”

Largo Medical Center Forges New Palliative Care Partnership

Dr. David Weiland

Similar to how colon polyps can progress into colon cancer, Permuth said they now know certain types of pancreatic cystic lesions can progress into pancreatic cancer. IPMNs account for nearly one-half of the estimated 150,000 asymptom-atic pancreatic cysts detected as ‘incidental findings’ on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans each year during the clinical work-up for an unrelated condition.

Imaging alone cannot reliably dis-tinguish between benign, pre-cancerous, and cancerous cysts, and cannot differen-tiate low-risk IPMNs (defined as low- or moderate-grade disease) that can be mon-itored from high-risk IPMNs (defined as high-grade or invasive disease) that should be surgically removed. According to Per-muth, the decision to undergo pancreatic surgery is not trivial for the patient and medical team since pancreatic surgery can be associated with an estimated 40 percent chance of complications and a chance of death. Noninvasive tests are needed to ac-curately detect precancerous lesions of the pancreas so that personalized risk assess-ment and care can be provided.

“One of our goals is to develop a blood test that can be used to help predict whether an individual has a high-risk IPMN that should be removed,” said Per-muth. “Our blood test is based on measuring substances in the blood called microRNAs (miR-NAs). These are small

molecules that act as ‘master-regulators’ of cancer-related processes in the body.”

Permuth and her team previously conducted a study in which miRNAs were measured in surgical tissue that was removed from patients with IPMNs, and they were able to measure the levels of miRNAs in the tissue and differentiate be-tween high-risk and low-risk tumors.

“We felt that a natural extension of this tissue-based research was to evaluate the levels of miRNAs in blood, as a blood test could serve as a less risky and more cost-effective approach to inform medical man-agement at the time of diagnosis,” she said.

One of the main purposes of their ‘proof of principle’ study was to measure miRNAs in the blood and determine whether a set of miRNAs could distinguish patients with IPMNs from healthy individ-uals. The team then sought to determine whether a set of miRNAs could distinguish patients known to have low-risk IPMNs from those with high-risk IPMNs.

“We show that new, relatively inex-pensive digital technology could reliably measure miRNAs in blood plasma from individuals newly-diagnosed with pan-creatic cancer precursors( IPMNs), and healthy individuals,” she said. “Thirty miRNAs out of 800 tested showed higher levels in IPMN patients compared to healthy individuals, providing a prelimi-nary miRNA signature that may be found only in people with early pancreatic dis-ease, suggesting it could serve as an early diagnostic tool.”

Furthermore, added Permuth, they also provide preliminary data to suggest

that a 5-miRNA signature can partially distinguish high-risk IPMNs that warrant resection from low-risk IPMNs that can be watched. This is important clinically because it would be opportune to person-alize care such that high-risk IPMNs that warrant resection are properly identified while individuals with low-risk IPMNs are spared the substantial risks of mortality and morbidity associated with over treat-ment from unnecessary surgery.

Permuth noted there are several chal-lenges involved when trying to develop a blood test to help in early detection efforts. To name a few, it is important to have blood and other pertinent information donated from a large number of people affected with the condition of interest as well as people not affected by the condi-tion. It is also critical that numerous steps are taken to make sure that the blood test captures important biological information that can be used to predict disease sever-ity rather than noise. Funding from fed-eral and non-federal agencies and groups is critical to the success of this research.

Looking ahead, Permuth said findings from this proof of principle study support further development of a miRNA-based blood test to detect precancerous lesions in the pancreas. Large-scale studies with rigorous designs are needed to further explore the potential for miRNAs to be utilized clinically as markers for the early detection of pancreatic cancer.

Through recently-obtained funding from the State of Florida and the newly established Florida Academic Cancer Center Alliance, her team at Moffitt Can-cer Center plans to further its research on IPMNs by partnering with researchers from the University of Florida Health Can-cer Center and the University of Miami/Sylvester Comprehensive Cancer Cen-ter. This new partnership, called the Flor-ida Pancreas Collaborative, represents the first state-wide multi-cancer center collabo-ration they are aware of that is dedicated to conducting research on IPMNs with the ultimate goal of promoting the prevention and early detection of pancreatic cancer.

“This is promising news and could someday lead to a noninvasive test for early detection of this disease,” Permuth added. “This could translate into earlier diagnoses and lives saved. However, it is important to note that the results pre-sented in this study are preliminary.”

Additional research is needed to de-termine if such a miRNA-based blood test could help diagnose pancreatic cancer earlier or more effectively than current methods. These results need to be verified in a larger prospective, or forward-look-ing, study before being available for use in the clinical setting.

“This could take several years and will involve pancreatic cancer researchers working together with patients and fami-lies affected by this disease,” she said.

Detecting Pancreatic Cancer Earlier, continued from page 1

November is Pancreatic Cancer Awareness month. For more information on this study, visit www.moffitt.org. Dr. Jennifer

Permuth


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Why wait for your monthly print edition to come in the mail?

“This summit is the event to attend if you’re interested in being part of the move-ment to advance telehealth in Florida,” said Rena Brewer, CEO of Global Partnership for Telehealth Inc., and principal investiga-tor (PI) of the Southeastern Telehealth Re-source Center (SETRC). “Come to meet, and network with those who are using tech-nology to profoundly impact how health-care is being delivered in Florida.”

For the keynote luncheon on Dec. 3, Curtis Lowery, MD, director of Maternal-Fetal Medicine at the University of Arkan-sas Medical Sciences (UAMS), and medical director of the ANGELS Telehealth Pro-gram at UAMS, will share his story about how the university’s telehealth has trans-formed healthcare delivery to many under-served and previously unreached residents in rural communities nationwide.

Conference registration begins late af-ternoon Dec. 2, and continues the following morning, as exhibits, sponsors and poster presentations are unveiled. Brewer and SETRC director Lloyd Sirmons will open the summit before introducing Mike Smith, MA, program director for the Center for Strategic Public Health Preparedness and PI for the Center for Universal Research to Eradicate Disease at FSU, to provide an update on Florida Telehealth Policy.

In August, the Florida TeleHealth Workgroup – an all-volunteer, multi-dis-ciplinary group of industry leaders tasked with providing insight and direction con-cerning the advancement of telehealth in Florida and encouraging collaboration

among existing telehealth networks and programs – developed a priority list of 2016 telehealth policy priorities and guid-ing principles.

Highlights include: • No legislation is preferred to poorly-

drafted legislation that would curtail good telehealth practice or create unnecessary restrictions.

• At minimum, telehealth legislation is worthwhile to provide standard of care and recordkeeping clarity to clinicians and protections to patients.

• While reimbursement remains a top priority for the majority of telehealth pro-viders, even if state lawmakers don’t seek a mandate, having simple foundational legis-lation in place will facilitate reimbursement discussions with payers.

• Telehealth, the broader use of tele-communication for the provision of health-related services, shouldn’t be confused with the practice of medicine; clarifying lan-guage is needed.

Ann Burdick, MD, MPH, associate dean of telemedicine and clinical outreach at the University of Miami Miller School of Medicine, will moderate a Telehealth Outcomes Panel on telehealth initiatives in Florida. The discussion – designed to provide perspectives from the patient, pro-vider, rural community and urban health system – will highlight TeleGenetics, pro-vider of specialist services to underserved areas in Florida, and Robert Zori, MD, professor and chief of the University of Florida’s Division of Pediatric Genetics &

Metabolism. After lunch, the first afternoon session

will focus on telehealth payment models in Florida, moderated by Ken Peach, execu-tive director of the Health Council of East Central Florida. In the second one, the Florida Medical Association and Florida TaxWatch will address telehealth’s “State of the State.”

A mid-afternoon session, “Telehealth: Let the Data Speak,” will be moderated by Leslee Gross, MHCA, RN, assistant vice president of operations for Baptist Health South Florida. The discussion will feature William Freeman, MD, a neurologist with the Mayo Clinic, and Michael Pizzi, MD.

In the last Day 1 afternoon session, Lauren Faison, telehealth administrator for Tallahassee Memorial Healthcare, will moderate a panel discussion on “Tele-health Best Practices.”

Day 2 will begin will a panel discus-sion focusing on mobile telehealth technol-ogy, moderated by Wayne Hodges, RN, PMD, telemedicine clinical manager of UF Health in Jacksonville.

Paloma Costa, manager of customer service and outreach for the University Service Administration Company (USAC), will moderate a discussion on “Telecom and Broadband Funding via the Rural Health Care Program.” A discussion on telehealth’s legal landscape will be mod-erated by telehealth consultant Deborah Randall, JD, and featuring Nathaniel Lacktman, JD, of Foley & Lardner LLP in Tampa, and Justin Stone, JD.

To address the financial aspect of telehealth delivery, Sirmons will moder-ate a panel discussion, “ROI: The Business Case.” The panel will include Jeff Robbins, director of telemedicine at Tift Regional Medical Center in Tifton, Ga.; Joseph Ebberwein, principal of Longitudinal Health; and Donna Jennings, RRT, MBA, of Telemedicine Programming Solutions, as they discuss how telehealth can positively impact the financial and social bottom line of providers and health systems.

Late morning, a 30-minute session on how telehealth is impacting the treatment of tuberculosis in Florida will be presented by the Florida Department of Health in Orange County. The final half-hour ses-sion will focus on understanding the di-rect-to-consumer telehealth model and its implications for patients and healthcare organizations.

“The exciting lineup of speakers in-cludes policy makers, physician telehealth practitioners, payers, implementers of suc-cessful programs, legal experts, and many others who have a telehealth story to tell,” said Brewer.

Immediately following the summit: a free hands-on lab for registrants who wish to experience the clinical side of telehealth.

“This lab will allow an opportunity for attendees to interact with telehealth experts who are implementing programs across the region,” Brewer said, “as well as to evalu-ate and become familiar with a variety of telehealth devices and services.”

Florida Telehealth Summit Slated for Orlando, continued from page 1


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By OLGA IVANOV

The statistics are alarming. Up to one in three women fail to complete their post-lumpectomy standard radiation treatment. Why? Traditional radiotherapy is time con-suming and stressful; requiring daily radia-tion to the whole breast for a total of three to six weeks. Consequently, thirty-five to forty percent of patients who did not follow through on their treatment experienced a reoccurrence of breast cancer.

Today, a more efficient option is avail-able to women with early stage breast can-cer. Intraoperative Radiation Therapy (IORT) is a single dose of radiation that is administered directly into the tumor bed im-mediately following a lumpectomy.

Who is a Potential Candidate?To be eligible for IORT at the Compre-

hensive Breast Health Center at Celebration Health, women must be 45 or older with a new diagnosis of early stage breast cancer (a tumor size less than or equal to 3 cm and no positive lymph nodes).

Is IORT the Better Option?Promising Clinical Trials:The TARGIT clinical trial showed a

similar risk of cancer recurrence within the breast among women treated with IORT compared to standard breast radiotherapy. A TARGIT summary is included below.

Less Stress and Travel Time:When compared to three to six weeks

of traditional radiation therapy, IORT offers patients reduced stress and less travel time. In addition, all radiation side effects are con-fined to the tumor bed.

Minimizes Exposure to Health Tissue:With the standard treatment, radiation

must first pass through the breast skin before reaching the inside. IORT minimizes expo-sure to healthy tissue and critical organs (in-cluding the skin, ribs and heart) by delivering less radiation and allowing for the skin to be pulled away during the procedure.

The Five-Step IORT Procedure

IORT is relatively fast and straight-forward. The first step is a biopsy of the lymph nodes to ensure there is no in-volvement with cancer. Next, the surgeon performs a lumpectomy, leaving a cavity

where the tumor was located. In the third step, the radiation oncologist places the Xoft® ballon applicator into lumpectomy cavity to administer the one-time dose of radiation intraoperatively. Retention su-tures secure the Xoft® balloon applicator. Radiation is delivered to the surrounding tissue for 9-15 minutes. Lastly, the Xoft® balloon applicator is removed and the sur-geon closes the incision.

Clinical Results Are Consistently Positive

Studies suggest that the new technique offers about the same overall survival rates as whole-breast traditional radiation therapy for women diagnosed with early stage breast cancer. In an article published in the Lancet in February of 2014, researchers calculated that the five-year risk of cancer recurrence was 3.3 percent for the women who had IORT, compared with 1.3 percent for the control group—a margin that was within the trial’s predetermined definition of “non-inferiority.” There was no difference in the long term survival between recipients of IORT or standard radiotherapy. The study also revealed that women who had IORT had fewer severe skin problems.

Early Stage Breast Cancer Patients Can Now Choose Single Dose RadiotherapyClinical Trials Promising for this Highly Efficient Treatment

Targit-A Trial Summary

3,451 women ages 45 or older diagnosed with early stage breast cancer (Size: < 3.5 cm) were randomly assigned to have either intraoperative radiation therapy or whole-breast external beam radiation therapy:

• 1,721 women got intraoperative radiation therapy (15.2 percent of these women had to have additional whole-breast external beam radiation therapy after surgery because their pathology report showed the cancer had more advanced characteristics than originally thought.)

• 1,730 women got whole-breast external beam radiation therapy

After 5 years of follow-up, researchers found that both radiation techniques had about the same breast cancer survival rates:

• 97.4 percent for intraoperative radiation therapy

• 98.1 percent for whole-breast external beam radiation therapy

Olga Ivanov, MD, FACS, is a leader in the field of breast health and specialized breast surgery. A board-certified and fellowship-trained breast surgeon, Dr. Ivanov serves as the Medical Director of the Comprehensive Breast Health Center at Celebration Health. She received her medical degree from the Medical College of Ohio, completed her residency in general surgery at Loyola and, in 2005, completed her breast surgery fellowship training at Northwestern Memorial Hospital. Dr. Olga Ivanov is one of a few breast surgeons in the United States to lead the clinical trials into Intraoperative Radiation Therapy (IORT).

Gary Wilson recently joined Tampa Bay Medical News as account executive, and will collaborate with healthcare industry part-ners in the Tampa Bay market area, including also Sarasota, Manatee and Charlotte counties, to expand coverage of the area’s only monthly B2B publication dedicated to medical professionals.

Wilson may be a fa-miliar face to local health-care industry partners. He was part of Medical News from 2006 to 2008, working with the publishing group’s flagship pub-lication, Nashville Medical News, direct-ing special publications in various Medical News markets, and launching Tampa Bay Medical News in 2007.

Wilson’s strong bass voice may also be familiar. An award-winning broadcaster, Wilson debuted his syndicated radio show – the Top 20 Gospel Music Countdown –in 1987. It’s broadcast on nearly 100 af-filiates in the United States and Canada,

and On Demand at www.sgusa.com. A non-commercial version is aired weekly on XM Radio, and worldwide on the Ameri-can Forces Radio Network (AFRN). The AFRN show is dedicated to the memory of his dad, Tech Sergeant Charles G. Wilson, a decorated World War II veteran who died in 2001. A native of Rocky Mount, NC, Wilson was inducted into the Mount Olive Hall of Fame for singing and broadcasting accomplishments.

Wilson also now produces a new syn-dicated show – Flashbacks – featuring no-repeat music from the 1980s and beyond (www.southerngospelusa.com).

“Gary returns to Medical News after some time away pursuing his radio syndi-cation passion,” said Dennis Triola, group publisher for Medical News. “Gary’s award-winning radio program will continue on weekends. He brings to Medical News a wealth of background in print and broad-cast media.”

Wilson may be reached in his Sarasota office via (615) 584-1005 or [email protected].

Gary Wilson Joins Tampa Bay Medical News

Gary Wilson


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By LyNNE JETER

ST. LOUIS, MO — Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America. Bishop Edward Rice of the St. Louis Arch-diocese officially blessed the nonprofit Catholic health system’s newest facility Oct. 6 in Chesterfield, Mo., a suburb lo-cated 15 miles west of St. Louis.

The new $54 million building on a 38-acre campus houses the nation’s larg-est single-hub electronic intensive care unit (ICU/Mercy SafeWatch), and also provides a center for telemedicine innovation and a testing ground for new healthcare products and services. More than 300 physicians, nurses, specialists, researchers and support staff at the four-story, 125,000-square-foot center are tapping into technology to de-liver care to patients around the clock via audio, video and data connections to loca-tions across Mercy and around the country through partnerships with other health care providers and large employers.

“This is a huge and impactful step forward for telehealth and I appreciate that Mercy leadership had the vision and determination to demonstrate to their community and the world how telehealth is one powerful and effective solution to the issue of diminished access to health-care that many citizens in America and across the globe are experiencing,” said Rena Brewer, CEO of Global Partner-

ship for Telehealth Inc., and director of the Southeastern Telehealth Resource Center.

Randall Moore, MD, MBA, Mercy Virtual president, spoke with Medical News exclusively about establishing the Virtual Care Center and the positive impact it’s already making on practices, clinics and hospitals across the United States.

How did the idea of Mercy creating a Virtual Care Center originate?

It was an evolutionary process. We launched our first virtual program – Mercy SafeWatch, our electronic ICU– in 2006, and we’ve experienced great success. As the team continued to build programs and saw the importance of virtual care becoming a transformational pathway for our health system, a light bulb went on. It made sense to create a Virtual Care Center that worked like a hospital to bring

together teams, resources and infrastruc-ture to care for patients in a much more coordinated manner and to offer a care continuum that extends 24/7/365. We needed a facility for this conduit of care, just as we’d need one for a particular ser-vice like cancer care.

How did the concept evolve into the world’s first-of-its-kind telehealth center?

The Virtual Care Center evolves from the culture and charism of Mercy. The Sisters of Mercy who founded our health system were famously known as ‘the walking sisters.’ That goes back 187 years, when nuns were mostly cloistered and did good deeds from their convent for people in need. The walking sisters, who were quite independent, didn’t want to wait for people to find them. Instead, they searched for people in need and addressed those needs on the spot. They were an anomaly for their time.

When you think about hospitals in general, we wait for people to come to us, and we give them exceptional care. The idea permeating our culture was to seek those needing medical care by tak-ing virtual care teams from our clinics and hospitals and proactively identifying their healthcare needs, intervening with them earlier and more completely. It translates to a lower cost, high impact option to keep a person from deteriorating.

At the board level and leadership level, (Mercy president and CEO) Lynn Britton and (Mercy CFO) Shannon Sock were the primary drivers of this project, understanding the Virtual Care Center is 100 percent consistent with our organiza-tional mission – and also a model for us to progressively replace our hospital-based care with care when and where people need it. If we do this well, we’ll be able to realign our contracts to be rewarded for keeping people well.

How have you made the Virtual Care Center a sustainable business model while also dealing with the complexities of regulations, interstate commerce, and the like?

First, it’s important to know we didn’t go into the Virtual Care Center thinking that a fee-for-service equivalent would make it a sustainable business model. We weren’t expecting, though we’d have welcomed it, very much direct reimburse-ment as has panned out. In Missouri, our parity laws have helped.

We’re broadening it to enable us to move our teams and our patient centric-ity from our facilities, which are some-what limiting, to virtual care anytime, anywhere. If we did that with something like performance-based, population health contracts, we could intervene earlier and more effectively, and then it would pay for itself.

For example, here’s how it works in to-day’s environment in the hospital ICU vs. the floor. In the hospital ICU, the hospital is paid a lump sum for a patient with a given condition and it’s a fixed amount of money. The ICU is more expensive, and the pa-tient usually doesn’t have as good an out-come. One result of our Mercy SafeWatch program shows the actual v. predicted mor-tality for the last few quarters in our Joplin (Mo.) hospital has been running around 50 to 55 percent. In other words, 45 to 50 percent of the patients who ‘should’ve’ died didn’t. That statistic doesn’t help much with finances, right? It should help us with market differentiation; by having Mercy SafeWatch in place, we can do a better job taking care of people. But here’s another example: Looking at the risk-predicted length of stay, both in the hospital and the ICU, our length of stay is running 20 to 30 percent less than predicted in the ICU, and 30 to 35 percent less than predicted on the whole hospitalization. If we can get a sick person well faster, that’s less time for the pa-tient in the ICU. Looking at it financially, the direct variable ICU costs us about of $900 a day. If it costs us $650 a day to use Mercy SafeWatch, then we’re getting 100 percent return on our investment of virtual care without being paid directly for it.

But the most important aspect is that a third of the ICU patients predicted to die aren’t dying. That’s just the tip of the ice-berg, and it implies that patients accessing the Virtual Care Center are doing better. We expect to deliver more efficient, effec-tive, and higher impact care as we inte-grate virtual into bedside and clinic care.

What’s Mercy’s longer-term goal for the Virtual Care Center?

One of our key growth areas for our mission is to create the Virtual Care Cen-ter as a conduit of care anyone, anywhere can access. We’ve been on a 10-year, sev-eral hundred million dollar journey to get where we are. We’ve learned many posi-tive things, and we continue to learn from missteps.

We’re proposing that instead of selling our services, or having an entity trying to replicate the same services without us being able to provide much support, we’d like to build a national consortium of interdepen-dent partners. We’d continue packaging our offerings and building our infrastruc-ture with our partners’ support. They could buy into our entity, we could capitalize it together and replicate what we’ve learned with a fraction of time and money, and also do it in an interdependent way so we could then go to GM, Boeing, CMS, United Healthcare to offer it to people they’re cov-ering throughout the 50 states.

Mercy Launches World’s First Virtual Care Center


GrandRoundsMoffitt Senior Member, Geriatric Oncology Gets Recognized at Assembly in Basel, Switzerland

Dr. Martine Extermann, senior mem-ber of Moffitt’s Senior Adult Oncology Program, has been honored with the Geriatric Oncology Lifetime Achieve-ment Award, originally known as the “Preis geriatrische Onkologie für das Lebenswerk 2015,” at this year’s Ger-man, Austrian and Swiss Congress of the Societies for Hematology and On-cology. She was recognized at a cere-mony in Basel, Switzerland.

Extermann’s main interests are to understand how the health of older patients affects their cancer’s behavior, which can be used to guide treatment choices. Among her many accomplish-ments, Extermann has established an index to assess an individual’s risk of severe toxicity from chemotherapy: the Chemotherapy Risk Assessment Scale for High-age patients, or CRASH, score.

In July, the Kay Yow Cancer Fund, in partnership with The V Foundation for Cancer Research, awarded a $1.25 mil-lion ovarian cancer research grant to Ex-termann. The grant will support research focused on how to personalize care for aging women with ovarian cancer.

Extermann has received numerous awards for her work in geriatric oncol-ogy including the ASCO B.J. Kennedy Award for Scientific Excellence in Geri-atric Oncology in 2009 and the Paul Ca-labresi Award in 2014 presented by the International Society of Geriatric Oncol-ogy. She has also served as president of the International Society of Geriatric Oncology, of which she is a founding board member.

Extermann received her M.D. and Ph.D. in Geneva, Switzerland, and later came to the University of South Florida College of Medicine for a fellowship in medical oncology/senior adult oncol-ogy. She has been at Moffitt since 1997.

Along with receiving this lifetime achievement award, Extermann also is one of the 35 experts presenting at the congress. She discussed the “Develop-ment of Geriatric Oncology in the USA” on Oct. 11.

Jim Burkhart Elected as Vice Chair/Chairman-Elect to Florida Hospital Association’s Board of Trustees

Jim Burkhart, president and CEO of Tampa General Hospital was named vice chair/chairman-elect of the Florida Hospital Asso-ciation (FHA).

Burkhart spent two years as an FHA trustee and this past year served as treasurer. FHA officers and trustees are nominat-ed by the executive committee, which includes past board chairmen. They were then elected by their peers.

The FHA has 214 member hospitals and health systems across the state. It supports the mission of its members to provide the highest quality of patient care through advocacy, education and informational services.

Burkhart came to TGH in 2013 af-ter serving as president and CEO of UF&Shands Jacksonville Medical Cen-ter, now known as UF Health Jackson-ville. He holds a Doctorate of Science, Administration-Health Services degree, and a Master’s of Hospital and Health-care Administration from the University of Alabama Birmingham.

Tampa General Wins Consumer Choice Award for 10 Straight Years

For the 10th straight year, Tampa General Hospital was named the Con-sumer Choice winner by National Re-search Corporation. The annual award identifies hospitals across the United States that healthcare consumers choose as having the highest quality, best repu-tation, and best doctors and nurses.

TGH is the only hospital in the Tam-pa-St. Petersburg-Clearwater market, and one of just 19 in the state, to receive this recognition. The winning hospitals are listed in the Oct. issue of Modern Healthcare.

Winners are determined by con-sumer perceptions on multiple quality and image ratings collected in the com-pany’s Market Insights survey, the largest online consumer healthcare survey in the country.

Jim Burkhart

World’s First VirtualCare Center Tailored to Improve Physicians’Quality of Life, Too

By LyNNE JETER

ST. LOUIS, MO — Internist Ran-dall Moore, MD, MBA, recalls countless nights of sleep interrupted by on-call re-quests.

Moore, now president of Mercy Vir-tual, is doing his part to make sure more doctors enjoy their private lives when they clock out of their practice, clinic or hospital.

“Instead of getting a 2 a.m. call to come in, they can sleep,” said Moore, who helped open the world’s first-of-its-kind Virtual Care Center last month near St. Louis, Mo. “It’ll enable them to be more productive, have less chance of burnout, and improve their quality of life while we enable better, more responsive care for their patients.”

When Mercy’s electronic intensive care unit (ICU), also known as Mercy SafeWatch, was established in 2006, Mercy had one “full” intensivist group in one site. Now, Mercy has intensivist groups at multiple sites, said Moore.

“One reason why, aside from our overarching mission of care, is to improve the quality of life for our doctors,” ex-plained Moore. “For example, if a doc-tor goes into a community with no virtual care and he’s the only intensivist, he’s on call all the time. It’s tough and doctors burn out. With the virtual team, the doc-tor can go home and have a life. We do that increasingly across the board, not just Mercy SafeWatch. Using a nurse-on-call feature, which is housed inside the Vir-tual Care Center, 70 percent of the calls our doctors were getting a couple of years ago are now handled without them being bothered.”

Moore said Mercy will take another step to making it easier for doctors by bringing more physicians into the Virtual Care Center.

“Hopefully, we’ll approach 100 per-cent of the calls at night no longer going to our doctors,” he said. “By not taking calls at night, doctors can be more productive.”

Physicians have shared concerns about Virtual Care Center operations and how it will impact their practices, Moore shared.

“The Virtual Care Center isn’t a call center,” he emphasized. “It should be progressively integrated into the doctor’s practice. We’ve designed it specifically the way the doctor would want it done. You might say it’s somewhat of a mass customization … supporting our doctors and other healthcare professionals via the Virtual Care Center.”

In one-on-one conversations with

doctors, Moore is often asked how the Virtual Care Center “can be better than what I can do?” Bolder ones ask: “Is it a threat to my practice?”

“The Virtual Care Center is another resource for a doctor or hospital to have in the care of their patient when they don’t have the time, resources or infrastructure to do it on their own,” he said. “It’s very complementary to what they do.”

One telehealth success story involves Mercy’s early warning system for sepsis. To identify patients at risk for sepsis and alert doctors to these risks for early inter-vention, Mercy’s Early Warning & Identi-fication System (EWIS) monitors multiple patient variables in real-time.

“We look at building programs as ways to partner with doctors to create a seamless integration for the patient,” ex-plained Moore. “We look at how we can improve the value of that entity – practice, clinic or hospital – in the local marketplace so they can show first and foremost, they can deliver better care with documented outcomes for the patients they serve. Sec-ondly, we show how they’ll be financially and operationally rewarded instead of having their revenue adversely affected. I’ve had doctors say, ‘I don’t know how to sustain my practice if that happens.’ Instead, we’re helping them build a finan-cially sustainable and professionally more rewarding offering in the community.”

Moore recalled a primary care phy-sician sharing his experience after work-ing with the Virtual Care Center. “He told me that after 35 years of the practice of medicine (without telehealth),” said Moore, “it was the most rewarding time of his professional life. That’s what we strive for, to allow doctors to get back to the basics of practicing medicine.”

W H O ’ S T E N D I N G O U R D O C T O R S ?

President of Mercy Virtual, Dr. Randy Moore, addresses a group of visitors. This room, like many areas of the Virtual Care Center, has the latest in audiovisual technology.

Balancing Act, continued from page 3

medical directors, whom Vega is train-ing through another program she created, “Transition MD.” “It is for physicians who want to truly practice preventive medicine and make a transformational movement in healthcare. They will want to practice for the love of their profession, in an environment where they also can practice their faith, their desire to help people in a more proactive or preventive fashion,” she said. She currently has eight enrollees, she said.

If that seems like a lot of plates to keep spinning, Vega is undaunted. She also travels to public speaking engagements on

behalf of several pharmaceutical compa-nies, as well as motivational speaking gigs for an array of educational and ministerial organizations.

And when Vega finds time to relax, it usually means working out at the gym, cooking all her own meals, playing piano, ballroom dancing (she used to compete), or working on the outlines for two books.

Vega acknowledges she still is shoehorn-ing an awful lot into her schedule, but “the difference now is I am creating and doing things I love. Down the road, it’s all going to pan out as it should,” she said. “It can only be done through the power of God.”


Moffi tt Cancer Center Researchers Seek Bilingual Smokers For New Study

Researchers at Moffi tt Cancer Center are actively recruiting Hispanic smokers that speak and read both English and Spanish for a study testing cessation education materials.

The Moffi tt study will incorporate fo-cus groups of smokers who speak both Spanish and English.

Researchers are currently recruiting for the bilingual focus group and to be considered for the study, participants must be 18-years-old or older, speak English and Spanish, been a smoker for at least and year and smoke at least fi ve cigarettes a week.

Each focus group will take 90 minutes and participants will be compensated for their time.

Physician Board Certifi cation in Administrative Medicine Offered

The American Board of Administra-tive Medicine® (ABAM) is proud to an-nounce that applications are now being accepted for its inaugural administrative medicine examination for physicians who serve in management and leader-ship capacities of healthcare organiza-tions. The initial exam will be adminis-tered in October 2016 at testing centers throughout the United States, Puerto

Rico and Canada. While many physicians pursue board

certifi cation in their medical specialty, the ABAM offers an opportunity for cer-tifi cation in the administrative side of medicine. This allows our Diplomates to further demonstrate their strong business acumen to employers, hospi-tal CEOs, boards of trustees, and other stakeholders.

The ABAM credential is designed to recognize physician leaders who hold a Master’s degree in a related fi eld or have signifi cantly relevant and practical ad-ministrative experience. There are mul-tiple pathways to apply for, and earn, the credential.

As the healthcare industry continues to evolve, physician leadership and busi-ness expertise is more important than ever before.

In order to be considered for board certifi cation through the ABAM, the phy-sician must:

• Hold a master’s degree in business administration, medical management, or healthcare administration, or have at least fi ve years of cumulative experience in an administrative position

• Currently hold, or previously have held, board certifi cation through the ABPS, ABMS, AOA, or a RCPSC board

• Have a valid and unrestricted li-cense to practice medicine

• Complete eligibility requirements

and application are available online at http://www.abamus.org.

Moffi tt Cancer Center Hosts Award-Winning Cancer Drug Developer and Researcher

Moffi tt Cancer Center is hosting its 17th-annual Ted Couch Cancer Research Lecture on Wednesday, Nov. 18 at 4 p.m. at the Vincent A. Stabile Research Build-ing, 12902 Magnolia Drive. Charles L. Sawyers, M.D., who serves as the Chair of the Human Oncology and Pathogen-esis Program at Memorial Sloan Ketter-ing Cancer Center, will give a free public lecture on his studies of mechanisms of drug resistance in cancer and his work in developing new drugs for cancer treat-ment.

Sawyers is a co-developer of Gleevec®, a drug that treats certain types of leukemia, and he co-discovered the anti-androgen drug Enzalutamide, which is used to treat prostate cancer. His research has signifi cantly contrib-uted to understanding the progression of cancer, and his fi ndings in drug resis-tance and work in developing new tar-geted anti-cancer drugs has made him a leader in his fi eld.

Sawyers is a member of the National Academy of Sciences, and of the Insti-tute of Medicine. He received the 2013 Breakthrough Prize in Life Sciences, the 2013 Taubman Prize for Excellence in Translational Medical Science and the 2015 BBVA Knowledge Award in Bio-medicine. He is a past President of the American Association for Cancer Re-search and was appointed to the Nation-al Cancer Advisory Board by President Barack Obama.

A cocktail reception will follow the presentation. Please RSVP to 1-888-MOFFITT (1-888-663-3488).

Moffi tt Cancer Center names Christine Chung as a New Chair

Moffi tt Cancer Center announced that Dr. Christine Chung has been ap-pointed as the new Chair and as Senior Member in the Department of Head and Neck, and Endocrine Oncology.

Dr. Chung comes to Moffi tt from Johns Hopkins University, where she was Director of the Head and Neck Cancer Therapeutics Program in the Depart-ment of Oncology and Otolaryngol-ogy. Prior to her time at Johns Hopkins, Chung was an assistant professor in the Division of Hematology and Oncology at Vanderbilt University Medical Center from 2003 to 2010.

She also hopes to advance the un-derstanding of the clinical and biological differences between human papilloma-virus (HPV) and tobacco-related head and neck cancers, as well as providing personalized care specifi c to the patient, building on Moffi tt’s experience in these areas.

Dr. Chung will facilitate the growth and development on the recently formed Department of Head and Neck, and Endocrine Oncology.

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