Tampa Bay Medical News April 2013

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Claudia E. Lago Toro, MD By LyNNE JETER

TAMPA - A college track coach taught William Pearce a valuable lesson: “Put yourself in position to succeed and the rest will take care of itself.”

Peace, a second-year stu-dent at the University of South Florida (USF) Morsani College of Medicine, and a 2011 NCAA Student Athlete of the Year, has taken that advice to heart.

The American Medical Association (AMA) recently selected him as the only student nationwide for the AMA’s 2013-14 Government Relations Advocacy Fellowship (GRAF) Program. Pearce is

the fi rst student to repre-sent USF’s medical school in that capacity, and only the tenth of a select group who have served as GRAF fellows since the prestigious program’s inception.

“I’ve been interested in this position since I learned of it as a fi rst-year medical student,” said Pearce, who gained expertise in the practical aspects of advocating

for medicine since attending his fi rst AMA Medical Student Section Interim Meeting last year, and was the primary author of an AMA resolution aimed at tying further

Rock StarUSF medical student selected as national pick for AMA’s GRAF Program

(CONTINUED ON PAGE 4)


William Pearce

By LyNNE JETER

ORLANDO — The primaveral an-nouncement by leaders of Florida Hospital and Florida State University (FSU) of a $2 million gift to boost medical training in Central Florida has industry insiders buzzing.

Speculation has swirled that the move further separates Florida Hospital from rival Orlando Health, and the University of Central Florida College of Medicine, which reportedly backed out of a deal with Florida Hospital late last year.

“Although no one’s saying it on the record, it’s true,” said a Florida physician leader, who

A Major Medical GiftFlorida Hospital partners with Florida State to boost medical education in Orlando

L-R: Dr. Michael Muszynski, dean of the FSU College of Medicine’s Orlando campus, FSU President Eric Barron, Florida Hospital Vice President Brian Paradis and Dr. John Fogarty, dean of the FSU College of Medicine.

If I could just inspire a few more students and physicians to (do that) … instead of letting lawyers and politicians decide what’s best for our patients; I think that would be an overwhelming success.WILLIAM PEARCE

Taming Disruptive BehaviorACPE doctoral-level therapists highlight “bad boy” workplace behavior in new manual on managing healthcare’s troublemakers ... 6

Beating the OddsKids Beating Cancer celebrates opening of Central Florida transplant center, founder eyes growing national registry of umbilical cord blood ... 7

2 > APRIL 2013 m e d i c a l n e w s . c o m

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Claudia E. Lago Toro, MDMedical director, St. Joseph’s Women’s Hospital Breast Center

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TAMPA - Growing up as an only child in San Juan, Puerto Rico, Claudia Lago Toro’s four cousins were more like siblings. “It was wonderful,” she said. “Life was simple, but filled with joy and love from friends and family.”

But when she was 13, one of her cous-ins was diagnosed with a brain tumor and died of complications from surgery. “It changed my perspective. I had a real curi-osity about what was going on,” she said, and “not understanding prompted me to learn more.”

When she got to high school she learned of a two-week medical summer camp in Indiana and persuaded her par-ents to let her attend. That is where she discovered a mind of her own – literally.

“I was allowed to hold a human brain in my hands. It was truly a fascinating ex-perience. Life as I knew it changed, and I became fascinated with the medical field,” she recalled. “I knew then what I wanted to do. I decided I would finish high school a year early.” That accelerated pace of learning continued in college as Lago Toro completed her undergraduate de-gree in general science in just three years. She enrolled at the University of Puerto Rico School of Medicine in San Juan; in 2004 she earned her MD.

Lago Toro said she became inter-ested with surgery as a third-year medi-cal student. “With surgery, you are able to intervene and cure in many instances. (So) I chose the path of general surgery.” She came to the U.S. to begin her surgical residency at Baystate Medical Center in Springfield, Mass.

The move to New England was a “huge change,” she said. “It’s a big dif-ference when you are used to being with family members and friends daily, and then you move to a place where you don’t know anyone. But you start building rela-tionships and soon it becomes home.”

Springfield was home from 2004 to 2009. “It was a five-year residency pro-gram. I was very fortunate to end up being with two exceptional breast surgeons who loved what they were doing,” said Lago Toro. “I saw how they treated their pa-tients, their rapport with the families, and their continuity of care, which was defi-nitely one of the things I was looking for-ward to for when I entered practice. With breast surgery you definitely have that. The data is changing constantly, so it’s not like you’re going to be at a standstill. There are multiple treatment options.”

“That’s when I decided to pursue a fellowship in breast surgical oncology,” she said. The surgery is “very intricate. It may not be as technically complicated as some other surgical specialties, but in terms of

the knowledge and background,” she said, it’s where she can best apply herself.

Lago Toro said she was very fortunate to undertake her fellowship “in a pristine environment at Bryn Mawr Hospital in suburban Philadelphia, overseen by her mentor, Thomas Frazier, MD, senior sur-geon and medical director of the hospital’s Comprehensive Breast Center. “It was the perfect scenario for me because not only did I get the research angle, but I also got an education about how to build a practice. He had his own breast surgery center. It was one of the best opportunities of my life. He and his partner, Andrea Barrio, MD, were both my fellowship attendings. I still use them as resources,” said Lago Toro.

The admiration between Lago Toro and Frazier is mutual. “We were ex-tremely lucky to match Claudia in the breast fellowship. She turned out to be a perfect fit for us. She has a great sense of humor, is very enthusiastic and a tireless worker. The patients loved her,” said Fra-zier. Lago Toro “has a nice way of relat-ing to patients. One of the things Claudia understood is we should treat patients like we, or someone in our family, would like to be treated. Claudia has that upbeat personality that allows her to see some-one who is scared and put them at ease. Not everybody can do that,” said Frazier, 69. “Claudia is a special person and I’m

delighted she has found such a good op-portunity in Florida.”

The opportunities Lago Toro found in Florida have been professional and per-sonal. After completing her fellowship she worked for three years for Physicians of Southern New Jersey in Vineland, where she established a comprehensive breast care program, oversaw the tumor board

and the cancer committee. Late last year she relocated to Ormond Beach to care for her mother Magaly, whom she helped recover from three primary cancers she was diagnosed with in the past three years. “It has been a very challenging time” for she and her father Jose, Lago Toro said. “It makes you appreciate the simple things in life. Thank God she is now doing well.”

Lago Toro was recruited by Health-Point Medical Group in Tampa. “I was looking for an opportunity to continue with a breast program ... but I wanted to take it a step further. HealthPoint offered that perfect opportunity,” she said, and it also was within a few hours driving dis-tance of her parents.

Lago Toro is medical director of St. Joseph’s Women’s Hospital Breast Center. “I can’t say enough about St. Joe’s. What I really love about St. Joe’s and HealthPoint is the sense of community and collabora-tion about building something great. Ul-timately, when you work someplace you want to become part of that community. That is what I’m striving for. It’s about be-longing to something, because when you belong to something that’s when you stand up for it,” she said.

When it comes to caring for patients, Lago Toro’s philosophy is homegrown. “My upbringing is that you treat everyone



advanced directives to driver’s licenses. As 2012-13 vice chair of the Florida Medical Association (FMA) Medical Student Section, he coordinated legislative affairs, served as USF student delegate to the FMA, and led the FMA’s medical student recruiting efforts at USF. Last month, he was among a group of USF students who traveled to Capitol Hill to push for greater funding of graduate medical education.

“(The GRAF post) always seemed sort of out-of-reach, so I just made sure to do the best I could at the state level with the FMA,” he said. “Late last year, I was encouraged by a former GRAF (fellow) to apply for the position, so I did – and it worked out!”

Starting this July, Pearce will work full-time for a year in Washington, DC, as a paid member of the AMA’s federal ad-vocacy team. He’ll meet with politicians, AMA leaders and medical students to ad-vance the association’s legislative agenda and policies on behalf of patients, physi-cians and medical students.

“For me, it means the opportunity to inspire medical students to get involved and take control of our future,” he said. “If I could just inspire a few more students and physicians to (do that) … instead of letting lawyers and politicians decide what’s best for our patients; I think that would be an overwhelming success.”

A native of Jacksonville, Pearce earned a biology degree from the Univer-sity of North Florida, where he won a full athletic scholarship and served as UNF track and cross-country team captain for

three years. “Even in college, if I turned on the

TV, it was only to check the news,” he admitted. “It’s what I enjoy and what I’ve always done for fun. When I got to medical school, getting involved in orga-nized medicine just made sense. I loved it. I also believe that organized medicine is the most powerful tool that students and physicians have to shape our future and do what’s best for our patients.”

Managing a hectic schedule of medi-cal school and policy advocacy work “can be a little bit tough,” sometimes, noted Pearce.

“I get way more excited about health policy than I do about biochemistry,” he said. “I’ve been able to balance everything just fine, though. As a student athlete in college, I really learned what it means to budget your time. Compared to that, medical school is easy. I’m honestly not worried about taking a year off at all. I’d head on up to DC tonight if I could.”

The Hillsborough Medical Associa-tion recently awarded Pearce an annual scholarship for outstanding service in or-ganized medicine.

“As with everything else in my life, I’m just going to do the very best I pos-sibly can with medicine and policy,” he said. “I’m not 100 percent sure what that’ll bring for me on either front. If we accomplish nothing more than to build strong grassroots student support for tak-ing charge of our future, I don’t think we could be any more successful than that.”

Rock Star, continued from page 1A Major Medical Gift, continued from page 1

declined to be identified. “That said, it’s great for Orlando to have a gift of this magnitude to further medical training right here at home.”

Another local healthcare leader said: “FSU Medical School-Orlando is proba-bly the best kept secret in Central Florida. The mission statement definitely differen-tiates from UCF’s College of Medicine.”

The gift will establish the Florida Hospital Endowed Fund for Medical Edu-cation to help the College of Medicine sup-port its faculty of nearly 600 Orlando-area physicians.

“A medical school with our unique, community-based curricular design requires outstanding, dedicated clinical partners if excellence in educating the next generation of Florida’s physicians is to be assured,” said Michael Muszynski, MD, dean of the FSU medical school’s Orlando campus.

Florida Hospital CEO Lars Houmann said the FSU College of Medicine teaching model is “an excellent and highly effective ap-proach to growing Flori-da’s much needed future physician population.”

“From a resource and efficacy standpoint, the community-based clinical training approach directly aligns with the requirements of a 21st century healthcare model,” he said.

The FSU College of Medicine’s Or-lando campus on East Colonial Drive has been in place since state lawmakers ap-proved it in 2002. Florida Hospital sup-ported the creation of the FSU College of Medicine during the legislative process and became one of its affiliates in 2002, just before the Orlando campus welcomed its first group of students.

The premiere class of third-year stu-dents began in 2003 and graduated in 2005. The Orlando campus has 20 third-year and 20 fourth-year medical students.

“Now that we’re celebrating the 10th anniversary of our Orlando campus, we appreciate this generous gift as an ac-knowledgement of that relationship, and a great help to us to support and sustain the

quality leadership, fac-ulty and programs there in the future,” said John P. Fogarty, MD, dean of the FSU College of Medicine.

Even though stu-dents use the Orlando campus as a home base for a longitudinal doctoring course, they spend most of their clinical training in the community. Students work directly with local physicians in a one-on-one appren-ticeship-style model to complete clinical rotations in family medicine, pediatrics, internal medicine, obstetrics-gynecology, surgery, emergency medicine, psychiatry or geriatrics and through other electives. The approach is meant to give students more involvement on the frontlines of the healthcare delivery system. For example, instead of operating a teaching hospital or academic medical center, the FSU College of Medicine partners with hospitals, medi-cal centers, health clinics and physician offices throughout the state to ensure stu-dents have an opportunity to work directly with the most experienced physicians in the community and get them more involved in patient care. As a result, of the 81 alumni physicians now practicing in Florida, 70 percent are primary care providers.

“We find the mission of the College of Medicine – to produce physicians who would focus upon pri-mary care and seek to in-crease access for citizens who live in underserved areas – to be very com-patible to our own his-tory and mission,” said Rich Morrison, regional vice president of govern-ment and public affairs at Florida Hospital.

The FSU College of Medicine oper-ates regional campuses in Daytona Beach, Fort Pierce, Pensacola, Sarasota and Tal-lahassee, and has rural training sites in Im-mokalee and Marianna.

Thirteen members of the 113-mem-ber FSU College of Medicine Class of 2013 recently matched with residency pro-grams in Orlando, including five at Florida Hospital. Those students are scheduled to graduate next month and begin their resi-dency training in July.

Rich Morrison

Dr. Michael Muszynski

Lars Houmann

Dr. John P. Fogarty

the way you would want to be treated – with respect and humility,” she explained. “Yes, there will be times when the news will not be good, but I want to bring peo-ple to a better state or, if necessary, a pal-liative state. The better you treat people, and the better relationship you have, the better response you get. Give them as much time as they need.”

When she’s not at work, Lago Toro has a host of active pastimes, including tennis, biking, running and in-line skating. She also loves to cook. “In my culture, ev-

erything revolves around food and family. The heart is in the kitchen. I’m not very fancy, but rice and beans and chicken has to be in the mix,” she said.

But when she really wants to im-press, Lago Toro pulls out a secret fam-ily recipe named after her grandmother: fiodono. It is a baked dessert that melds flan and cheesecake. It’s so popular at family gatherings, she demured, that “I may be asked to bring two or three because one is never enough”

Claudia Lago Toro, MD, continued from page 3

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Our experienced, board-certified surgeon specializes in the surgical treatment of clinically obese patients. We offer the Roux-en-Y Gastric Bypass, Adjustable Gastric Band, Sleeve Gastrectomy, Revisional Bariatric Surgery and Abdominoplasties. We also offer the latest advanced endoscopic techniques available for treating weight gain.

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20094 medical news.indd 1 1/16/2013 12:38:07 PM

By LyNNE JETER

TAMPA - The medical community took notice when the Indiana Supreme Court ruled in Raess v. Doescher that the hospital had to pay $325,000 in damages resulting from the misconduct of a surgeon in a landmark workplace bullying case.

The state’s highest court acknowledged it as possibly the basis of a claim for inten-tional infl iction of emotional distress arising from a supervisor’s workplace misconduct. In this case, a hospital room perfusion-ist claimed a cardiovascular surgeon ap-proached him with “clenched fi sts, piercing eyes, a beet-red face, and popping veins,” spouting obscenity-laced threats that he “was fi nished!”

The advent of health reform has per-haps exacerbated disruptive behavior, along with empirical linkage between disruptive behavior and clinical outcomes ranging from medical errors to mortality, prompt-ing healthcare executives to expeditiously mainstream preventive measures and take corrective action quickly.

In the last decade, 21 states have in-troduced the Healthy Workplace Bill, with 16 bills active in 11 states. The Joint Com-

mission addressed the issue by adopting a new leadership standard con-cerning “behaviors that undermine a culture of safety,” effective Jan. 1, 2009. The Tampa-based American College of Phy-sician Executives (ACPE) is among national profes-sional organizations that have adopted zero toler-ance for abuse policies.

“A measured ap-proach is recommended in defi ning inappropriate and disruptive behav-ior,” said Marty Martin, PsyD, co-author of Tam-ing Disruptive Behavior, pub-lished by ACPE earlier this year. “The defi nition shouldn’t be overly inclu-sive or narrow. If (it’s) too inclusive, you’ll be wasting organizational resources addressing incidents that later turn out to be ‘false positives.’ On the other hand, if too narrow, you’ll be siphoning off resources to

craft ‘damage control’ strategies when a real case of inappropriate or disruptive behavior ‘falls through the cracks.’”

A few years ago at a spring meeting of the ACPE in Tuscon, Ariz., Martin and Phil-lip Hemphill, PhD, crossed paths when both doctoral-level therapists were making presenta-tions – Martin on disrup-tive behavior; Hemphill on managing physician performance.

Hemphill had fo-cused on social work; Martin had pursued clinical psychology. One was a researcher and published author of disruptive behavior and workplace bullying issues; the other was a

lead clinician in an assessment and treat-ment program with a national reputation for treating disruptive behavior.

“We were familiar with each other’s work … and came to the same conclusion: the fi eld needed a manual to assist physi-cian leaders and other leaders on how to ad-dress disruptive behavior and where to send individuals who engage in such behavior,” recalled Martin. After noting a marketplace void for such manuals and guides, the two embarked on the collaborative book.

The 126-page, fact-rich manual is or-ganized by a series of questions that are ex-plored in detail:

• What is disruptive behavior and how common is it?

• What are the impact, costs and risks of disruptive behavior?

• How can you prevent disruptive be-havior?

• How can you address disruptive be-havior from a leadership and organi-zational perspective?

• What are special considerations when working with physicians?

• What are special considerations when dealing with nurses and other mem-bers of the care team?

• What are special considerations when addressing disruptive behavior of

Taming Disruptive BehaviorACPE doctoral-level therapists highlight “bad boy” workplace behavior in new manual on managing healthcare’s troublemakers

Dr. Marty Martin

Dr. Phillip Hemphill



LIGHTER FUTURES SURGICAL WEIGHT LOSS at Town and Country Hospital helps patients lose weight and keep it off. We go far beyond the surgery by providing a life-changing program that includes nutritional, physical activity and emotional guidance, as well as support groups.

Our experienced, board-certified surgeon specializes in the surgical treatment of clinically obese patients. We offer the Roux-en-Y Gastric Bypass, Adjustable Gastric Band, Sleeve Gastrectomy, Revisional Bariatric Surgery and Abdominoplasties. We also offer the latest advanced endoscopic techniques available for treating weight gain.

Our program will provide to you a multidisciplinary team that will help in maximizing your results. This team includes surgeon Dr. Alfredo Fernandez, a registered dietitian, a psychologist and an insurance specialist. By choosing to have surgery at Lighter Futures at Town and Country Hospital, you are selecting a program that is specifically tailored to meet your individual needs. We believe in educating patients to make the lifestyle changes required for successful weight loss, and we are committed to providing the support needed to lose the weight and keep it off. Call or visit our website to learn more and find out about our free seminars. IS TODAY YOUR DAY?

Call (813) 443-5650 for an appointment. Dr. Patel and Dr. Parker accept most insurance plans.

11031 Countryway Blvd., Tampa

A LIGHTER FUTURE IS A BRIGHTER FUTURE.

866.362.7335 lighterfutures.com

M E D I C A L W E I G H T L O S S S U R G E R YL I G H T E R F U T U R E S

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20094 medical news.indd 1 1/16/2013 12:38:07 PM

By LyNNE JETER

Most folks in Central Florida know about Margaret Guedes, the mother of a 9-year-old son who lost his fight with leukemia more than 20 years ago.

Yet it may be surprising to many Florida healthcare professionals to learn the impact her non-profit organi-zation, Kids Beating Cancer, has had in medical circles around the globe.

Since Guedes established Kids Beating Cancer Inc. on Aug. 13, 1992, in memory of her firstborn, John Robert Voight, it’s served nearly 6,000 children and families fight-ing pediatric cancer, and maintains its mission to providing 96.5 percent of all income to those families, while also increasing access to treatment for children with cancer and life threatening diseases in need of a bone marrow or um-bilical cord blood transplant.

Guedes’ non-profit organization funds the cost to identify compatible do-nors, funding uninsured medical expenses and providing support for families facing the challenging journey toward a cure.

For example, Guedes said a national bone marrow search costs about $4,000, which is an uncovered expense. Total, each transplant costs roughly $40,000 to $50,000 per patient.

The non-profit organization hosts fundraising events throughout the year, through its online sales of pediatric patient-

created artwork, planned workplace giving, golf tournaments, and signa-ture annual events: A Spoon Full of Sugar High Tea and Fashion Show every spring, and the Hats & Heroes Ball in the fall. This year, the Sept. 28 ball is Golden Age-themed at the Waldorf Astoria in Orlando. Last Oc-tober’s ball marked Kids Beating Can-cer’s single-largest fundraising event.

Kids Beating Cancer has gone a step further than the dozen or so sim-ilar organizations across the United States, also established by parents of children with cancer. It was the first non-profit organization of its kind to make a $1 million pledge to establish a transplant center. Earlier this year, Guedes cut the ribbon at the grand opening of the Kids Beating Cancer Pediatric Transplant Center, named

in memory of Voight, at the Walt Disney Pavilion at Florida Hospital for Children in Orlando.

Guedes’ organization began as a re-cruitment center for the National Marrow Donor Program® and its registry for un-related donors.

Beating the OddsKids Beating Cancer celebrates opening of Central Florida transplant center, founder eyes growing national registry of umbilical cord blood

The National ScopeThe federal government selected the National Marrow Donor Program (NMDP) to operate the nation’s Cord Blood Co-ordinating Center, as mandated by the Stem Cell Therapeutic and Research Act of 2005 and amended by the Stem Cell Therapeutic Reauthorization Act of 2010. In this role, the NMDP works with doctors and researchers to continually improve cord blood transplantation and to educate medical providers. The NMDP also oper-ates Be The Match® to encourage expect-ant mothers to donate umbilical cord blood to the Be The Match Registry®.

“By growing the cord blood registry na-tionwide with all ethnicities, it will solve a huge crisis when identifying a donor, espe-cially minority populations, who are under-served,” said Margaret Guedes, founder and CEO of Kids Beating Cancer Inc. “Transplants are a cure for not only leuke-mia and cancer, but also 72 malignant and non-malignant life-threatening diseases.”

Save the DateKids Beating Cancer’s Hats & Heroes Ball, the non-profit organization’s largest fund-raising event of the year, will be held Saturday, Sept. 28, at the Waldorf Astoria Orlando. Sponsorship informa-tion is available via [email protected] or (407) 894-2888.



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“For the first 20 years, that’s what we were contracted to do,” said Guedes, wife of Ben Guedes, MD, medical director of the Pediatric Intensive Care Unit at Florida Hospital for Children, a Florida physician since 1983. “Many people don’t know this, but about 75 percent of the time, family mem-bers’ bone marrow doesn’t match. Over the course of 20 years, we’ve added more than 37,000 potential donors to the registry.”

After the non-profit organization’s 20-year anniversary, Guedes moved in a broader direction. “We’d been focused so heavily on the recruitment of donors and traveling throughout the state and south-east promoting awareness and testing po-tential donors,” she explained. “For the first part of the 20 years, potential bone marrows had to give blood samples. Now, we just need inner cheek swabs.”

When the National Marrow Donor Program (NMDP) topped 10 million reg-istrants, Guedes downsized the outreach and recruitment component of Kids Beat-ing Cancer, and focused on the transplant

side of the procedure. “Before, we were removing the bar-

riers to transplant, which involved secur-ing potential donors,” she said. “Today, we’re removing the barriers to transplant, which are financial. It’s the same long-range goal: getting every child a transplant that needs one.”

In addition to assisting pediatric cancer patients’ families with financial and moral support and collaborating with industry partners such as the Ronald McDonald House, Guedes has become a staunch sup-porter of the national Be The Match® pro-gram that connects patients with their donor match for a life-saving marrow or umbilical cord blood transplant.

“Now, umbilical cords have become another option, and there’s been an in-crease in mothers donating their baby’s umbilical cords,” she said. “However, we still need help from the medical commu-nity – obstetricians and labor and delivery staff, for example – to make expectant mothers aware of this important option.”

Beating the Odds, continued from page 7

board members and senior leaders?• What are special considerations when

dealing with sexual misconduct at work?• What’s the role of human resources,

the legal department, patient safety, quality management, risk management and medical staff?

• What if I’m perceived to be disruptive? Me, really?

• How may I use multi-source feedback in the management of individuals with disruptive behavior?The book ends with resources of pro-

grams across the United States focusing on disruptive professional behavior.

“As the medical director of the Phy-sician Health Program for our state, I en-counter physicians with problems related to disruptive behavior on a daily basis,” said Scott Hambleton, MD, FASAM. “The negative impact that an organizational leader with these behaviors will have on the organization can be tremendous, with a trickle-down effect that can damage the entire institution. Intervention and treat-ment are very effective, and can turn even the most seemingly hopeless situations into positive experiences. This book provides a

framework that clearly describes the prob-lem and the solution.”

The authors leave readers with 10 tips in the development of a monitoring program:

1. Develop a positive culture.2. Be clear about the purpose.3. Clearly express any desired behaviors.4. Keep the number of items to be

scored few.5. Keep the scale simple and fit-for-

purpose.6. Use six to 10 raters.7. Compare results with self-assessment.8. Train those giving feedback.9. Involve the ratee.

10. Incorporate development. “If individuals with disruptive behav-

ior are provided with the expectations and goals of your organization, you’re offering directionality, effort, persistence and stra-tegic development,” said Hemphill. “Re-member, the more difficult, specific, yet realistic your goal setting, the higher the level of performance you can expect. Avoid non-specific, easy, and/or do-your-best goal setting. Giving and receiving feedback re-garding goals in progress is an important factor in goal accomplishment.”

Taming Disruptive Behavior, continued from page 6


By JEFFREy L. COHEN

“Healthcare Reform,” “PPACA” and “ACOs” all have one certain thing in com-mon: cost-saving change. Though debate swirls about politics, timing and the par-ticulars of change, it seems clear that the changing demographics of our country (aging baby boomers) in our economic cli-mate is not sustainable as is. And it’s no sur-prise that a compensation system based on how much is done and how much it costs leads to greater expense. An economic re-ward system that drives costs up as more and more people are set to join the ranks of the insured (through mandated health insurance and expanded Medicaid) simply underscores the timing of the change. What does that mean for physicians? Physicians are asking three key questions:

1. Is there a future for small or solo prac-tices?

2. Is fee for service really gonna change?3. What can I do right now to adapt?

The Future of the Small Practice

The only solid answer is “less.” It really depends on complex things like the demo-graphics of where the doctor practices and the number of competitors close by. That said, as change happens, the hardest hit will likely be the smaller practices, since they lack the personnel and financial resources to weather the change and to invest in ad-aptation. Many small practices will likely experience change in such a way that the best they can hope for is to survive, rather than thrive. Even worse, solo practitioners already know what it’s like to handle all the duties as a physician, keep track of business operations and keep the patients flowing into the practice. Exhausting. Without sub-stantial support and resources, it’s just not realistic for most solos to expect to keep up.

Even larger practices are not often run like a business. The professionals that generate the revenue often manage as well. Moreover, most practices do not market or do any serious “back office” magic (rev-enue cycle management). As such, change hits small practices especially hard. Imple-menting even new EHR requirements can be consuming for a small practice. How will it be as changes are made to reduce cost and improve quality? How will it be when practices begin to see there is oppor-tunity in change, that they may actually make more money in a prevention-based, risk-based compensation environment? Rougher. Like a herd of buffalo when at-tacked, circling together is a good strategy.

That said, the vision has to be clear. Why circle together? Most practices are combining and growing to guard market

share, not to manage costs or measure and demonstrate quality. This is probably the biggest reason why we see larger practices in single specialties, not multi-specialty or primary/specialty based practices. Most physicians that are adapting by joining larger practices are doing so for the same reason why buffalos circle together—the threat of change. Though size alone is no panacea, larger practices are definitely in a better position to adapt.

Let’s face it: few are running after change in healthcare right now. Few see the opportunity and are leading the charge. Most are waiting or are just setting the stage. And most large practices are, at best, good platforms where change can be implemented and costs can be shared and spread among a larger pool.

Will There be a Change to Fee for Service Payment?

Yep. Simple as that. It’s already hap-pening. Bundled payments are in place, even in Florida. Capitation is old hat for many now.

When? Over time… Not right away. Even ACO aspirants are selecting just one sided risk, testing the water as they see how well they do to reduce costs, improve qual-ity and “earn” their right to bonus money. Physicians that think fee for service will thrive for decades are kidding themselves, at least in the insured market. Is there a basis for it in a “second tier” or concierge sort of environment? Probably.

What Can I Do Right Now?First, accept that we are approaching a

new paradigm of healthcare delivery. The current model of disease/injury crisis man-agement has prepared no one for the move from intervention to prevention. And yet, systems that are solidly based in wellness and prevention stand to profit most from the change we all face.

Second, look to shore up your business model. That means:

• Look to join a larger practice that is committed to thriving in the future prevention-based, risk-based compen-sation scenario. If the practice is there just to thrive in a fee for service envi-ronment and has no commitment to thriving in a risk based compensation model, keep looking;

• Market. Most practices do not market at all, and yet consumers are selecting healthcare in the most unlikely envi-ronment—the Internet;

• Look at anything concierge-like. Most of the public conversation centers around the insured market, mostly the Medicare Shared Savings Pro-gram (which has spawned the ACO concept). What about the rest of the consumers? As the insured market gets squeezed (remember that consum-ers are feeling the pressure too with heightened copays, deductibles and benefit limits), you can expect growth of the “second tier,” those who want more and are willing to pay for it;

• Build in wellness and prevention. Not all practices lend themselves to well-ness related services that can reduce healthcare costs, but those that do must look at ways to offer cost-saving,

wellness and prevention-oriented ser-vices. Smart patients may welcome the message that “prevention saves (money and lives)”;

• Enlist the patients. The concept of “partnering” with patients is strange, but consider the amount of savings and the enhancement of outcomes if physicians could incentivize healthy patient behavior. Though absent from the public policy conversation, health-care businesses that build in patient accountability stand to win big in a payment system that rewards clinical outcomes and cost savings. Change is frightening. Even “good”

change is frightening. Just look at all the upset stomach meds sold at airport kiosk counters. Physicians have a terrific burden at this time. They not only hold our health in their hands, they are expected to have skills and time to help create a new envi-ronment in which care will be delivered. Denying change in the healthcare sector is a waste of time and energy. Looking for ways to thrive in it and even drive it is wise.

With over 24 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians, including chiropractic physicians, the Florida Healthcare Law Firm is immersed in regulatory, contract, corporate, compliance and employment related matters of practices, surgery centers and other healthcare businesses. He can be reached at www.floridahealthcarelawfirm.com

From Intervention to Prevention

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GrandRounds

St. Joseph’s Hospital Expands Robotic Surgery Program with First Surgery at St. Joseph’s Hospital-North

The most comprehensive robotic sur-gery program in the Tampa Bay area now offers the latest in minimally-invasive procedures at its newest hospital just north of Tampa. Obstetrician and gyne-cologist Pamela Dale Twitty, M.D., per-formed the first robotic hysterectomy at St. Joseph’s Hospital-North on March 13.

Today, some patients even leave the hospital the day after their procedure.

With nearly 30 physicians who to-gether offer more than 40 different ro-botic procedures for patients, the di-versity of Advanced Center for Robotic Surgery at St. Joseph’s is unlike any other in the country.

St. Joseph’s offers robotic-assisted colorectal surgery, general surgery, gyne-cological surgery, gynecological/oncol-ogy surgery, pediatric urological surgery, and urological surgery as well as single site gallbladder surgery, which takes cho-lecystectomy to a whole new level.

St. Joseph’s Hospital in Tampa was the first in hospital in Florida to use the da Vinci®surgery system for general surgery. Now all of St. Joseph’s Hos-pitals are performing robotic surgery with da Vinci®robots located at St. Jo-seph’s Hospital in Tampa, St. Joseph’s

Women’s Hospital and now, St. Joseph’s Hospital-North.

New Advanced High-Field Short-Bore MRI at Bloomingdale Radiology

Bloomingdale Radiology is proud to announce the arrival of our new 1.5T MRI scanner. This upgrade will significantly benefit both our patients and medical community due to its 1.5T field strength which allows us to deliver outstanding image quality that supports a complete range of clinical applications. These appli-cations include neurology, orthopedics, body imaging, angiography, breast imag-ing, oncology and pediatric imaging.

The Tim™ (Total imaging matrix) technology, increases throughput with the combination of up to four matrix coils which makes patient repositioning virtually unnecessary. This advancement results in workflow improvements that can lead to reduced exam times. Ad-ditionally, the system’s ultra-short bore will alleviate concerns of claustrophobia since many patients can be imaged with their head outside of the bore. Addition-ally, Bloomingdale Radiology will now be able provide patients with benefits such as: breast MRI exams, faster more com-fortable exams with ultra-lightweight coils, more “head-out” exams thanks to the ultra-short magnet design, exams

with flexible combinations of up to four different coils and improved diagnostic confidence with 1.5t image quality.

Eighth Annual PNC Bank Miles For Moffitt Race On May 11

WHO: PNC Bank Miles for Moffitt and Moffitt Cancer Center, the only NCI-designated comprehensive cancer center based in Florida.

WHAT: The 2013 PNC Bank Miles for Moffitt - offers five-mile, 5K and one-mile races. With 7,000 partici-pants expected in 2013, the PNC Bank Miles for Moffitt race offers everyone a chance to be on the team to fight can-cer. One hundred percent of all regis-tration fees go to benefit Moffitt Can-cer Research. Online registration closes May 5, 2013 at midnight. After May 5, participants must register in person at one of the packet pick up locations. Par-ticipants who register on race morning will not be chip timed. Increased entry fees will apply to all registrations effec-tive Monday, May 6, 2013. The cost of the eight training sessions is $85, which includes the PNC Bank Miles for Mof-fitt entry fee for the 5K or 5-mile race. Please contact Lynn Gray at 813-453-7885 or [email protected] to register or for further details. WHEN: 2013 PNC Bank Miles For Moffitt: Saturday, May 11, 2013. WHERE: University of South Florida - Tampa Campus 4202 E. Fowler Ave., Tampa, FL 33620

For more information, visit www.miles-formoffitt.com, or follow on Facebook at-www.facebook.com/MilesForMoffitt

St. Joseph’s Hospitals Enrolling Bay Area Residents in Nationwide Cancer Study

St. Joseph’s Hospitals are helping the American Cancer Society find “cancer fighters” in the Tampa Bay area who want to join a historic nationwide study about how genetic, environmental and lifestyle factors may cause or prevent cancer.

Men and women ages 30-65 who have never been diagnosed with cancer are encouraged to enroll in Cancer Pre-vention Study-3 (CPS-3), and can do so during a registration event hosted by St. Joseph’s Hospitals on May 2, 10 a.m. – 4 p.m. in the Medical Arts Building.

During the May 2 enrollment event at St. Joseph’s Hospital, research partici-pants will complete a questionnaire and give a small blood sample, along with height, weight and blood pressure infor-mation. Participants don’t have to know all of the answers to the questionnaire at the time of the enrollment event – there will be a timeframe for participants to go back and research health history, if need-ed. The most important things to do are explore the CPS-3 website, get answers to any questions and consider register-ing for the study. Your health information can help researchers save lives.

The study will follow participants for

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GrandRounds

at least 20 years. St. Joseph’s Hospitals Cancer Institute hopes that folks in the community will honor their friends and family members who have been touched by cancer by joining in this landmark re-search study.

So far, 100,000 people across the United States have enrolled in CPS-3 in the past two years, but this is the fi-nal year of enrollment and Hillsborough County has a goal of 900 participants for 2013. Last year St. Joseph’s Hospitals alone enrolled 240 participants.

For more information about the study, visit www.cancer.org/cps3florida.

Tampa General Hospital Opens New Primary Care Center In Carrollwood

Tampa General Hospital has opened its new Tampa General Medical Group (TGMG) Family Care Center in Carroll-wood. It is the hospital’s fifth primary care facility and the third to open since May.

The center, located at 13860 N. Dale Mabry Highway, is open weekdays. Same-day appointments are also available, and all major health plans are accepted.

Board-certified family practice phy-sician Antonio Farrales, MD, provides primary care and chronic disease man-agement for all age groups at the new center. Services include routine exams, EKGs, minor procedures, well-child and

well-woman checkups, and school and sports exams by appointment. TGMG nephrologist Denise Alveranga, MD, also relocated her medical practice to the new Carrollwood location, and is ac-cepting new patients.

TGH Foundation announces 16th Annual Gala: License to Thrill - Which Bond Are You?

You only live twice, so why not in-dulge in Tampa General Hospital Foun-dation’s 16th Annual Gala on Saturday, May 4, beginning at 7:30pm at the Hilton Tampa Downtown?!

Embrace your inner agent and discov-er the secrets of an evening full of thrills.

Try your hand at the Casino Royale tables, place your bid on a silent auc-tion item or test your spy skills with chal-lenging interactive activities. Indulge in a special Bond (shaken, not stirred) and enjoy cuisine fit for 007.

Enter our infamous “high stakes” Chance Drawing Contest and you could take home a cool $10,000.

All sponsors at the $1,500 level and above are invited to the exclusive Pre-Gala Patron’s Party at 6:30pm. The Gala is presented by SKANSKA and the me-dia sponsor is the Tampa Bay Times.

The Gala benefits Tampa General Hospital’s Fund for the Future, help-ing TGH achieve its vision of being the

leading medical center in West Central Florida. Your generous contributions ensure that our dedicated physicians and patient care staff have all the tools necessary to provide excellent medical care and advance teaching, research and service to our community.

The Gala is Co-Chaired by McIver Grim and Wayne Lewis.

Attire: Secret agents, Bond girls and villains, come dressed to kill.

For more information, call: (813) 844-8217…or www.tgh.org/foundation_events.htm

Tampa General Among Nation’s Best Heart Programs

Tampa General has been named one of the nation’s “100 Hospitals With Great Heart Programs” by Becker’s Hospital Re-view, a national healthcare publication.

The publication’s editorial staff se-lected hospitals based on clinical acco-lades, recognition for quality care and contributions to the fields of cardiology and cardiovascular surgery, according to its website.

In addition, the hospitals were cho-sen for their excellence in heart care and research by reputable healthcare rating resources, including U.S. News & World Report, HealthGrades, Thomson Re-uters, and the American Nurses Creden-tialing Center.

Tampa General is the only Hillsbor-ough County hospital, and one of only two Tampa Bay area hospitals to make the list. Eleven Florida hospitals were named.

Tampa General’s Cardiovascular Center has six cardiac catheterization laboratories and six interventional ra-diology suites. It nine cardiovascular operating rooms, including a state-of-the-art hybrid operating room where the most complex cardiac surgeries, such as Transcatheter Aortic Valve Replacement (TAVR) procedures, are performed. Com-plex arrhythmia procedures, including atrial fibrillation ablation and ventricular tachycardia ablation, are also performed at the hospital.

Physicians with the hospital’s heart transplant program have performed more than 1,000 transplants, which is the fifth busiest heart transplant program in the country with one of the highest sur-vival rates. In 2012, Tampa General be-gan offering an investigational treatment for people battling treatment-resistant hypertension.

Since 2008, U.S. News & World Re-port has rated Tampa General as one of the nation’s Top-50 hospitals in cardiol-ogy and cardiac surgery. In 2012 U.S. News also ranked Tampa General the number one hospital in Florida.

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Rafael W. Blanco, MD

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Mamta T. Choksi, MD

Rushir Choksi, MD

Julia Cogburn, MD

Michael Diaz, MD

Robert L. Drapkin, MD

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Tampa Bay Area Physicians

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Tampa Bay Medical News April 2013

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