Tampa Bay Medical News January 2014

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PHYSICIAN SPOTLIGHT

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ON ROUNDS


Boosting Weight LossA surgical weight loss procedure goes robotic for the fi rst time in Pinellas CountyLARGO—Soon after Tiffany Jessee, DO, performed Pinellas County’s fi rst minimally invasive robotic bariatric vertical sleeve gastrectomy procedure Nov. 19, another 20 cases were on the books ... 5

Changes to Tax Code Impact the Bottom Line at Work and HomeAs the clock ran down on 2013, a number of deductions healthcare providers have come to depended upon to lessen their tax burden expired ... 9

By LyNNE JETER

The new obesity guidelines – updated for the fi rst time in 15 years – are geared to pri-mary care providers (PCPs) and offer an algo-rithm for managing obesity.

The protocol for the management of over-weight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and devel-oped by the American Heart Association and the American College of Cardiology to identify at-risk patients and prescribe appropriate inter-ventions. The timing coincides with the Ameri-

can Medical Association’s recent classifi cation of obesity as a “disease.”

To guide weight management decision-making, an algorithm focuses on the identifi -cation of patients with excess body weight and those at risk for obesity-related health prob-lems.

Most information is straightforward: • Patients with a BMI of 30 or higher are

considered obese and need treatment. • Patients with a BMI 25 to 30 are

considered overweight and should be treated if they have additional risk

Obesity: The New Chronic Disease?Updated guidelines encourage PCPs to focus on obesity

By LyNNE JETER

SARASOTA—Early on, Eric Folkens, MD, spotted the growing void between family medicine practices and emergency room care. He also was an initial adopter of electronic medical re-cords (EMR), setting up his system in 2007 before federal incentives were in-troduced.

This month, Folkens will open his fourth urgent care clinic at 1435 South Tamiami Trail, across the street from

Sarasota Memorial Hospital (SMH). At the new Sarasota Urgent Care, his second location in the county seat, he’ll provide the local community with walk-in, extended hour medical attention with a licensed provider seven days a week from 8 a.m. to 8 p.m.

“I was doing family practice and working weekends to meet bills,” said Folkens, an Illinois native who gradu-ated from the Saba University School of Medicine, and served his internship

Emerging Urgent Care Local doctor marks 2014 with opening of fourth location in Sarasota

Click on Blog and Contribute Healthcare Solutions

BLOG TONIGHT www.tampabaymedicalnews.com

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2 > JANUARY 2014 t a m p a b a y m e d i c a l n e w s . c o m

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t a m p a b a y m e d i c a l n e w s . c o m JANUARY 2014 > 3

By JEFF WEBB

ST. PETERSBURG - If there was a physician-only version of Facebook, Abie Samuel’s profile status could declare she is seeking a long-term relationship - with her patients.

Samuel, a rheumatologist who joined Bayfront Primary Associates in October, said her medical subspecialty affords her the opportunity “care for patients on a long-term basis and develop lasting re-lationships.” The 32-year-old said that interaction was “a central factor in my de-cision to pursue a career in rheumatology. You can watch some patients grow from adolescence to middle age to becoming elderly. You can really see how they prog-ress,” said Samuel.

“We follow the patients (and) we are constantly re-evaluating to make sure they are responding to treatment,” she said. The chronic condition of arthritis is a good example. “Sometimes the medica-tions wear off and there will be a a flare-up. There’s a lot of continuity of care and we are able to see the improvements they make and then tailor our therapies,” said Samuel, who credits one of her mentors during her internal medicine residency training at the University of Connecti-cut Health Center with helping her gain appreciation for this aspect of rheuma-tology. Namoi Rothfield, MD, a “world-renowned expert and pioneer in the initial diagnosis and treatment of lupus, really influenced me,” said Samuel. “She has been doing this for 40 years and has pa-tient charts that go back decades.”

Beyond the fulfillment that comes from patient interaction, Samuel said she was drawn to rheumatology from an academic perspective. “I was fascinated by the pathophysiology of rheumatologic conditions and the intricacies of the mus-culoskeletal system. Rheumatology is an exciting field that is constantly developing and evolving,” she said.

Also playing a large role in Samuel’s relationship with patients is the opportu-nity to educate them about their condi-tions. “Patient education is a big part of how I practice medicine. I make the time to listen and explain things to my patients. I encourage them to ask me questions. No matter how perfect your medical diagno-sis and treatment plan seems, if a patient does not understand his/her condition and the plan of action, chances are he/she is not going to get the best care,” ex-plained Samuel.

And Samuel’s skills as an educator extend beyond her patients. “I also have spent time giving lectures to the family practice residents and medical students” who are training at Bayfront Hospital. “Rheumatology is a big part of primary care and often it is those physicians who

make the initial diagnosis of a rheumato-logic condition. This way we can improve their diagnostic capability,” she said.

Samuel grew up in New Jersey and is the middle of three siblings who all are physicians.

When she graduated from medi-cal school at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, she didn’t yet

know she would pursue rheumatology as a subspecialty. That came subsequent to her training with Rothfield. But after she decided, she was very pleased to accept a fellowship at the USF Health Morsani College of Medicine and study for three years under Joanne Valeriano-Marcet, MD, and John Carter, MD. Now that she is in private practice, Samuel said she still routinely attends conferences at USF, an extra effort that has not gone unnoticed by Valeriano-Marcet, the rheumatology fellowship Program Director.

“I had the great pleasure of training Abie during her fellowship. Abie’s passion for rheumatology is evident in her contin-ued pursuit of knowledge, keeping abreast of the latest developments and attend-ing conferences. Abie’s colleagues and patients hold her in the highest regard. I would refer my own family members to her,” said Valeriano-Marcet.

Samuel said she has been very pleased with her reception at Bayfront. “They’ve been very supportive” as she moved into a renovated office on 4th Street North in St. Petersburg, where she is beginning to do biologic therapy infusions for patients with osteoporosis and inflammatory arthritis. “Immunology and genetics are playing a stronger role in the early diagnosis and management of these complex conditions and there continues to be new therapies

on the horizon,” she said.Samuel’s husband, Vinny Samuel,

MD, is a pulmonologist with Coastal Pulmonary & Critical Care in St. Peters-burg and a native of Ft. Lauderdale. They married in 2008, but their post-graduate training separated them until 2011. “I was completing my internal medicine residency at the University of Connecti-cut,” she said. Her husband was doing his fellowship in Jacksonville while she completed hers in Tampa. “We would fly or drive back and forth to see each other on most weekends,” said Samuel. Even though it was a difficult challenge, she said, “we were both very supportive of one another and considered this to be a neces-sary sacrifice so we could each achieve our professional goals.”

The couple are under one roof now and have a 14-month-old son, who is the primary source of Abie Samuel’s happi-ness and, for now, the sole source of her exercise. “As soon as I come home I just want to chase around and play with him,” she said.

But Samuel plans to mix it up soon. Confessing that she “took lessons for years as a child,” Samuel said she never learned to swim. “But since it’s a big part of life in St. Petersburg, I have to learn.”

PhysicianSpotlight

Abie Alias Samuel, DOBayfront Primary Care Associates

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and residency in family medicine at Chris-tus Spohn Memorial Hospital in Texas. He was part of a family medicine prac-tice and a contract physician for several urgent care clinics before establishing the Lakewood Ranch, Bradenton and Sara-sota Urgent Care clinics. “Family practice is definitely nice, but I was intrigued by the idea of helping people from an urgent care aspect and the opportunity to do dif-ferent things outside the traditional family medicine practice. We built slowly and the community has supported our growth.”

In 2007, Folkens opened Lakewood Ranch Urgent Care in Bradenton, with an EMR system in place from day one. In 2009, he opened Bradenton Urgent Care on Manatee Avenue, followed by Sarasota Urgent Care on Lake Osprey in 2011. His community outreach efforts, including sponsorship of local school and community events, have been well received. He also works as a volunteer physician, seeing indigent patients for We Care Manatee.

As the number of Urgent Care clin-ics increased, his wife, Teri, a registered nurse, essentially became the CFO for a staff that now outnumbers 40. Before joining her husband’s practice full-time, Teri most recently served as a staff nurse at Manatee Memorial Hospital, where Folkens has privileges, with experience ranging from neonatal nursery care to cardiac floor nurse.

During the snowbird season that be-gins in October, Folkens adds a second provider to float between clinics. Typi-cally, the busiest day of the year is Black Friday, the day after Thanksgiving. In 2013, the busiest days shifted to February and March.

“When it’s busy, we double our cov-erage to get patients in and out quicker,” he said.

Folkens, a U.S. Citizenship and Im-

migration Services civil surgeon who conducts medical exams of emigrants applying for citizenship, also maintains a family practice clientele.

“At first, I wasn’t doing any family practice, but patients began coming back to see me for family medicine, chronic dis-eases” he said. “I still do a good percent-age of family medicine work, though the majority of our patients are walk-ins. Pa-tients can book appointments online and we’ll fit them in rather than just coming in and waiting.”

Folkens’ business model includes re-duced fees for self-pay patients and the lowest area rates for onsite digital x-rays, EKGs, and lab work. He’s changed one aspect: after determining it was too time-consuming with administrative details to dispense medications, he eliminated the onsite pharmacy. He’s also adamant about sending patients only one bill.

“We’re very careful about everything we charge,” Folkens noted. “Most people know hospitals charge more, just by the way of how hospitals operate, so emer-gency room patients may get three bills for a visit – one from the hospital, another from the doctor, and another from the doctor who reads the x-ray.”

As the market for urgent care clinics continues to surge, with SMH planning its fifth urgent care clinic near Doctors Hospital of Sarasota, Folkens is mulling additional sites. (SMH’s urgent care cen-ters are open in Bradenton, Sarasota, and most recently, Venice.)

“I have other locations in mind that would be very good,” said Folkens. “The need is there. Customer service is a big part of it, but also being able to fill a void. We’re here to give patients excellent care for less money, to send them back to their primary care doctors, and to keep them out of the ER. We’re supplemental to the existing healthcare system.”

Emerging Urgent Care, continued from page 1

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ALL-NEW SHOW LIVE ORCHESTRA

“The conductor is fabulous, the orchestra was fabulous—so, so wonderful... the composers, the people that did some of the work to bring this music together, mixed with the [dance] perfectly... the music, the conductor is the

best I’ve ever heard.”— Rick Crompton, musical conductor

“I believe that many artists in the world admire Shen Yun’s quality. It is the highest form of dancing art that mankind

could possibly achieve. I am beyond admiring it!”— Joseph Kuo Nan-Hong, celebrated director and producer,

known as the godfather of films in Taiwan

“My overall impression is that it is beyond anything I can put into words. It’s the most amazing, uplifting, spiritual journey... it transcends you to a higher state of

consciousness. Amazing!”— Margaux Brooks, executive film producer

ALL-NEW SHOW

Call: 888-974-3698 | 727-248-0115 Visit: Shenyun.com/St-Petersburg

FEBRUARY 5-8The Mahaffey Theater, St. Petersburg

Witness The Divine Culture’s Return This Year, You Must Not Miss It!

“I’ve seen many Chinese performances. I was touched by some of the performances and concerts, but I was never moved so deeply as I was today… The programs stirred me again and again. I was constantly trying to keep myself

contained, but in the end I couldn’t control myself. I cried...”— Dr. Thomas Weyrauch, author and China expert

Presented by Florida Falun Dafa Association

“The costumes, the colours, the dancing, they’re all at a very high level and very beautiful… There’s a lot of talent

that [Shen Yun] has employed.”— Consiglio Di Nino, former Canadian Senator

“The dancers are some of the most phenomenal, especially the male dancers are absolutely amazing... it resonates through you, no matter you are 5 or 65, it was just an

amazing show.”— Jessica Black, Miss USA 2010

By LyNNE JETER

LARGO—Soon after Tif-fany Jessee, DO, performed Pi-nellas County’s first minimally invasive robotic bariatric verti-cal sleeve gastrectomy proce-dure Nov. 19, another 20 cases were on the books.

This month, Jessee, a bar-iatric and general surgeon at Florida Bariatric Centers at Largo Medical Center, plans to place the first Adjustable Gas-tric Band System (LapBand®) robotically in a bariatric patient, perhaps the first of its kind pro-cedure in Greater Tampa Bay.

“This sleeve procedure is a great al-ternative for those with higher BMIs,” said Anthony Degina, CEO of Largo Medical Center, one of five hospitals in the HCA West Florida District performing surgical bariatric procedures. “We’re excited to offer this new technology to those living here in Pinellas County and beyond who can ben-efit from this type of surgical approach.”

This robotic surgical weight loss pro-cedure uses the da Vinci Si surgical system, which works in 3D high-definition with special wristed instruments that bend and rotate, giving the surgeon a greater range

of motion than the human wrist. It enables surgeons to operate with enhanced vision, precision, dexterity and control.

“We’ve been doing these surgeries laparoscopically in our practice for the last decade,” said Jessee; gallbladders represent about half the robotic surgery caseload. “Patients are out of the hospital sooner, back to work sooner, and—what they’re most interested in—they have less pain. The majority of pain associated with laparoscopic surgery isn’t really what you do on in the inside; it’s cutting through the muscles and placing the instruments to

do the surgery. When you have a hole in the muscle and then you put instruments through it, and then torque or place strain on those instruments, you can’t really tell the exact amount of pressure on those muscles. Pa-tients tend to get bruised and have soreness in the area. That’s what takes so long to heal.”

With robotic surgery, the machine is programmed to the precise degree of pressure and the exact angle to place torque and strain, significantly minimal-izing tissue damage and muscle strain.

“Patients I’ve seen post-op didn’t need narcotic medicines when they got home, and they’ve been asking me, ‘why didn’t I have pain from the proce-dure?’ They’re happy they didn’t experi-ence it,” she said. “The benefit to surgeons is that we’re able to add extenders to the end of the robotic ‘chopsticks’ and reach places we could only dream of reaching laparoscopically. We can put ourselves in certain positions to reach around organs and other instruments in a way we could never do before. It’s a double barrel ben-efit.”

Several years ago, Jessee was com-

pleting a fellowship in Miami when her mother, Kathy Lusk, had the original LapBand inserted.

“She was having a lot of prob-lems with it, so a year and a half ago, I changed it out for a newer Lap-Band, and she’s doing great. She’s lost 90 pounds and has 20 more to go,” she reported in mid-December. “She wouldn’t trade her band for the world.” Patients at the Florida Bariatric Centers at Largo Medical Center are held ac-countable for safe, permanent weight loss with a companion program that involves a rigorous pre-operative training program with an in-office dietician, a psychologist, an evaluation from the surgical team, and post-operative appointments on a monthly basis. Support groups and community ac-tivities round out program activities.

“We give patients a balanced diet with limitations,” said Jessee, who offers supplemental medications as needed for bariatric patients. “We recognize that pa-tients want to eat most of the foods they’ve enjoyed. We just teach them to pick the right foods and eat them in moderation. It’s much easier on the patients if the Lap-Band procedure itself doesn’t result in a painful recovery. The robotic surgical ap-proach gives them a great start on their path to a healthier life.”

Boosting Weight LossA surgical weight loss procedure goes robotic for the first time in Pinellas County

Dr. Tiffany Jessee with da Vinci Si surgical system.


Town & Country Hospital Behavioral Health

We’re here to help put your loved one on a path of help and hope.

Call: 1-855-245-8330

Attempting to help a loved one that is having a crisis can be difficult and confusing. Town & Country Hospital’s Behavioral Health Program, with our specially trained

staff of physicians, nurses, social workers and therapists, makes sure our patients receive the care they need with the goal of a safe return to healthy living in the

community. We work with the family to better understand mental illness and its treatment so they may work together in the care and future treatment of the disease.

We are also a voluntary and involuntary Baker Act facility that accepts patients who may be a danger to themselves or others. Please call if you need our help.

6 0 0 1 W e b b R o a d , T a m p a , F L 3 3 6 1 5t o w n a n d c o u n t r y h o s p i t a l . c o m

20767 medical news.indd 1 10/16/2013 4:44:21 PM

factors, such as an elevated waist circumference of 35 inches or more for women, or 40 inches or more for men.

However, even though research soundly shows the higher the BMI, the greater the risk for cardiovascular disease, diabetes, and cancer, the question about the use of BMI as a screening tool has drawn debate.

Healthcare providers agree that every 5 to 10 percent of total body weight lost is a milestone that reaps health benefits. But with so many diet programs available – the guideline committee reviewed 17 different plans and concurred that as long as there’s a negative energy flow, and the intake of calories is reduced daily to 1,000 or less, it should work – determining the right one, and the amount of weight that’s safe to lose over the course of weeks and months, has also been the center of controversy.

The diet, guidelines say, should be a component of a comprehensive lifestyle in-tervention including physical activity and behavioral changes, delivered by a trained counselor. The guidelines suggest that pa-tients meet with the interventionist 14 times in the first 6-month period.

Donna Ryan, MD, co-chair of the guideline committee and a professor emeri-tus at Pennington Biomedical Research Center in Louisiana, admitted the current approach is for PCPs to simply tell patients to lose weight but “they don’t really engage in helping patients achieve weight loss, ei-ther through referral or providing counsel-

ing or prescribing. They’ve been reluctant … but that’s changing.”

What’s not addressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot success-fully reach a more optimal weight for their body frame.

“It’s not as simple as telling a patient, ‘you need to lose weight,’” said Gus Vick-ery, MD, a North Carolina family medicine physician. “Sometimes, it takes some inves-tigating to determine the source. It might be thyroid issues, or a combination of medical problems. Unfortunately, we (PCPs) stay so busy … it’s helpful when patients come pre-pared. It’s OK for a patient to say, ‘I can’t lose weight and I don’t know why. It doesn’t always seem to be a matter of willpower.’”

After Vickery talked to a colleague about the colleague’s doctor-supervised weight loss clinic focusing on a well-rounded, low-calorie, low-carbohydrate food plan, he ditched his own in-house pro-gram and began referring patients there. One couple, patients of Vickery, lost a com-bined 140 pounds in less than a year. Other patients returned to Vickery tens of pounds thinner – and much healthier.

“My colleague,” said Vickery, “does the heavy lifting; I monitor the results.”

The impetus for the proactive move-ment of PCPs may be practice for the fu-ture, when they may be accountable for patients who haven’t made sincere efforts to lose weight to get healthier. Patients could eventually be penalized by insurers for not

taking documented action to achieve a healthier weight.

“I could see (insurers) really increasing people’s premiums if they don’t follow cer-tain preventive measures in the future,” said urolo-gist Stan Sujka, MD, a partner of Orlando Urol-ogy Associates in Central Florida. “Unfortunately, we’re becoming a society of regulations. A lot of people don’t seem to want take personal responsibil-ity for their well-being.”

Recently, to set an example for patients and to improve his health, Sujka dropped 36 pounds in nine months with the assistance of a diet app on his smart phone, a practice he encourages patients to follow as a first course of action for losing excess weight.

“Your smart phone can serve as your personal coach to shed those unwanted pounds,” he said. “It’s easy, free, and stud-ies show it works.”

The two most popular free apps are “Lose It” and “My Fitness Pal,” which al-lows patients to meet pre-set calorie and exercise goals.

Sujka’s partner, Albert Ong, MD, gave him a kickstart on the new lifestyle modifi-cation by downloading the “Lose It” app on Sujka’s smart phone and programming it to lose one pound per week. Sujka is now very close to his college weight goal of 200 pounds.

“Since losing weight, a lot of my pa-tients have asked, ‘how did you do it?’ After explaining to them about using their (smart) phones to lose weight, many of them have come back to the office and told me their doctors for years have been telling them to lose weight but have never told them how,” explained Sujka. “They’ve told me they’ve found the app simple and effective. As a result, I wrote up the principle of using your smart phone to lose weight. A lot of patients appear more excited about losing weight than the affects of Viagra or Cialis!”

Overall, the guidelines don’t focus on specific obesity medications. Only orlistat (Alli or Xenical) was available during the committee review process. Since then, the FDA has approved new diet drugs – lorca-serin (Belviq) and phentermine/topiramate (Qnexa) – that are recommended for use as “an intensification approach.”

Bariatric surgery for weight loss was the fifth and final recommendation “when other interventions fail.”

Obesity: The New Chronic Disease, continued from page 1

Dr. Stan Sujka

Read Tampa Bay Medical News Digital:

TAMPABAYMEDICALNEWS.COM


Town & Country Hospital Behavioral Health

We’re here to help put your loved one on a path of help and hope.

Call: 1-855-245-8330

Attempting to help a loved one that is having a crisis can be difficult and confusing. Town & Country Hospital’s Behavioral Health Program, with our specially trained

staff of physicians, nurses, social workers and therapists, makes sure our patients receive the care they need with the goal of a safe return to healthy living in the

community. We work with the family to better understand mental illness and its treatment so they may work together in the care and future treatment of the disease.

We are also a voluntary and involuntary Baker Act facility that accepts patients who may be a danger to themselves or others. Please call if you need our help.

6 0 0 1 W e b b R o a d , T a m p a , F L 3 3 6 1 5t o w n a n d c o u n t r y h o s p i t a l . c o m

20767 medical news.indd 1 10/16/2013 4:44:21 PM

Tuesday, February 11, 2014InterContinental Hotel, Kennedy & Westshore Blvds.HCMA General Membership Dinner Meeting

Florida Attorney General, Pam Bondi, will be HCMA’s featured speaker. The event begins at 6PM and is for HCMA members and their guests only. Call Kay Mills at the HCMA: 813-253-0471 to RSVP.

2013 HCMA/HCBA Medical Legal Code Now Available

The HCMA and the Hillsborough County Bar Association (HCBA) joined ef-forts to update the HCMA/HCBA Medical Legal Code which was originally created in 1983 and revised in 1998. Members of the HCMA and the Bar Association collabo-rated to clarify several topics in the Code as well addressed issues not present in previous editions. The Bar Association has also agreed to provide a hotline for HCMA members’ questions, which will be imple-mented in the new year. To receive the 2013 HCMA/HCBA Medical Legal Code, contact the HCMA office at 813-253-0471.

HCMA Benefit Provider Program is Growing!

The Hillsborough County Medical As-sociation’s Benefit Provider Program pro-

vides value to physicians with products, programs, and services that far exceed the cost of annual dues.

Newest additions to the Program:

ProAssurance (PRA) - Offering medi-cal professional liability insurance and risk management services. HCMA’s exclusively endorsed medical professional liability in-surer rewards eligible HCMA members with a 5 percent discount on their premi-ums. You also receive fair treatment from professionals who are committed to mak-ing it easier for you to secure the coverage, services, and support you want. Find out how you can benefit with steadfast protec-tion from PRA – Rated A+ (Superior) by A.M. Best and serving Florida physicians since 1975. For a no-obligation premium quotation, contact Barbara Daugherty, account executive, at 863-324-2650 or [email protected].

Transworld Systems, Inc. (TSI) - De-livering progressive cash-flow solutions since 1970. HCMA members receive a members’ only discount, on the already fixed-fee pricing, regardless of account balance. Medical practices receive 100 percent of all recovered money, as well as monthly reporting, on all accounts placed in any of the flat fee services. Transworld

has assisted over 200,000 clients resolve $6 billion in accounts receivables in the past decade. Contact Gene Rodriguez at 813-286-2543, 727-432-5690, or [email protected].

If you have any questions, please contact Debbie Zorian, HCMA executive director, at 813-253-0471 or [email protected].

HCMA Has Gone SocialLike the HCMA on FaceBook www.

facebook.com/HCMADocs. Keep updated on HCMA events and important notices!

HCMA Members Making NewsDr. Edward Farrior has been elected

to serve as 2013-2014 President of the American Academy of Facial and Re-constructive Surgery. He took office in October and brings more than 25 years of experience as a leader in the field of facial plastic surgery as well as academic appoint-ments at USF and the Univer-sity of Virginia. Dr. Farrior served as HCMA President in 2003.

Dr. David Lubin was recently featured on Chan-

nel 10 during their “Healthcare 411” seg-ment. Healthcare 411 provides patients with information on how to navigate the new healthcare law. Watch the clip by vis-iting: www.wtsp.com/news/local/story.aspx?storyid=335608

Dr. Robert Norman has been signing copies of his book, Discover Magazine’s Vital Signs – True Tales of Medical Mys-teries, Obscure Diseases, and Life-Saving Diagnosis throughout the Tampa Bay area. “Vital Signs,” a popular column featured in Discover Magazine, has long been a favorite of readers, showcasing, each month, fasci-nating new tales of strange illnesses and diseases that baffle doctors and elude di-agnosis. Each tale is true and borders on the unbelievable. Throughout the years the column has become an unofficial textbook for medical students, interns, and physi-cians. Dr. Norman, “Vital Signs” editor, has compiled the very best of the series into an intriguing and suspenseful collection for fans and new readers alike. For more information, please contact Dr. Norman: [email protected].

Dr. Martha Price appeared on Bay News 9 providing insight on the reasons for

HCMA Events and NewsFrom Hillsborough County Medical Association

Dr. Edward Farrior

Dr. David Lubin

Dr. Robert Norman



getting your flu shot. You can watch the interview by visiting the HCMA site (www.HCMA.net) and clicking on Members in the News.

On October 18th, 184 vasectomists, in 25 countries, performed approximately 1,000 vasectomies in the spirit of World Vasectomy Day. Dr. Doug Stein initiated the day at the Royal Institute of Australia Science Exchange in Adelaide where he per-formed fifteen vasectomies in front of a live audience.

Dr. Stein stated that it was the pro-fessional thrill of a lifetime. He is now pre-paring for the next No Scalpel Vasectomy International, Inc. mission: to the Philip-pines in January (www.nsvi.org/where-we-work/invitation-to-join-nsvi-in-2014/) to try to beat the record of 385 done in one week, last February. If anyone is inter-ested in learning more, please contact Dr. Stein: [email protected]

Dr. Jason Wilson made the list! Tampa Bay Business Journal will honored 43 businesspeople under the age of 40 as “2013 Up & Comers.” Check out the article and photos of the event held November 20th honoring them: www.bi-zjournals.com/tampabay/slideshow/2013/11/21/2013-up-comers-event-photos.html

Dr. Miguel Rivera, of Tampa Bay ENT was named 2013 Florida Otolaryngologist of the Year by the Network of Florida Otolaryngologists, Inc. “in recognition of his outstanding dedicated ser-vice to, and promotion of, the specialty of otolaryngology/head and neck surgery, in the state of Florida for his benefit of his colleagues and patients.”

The award was presented at the FSO - HNS (Florida Society of Otolaryngology - Head & Neck Surgery)/FSFPRS (Florida Society of Facial Plastic and Reconstructive Surgery) annual meeting in Palm Beach, Florida.

The Florida delegation to the AMA struck a distinguished group pose during the AMA Interim Meeting in National Har-bor, MD in November. HCMA members,

Drs. Madelyn Butler (not pictured), Ken Louis (back row/second from left), and Mi-chael Wasylik (front row/fourth from left) serve as FL AMA delegates/alternate del-egates; again the HCMA, and Florida, are very well represented.

Small Business of the Year AwardTampa Chamber of Commerce

Winner in the 51-250 Employees Category: The Woman’s Group, PA. The Woman’s Group was founded in 1998 by HCMA member and Past President, Dr. Madelyn Butler (center holding award), with a vision to create a practice dedicated to high-quality obstetrical and gynecologi-cal care and education for women of all ages. Their values include thorough, high quality and compassionate medical care for their patients in a pleasant, comfortable and friendly environment. Fourteen years later, those guiding principles form the core culture of an organization that now employees 90 women, has 17 top notch practitioners, spans three office locations and serves three area hospitals.

The WMS event, Hats off to the Holi-days, could not have been better repre-sented than by Dr. Catherine Cowart’s work of art! Dr. Cowart took the theme literally as she cre-ated a hat for ALL HOLIDAYS! Halloween, Thanksgiving, Ha-nukkah, Fourth of July, New Year’s, Christmas, are only some of the holidays included on her chapeau!

Needless to say, Dr. Cowart won the “best hat” contest sponsored by ProAssur-ance and received a $500 shopping spree at the International Mall!

To learn more about the Hillsborough

County Medical Association, or to find out how to become a member, please contact the HCMA at 813.253.0471 or visit our website at www.HCMA.net.

HCMA Events, continued from page 7

By MATT BOHANNON

In today’s business environment it seems like almost 90 percent of business is done through e-commerce. Everyone from teenagers to grandparents have mo-bile computers in their pockets and usually a tablet or laptop to compliment it. With all this technology at our finger tips it is no wonder that consumers do research, and make their buying decisions online.

Today, we see consumers who text instead of call, who message on social sites instead of meet up, and who go to the In-ternet first before shopping in store fronts. Even with the rapid expansion of mobile technology since the early 90’s, one indus-try has been lacking in their ability to reach consumers on the go, healthcare. Health-care has been slow to adapt and accept the importance of being optimized in the tech-nological world but new services are mak-ing it easier for patients to find doctors in their area that meet their required needs, and even book appointments online.

In Central Florida, Google gets over 300,000 hits per month pertaining to healthcare, but Google is just a search en-gine that indexes individual websites that can help you. These individual websites are where the consumers find the technol-ogy that helps them complete the task at hand. The problem with many of the exist-ing websites that focus on healthcare is that they are self-service and require the patient

to map out the location of the doctor’s of-fice, find the relevant phone number, and call the practice to see what availability they have. Even worse are the websites that sell advertising, these sites make it even more confusing to find the relevant content for the patient and misrepresent the doctor.

Out of the websites that focus on healthcare, BookThatDoc.com is trying to meet the needs of both doctors and pa-tients. This service in Central Florida helps finding a doctor and booking appointments online an easy and convenient experience. Most families and individuals don’t have the time during a busy work day to call a doctor and book an appointment. This process is made more difficult with the fre-quency in which individuals and families are relocating to seek better employment opportunities. Patients that move to a new city have no idea who to call about local doctors, so they go to what is familiar, the Internet. Research also shows that health-care decisions are usually made at night or on the weekends when a doctor’s office is typically not open and many doctors can’t afford a 24/7 staffing solution.

With this new age of healthcare websites patients can find a doctor by zip code, health insurance carrier, languages spoken, and specialty. It is no longer an issue if you are new to an area or can get in touch with your friends. It also gives doctors an opportunity to reach these patients at the time they are ready to make a decision. Healthcare web-

sites in today’s environment should have all the information a patient needs to make a decision at their fingertips. A comprehensive profile for the doctor with recommendations for patients to read is ideal. Even better is a website that gives the patient the opportunity to request an appointment with the doctor 24/7, from any device they choose.

Consumers are getting more accus-tomed to being able to manage their lives on-the-go and they are looking for a solution that helps them manage their health and en-gages them on their computers and mobile devices. The doctors are also just as excited

that they now have an opportunity to attract new patients at a very minimal cost and with no additional staffing requirements. Doc-tors can also leverage the marketing and e-commerce knowledge of these companies without distracting them from focusing on medicine. With the innovation we are start-ing to see with technology in healthcare, finding doctors online is here to stay.

Matt Bohannon is the president of BookThatDoc.com, a healthcare website providing a streamlined process for finding and booking healthcare providers where and when you need them with real time referrals. Matt can be reached at [email protected]

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By CINDy SANDERS

As the clock ran down on 2013, a number of deductions healthcare pro-viders have come to depended upon to lessen their tax burden expired. Last year also saw an increase in federal tax rates, including higher taxes on investment in-come and capital gains. This combination has accountants nationwide bracing for a widespread outbreak of severe sticker shock come April 15.

Tom McGuinness, CPA, CVA, of Reimer, McGuinness & Associates, PC in Houston said his firm has run tax scenarios for high net worth individu-als for more than a year. “We’re doing this as a service to prepare you for the blow … but the blow is coming,” he stated. For one client whose income hit the $2 million mark, there was a six-figure difference in taxes owed. “Looking at 2012 actual income data, the tax differ-ential was 22 percent,” McGuinness said of the $860,000 that would be owed for 2013 as compared to $706,000 for 2012. “It is real money.”

He added that many of the changes in 2013 and 2014 will hit healthcare professionals and providers both as busi-nesses and as individuals. McGuinness said at the beginning of 2013, Congress was upset about the fiscal cliff and proud of themselves for ‘fixing’ it. However, he continued, as 2013 tax bills come due, “It’s going to be the taxpayers turn to be mad because they are going to see how the fiscal cliff was avoided.”

Key Business ChangesBeneficial depreciation options take

a big hit in 2014. Changes to expensing qualified purchases, bonus depreciation, qualified leasehold improvements and a new IRS capitalization policy are all an-ticipated to impact many in the healthcare space.

“Congress did not extend the fa-vorable 179 deduction, which allows a taxpayer to expense im-mediately the cost of an otherwise capitalizable asset,” said Scott Tomi-chek, JD, CPA, senior tax manager for Carter Lankford CPAs PC, lo-cated in Tennessee. “The 2013 Section 179 deduc-tion was $500,000 for purchases up to $2 million and is set to be reduced to $25,000 for purchases up to $200,000 in 2014.”

Accelerated depreciation, which has been heavily used by healthcare provid-ers and facilities to make equipment pur-chases more affordable on the front end was another incentive that expired at the end of 2013. Tomichek noted that on the purchase of capitalizable assets in 2013,

a taxpayer was allowed to deduct 50 per-cent of that asset in the year of purchase and then depreciate the remainder. The accelerated 50 percent goes away in 2014 and reverts to the regular rules of a more even-based depreciation schedule without Congressional intervention.

Another change is in the life of quali-fied leasehold improvements, which are defined as any improvement to an interior part of a building that is nonresidential property. “Qualified leasehold improve-ments were able to be depreciated using a 15-year life and included in the previous Section 179 and bonus depreciation cal-culation in 2013,” Tomichek explained. In 2014, those improvements return to a 39-year depreciable life, which means the expenditures are depreciated at a much smaller annual amount over nearly four decades and no longer qualify for the other depreciation benefits.

Tomichek said the new IRS capi-talization policy that went into effect on Jan. 1 is a bit of ying to the yang of losing the other deductions. “The most impor-tant part of the rule is the de minimis safe harbors that apply to not only improve-ments but to certain tangible property purchased,” he said. “The de minimis safe harbor allows a taxpayer to deduct pur-chases under a certain threshold. For tax-payers with audited financial statements, the threshold is $5,000 per invoice or per item as substantiated by invoice. For those without audited financial statements, the threshold is $500.” He noted that previ-ously, these qualified items had to be de-preciated but now can be expensed, which is a tax benefit. However, he added, “To qualify, the taxpayer must have a written accounting policy in place at the be-ginning of the tax year.”

Doug Funke, CPA, a partner with Honkamp Krueger & Co. PC, a CPA firm headquartered in Dubuque Iowa, noted a number of other general 2014 tax changes could impact medical practices and hospitals. One example is the transit benefit allowance. “The amount of transit fringe benefits that em-ployers can provide to employees on a pre-tax basis for using public transporta-tion and van pooling will drop from $245 per month in 2013 to $130 per month for 2014.”

He said dozens of other extenders, or tax incentives, including the work oppor-tunity tax credit for hiring targeted indi-viduals and the research tax credit, as well as various energy credits, expired at the end of 2013. A list of expired provisions is available through the Joint Commission on Taxation at www.jct.gov.

For exempt organizations, which in-cludes many hospitals, Funke said the IRS is focusing on compliance, using informa-tion reported on Form 990. “Indicators of

potential noncompliance that they have identified include the following relation-ships:

• Large fundraising revenues and small fundraising expenses,

• Large fundraising revenues and small charitable program services expense,

• Large unrelated business income but no income taxes due on the unrelated business income,

• Large total compensation to officers, directors, trustees and key employees and small annual gross receipts.”

Funke added, “An accurate Form 990 generally decreases the likelihood of being selected for examination.”

Also pertaining to some employ-ers, Funke said, “The June 2013 U.S. Supreme Court decision related to the Defense of Marriage Act recognizing same-sex marriages affects employers in states where same sex marriage is recog-nized. Employer-provided healthcare cov-erage for same-sex spouses get the same tax-favored treatment.” He added the IRS announced two special administrative pro-cedures for employers to make claims of refunds or adjustments to employment taxes for certain benefits paid to same-sex spouses during 2013.

This Time It’s PersonalMuch has been written about the

higher tax brackets and rates, but Mc-Guinness said a lot of people will still be surprised at the cumulative effect.

“The top tax rate went from 35 to 39.6 percent and that happens start-ing at $450,000 married filing jointly or $400,000 for single filers,” he explained.

However, McGuinness continued, that’s just one of six tax changes that will impact high income taxpayers. A 5 per-cent increase (from 15 percent to 20 per-cent) in capital gains and dividends tax has also been instituted for those at the same income levels as the highest tax bracket. For individuals starting at $200,000 and married filing jointly at $250,000, the Af-fordable Care Act added a 0.9 percent additional FICA tax on wages and a 3.8 percent Medicare tax on investment in-come.

“The rules regarding the 3.8 percent investment income are more complicated than you might think,” he explained in a recent blog for physicians. “You do not include income from S Corporations or a trade or business in which you are actively involved … but do include interest, divi-dends, annuities, royalties, rents and net gain from the disposition of non-business property.”

When looking at the combination of the increased investment income and capi-tal gains taxes, McGuinness said, “What was being taxed at 15 percent is very pos-sibly going to be taxed at 23.8 percent.”

Additionally in 2014, the sales tax de-duction goes away … and for single wage earners beginning at $250,000 and mar-

ried filing jointly at $300,000, itemized deductions and personal exemptions are being phased out.

“If you’re taking a deduction away from me, that’s a tax increase,” McGuin-ness said of the bottom line for taxpayers. He added the itemized deduction phase-out could be quite costly, particularly to those who give large amounts to charity and have significant home mortgage in-terest they were used to deducting. “The personal exemption is equal to $3,900 (in 2013) per exemption you claim, and all exemptions are lowered by 2 percent for each $2,500 of income above the numbers ($250,000 single, $300,000 married filing jointly),” he explained. “The larger your family, the larger the tax increase.”

McGuinness noted there is a grow-ing feeling of frustration. At the same time many of his physician clients are paying significantly more in taxes, reimburse-ments are shrinking. The net result is people are having to work much harder simply to make the same money.

McGuinness said individuals should have already asked their tax advisors to provide estimates of what their 2013 tax burden will look like. If that hasn’t hap-pened, he suggests doing it now to prepare for April 15, 2014. Quoting one of his colleagues, he said, “It’s not going to be pretty in a lot of cases … but better than finding out on April 10 that you need to either drain your savings or take out a loan to pay your tax bill.”

End Notes & DisclaimerThe experts who contributed infor-

mation to this article are members of the National CPA Health Care Advisors As-sociation. Headquartered in Nashville, HCAA is a nationwide network of CPA firms devoted to serving the healthcare in-dustry and educating its members about the ever-changing financial and regula-tory landscape impacting the industry. The financial professionals stressed the importance of consulting a tax specialist to ensure advice is specifically tailored to your unique business or personal situation to minimize the tax burden while fully complying with state and federal man-dates.

Additionally, the information in this article was provided prior to the end of 2013. It is possible that some of the ex-piring tax incentives could be extended through legislative action. However, the consensus opinion was that Congress is unlikely to reinstate all … or even very many … of the sunsetting extenders.

Changes to Tax Code Impact the Bottom Line at Work and Home

Tom McGuinness

Scott Tomichek

Doug Funke

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Right Partner is Key to a Smooth Transition When MOBs are SoldBy MARK DUKES AND KETAN SANGHVI

More and more hospitals and health systems are considering the sale of some of their medical office buildings or other “non-core” assets. But the change in real estate ownership and management can cre-ate uncertainty for both the hospital and physician-tenants, and that can be com-pounded when a third-party investor later re-sells the buildings to another. Here’s what buyers and sellers can do to lessen the uncertainty and ensure smooth transitions.

Hospitals and health systems have many good reasons to sell medical office buildings (MOBs) and other “non-core” real estate assets to outside investors. Such sales create financial liquidity that frees up capital for other uses, allow providers to concentrate on their core business of healthcare, and help hospitals avoid po-tential Stark and Anti-Kickback Law viola-tions, to name just three. So in this era of seemingly insatiable capital needs, it’s no wonder that more and more providers are selling or “monetizing” their MOBs – or at least considering it.

When a hospital, health system or physician practice group sells a building to a third-party real estate investor, the phy-sicians leasing space there find themselves with a brand new landlord. Sometimes the hospital itself ends up leasing back space in what used to be its own building. And sometimes the original third-party buyer of the building subsequently re-sells it to an-other investor.

What are the implications of such transactions on the provider and its physi-cians? Does this mean they lose all control over the asset and how it’s managed and leased? How can the hospital protect itself and its physicians from that uncertainty? How can the seller and buyer ensure the transaction will be a success before, during and after the closing?

Florida Hospital: Third-Party Acquisition from a Third-Party Owner

A perfect example is Duke Realty’s recent acquisition of 14 healthcare facili-ties in six states from third-party owner Seavest Healthcare Properties, which had earlier acquired the properties from various health systems and then developed them. The acquired properties were 54 percent leased to hospital systems or their affili-ates and 89 percent leased overall. Four of these properties, and a fifth property that was acquired later, are located on Florida Hospital campuses in central Florida: Cele-bration Medical Plaza, Kissimmee Medical Plaza and East Orlando Medical Surgical Plaza, all in the Orlando area; Sebring Medical Pavilion in Sebring; and Health and Wellness Center at Florida Hospital in Wesley Chapel. Florida Hospital, one of the country’s largest not-for-profit health-care providers and a member of Adventist

Health, serves patients through 22 cam-puses in Florida.

The acquisition of the Seavest MOB portfolio posed a number of challenges for all parties involved. Seavest and Duke Re-alty had never before partnered on an ac-quisition. And although Duke Realty and Florida Hospital had been engaged in talks for some time about possible development projects, Duke Realty had never acquired or developed a Florida Hospital-owned or leased facility.

Post-Acquisition Successes Like Seavest, Duke Realty has spe-

cialized healthcare real estate experience, which went a long way toward making Florida Hospital and its tenants more com-fortable with the latest ownership change. Although the acquisitions closed less than a year ago, the transaction looks like a suc-cess for everyone involved.

Previously, the facilities were owned, managed and leased by three different firms. Now, Duke Realty plays all three roles.

Before, tenants were confused about who to contact but now, whether it’s a need for additional space or a concern about building services, the tenants have a much more streamlined process to communicate with ownership.

Duke Realty also has implemented a number of building improvements in the facilities, including developing more visible signage; improving tenant directories; and adding new paint, carpeting and other en-hancements. It added much-needed sound insulation in the surgery center of the Se-bring Medical Pavilion to shield against the high noise level and is adding a console in the Celebration Medical Plaza lobby to assist patients with wayfinding and other needs.

While Seavest did an excellent job with the buildings over the years, the new owner, Duke Realty, saw the improve-ments as an opportunity to make a good first impression and demonstrate goodwill to the hospital client, as well as help them improve their image in the communities they serve.

Those efforts are working if tenant feedback is any indication. In a recent survey, 90 percent of responding tenants expressed overall satisfaction with manage-ment and the quality of the buildings.

That’s good news for the tenants, and there has also been good news for the new owner as the buildings have seen increased occupancy since the acquisition. The hos-pital is even in talks with Duke Realty about expanding the Celebration facility or developing another freestanding building.

Lessons LearnedExecutives from both Florida Hospital

and Duke Realty believe the Seavest acqui-sition shows how important it is for all par-ties to do thorough due diligence and really get to know one another.

Before a hospital or health system con-siders selling its facilities, it should study the prospective buyer’s reputation, financial situation and track record. What’s the size and quality of the buyer’s current health-care portfolio? How much experience does it have owning and managing healthcare facilities? Does it tend to hold onto its healthcare properties long-term or does it “flip” them? Is it well capitalized? Publicly traded? Is it a cash buyer and can it close quickly? These are all important questions.

The health system and its tenants also should pay careful attention to whether the potential buyer learns as much as pos-sible about them, takes their concerns into consideration and works to make them comfortable with the new ownership. The bottom line is that hospital executives who are considering selling their facilities should sell them to an organization they want to have a relationship with and that will be the best partner for the long term.

But what should the health system do if the current owner sells to another third-party owner such as the acquisition of the Florida properties? One way the hospital can protect itself is with a long-term ground lease – selling the buildings but not the un-derlying land. This means that any new owners of properties on those grounds must work in partnership with the hospital, and the hospital has a say in any potential sale. Sometimes hospitals even insist on having the right of first refusal to buy back their buildings if third-party owners decide to sell.

In addition, just as when the hospital first sold its facilities, it should spend time getting to know the prospective, new third-party owner and make sure the potential owner understands its perspective and challenges. Responsible, smart healthcare real estate buyers will listen seriously and learn from these interactions. After all, the buyers want the transaction to be success-ful and know it’s imperative to ensure that the hospital and its tenants are satisfied and stay in the facility, keeping occupancy rates and patient traffic high.

That’s definitely the case with the five Florida medical office buildings that Duke Realty purchased. Jody Barry, Florida Hos-pital Administrative Director, Strategic Development, noted that it has been a fa-vorable investment for everyone, especially when considering all the improvements that have been made to the buildings.

Mark Dukes is vice president, Asset Management for Duke Realty’s assets in Florida, and Ketan Sanghvi is executive director, Business Development and Leasing for Duke Realty. Mr. Dukes can be reached at [email protected] and Mr. Sanghvi can be reached at [email protected]. Duke Realty’s healthcare experts can be visited at www.dukerealty.com/healthcare.


GrandRounds

Restaurateur Chris Sullivan donates $5 million to Moffitt Cancer Center

Moffitt Cancer Center received a $5 million donation from Chris Sullivan, res-taurant developer and co-founder of Outback Steakhouse and its parent company Bloomin’ Brands, Inc. The gift will help ad-dress the pressing need for more effective therapy for patients with melanoma.

The contribution will support work at Moffitt’s Donald A. Adam Com-prehensive Melanoma Re-search Center of Excellence where researchers are se-quencing the human ge-nome and developing personalized treatments for melanoma to ultimately improve patient survival.

Moffitt celebrated the gift with a private reception. During the event, it was an-nounced that the atrium of Moffitt’s McKinley campus outpatient facility, currently under construction, will be named The Chris Sullivan Family Atrium.

The Donald A. Adam Comprehensive Melanoma Research Center of Excellence was established at Moffitt in 2008 to advance research on the biology and treatment of melanoma. The program unites clinical and basic scientists to quickly translate laboratory discoveries into new treatments for patients. In just a few years, the center completed the deep sequencing of the entire DNA of 16 melanoma tumors, repre-senting the first complete sequencing of the entire melanoma genome, and they have successfully grown tumor infiltrating lymphocytes, leading to multiple clinical trials involving adoptive cell transfer with impressive results for melanoma patients. Moffitt is one of only three centers in the United States to conduct work like this.

Tampa General Receives Senior Friendly DesignationTampa General is the only hospital in Hillsborough County – and one of only

five hospitals in Florida – to earn the Senior Friendly designation from the Nurses Improving Care for Healthsystem Elders (NICHE) organization.

NICHE, based at the NYU Col-lege of Nursing, is the leading nurse-driven program to help hos-pitals improve the care of older adults.

Achieving Senior Friendly des-ignation means TGH has estab-lished programs and practices tailored to caring for older adult patients. Elderly patients – de-fined as those who are 65 years old or older – often have symp-toms or conditions unique to their age group, said Horacio Figueroa, nurse manager of the Acute Care for the Elderly (ACE) Unit which cares for geriatric patients. They may be at risk of falling, may be hard of hearing, or exhibit signs of delirium, he said.

The unit has implemented several initiatives to provide exemplary care to these patients. To prevent fall-related injuries, the unit last year was outfitted with beds that are lower than standard patient beds. The move paid off; the unit did not have any falls with major injuries during the last fiscal year, Horacio said.

ACE Unit patients who are 70 years old or older also receive mobility screenings. Those that score below the norm automatically receive physical therapy during their stay. Each room is also equipped with a walker and rubber mats in case they fall, Horacio said.

The unit’s nurses are also encouraged to receive additional training and certifica-tion in geriatric care. Six of the unit’s 34 nurses have already received certification in gerontology nursing from the American Nurses Credentialing Center (ANCC). Nurs-es can also take NICHE’s online program for geriatric resource nurse certification, said Felice Rogers Evans, a unit base educator on the ACE Unit.

The hospital’s NICHE Steering Committee meets monthly as part of the Nurse Prac-tice Council and includes representative from a community-based agency, said Robin Atkins, TGH’s NICHE coordinator. TGH’s NICHE program also works closely with the ACE Unit and hospital educators to help improve care provided to older patients. The pro-gram also sponsors an annual regional gerontology conference for healthcare providers and a Senior Expo that highlights services available to older patients.

Former U.S. Senator Connie Mack, Restaurateur Chris Sullivan, Moffitt Founder H. Lee Moffitt and Moffitt President and CEO Alan F. List, M.D. unveil the artist rendering of the Chris Sullivan Family Atrium.

Robin Atkins TGH’s NICHE coordinator and Horacio Figueroa, ACE Unit nurse manager, have developed programs that earned the hospital NICHE’s Senior Friendly designation.

St. Joseph’s Hospital Offers Resources for Cancer Patients

According to the American Cancer Society, more than one million people in the U.S. are diagnosed with cancer each year. After the initial shock wears off, a patient’s concerns turn to more pragmatic issues, such as, “Will my in-surance pay for this?” “How will I get to my appointments?” “Where do I get a wig?”

Ronda Buffington, community out-reach resources coordinator, at St. Jo-seph’s Hospital’s Cancer Institute said that to help patients navigate through the healthcare system, St. Joseph’s Hospital created a 20-person naviga-tion team and a program entitled, “Cancer Orientation: Resources and Financial Information to Assist You.” The next session takes place Feb. 11, 6 p.m., at St. Joseph’s Hospital Medical Arts Building.

There’s no way one or two naviga-tors can take care of the large popula-tion of cancer patients explained Buff-ington. By having a multi-disciplinary team, they don’t have to pass people off to someone else when they have questions. Each member of the team is co-educated so that they have knowl-edge of the resources available.

Topics covered in “Cancer Orienta-tion: Resources and Financial Informa-tion to Assist You,” include:

• Cancer treatments (surgery, che-motherapy, radiation therapy)

• Managing employment, insurance and financial worries

• Communication with the medical team, family and children

• Managing side effects• Nutrition issues• Coping and psychosocial matters• Handling daily living concerns.The class is free and is open to all

cancer patients and their familiesThe class runs for two hours. To reg-

ister or receive more information, call (813) 443-3078 or go to BayCareEvents.com.

InformedDNA Partners with Three New Cancer Centers to Provide Genetic Counseling

InformedDNA announced the addi-tion of three cancer centers to its grow-ing list of providers, who partner with InformedDNA to provide genetic coun-seling and risk assessment to patients seeking information about inherited cancer risk.

With the addition of the Cancer Treatment Centers of America® in Goodyear, Ariz.; Cookeville Regional Medical Center in Cookeville Tenn.; and Holland Hospital of Holland, Mich., InformedDNA now provides a full ser-vice genetic counseling program to 24 centers in nine states.

InformedDNA’s turnkey solution is helping health systems and cancer centers meet the 2012 Commission on

Cancer (CoC) Standards, which include a new requirement for cancer programs to provide genetic counseling and test-ing services to patients.

Peace River Regional Patient Happy with “no scar” Gall Bladder Removal

When Samantha Nichols found out she would be having gall bladder sur-gery through her navel, one of her con-cerns was that it would ruin her navel piercing.

Not only was surgeon Dr. Domin-go Galliano able to save the piercing, Nichols emerged from the surgery with no visible scar. This was accomplished with a specialized type of surgery per-formed with Intuitive Surgical’s da Vinci Surgical System, which was acquired by the Institute for Robotic Surgery at Peace River Regional Medical Center in Port Charlotte earlier this year.

The da Vinci is probably the most well-known robotically assisted surgi-cal equipment in the world. Its multiple arms usually require that an incision be made for each. Even though the inci-sions are small (1 to 2 centimeters in di-ameter – about the thickness of a pen-cil), Nichols was fortunate enough to have surgery with a refinement: removal of a gall bladder with only a single inci-sion.

This takes robotic surgery to a whole new level.

The da Vinci system is a significant investment for any hospital, costing from $1 million to $2 million apiece. But it’s efficient enough to be worth the in-vestment. Already, tens of thousands of general and specialized surgical proce-dures have been performed throughout the world, on da Vincis in hundreds of locations. There are more than 2,500 da Vinci systems installed in more than 2,000 hospitals.

With the single-incision option, three robotic arms are encased in a trocar, an instrument that pierces the surgical site. Once inside, the arms can emerge from the trocar so that the pro-cedure can be performed.

Thus far, the single-site option is only approved by the federal Food and Drug Administration for gall bladder surgery and hysterectomies.

The da Vinci is robotic – but it’s not a robot. It’s only as good as the surgeon operating it.

In that department, Nichols had no concerns. Galliano has achieved not one, but three board certifications – in colon and rectal surgery, general sur-gery and surgical critical care. In addi-tion, he is a clinical assistant professor in the Department of Surgery at Univer-sity of South Florida.

The procedure was done as an outpatient; Nichols was able to return home the same day.

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PROMPT AND PERSONAL – IT’S HOW REGIONS KEEPS THE WHEELS OF PROGRESS TURNING FOR SMALL BUSINESS. Dr. Susana Leal-Khouri began her relationship with Regions in 1996 at the suggestion of her personal accountant. She was just starting her private practice, the Miami Dermatology Center, and needed to furnish the offi ces. “Regions has been very helpful in allowing us to be able to start and grow the practice. They’ve also helped make it possible for us to hire the right people,” says Dr. Leal-Khouri.

“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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Tampa Bay Medical News January 2014