tampa bay medical news july 2014

By LyNNE JETER

Less than a year after they were purchased by HCA West Florida, three Tampa Bay-area hos-pitals – Memorial Hospital of Tampa, Palms of Pasadena Hospital, and Town & Country Hospi-tal – have earned one of the nation’s most prestigious accreditations – the Joint Commission’s Gold Seal of Approval®.

HCA West Florida purchased the three hospi-tals from IASIS Healthcare last October, expanding the regional footprint to include 16 hospitals, 12 am-bulatory surgery centers, and more than 19,000 em-ployees in West and Central Florida. All 16 hospitals are now Joint Commission accredited.

“Achieving Joint Commission accreditation is

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Earning Impressive Credentials in (Arguably) Record Time

Searching for Power Players in the New Health EconomyHRI shows why the industry is ripe for picking; players compete to be healthcare’s new Amazon.com

By LyNNE JETER

In 2010, CellScope was birthed in tech-savvy San Francisco with the mission of creating a home medical kit of smartphone-friendly devices. Its debut offering – Oto, an otoscope that takes digital images of the ear canal – was promoted as a way to reduce

up to 30 million offi ce visits annually for ear infections in the United States. Oto repre-sents an early wave of players threatening to bulldoze the healthcare landscape in the $2.8 trillion, consumer-slanting New Health Economy.

“We’re our own construction workers and we can do our own contracting jobs.

We’re our own travel agents. We’re our own movie producers. We’re accepting all of these technologies to do things for ourselves and … healthcare is the next frontier,” CellScope CEO Erik Douglas told the Health Research Institute (HRI) for the

All 16 HCA West Florida hospitals are now Joint Commission-accredited

Minimizing EmbezzlementPNC’s Jeff Holt shares red fl ags, security measures to plug internaltheft opportunities ... 6

ExchangeRateAn early analysis of the federal health exchange ... 7

2 > JULY 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 JULY 2014 > 3

By JEFF WEBB

TAMPA - Harry van Loveren said he is the poster child for worried parents who ask themselves “Is my kid ever going to get his act together?”

Now that he is one of America’s top neurosurgeons and the chairman of the Department of Neurosurgery at USF Health Morsani College of Medicine, the answer to that speculative lament is obvi-ous. Clearly, van Loveren got it together. But it is understandable there may have been doubts about that outcome.

Van Loveren started overcoming ob-stacles at age 4, when his family moved from the Netherlands to the Cincinnati suburb of Mount Washington. No one spoke English. His father grew up in Nazi-occupied Holland and then joined the Dutch Marine Corps, which deployed him to Indonesia to fight the Japanese in World War II. That’s where he met van Loveren’s mother, whose family were Chi-nese nationals living on the island of Java. After the war his parents moved back to the Netherlands, where van Loveren and his older brother were born, before being sponsored through the Catholic church to emigrate to the U.S., where they were em-ployed as house servants.

Van Loveren acclimated in a house-hold where his dad, who had started his own home construction business, ruled with a no-nonsense approach. “When my master sergeant father drove home a point, he drove it hard. Everyone was going to get educated. Everyone was going to work. No one was going to complain. Period. End of story,” remembered van Loveren, who also has two younger sisters.

In an effort to satisfy his father’s “quest for a return to religion and make up for his years in combat,” van Loveren said he spent his freshman year of high school at a seminary in St. Louis as he considered studying for the priesthood. But he came back home and “got sucked into a bad lifestyle. … I was temporarily a very bad kid (and) became involved with a group that liked to start fights and steal cars.” Still, he made good grades, he said, and “everyone in my (graduating) class was surprised when they announced I was the salutatorian.”

Van Loveren went east to Holy Cross in Boston for college, but dropped out after a year and came back to Ohio to join the family business. “I was well on my way to becoming a full-time carpenter. For better or for worse, my father eventu-ally fired me and let my older brother take over,” he said. After a year at Ohio State University, he transferred to the Univer-sity of Cincinnati. He didn’t know what he was going to do with his degree in chem-istry, so he acted on the suggestion of a couple of buddies who “thought it would

be fun if we all went to medical school” at the University of Cincinnati College of Medicine, he said.

Van Loveren would spend the next 17 years training, teaching and in prac-tice in Cincinnati. “I really thought I’d be there forever,” said the 61-year-old, who chose neurosurgery because “Neurosur-gery was touted to be the longest hardest road to follow, so I took it.”

But in 2002 van Loveren seized an opportunity to come to Tampa, where he is “building the best and largest depart-ment of neurosurgery in the Southeast and one that reflects my mission to leave our place in the world better than we found it.” Van Loveren said he saw working for USF at Tampa General Hospital as “a great opportunity to develop something on my own. His vision “developed along the way as he began to understand the marketplace and the relatively unsophisti-cated nature of medical care once you get outside the cities in Tampa Bay,” he said. “There was an opportunity to consolidate what we do and raise the general level of care. When I arrived I saw that a lot of the neurosurgery (patients) were leaving Tampa to go to Gainesville.”

“Now we have an incredible ability to recruit high-level neurosurgeons into this area. Everybody supports success,” he said, adding that he oversees “about

20 neurosurgeons and nine PhDs doing full-time research.” Van Loveren noted that “we are based at Tampa General, but we provide exclusive neurosurgical services for a large region” and network of hospitals. Last fall he oversaw the installa-tion of the MRI-guided laser ablation for minimally invasive neurosurgery, making Tampa General the first in the area to offer the treatment.

As one might expect, running such a

large operation can be a challenge, and it was even more so last year as van Lov-eren assumed the duties of interim dean of the Morsani College of Medicine as a search was underway to replace departing Stephen Klasko, MD. But now van Lov-eren is back into his routine of “three days operating and a day-and-a-half in clinic seeing patients.” The rest of his time he spends on “administrative responsibilities, negotiating with hospitals and providers, a little bit of time in the classroom and a fair amount of time on the road lecturing na-tionally and internationally,” he said. “But mostly I train residents. It’s a seven-year program … and I train one fellow per year in what is probably the highest-level cra-nial program in the country. Look at our grads and you will see that we’ve trained faculty for the Mayo Clinic and MD An-derson. We are a finishing school at the highest possible level,” said van Loveren.

Van Loveren also makes charitable work a priority. “I was surprised by how many unfunded patients there are here,” he said. He and his colleagues “spend a lot of time doing charity care. I really pro-mote that,” he said, while also demurring about specific organizations he supports. “It’s never enough and I was taught that talking about it lessens its value. It gets close to bragging and then your motives are contaminated.”

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Harry van Loveren, MDChair, College of Medicine Neurosurgery, USF Health


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Van Loveren also is a self-described adrenaline junkie, who started sky-div-ing when he was 16. “I have 500 jumps behind me. I can’t go a month without jumping out of an airplane,” he said.

Van Loveren rounds out his free time sailing, riding motorcycles, gardening and cooking. “I’m the biggest play baby in the world,” he said.

But even with all that, he said his favorite vacation was climbing Mount Kilimanjaro with his wife Jeffrie, “a good-looking, super-intelligent and independent woman who is smarter than me” and with whom it was “infatuation at first sight.” The high praise for the mountain-climb-ing adventure was not because of the sum-mit, van Loveren said, “but just watching

my beautiful wife surviving life with such class in a two-man frozen tent, no water and no bathrooms. It was an absolutely miserable experience and I would recom-mend it to anyone,” he laughed.

What’s next for van Loveren? “We’re on the threshold of completing my work building this department (at USF/TGH). My wife and I fantasize about ending my career at a small clinic in Africa some-where. I’ll probably just disappear one day,” said van Loveren, who already has traveled on humanitarian missions to op-erate in Egypt, Mexico and Guatemala. “It’s a bit self-serving because when I am no longer worthy around all the young neurosurgeons in the United States, I’ll still have great value in the Third World.”

PhysicianSpotlight

Harry van Loveren, MD, continued from page 3

by JeFF webb

TAMPA - Complex cranial and skull-base surgery is only part of what Harry van Loveren, MD, teaches the surgeons who study under him. He also places great emphasis on getting emotionally involved with his patients.

“I spend a lot of time getting to know them and their families. I find it so much easier to make decisions when I know someone and they know me and we trust each other and we have formed a relationship,” he said.

Of course, things don’t always go well and delivering bad news never gets easier, he said. “Don’t overanalyze it or over-pre-pare for it. It’s better to just walk into the room and sit down and start talking and let yourself go. Say you feel bad about it. Say it hurts. Apologize and be sorry for things not working out better. You have to suffer with them,” said van Loveren.

“When I talk to my trainees – and I have them for 7 years so I can talk their ears off – I tell them the most important thing in these situations is to make abso-lutely certain you are forgivable. And then I talk to them about all the things that would define you as forgivable: That you really did train hard to get ready for this

case. That you did really get to know this person. That your decisions were made for the right reasons, not personal gain or notoriety. That you really did bring your A-game. That you did everything pos-sible. So then, if something goes wrong, you’re still worthy of forgiveness. Then you can sleep at night,” he said.

That personal and humble approach is partly inspired by one of van Loveren’s mentors when he worked at University Hospital in Cincinnati, Charles Aring, MD, a world-renowned neurologist. Aring, now deceased, was a polio-stricken or-phan who moved into the boiler room of a hospital in the 1920s at age 15, and was informally adopted by the staff. “In spite of becoming famous (Aring) retired from the chairmanship (of the University of Cincinnati College of Medicine’s De-partment of Neurology) and took charge of making morning coffee for the house staff so they could be awake to learn,” said van Loveren.

Aring also imparted sage advice that van Loveren repeats today. “Show up every day and do your job. Do that long enough and you’ll see that everyone around you will find a reason to quit.”

“I didn’t quite get it back then,” van Loveren admitted, but I sure do now.”

Neurosurgeon stresses being ‘forgivable’

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recently released report, “Healthcare’s New Entrants: Who will be the industry’s Amazon.com?”

“Dramatic change has been predicted for the healthcare industry many times over,” wrote HRI. “This time, the envi-ronment is fi nally ripe for that transfor-mation. Revenue will circulate differently, and to many new players. Consumers, spending more of their own money, are exerting greater infl uence and going be-yond the traditional industry to fi nd what they want and need. In the New Health Economy, purchasers increasingly will reward organizations providing the best value, whether it’s an academic medical center, a tech company with a great app, or a healthcare shopping network.”

At play: Sharp new recruits versus healthcare incumbents. Potentially disrup-tive entrants to the playing fi eld include well-established companies outside the in-dustry expanding to the medical fi eld, and non-traditional companies creating new modes of care.

Case in point: At the JP Morgan Healthcare Conference in January, Wal-green CEO Gregory Wasson, a Purdue-trained pharmacist, reminded investors that “hardly anyone went to a drugstore for a fl u shot” fi ve years ago. Now it’s a mini-healthcare center.

Another example of the ripple effects of slight shifts in the $2.8 trillion pie: If half of all patients choose new alternatives for some dozen medical procedures, such as an at-home strep test, it could impact roughly $64 billion of traditional provider revenue, according to a December 2013 HRI-commissioned consumer survey.

Here’s the rub: Even though the U.S. healthcare system is known for pi-loting life-saving medical interventions, it’s failed in attempts to produce effi cient business models to deliver outcomes pro-portionate to cost. The trend leaves an opening for power players traditionally outside the medical sector. For example, of the 38 Fortune 50 companies listed in 2013 with a major stake in healthcare, 24 are new entrants. Of those, 14 are tradi-tional healthcare organizations, seven are retailers, fi ve are technology companies, four are fi nancial fi rms, three are tele-communications companies, and two are automakers. One of those is developing services such as chronic condition man-agement while driving.

Companies that already possess im-peccable consumer credentials, such as Walgreen, with its active customer base of 74 million, are poised to upend the health sector via cost-saving products and services:

Apple was issued a U.S. patent in 2013 for a “seamlessly embedded heart rate monitor” for iPhone and other devices.

AT&T opened its mHealth platform to developers in 2012, hoping to become the essential component in healthcare’s game-changing apps. Nasrin Dayani, executive di-rector for AT&T ForHealth Solutions, told HRI, “We believe the ultimate jury … is the consumers themselves. It won’t be decided by the providers or payers.”

CVS Caremark, a 7,600-store chain, made a splash in February with a revised strategy to brand itself a healthcare com-pany that includes having tobacco-free pharmacies by year’s end.

Google last year rolled out Calico, a company with expertise in both healthcare and consumer-oriented technology that focuses on aging and associated illnesses.

Samsung unveiled its new Galaxy S5 smartphone earlier this year, with a built-in heart rate monitor.

Time Warner Cable recently revealed a “virtual visit” pilot project with Cleve-land Clinic caregivers to interact with pa-tients via telemedicine.

Who’s going to grab the most pie dollars?

“Is it going to be some random startup or … your doctors?” Target CMO Joshua Riff, MD, questioned. “You have the infrastructure. You have the knowl-edge. You have the experts. You need to be leveraging these technologies.”

Editor’s note: Please see companion article, “Com-pete or Partner?” in this edition, also focusing on the Health Research Institute’s recently released report, “Healthcare’s New Entrants: Who will be the industry’s Amazon.com?”

Searching for Power Players,continued from page 1

an intensive, thorough process that requires a great deal of trans-parency and a proven commit-ment to quality,” said HCA West Florida CMO Larry Feinman, DO, FACOS. “We’re pleased that Memorial Hospital of Tampa, Palms of Pasadena Hospital, and Town & Country Hospital are demonstrating their commitment to excellence to their communi-ties by implementing those best practices in patient care that we’ve seen exemplifi ed in our HCA West Florida hospitals.”

Within nine months, the three hospitals underwent rigorous on-site surveys for compliance with

standards of hospital manage-ment and patient care, including infection prevention and control, leadership and medication man-agement.

“The Joint Commission ac-creditation reinforces our staff’s high standards of patient safety and quality of care – and it holds us accountable for continued im-provement,” said John Mainieri, CEO of the 183-bed Memorial Hospital of Tampa.

Sharon Hayes, CEO of the 307-bed Palms of Pasadena Hos-pital in St. Petersburg, said the entire clinical team at Palms of

Earning Impressive, continued from page 1

John Mainieri

Sharon Hayes


REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.

’’

The Joint Commission accreditation reinforces our staff’s high standards of patient safety and quality of care – and it holds us accountable for continued improvement.JOHN MAINIERI, CEO, Memorial Hospital of Tampa, HCA West Florida

’’

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COMMUNIT Y is our middle name.


By LyNNE JETER

When Jeff Holt begins talking to groups about healthcare embezzlement, he immediately gets everyone’s attention with these opening remarks:

“Look to your left and right. Chances are two of three people you see are being, have been, or will be embez-zled from,” said Holt, vice president of health-care business banking for PNC Financial Ser-vices Group, Orlando, Florida.

Then he hits home with statistics from the Association of Certifi ed Fraud Examiners: “The median loss for small businesses, defi ned as 100 employees or less, is about $150,000 through embezzle-ment alone. Medical and dental practices lose $25 billion annually from the combi-nation of fraud and embezzlement.”

Holt emphasized the statistics only represent those incidents reported.

“In many cases, it goes unreported,” he said. “Practices don’t want to make it public because then the public may think ‘what else was stolen … my personal information?’

In some cases, more embezzlement simply isn’t discovered. Or perhaps the

employee was fi red and never prosecuted, so it becomes an unreported statistic. I had a case recently where the healthcare attorney’s client didn’t want to look any further because he knew they weren’t going to recover any money anyway.”

Holt recently discussed “Protecting your Practice: What does embezzlement look like, and what are the best practices to secure your valuable business?”

“After my talk, almost every hand went up with questions,” said Holt.

After all, much of the pre-meeting buzz had centered on Christie B. Hunt, the 32-year-old offi ce manager from Mel-bourne, Florida, who had been arrested for embezzling nearly $700,000 from a medical group to fi nance a lavish lifestyle that included high-priced real estate and two 2014 Audi Q7s. While handling all fi -nancial management, and marketing and business development at the Titusville lo-cation, Hunt had allegedly diverted funds to shell corporations.

“There are more than 1,000 ways to embezzle money from a practice,” cautioned Holt. “Estimates are that each organization loses 5 percent of their rev-enue to fraud each year. That’s signifi cant! Small organizations are disproportionally victimized by occupational fraud; they

typically lack anti-fraud controls com-pared to hospitals and banks.”

Who’s Embezzling?Embezzlers are tricky to spot. Eighty-

fi ve percent have never been convicted pre-viously of fraud-related offenses, noted Holt.

“In most cases, life events happen that bring about a change – addictions, divorce, family problems, mid-life crises,” he explained.

Yet there are some typical character-

istics to consider, Holt said, noting that 40 percent of embezzlers are circling the age of 40.

“The embezzler is typically a long-time employee with the full trust of the doctor and, on the surface, a devoted em-ployee,” he said. “They typically don’t take vacations. They’re very protective of their job and work many hours of over-time, often alone – that’s key because it’s typically when they commit the crime. Also, they never really train a substitute, so nobody else can interfere.”

Embezzlers despise operational changes; however, they can be very in-novative working different ways to funnel money to their pockets.

“It doesn’t necessarily have to be cash,” he said. “You can notice their at-titude change when you try to take the responsibility away from them or change

the processes.”

Investigative Hat Holt suggests that doctors take extra

time to understand their employees and changes going on in their lives, such as buying a bigger house or a boat, especially when nothing fi nancially has seemingly changed in their lives.

“Notice things going on in the prac-

Minimizing EmbezzlementPNC’s Jeff Holt shares red fl ags, security measures to plug internal theft opportunities

Jeff Holt

If embezzlement is suspected, immediately contact your banker, CPA and attorney. Also, it’s critical not to share suspicions. Professional partners will convey the next steps, which may include contacting the police. For more information, contact [email protected].

According to a recent Marquet Report on Embezzlement, a white-collar fraud study on major embezzlement cases in the United States, healthcare ranks fi fth, followed only by fi nancial services, government agencies, non-profi ts, and manufacturing.


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For free 24/7 health information or physician referral, please call 1-855-245-8330. 6001 Webb Road, off of Hillsborough Ave. TampaCommunityHospital.com

COMMUNIT Y is our middle name.

By CINDy SANDERS

After a very rough start, the federal health exchange managed a healthy re-bound before the March 31 general signup deadline. Similarly, state exchanges have hit some glitches but are also now up and running.

Finishing the first half of the year, are the exchanges panning out to be as good as promised … as awful as predicted … or somewhere in the middle? Although much too early to make a definitive pronounce-ment, two of the nonpartisan experts on staff at The Advisory Board Company shared insights into what the first few

months have revealed about the exchanges in terms of access, affordability, and expec-tations.

Rob Lazerow serves as practice man-ager and David Lumbert as a senior ana-lyst in the Research & Insights division of the global healthcare technology, research and consulting firm head-quartered in Washington, D.C. Despite the physical location of The Advisory Board Company, Laz-erow noted, “Our work is completely non-political. I stress this because every-thing with Obamacare is

so politically charged.”With that in mind, he and Lumbert

broke down what they’ve seen so far.

Big Picture“We wound up with just over 8 mil-

lion, and that includes the special enroll-ment period which extended to April 19,” Lumbert said of the numbers for the public exchanges. He added the extra two-week period was only for those who had started the enrollment process before the March 31 deadline. “Originally, the Congressio-nal Budget Office had projected 7 million so it did exceed that by just over 1 million,” he continued. Lumbert added nearly half of the enrollees selected a plan in March. “There was definitely a surge at the end due to technical problems being fixed and more education about the process and deadlines.”

Lazerow said the CBO provided ag-gregate coverage expansion figures that included exchange uptake, Medicaid expansion and potential changes in the employer market for a net/net effect on coverage in the wake of the Affordable Care Act. “From estimates in February 2013 from the Congressional Budget Of-fice, they expected ultimately around 27 million individuals to gain coverage by

2017,” he said. Lazerow added those pro-jections were adjusted downward in Febru-ary 2014 to project an increase in coverage for nonelderly individuals by about 13 mil-lion in 2014, 20 million in 2015, and 25 million in each of the subsequent years through 2024. The latest report from Health & Human Services shows cover-age hitting the CBO projection with 8.019 million enrolled through marketplace plans and an uptick in Medicaid/CHIP enroll-ment of 4.824 million.

Even with expanded coverage, that still leaves about 31 million nonelderly U.S. residents uninsured. However, about 30 percent of that group, according to the CBO and Joint Committee on Taxation (JCT), are unauthorized immigrants who would not qualify for most Medicaid ben-efits and exchange subsidies. As for the oth-ers, the CBO and JCT estimate 20 percent would qualify for Medicaid but choose not to enroll, 5 percent would not be able to get Medicaid coverage because they live in states that didn’t expand the program, and 45 percent would simply opt not to purchase coverage even though they have access to insurance through the exchanges, an employer or directly from an insurer. Still, by 2016, more than 90 percent of legal nonelderly residents are anticipated to have

Exchange RateAn early analysis of the federal health exchange

Rob Lazerow (CONTINUED ON PAGE 8)


The nightmare rollout got the federal exchange off to a bumpy beginning. “The turn-around seems to have done the job, but I don’t think it was the starting place the administration was hoping for,” Lazerow said tongue-in-cheek. Although en-rollment rebounded, the ques-tion remains whether or not the rough start will have a lasting impact on public perception.

’’

’’

health coverage in the United States.In assessing the pros and cons of

ACA, both analysts noted items in the ‘good’ column might go south down the road just as those tallied as potential nega-tives might not turn out to be a problem over the long term.

So Far, So Good“One of the more baseline elements is

that we now have a reliable, working mar-ketplace where people can go to see a range of plans and the prices for them,” said Laz-erow. He added one of the policy objec-tives was to offer individuals more choice when it came to coverage options. Prior to ACA, most employers and individual car-riers offered limited plan options. Lazerow noted that expansion is happening not only in the public marketplaces but also in pri-vate exchanges now, as well. “Consumers shopping on exchanges often have a lot more choice in the types of health insur-ance plans available to them,” he said of the current climate.

Another goal was to create affordable options. “When you factor in all the subsidies — and there are subsidies for premium support and cost-sharing subsidies — it appears affordable coverage is now within reach for many,” Lazerow continued.

While most people know front-end subsidies are available to individuals be-tween 100 percent and 400 percent of the federal poverty level (FPL), Lazerow said not as many individuals are aware of the cost-sharing subsidies that also exist. “This is for individuals below 250 percent of the federal poverty level,” he explained, add-ing it helps reduce costs associated with co-payments, deductibles and co-insurance. “That’s really important because indi-viduals may not fully understand they’re exposed to those deductibles when they ac-cess certain services,” he continued.

“The insurance companies have reported between 80 and 90 percent of enrollees did pay their first month pre-

mium,” Lumbert said. Lazerow added this is on par with what has historically been seen with other individual commer-cial plans. “The question now,” Lumbert continued, “is whether people will con-tinue to pay the second, third months … especially those who were uninsured be-fore and are unaccustomed to paying a premium every month.”

Another positive for consumers and providers is the new plans include a more generous benefits package. Lumbert noted a 2012 analysis published in Health Af-fairs found 51 percent of pre-ACA policies didn’t offer the minimum standard for ‘es-sential benefits’ the law requires.

However, when policy termination notices were sent out last year for plans that didn’t meet the litmus test, some families found the new standards to be a negative, rather than a positive. In the wake of the outcry … and President Obama’s assertion people could keep plans they liked … car-riers have been allowed to extend coverage deemed out of compliance until 2015.

Red Flags & Open QuestionsThe nightmare rollout got the federal

exchange off to a bumpy beginning. “The turnaround seems to have done the job, but I don’t think it was the starting place the administration was hoping for,” Lazerow said tongue-in-cheek. Although enrollment rebounded, the question remains whether or not the rough start will have a lasting impact on public perception.

Long before the rollout however, the die was cast in what has become a serious issue for long-term hospital survival … par-ticularly in rural areas. In negotiating the terms of ACA, hospitals made concessions based on certain coverage assumptions. Lazerow noted the ‘gets’ outweighed the ‘gives’ in the original scope of the legisla-tion. However, he continued, “The Medic-aid expansion is a state-by-state issue now. One thing we see for hospitals and health systems is they face all of the downsides of the Affordable Care Act, but they don’t

necessarily get all the upside.” Several states without Medicaid expansion have already witnessed the demise of some rural inpatient facilities, which could create ac-cess issues down the road.

Another issue now that the exchanges are active is how patients will operate under the new plans. Lazerow questioned how newly insured individuals would react to costs. “Is there going to be sticker shock … not at the point of coverage … but at the point of service, and how does that impact their utilization?”

Lazerow and Lumbert are also tak-ing a wait-and-see stance when it comes to narrowing networks. Lazerow noted a number of health systems and hospitals are increasingly willing to explore the tradeoff between price and volume … ac-cepting lower reimbursement rates in ex-change for creating a deeper relationship with a payer. The same is being seen with private practices.

“It is not just an exchange issue by any means,” Lazerow noted. However, he continued, “It might be more visible on the exchange side.”

Lumbert said it would be interesting

to see how patients respond to not having every hospital, every physician included in their plan. Another concern is whether or not there is enough transparency for consumers to figure out on the front end exactly who is included in a plan. “For some state-based plans, California comes to mind, there was a feature where you could search for plans based on providers, and there was a glitch where some provid-ers were coming up that weren’t actually in plan,” Lumbert said.

The Bottom Line“We’re fundamentally talking about the

restructuring and changing of the health in-surance marketplace,” Lazerow stated.

He said while it is too early to deter-mine whether ACA is the major catalyst for the fundamental changes that are begin-ning to be seen in the employer-sponsored market … changes that were already un-derway before the health reform legislation … the law clearly impacted the individual side of the equation. “Certainly it was transformative for those who didn’t have coverage options before and the individual market as a whole,” Lazerow noted.

With the rise of private exchanges, employers are looking to employees to take more responsibility for their own health and make more decisions about their plans and coverage options … much like in the public exchanges.

“One of the questions we’re asking is if we are on the brink of a new retail healthcare experience,” Lazerow said. “Are we headed into a retail insurance marketplace when the individual patient … the end consumer … is making a lot more decisions especially in three areas — point of coverage, point of service and again at the point of renewal?”

Only time will tell how it all plays out and what it will ultimately mean for pro-vider market share.

Exchange Rate, continued from page 7

tice, too,” he said. “Indicators may show unusual adjustments on bank reconcilia-tions; audit controls in place on finances will help sniff out trouble.”

Some other red flags:• Issues with receivables, such as nu-

merous charge-offs;• Discrepancies between bank deposits

and postings;• Abnormal numbers with personal ex-

pense reimbursements (if so, request backup documentation and proof of expenses);

• Increasing payroll costs, with no time clock for accountability; or

• Financial reports income/expense line items aren’t in line with prior time periods (benchmarking is key to recognizing issues here). “Even $50 a week times 52 weeks,

times the years of service … it can add up,”

said Holt. “Over 20 years, that’s $52,000.”

Security MeasuresWhen hiring a new employee, pay

the fee for background checks on the front end, emphasized Holt.

“If not, you could pay for it on the back end. Also, look at possibly bonding and/or insurance for employees,” he said.

Holt advised doctors to have financial statements mailed to their home, a post of-fice box, or a CPA, to bar the embezzler from valuable information.

Other suggestions:• Do use invoices and statements on-

line instead of paper. “With paper, the employee can give you copies where they’ve cut-and-pasted in-formation the way they want you to see it,” explained Holt.

• Don’t have employees jot down

financial information on patient credit cards, or worse yet, keep a log. “Because of potential problems with HIPAA compliance, credit card compliance (PCI, for exam-ple), and huge penalties for a prac-tice – a severe fine is up to $100,000 per case – do have a management security code for patient refunds at the merchant terminal,” said Holt. “Have the credit card information digitally stored and encrypted. It also keeps the patient feeling secure about their other confidential infor-mation at the practice.”

• Do engage your CPA or consultant to conduct random audits.

• Do make sure checks are stamped “for deposit only.” “An Orlando employee diverted $650,000 into a separate account because she had

so much control,” lamented Holt. • Don’t have signature stamps. “It’s

very high risk,” he said.• Do compare daily receipts to the

bank deposits. “That’s a small daily audit you can do yourself,” he said.

• Do have in place inventory con-trols, IT security, cash controls.

• Do benchmark accounts month-to-month.

• Do keep seeking red flags. “The older the embezzler, the more money is typically taken,” he said. “Older em-ployees usually feel they’re so slick; they won’t get caught. Personality remains the greatest indicator of a hint there’s something you should be concerned about.”

Minimizing Embezzlement, continued from page 6


Tra in ing · Educat ion · Innovat ion · Communicat ion

Multidisciplinary Conference and Trade Show for the Healthcare Sector!

Improving Training and Education to Enhance Safety and Performance

22-24 August 2014 | Rosen Shingle Creek Resort | Orlando, Florida, USA

Keynote Speaker!John Armstrong, MD, FACS, Florida’s State Surgeon General will speak at this year’s Healthcare Education Assessment Training & Technology (HEATT)Conference and Trade Show.

Don’t miss your opportunity to hear him speak on Florida’s healthcare perspective and discuss the use of simulation as a tool to enhance medical education and training.

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A Component of Niche Marketing

By JOHN KELLy

Recently, I read a 2012 editorial by Digiday’s Brian Morrissey, a talented editor who discussed challenges often associated with contributed editorial. He astutely identified the downside:

• “Many submissions are simply mar-keting pitches.”

• “A deeply held point of view is missing.”• “No point of view calls for an argument.”

Fast forward to 2014; Morrissey re-mains correct. I routinely hear similar comments from Pepper Jeter, the editor-in-chief of Medical News, when discussing the pitfalls. The upside has tremendous benefits. Well-written contributed edito-rial absolutely provides value to niche au-dience marketing.

• Local audiences value local authors. • It provides feedback and discussion, or

what Morrissey calls a “point of view calling for an argument.” He added: “The best digital media practitioners who write regularly – Fred Wilson and Mark Cuban spring to mind -- com-bine deep expertise with passion and a willingness to write what they really think. You cannot outsource expertise, passion and honesty to a PR firm try-

ing to earn its retainer.” • Today’s digital environment provides

a far-reaching proliferation of the author’s point of view by leveraging multiple mediums: print, digital, so-cial media; Facebook, LinkedIn, You Tube, Twitter.

• It positions the author as an expert sharing resources. This is a critical po-sition for niche audience marketing.Here’s my take. Advertising campaigns

leverage well-designed print and digital ads, combined with passionate contributed edito-rial from an industry leader. Together, this combination historically performs better than ads alone. Successful business profes-sionals are continually striving to improve their business models. Contributed editorial provides an opportunity that can be analyti-cally measured, which is extremely valuable in today’s whirlwind environment.

In 2006, John Kelly developed Orlando Medical News, followed by Tampa Bay Medical News and Sarasota-Manatee-Charlotte Medical News. As Florida market publisher for Medical News Inc., John engages community leaders on his sales teams. His philosophy speaks to working “outside the box,” which involves innovative and often unprecedented ways to collaborate with industry partners. John may be reached at [email protected].

Earning Impressive, continued from page 5

Pasadena Hospital is dedicated to deliver-ing the highest quality of care possible to its patients.

“The Joint Commission accredita-tion strengthens community confidence in our hospital by providing them with an unbiased assessment of our healthcare ser-vices,” she added.

In February, Jake Fisher, an HCA veteran who had been promoted from COO at HCA’s 425-bed Largo Medical Center to CEO of the 201-bed Town & Coun-try Hospital in Tampa, had discussed the “long checklist year,” with Tampa Bay Medical News, which included focusing on Joint Commission accreditation as part of the changeover.

“IASIS facilities are accredited by DNV Healthcare, which was new to me,” Fisher admitted. “At HCA, we use Joint Commission for accreditation in all our fa-cilities. The standards and regulations are similar, but there are also different focus aspects over the environment of care and life safety – that’s been a big priority for the Joint Commission over the last couple of years. Plus, the Joint Commission is the largest accrediting body for healthcare or-ganizations in the nation.”

HCA West Florida President Peter Marmerstein, FACHE, emphasized that

Joint Commission ac-creditation “reinforces our dedication to pro-viding quality, com-passionate care – and we’re particularly proud of Memorial Hospi-tal of Tampa, Palms of Pasadena Hospital, and Town & Country Hospital for achieving this milestone so quickly after joining the HCA family. This accomplishment is a testament to our hospital leadership and staff who work hard every day to maintain excellence and continually improve the pa-tient care experience.”

Mark G. Pelletier, COO of The Joint Commission’s Division of Accreditation and Certification Operations, lauded hos-pital leaders for their diligence in the ex-pedited evaluation process during a time other major system changes were under-way at the three hospitals, including a transformation of the electronic medical record (EMR) system from the McKesson to the Meditech platform.

“By achieving accreditation, Memo-rial Hospital of Tampa, Palms of Pasadena Hospital, and Town & Country Hospital have demonstrated their commitment to the highest level of care for patients,” he said. “I commend HCA West Florida for undertaking this voluntary challenge to el-evate its standards and instill confidence in the communities it serves.”

Jake Fisher

Peter Marmerstein


Free Community Lecture on Prostate Enlargement

Thomas Williams, M.D., a Board Cer-tified Urologist, will discuss understand-ing the cause and treatment options for prostate enlargement at a free commu-nity lecture on Tuesday, July 15 at 4 p.m. The program will be held in the Medical Office Building Auditorium, on the hos-pital campus.

Prostate enlargement is a common condition that increases with age. It is not associated with an increased risk of prostate cancer, and there are steps that can be taken to reduce symptoms.

Seating is limited. To make your res-ervation, please call the hospital’s Con-sult A Nurse® class registration, health-care information and physician referral service at 1-888-685-1596.

St Petersburg General Hospital Names First Quarter Nursing Excellence Award Recipients

Carla Comp, RN, Michelle Kieffer, RN, Renee Jackson, RN and Andrea Wislotsky, RN accepted the Nursing Ex-cellence Award presented to them by Herman Zaharowitz, MD, Chief of Staff at St Petersburg General Hospital early last week. This award is highly regarded and highlights the dedication and excel-lence St Petersburg General Hospital has come to expect from its nurses.

Carla Comp, RN: Carla always brings a positive attitude and supports the rest of the team as a charge nurse. Whenever Carla is presented with a challenge, she rises above and gets the job done. Carla is an excellent resource for others and is

Tampa Bay Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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GrandRoundsTampa General Hospital Nationally Recognized For Being “Green”

Tampa General is the only Hillsborough County hospital nationally recognized for its comprehensive environmental program. TGH earned the 2014 Partner for Change Award for the third straight year from the Practice Greenhealth organization.

Practice Greenhealth is the nation’s leading healthcare organization that empowers its members to increase efficiencies and environmental stewardship while improving patient safety and care through tools, best practices, and knowledge.

The award recognizes healthcare facilities throughout the nation that have estab-lished sustainability programs. Just 11 hospitals in Florida earned the award this year.

More than 20 percent of the hospital’s entire waste stream - including bottles, cans, paper, cardboard, lead aprons used in radiology, and old medical equipment - is recycled.

John Scolaro, director of Environmental Services and Patient Transport, left; Lisa Ma-nis, surgical education specialist, and Paul Harvey, director of Hospitality Services and the hospital’s sustainability initiatives coordinator, developed Tampa General’s com-prehensive sustainability program. TGH recently earned the 2014 Partner for Change Award from the Practice Greenhealth organization for the third year in a row.

Bring Clarity to Your Financial Future

Kimberly D. Overman, CFP®

President & CEO(813) 229-2000 | Tampa, FL

www.TheFinancialWell.com



dedicated to the patients she cares for.Michelle Kieffer, RN: Michelle has

been employed at St Petersburg General Hospital since 1986. Michelle is dedicated, kind and caring. She is always willing to go the extra mile for our patients and sur-geons. She is the type of person that any nurse would love to work beside. Michelle is always the patient’s best advocate.

Renee Jackson, RN: Renee has be-come a mentor and coach for the newer nurses on the night shift. She has built a team that works together to ensure call lights are answered within 3 minutes. She loves teaching the newer nurses and fol-lows through with patient education.

Andrea Wislotsky, RN: Andrea has worked at St Petersburg General Hos-pital for several years. Her current role is the weekend night shift Charge Nurse in the Intensive Care Unit. Andrea consis-tently displays a great attitude, pushing through with her, ‘we can get through it’ determination. She cares for her staff; she even brings in baked goods for them each weekend. Andrea is passionate about patient care and is currently pursu-ing the career path of Nurse Practitioner.

MedEvolve EHR Software is Certifi ed for Meaningful Use Stage 2

MedEvolve, a provider of practice management software, electronic health records (EHR), and physician revenue cycle management services, today an-nounced that its EHR solution, MedE-volve EHR 6.0, has been tested and was certifi ed for Meaningful Use Stage 2 on April 13, 2014 by Drummond Group’s Electronic Health Records Offi ce of the National Coordinator Authorized Cer-tifi cation Body (ONC-ACB) program. MedEvolve EHR 6.0 met the require-ments for ONC’s Complete EHR 2014 criteria which were adopted by the Sec-retary of the US Department of Health and Human Services. MedEvolve’s EHR 6.0 supports both Meaningful Use Stage 1 and Stage 2 measures, and is certifi ed for use by eligible providers to qualify for EHR incentives.

Drummond Group’s ONC-ACB cer-tifi cation program certifi es that EHRs meet the meaningful use criteria for ei-ther eligible provider or hospital tech-nology. In turn, healthcare providers us-ing the EHR systems of certifi ed vendors are qualifi ed to receive federal stimulus monies upon demonstrating meaningful use of the technology - a key component of the federal government’s push to im-prove clinical care delivery through the adoption and effective use of EHRs by U.S. healthcare providers.

This Complete EHR is 2014 Edition compliant and has been certifi ed by an ONC-ACB in accordance with the ap-plicable certifi cation criteria adopted by the Secretary of the U.S. Department of Health and Human Services. This certi-fi cation does not represent an endorse-ment by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments.

Chris Fensterle Promoted to Associate Administrator at Manatee Memorial Hospital

Kevin DiLallo, Chief Ex-ecutive Offi cer Manatee Healthcare System, Group Vice President UHS of Dela-ware, Inc. announced the promotion of Chris Fenster-le to the position of Associ-ate Administrator at Mana-tee Memorial Hospital.

Chris joined Manatee Memorial Hos-pital in 2005 as the Manager of Security and Transportation. Since then, he has held several leadership positions at both Manatee Memorial Hospital and Lake-wood Ranch Medical Center, and is cur-rently the Director of Business Develop-ment for the Manatee Healthcare System. Chris has served on various Boards in our community; most recently the American Cancer Society of Manatee County.

Chris holds a BS in Psychology from Mary Washington College and an MSA in Healthcare Administration from Cen-tral Michigan University. He and his wife, Courtney, reside in Bradenton and have two daughters and enjoy all outdoor activities.

Sarasota Memorial Pain Care Center Welcomes Two New Pain Care Specialists

Sarasota Memorial has wel-comed two new pain medicine specialists - Eugene Pereira, MD, and Lindsay Shroyer, MD - to its Pain Care program.

Pereira is board certifi ed

in Anesthesiology/Pain Medicine and Shroyer is board certifi ed in Physical Medicine & Rehabilitation/Pain Medi-cine. The pain care physicians join an interdisciplinary team of pain manage-ment specialists who offer customized rehabilitation, treatment, medications and interventional procedures to people suffering from a range of painful condi-tions, including arthritis, back/neck pain, cancer pain, muscle pain, sciatica, neu-romuscular and spinal cord pain, diabet-ic neuropathy, facial pain, fi bromyalgia,

shingles, headaches/migraines, as well as work-related injuries.

Involving a Genetic Healthcare Professional May Improve Quality, Moffi tt Study Shows

A new Moffi tt Cancer Center study published Thursday in Genetics in Medi-cine shows that counseling from a ge-netic health care provider before genetic testing educates patients and may help reduce unnecessary procedures.

Up to 10 percent of cancers are inher-ited, meaning a person was born with an abnormal gene that increases their risk for cancer. Pre-test genetic counseling in which a health care provider takes a thor-ough family history and discusses the po-tential risks and benefi ts of genetic test-

ing is standard of care as recommended by the American Society of Clinical Oncology and National Society of Genetic Counselors, said Tuya Pal, M.D., a board-certifi ed ge-neticist at Moffi tt and

senior author of the paper.In the Moffi tt study, researchers sur-

veyed 473 patients who had genetic testing for BRCA1 and BRCA2 gene mutations, which are associated with an increased risk of breast and ovarian can-cers. Among study participants who saw a board-certifi ed geneticist or genetic counselor, almost all recalled having a pre-test discussion, compared to only 59 percent of those who did not. These fi nd-ings suggest large differences in quality of care across providers who order testing.

The researchers also suggest there may be cost-of-care implications when genetic health care providers are in-volved. “Our results suggest that genetic health care providers are less likely to order more expensive comprehensive genetic testing, when less expensive testing may be appropriate,” said Deb-orah Cragun, Ph.D., lead study author and post-doctoral fellow at Moffi tt. “Our study found that in cases where less ex-pensive testing may be appropriate, genetic health care providers ordered comprehensive testing for 9.5 percent of participants, compared to 19.4 percent when tests were ordered by other health care providers. At the time of data collec-tion, comprehensive genetic testing cost approximately $4,000, compared to $400 for the less expensive testing.”

The fi ndings are important, noted re-searchers, because costs and quality of care are often the focus of policy-level decisions in healthcare.

GrandRounds

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

Dr. Eugene Pereira

Dr. Lindsay Shroyer

Chris Fensterle

To learn more, visit healthcare.goarmy.com/y941 or call 1-888-550-ARMY.

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