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(CONTINUED ON PAGE 4)

Succession PlanningHow to concoct a good exit strategy ... 6

The Move from Social Media Marketing to Social Business Strategies At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. ... 9

By LyNNE JETER

LITTLE ROCK – When Bill Hefl ey, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new informa-tion technology (IT) system to replace an antiquated one. After completing due diligence on various options, he played it safe and purchased a new system from the nation’s largest vendor.

“It was a complete disaster,” recalled Hefl ey, noting the software was different than the demonstration version, the trainer was

“preoccupied and disinterested,” and customer support was practi-cally non-existent. “Our practice collections soon approached zero. I knew there had to be a better way.”

A hobbyist computer programmer, Hefl ey devoted his energies to fi lling the void in the

marketplace. From it, he established MedEvolve as a truly collaborative industry partner to solidify the IT backbone of medical practices. The success

IT AccelerationMedEvolve fi nds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide

By JEFF WEBB

SARASOTA - It’s an arrival that perina-tologist Felice Baron, MD, has been expecting for 18 years, and she couldn’t be more excited that Sarasota Memorial Hospital is poised to give birth to a dream.

As director of SMH’s Maternal and Fetal Medicine Department, Baron, who specializes in complicated and high-risk pregnancies, has been a strong, long-term advocate of creating a facility that provides expectant mothers with natural childbirth options and on-site intensive care in case something goes wrong.

“This has been an idea that has had many stops and starts over the years, but we are build-ing a fantastic facility,” said Baron. “When I got

Special DeliveriesTower at SMH will take childbirth options to new heights

Dr. Bill Hefl e

(CONTINUED ON PAGE 8)

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

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By JEFF WEBB

VENICE – When he was growing up in a small town near Pittsburgh, Derek Cuff often would awake to the sounds of his father getting ready for work at 5 a.m. The man Cuff described as “the definition of a self-made” who navigated his way from low-income housing in the city to become the chief financial officer of a Fortune 500 company, “was always the first guy in the office and the last guy to leave,” said Cuff. “His work ethic was amazing.”

“I remember as a teenager thinking it must be brutal getting up at that hour every day to do what he did. One day, Cuff said, he asked him why he did it. “What he said was simple and has always stuck with me. He told me ‘The key to life is to find some-thing that gets you up in the morning,’” Cuff recalled. “He was fortunate in that he had found a career he was incredibly passionate about and each day was excited to get up, head into work and advance his career.”

Cuff lost his father to prostate cancer in 2012, but the sage advice has been a touchstone and “played a big role ... when I started my career in medicine,” he said. “I had truly found something I was passionate about ... Now I am very lucky to have a job that has me excited to get up and face the challenges of being a surgeon each day.”

For the past five and a half years Cuff has embraced his passion at Suncoast Or-thopaedic Surgery and Sports Medicine in Venice, where he sub-specializes in repair-ing upper extremity conditions. “Ninety-five percent of what I do is shoulder and elbow surgery,” Cuff said. “It’s a very specialized, niche practice,” that includes replacements and arthroscopies that re-sult mostly from degenerative or athletic injuries, of which there is no shortage in this region, he said. “The activity level of the people who retire here is phenomenal – golfers, tennis players, swimmers,” Cuff said. That reality “keeps all orthopedists busy,” he said, estimating that about 65 percent of his patients are older than 50.

Cuff said he works in the office on Sunset Lake Boulevard three days a week and two in the operating room, usually at Venice Regional Medical Center. “The staff there is great. We do a lot of complex reconstruction cases and we’ve built a nice little shoulder center there,” he said.

Another niche in Cuff’s private prac-tice, he said, is his heavy academic interest. “I collaborate a lot with the Foundation for Orthopaedic Research and Education in Tampa, which assists me in my research projects. In the last five years I have been fortunate to be the lead author on five dif-ferent papers published in major interna-tional orthopaedic journals, and we have more in the works,” he said. Evidence of the impact of his research came in 2011

when Cuff earned the prestigious Charles Neer Award by the American Shoulder and Elbow Surgeons Society at the annual American Academy of Orthopaedic Sur-geons meeting.

The journey into medicine that even-tually led Cuff to Florida, began when he left Pittsburgh to accept an academic scholarship to attend Washington College in Chestertown, Md., which had the added opportunity of playing basketball for the Division III Shoremen. “I was a biology major and I took a comparative anatomy course and loved it,” said Cuff, who gradu-ated in 1997. His intrigue with anatomy continued at the University of Maryland School of Medicine where he decided early on he wanted to be an orthopedic surgeon.

After earning his MD, Cuff spent the next five years completing his surgical resi-dency at the University of Maryland Medi-cal System’s John Hopkins Hospital. His parents had since retired to Clearwater, so he began to explore his options on Florida’s west coast. He found an ideal opportunity at the Florida Orthopaedic Institute, work-ing mainly out of Tampa General Hospital, where he accepted a one-year fellowship focusing solely on shoulder and elbow re-construction. “I had a chance to receive impeccable training while also being near my family and the water,” said Cuff, adding that the high volume of those particular sur-

geries at TGH is one of the highest in the world. “It’s a sneaky fact that not many realize.”

Cuff’s men-tor during that fel-lowship was Mark Frankle, MD, who Cuff praised as “one of the greatest living shoulder surgeons in the world.” Frankle’s admiration for Cuff is mutual. “I have trained around 25 shoul-der and elbow surgeons. Each has his own strengths. ... The Manatee-Sarasota area is fortunate to have Dr. Cuff, (who is) hard-working, dedicated, caring, disciplined and brilliant. ... Derek has done exceptional re-search,” said Frankle.

Cuff’s mother, a former school teacher and travel agent, still lives in Clear-water, but she’s a frequent traveler on I-75 to Sarasota, where her son lives with his wife Silke (pronounced Silk-ah) and their 20-month-old son, Miles. Cuff said he has been “very fortunate in many areas of life, but meeting my wife is hands-down the best thing that has happened for me. She is the brains in the family.” Silke is a native of Belgium and lived in Berlin before moving to the U.S. where she played soccer and graduated from Emory University in At-

lanta. She was selling orthopedic equip-ment in Tampa Bay when they met – in an operating room.

Cuff likes to play golf, lifts weights two days a week and runs 5 miles four days a week. But Silke is the real athlete in the house, having com-

pleted several ironman triathlons, Cuff said. “She is the bionic woman and I am just trying to keep up!”

But when it comes to spectator sports, especially those that involve professional teams from Pittsburgh, Cuff is king. “I am obsessed with my hometown Steelers,” he said. On game day he rises early, eats a good breakfast, dons his game gear and awaits kickoff. “Silke teases me ‘You’re not on the team!’” he laughed.

And a sense of humor is a constant arrow in this talented surgeon’s quiver.

A large portion of the surgeries he performs are to repair rotator cuffs. Those patients find it pretty funny that Dr. Cuff is their surgeon. “I hear the joke every day and each one says it like they are the first ones to make the joke,” he said. “But I don’t mind a bit.”

4 > MAY 2013 m e d i c a l n e w s . c o m

hired there were plans in place for this and it has been a very long process to bring it to fruition. I am ecstatic that we are so close to having a brand new facility for the women of Sarasota County,” she said.

The facility Baron describes is the Courtyard Tower, a $186-million, nine-story structure that will have separate floors for obstetrics, surgery, orthopedics and cardiac care. Scheduled to open this fall, floors four, five and six in the tower will be dedicated to pregnant moms and their babies. Those floors will include labor and delivery suites, mother/baby suites, the neonatal intensive care unit, or NICU, three operating rooms, and homey amenities for expectant mothers who opt for an all-natural or low-inter-vention childbirth experience.

Consolidating these obstetrical ser-vices under one roof is an investment driven both by medical care, efficiency and patient demand. According to spokeswoman Kim Savage, SMH is the only hospital in Sarasota County that of-fers obstetrical care. About 3,000 babies are born each year at SMH, she said. About 925 of those require treatment by neonatal specialists, and about 400 are admitted to the NICU, said Savage. Forty-two percent of the total births dur-ing 2012 were by Caesarian section, she

said, and of that number, about half were women who previously had a C-section.

“The timing is perfect” for opening the tower and offering these services, said Baron. Nationally and locally, she said, “women are saying ‘Pregnancy is not an illness.’ There can be complications that need to be managed, but we need to get back to the roots of this natural process.”

The trend to which Baron referred was echoed by Kyle Garner, MD, the chief of obstet-rics and gynecology at SMH. “There clearly is a new momentum for patients to take owner-ship of their health and their labor process,” said Garner, who practices at Gulf Coast Obstetrics & Gynecology of Sarasota. “Given that the United States has such a high C-section rate, institutions now are trying to look at policies and procedures to see how we can maximize dollars and improve patient outcomes,” he said.

To that end, SMH is tightening up its policies on non-medically indicated inductions, reducing C-sections, offer-ing alternative pain control methods and supporting VBACs (vaginal births after Caesarians) for low- and moderate-risk births, said Savage.

Garner said “there is pressure from patients who want to minimize the (possi-bility) of a C-section,” and to give birth as

naturally as possible. “We see evidence of this trend with the (prevalence) of birth-ing centers. People are turning to those types of facilities because they are more comfortable and it’s less invasive. With this opportunity to create and move to a new space, we are looking for ways to give those patients what they are asking for. (SMH) will provide a better experi-ence for our patients and reduce the number of C-sections,” he said.

“Patients are saying they want a hos-pital that will accommodate their wishes. They don’t want to be tied to a bed. Al-lowing them to ambulate during labor, giving them the right environment and alternatives to pain management helps meet those demands,” Garner said.

Garner said his role has been mainly to help plan and coordinate the move, and help with policies that improve patient safety. He and Baron are work-ing together to help the administration, doctors and patients make the transition as they move Sarasota Memorial into a new era.

For Baron, who oversees decisions to transport patients from outlying com-munity hospitals to Sarasota Memo-rial’s NICU, which is the only Level III unit in a four-county area, the new 32-private-bed facility will better serve mothers who have prepared for a low-intervention childbirth, but who may experience unexpected complications. “Women want as gentle and sooth-

ing a childbirth experience as possible, but they also don’t want to take any chances,” she said. “We are committed to providing as natural a delivery as we can – with little to no intervention – in the safety of a hospital setting.”

Low-intervention childbirth features that will be included in the 14 labor and delivery suites, which are adjacent to three operating rooms, and 30 mother/baby suites of the tower include:

Bright, colorful rooms large enough for family and friends.

Wireless fetal monitors that allow moms in labor to move about instead of being confined to a bed.

WiFi and flat-screen televisions.Family lounges with refrigerators

and microwaves.Whirlpool tubs and birthing balls in

the labor and delivery suites.Private baths in all rooms.Medical equipment built into custom

cabinetry or suspended from ceilings, leaving more floor space for patients, visi-tors and health care providers.

But, Savage added, the changes at SMH go beyond new construction and equipment. “Our OB team is committed to transforming the birth experience for new moms ... and to customizing birth plans that meet each family’s unique preferences and needs,” she said.

Special Deliveries, continued from page 1

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Patrick Horan, MDBoard Certified in Sports MedicineBoard Certified in Orthopaedic Surgery

You know that if you have knee or joint pain that you’re just not yourself. Dr. Horan specializes in sports medicine and can assist you with your diagnosis, treatment and rehabilitation. Life is too short to live with a physical problem that’s keeping you from doing what you love. Call us today to set up an appointment so we can help you get back to being you again.

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20281 medical news.indd 1 4/22/2013 9:39:13 AM

By LyNNE JETER

In uncertain economic times, planning for the future – retirement, selling a com-pany, or transitioning a family business into the next generation – is critical to maintain-ing financial stability in a medical practice.

Despite industry projections reflect-ing that half the nation’s active doctors will reach traditional retirement age by 2020, and physicians typically live into their early eighties, very few practitioners are succession ready.

Plan AheadPlan years in advance to mitigate risks

associated with succession planning. “The earlier, the better,” said Jim

Ray, senior vice president and commercial banking executive for Fifth Third Bank (South Florida affiliate).

“One to three years is short and the bare minimum. Sometimes, depending on the complexity of the issues at hand, it can be 5 to 10 years in the making.”

Why? The legal, financial and tax implications of succession planning can be extremely complex, based on the orga-nizational structure of the business, com-position of ownership, and whether the business will be sold to employees, a third party, or transferred within the family.

Trying to resolve issues just prior to a sale or trans-fer is virtually impossible to do properly. There’s too much value at stake,” said Ray. “You should start early and over the years make changes as the busi-ness evolves. It’s not un-usual to start down one path and then course correct as conditions change. As an example, by starting earlier, you’re able to diversify the business, which can add sig-nificant value. And if com-petitive landscape changes, you can be prepared to move quickly … whether your goal is to sell, exit, acquire or grow. Without early plan-ning, and on-going mainte-nance of that plan, it will be more difficult to achieve your goal.”

Find the Right Wealth Management Advisor

Accountants and attorneys often rec-ommend involving a wealth management advisor to the succession team to provide critical financial planning advice prior to the business transition.

“A wealth advisor can identify and help rectify potential issues that result in significant estate tax savings and help avoid potential conflicts between family members,” said Ray. “If the goal is to sell the company, business owners need to work with someone savvy in their industry. This has many advantages, including hav-ing the network and inside knowledge to

take that business to the correct potential buyers. Having a bank with specialty in the healthcare industry, for example, will help doctors better understand the process and may bring major players in the industry to the table to garner maximum dol-lars possible.”

Ask about the Money Succession planning isn’t

very expensive. Compared to the value created, the process becomes quite affordable.

“Providing solutions could get expensive, but doesn’t need to be,” explained Ray. “Imagine having a lawn overgrown with weeds and vines. The longer you let it go, the tougher and more expensive it’ll be to get it back into shape. But if you maintain

it, the incremental investments are much smaller. Depending on how active you are with managing personal affairs, it could be simple adjustments, but if we undo years of neglect, it can potentially grow into a complex and intensive project. The bot-tom line is start early and maintain often – you won’t regret it.”

Succession PlanningHow to concoct a good exit strategy

(CONTINUED ON PAGE 10)

Succession planning involves determining how one will transfer wealth to the future generation.

“That game plan changes frequently, depending on life events,” explained Jim Ray, senior vice president and commercial banking executive for Fifth Third Bank (South Florida affiliate). “For instance, a 35-year-old with young kids should make sure they have very good insurance coverage. Once children are through college and the company matures, the focus should turn to the next step – suc-cession planning. Anyone who owns a company should be thinking about the long-term position of their business.”

m e d i c a l n e w s . c o m MAY 2013 > 7

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Official Sports Medicine Provider of the Tampa Bay Rowdies.

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20281 medical news.indd 1 4/22/2013 9:39:13 AM

By CHARLES EGERTON

When it comes to health benefits, the rules are about to change dramatically for companies with 50 or more full-time employees. The so-called “employer man-date” of the Patient Protection and Afford-able Care Act (ACA) includes so-called “pay or play” regulations, which will soon begin imposing significant penalties on those who fail to offer “adequate and af-fordable” health insurance coverage.

Understanding the PenaltiesAfter December 31, 2013, ACA pro-

visions levy penalties on “applicable large employers” – those with more than 50 full-time workers – that don’t offer em-ployees and their dependents the chance to enroll in a minimum essential coverage health plan. The fine for noncompliance is $166.67 per month per employee, except for the first 30 employees. For a business with 60 employees, the penalty would add up to $5,000 each month, or $60,000 each year, beginning in 2014. And a 600-per-son company that failed to comply with the law would be fined $95,000 a month,

or $1.14 million a year.Penalties are even less forgiving when

it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from exceeding 9.5 percent of their household income. Employers that don’t offer a “qualified health plan” and premium assistance to employees to keep their cost below 9.5 percent will be subject to this penalty. The fine is $250 per month, multiplied by the total number of full-time employees who buy coverage through a Health Insurance Exchange (not just those in excess of the first 30, as with the other aspect of the law). In other words, if your company attempts to offer a plan, but it doesn’t measure up to federal standards – the penalty can be as much as $3,000 per employee. This second penalty cannot ex-ceed the total amount of the first penalty. Both of the law’s penalty provisions will be adjusted for inflation each year.

The ACA penalties that go into effect next year can represent a significant cost for a business of any size. But since offering health insurance is typically more expen-sive than that, some businesses are consid-ering whether to simply pay the fines. As

a financial professional, how should you advise your company … pay or play?

Evaluating Your Company’s Standing as an Employer

The first step is to determine whether the federal government will regard your organization as an “applicable large em-ployer.” Your company is exempt from the law if it has less than an average of 50 full-time employees. But defining a full-time employee is complicated; especially for companies that employ lots of part-time or seasonal workers.

Simply put, according to the ACA regulations, a full-time employee is one

who works an average of at least 30 hours per week. This news won’t come as a shock to many human resources professionals, who have long used the 30-hour mark as a litmus test for determining whether an em-ployee was considered full-time and eligi-ble for healthcare coverage. But beginning in January 2013, companies must also take into consideration the average amount of hours logged by all workers within a calen-dar month. The statute requires businesses to determine their number of “full-time equivalent” employees. To get this figure, add the hours of all of your company’s part-time employees and divide by 120, or a month’s worth of hours for one full-time employee at 30 hours per week.

This provision was included to pre-vent businesses from trying to circumvent the law by cutting their employees’ hours to less than 30. Similarly, the ACA pro-hibits companies from subdividing their business into separate companies to create the appearance of multiple employers with less than 50 full-time workers. The law was written so no matter whether companies “pay or play,” they must play fairly.

Pay or Play … What Makes Sense for Your Company?Preparing for the Affordable Care Act Implementation in 2014

Penalties are even less forgiving when it comes to the “affordable” aspect of the law, which prohibits the cost for coverage to employees from exceeding 9.5 percent of their household income.

(CONTINUED ON PAGE 9)

8 > MAY 2013 m e d i c a l n e w s . c o m

IT Acceleration, continued from page 1of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing BoardIn searching for a better solution in

the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Hor-sham, Pa., and a pioneer in the emerging field of electronic medical records (EMR).

“Intrigued, I became an early inves-tor and a development partner focused on orthopedic clinical content,” he said, not-ing that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an ortho-pedic specialist in minimally invasive sur-geries for the knee, hip and shoulder using arthroscopic and joint replacement proce-dures, became a development partner with NextGen in 1994, working on the develop-ment of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing com-puterized billing and scheduling, the avail-able systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atro-cious in delivering support and customer

service. I frequently heard my physician friends and colleagues recount horror stories of flawed software systems with dismal sup-port that were making it impossible to run their practices successfully. I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.”

In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service.

“My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We inte-grated our PM product with several spe-cialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.”

With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for exper-tise in RCM.

“Physicians were struggling with in-creasingly complex third-party payor systems, growing documentation require-ments, mounting government regulations, and threats of audits, fines and imprison-ment,” said Hefley. “Practices were search-ing for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of

the ever-changing rules and regulations. Physicians wanted to focus on the practice of medicine and leave the headaches to peo-ple that specialized in those matters.”

MedEvolve developed an RCM divi-sion, acquired three small RCM compa-nies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists.

“With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 per-cent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in ac-counts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers im-mediately experience less hassle, lower costs and increased revenue that result in an im-proved bottom line and peace of mind.”

Health Reform Impact The 2009 American Recovery and

Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Ser-vices (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system.

“With the new criteria defined, MedE-volve saw a need for a modern EHR prod-uct designed from the ground up to meet Meaningful Use mandates and finally de-liver on the industry’s promise of a cutting edge, customized solution that helps prac-tices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is de-signed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.”

Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excel-lent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature. As a result, employees strive to achieve the distinction of a “Four-time Re-cipient of the MedEvolve WE Award.”

“In the software business, that means several operators are at the ready for pe-riods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less sup-port is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some de-tached, impersonal entity; we partner with the practice in achieving their goals.”

Today, MedEvolve offers PM and EMR software and RCM services to phy-sician partners, and also electronic pre-scribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitio-ners to practices with more than 50 physi-cians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide.

By year’s end, MedEvolve will outgrow its new corporate headquarters in down-town Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion.

“We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare envi-ronment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”

‘‘With specialization, scale, and great software, we’ve been able to produce some of

the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue and a 38 percent average reduction in

accounts receivable days…’’

- Bill Hefley, MD, President and CEO of MedEvolve.

m e d i c a l n e w s . c o m MAY 2013 > 9

By CINDy SANDERS

Earlier this year, An-drew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit.

At the core of a social business strat-egy is the desire to deepen connections, engagement and collaboration within various communities touched by the com-pany or industry. For healthcare provid-ers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients.

“Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.”

One of the fi rst steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “So-cial business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.”

He continued, “The most popular

tool being used today to do that is email, but email was never intended to be a col-laborative tool.”

In a typical scenario, he contin-ued, one person would email an at-tached document to 10 people for comments and input, which leads to 10 different documents with notes that might be confl icting to compile into one master fi le … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years.

To address this issue, social business

software designers have taken a cue from technologies like Facebook and Twitter,

which started in the consumer realm. Dixon said the beauty of these tools

is that they are lightweight, easy to navigate, simple and very effec-

tive in keeping individuals con-nected to their social network, which is a sophisticated online community.

The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would

have early dos-based discussion boards. Around 2000 … 2002 …

we started to see the emergence of heath information repositories like

WebMD. For consumers, it was the fi rst time they could easily get information

The Move from Social Media Marketing to Social Business Strategies

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(CONTINUED ON PAGE 10)

Weighing the OptionsIf you establish that your company is

affected by the ACA regulations, you must then weigh the consequences of either of-fering healthcare coverage that complies with the law or paying the penalties. From a fundamental business standpoint, many organizations would certainly save money by paying $2,000 per full-time employee rather than offering employee health benefi ts. But there are intangible consid-erations – such as employee relations, mo-rale among workers and the company’s public image – which must be evaluated.

The bottom line? This is a complex law and the stakes are high. Even the most experienced fi nancial professional would benefi t from legal counsel as they decide whether to “pay or play” in this new realm of healthcare regulation.

Charles Egerton is a founding shareholder of Dean, Mead, Egerton, Bloodworth, Capouano & Bozarth, P.A., a commercial law fi rm that has provided full-service legal representation to businesses and individuals throughout Florida since 1980. Charles can be reached at CEgerton@deanmead.com .

Pay or Play … continued from page 7

Three Trends Driving ChangeThree trends are driving change in the workplace – social,

mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space.

“It’s incredible how powerful each of these trends are alone, and they are all converging,” said Andrew Dixon of Igloo Soft-ware. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statis-tics. “All of their IT requirements will be outsourced and provided to them by the cloud.”

Citing recent research from business and technology research

fi rms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.”

Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Tak-ing the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone profes-sionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent. Furthermore, half of the tablet-owning doctors have used their device at the point of care.

Andrew Dixon

10 > MAY 2013 m e d i c a l n e w s . c o m

Be CandidAccording to the Institute for Family

Business, about one-third of family busi-nesses survive into the second generation. Roughly 12 percent remain viable into the third generation. Yet only 3 percent oper-ate into the fourth generation or beyond!

“From what I’ve seen, you usually have a founder with a strong entrepre-neurial gene who has created an idea or product,” said Ray. “They then build a company around it. In most instances, they hope and pray that the kids share the same entrepreneurial gene and want to continue the family business. However, that’s not always the case.”

Even though it’s rare, sometimes chil-dren come into a family business with the energy and talent – matched with an en-trepreneurial gene – to improve it.

“If handing the business off to a family member isn’t in the cards, you still have other options for the business to flourish,” said Ray. “You can find tal-ented components, such as hiring a pro-fessional CEO, and build the company/infrastructure around it. For some, this might be a better route, but then one must consider how to build an estate in-stead of counting on the business.”

Cover the Bases Having business partners makes it

even more important to have a plan in

place so all parties are prepared for suc-cession, noted Ray.

“With partners involved, it can be very complicated,” he said. “It’s incredibly important to have candid conversations with them in a business to discuss what would become of a company if something unfortunate happened to one of its own-ers. Sometimes, the business has to be sold to cover estate taxes if a partner dies. Stakeholders in multi-physician practices need to be prepared. What happens if one of them leaves, dies or is injured?”

Therefore, having the right insur-ance program, including life and disabil-ity coverage is a critical component to a succession plan.

“Injury, as opposed to death, is a higher risk, higher probability scenario for many,” explained Ray. “For instance, a surgeon who hurts his hand won’t be able to perform his job.”

Reconcile Goals “Have a realistic picture of what your

company’s worth if you’re considering selling it,” said Ray. “Going through an advisor can help develop a capital strategy plan based on the end goal. It’s important to get a true valuation of company. Busi-ness owners need experts to help maxi-mize gains in these areas depending on your corporate goals – max dollars from a sale in three years – versus personal goals

– wanting to maintain the company and minimize the estate gap.”

Pay Attention to TrendsRight now, hospitals are snapping up

physician practices. “From cardiologists in Naples to

gastroenterologists in Sarasota, most are employed by or have collaborated with a major hospital system,” said Ray. “A recent example of this consolidation trend playing out locally is Health Management Associ-ates joining forces with Bayfront Health System. I see this trend continuing and physicians should be proactive to maxi-mize their transaction by planning early. If practitioners are thinking about selling to a hospital and they haven’t gone through the process of succession planning and business positioning, they need to now.”

Be a Good Client Avoid the frequent phrase: “I’m too

busy.”“Estate and wealth planning deserves

high priority and can be very risky should you leave it uncared for,” said Ray. “We help them think through it, but we bring so-lutions to the table so they don’t have to fig-ure it out by themselves. Some might believe the process of facing one’s mortality and put-ting a plan in place is uncomfortable … but at the end, they’re always relieved.”

Succession Planning, continued from page 6

The Move from Social Media, continued from page 9

outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other.

“Fast forward to where we are today, and what we really have are health net-works. They really are communities, but they’ve introduced much richer communi-cation and collaboration tools,” Dixon con-tinued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a com-munity setting. “The reason social busi-ness tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.

Creating Engaged Communities

Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social busi-ness model. Today, patients with similar ailments can tap into a network to share ex-periences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions.

“It’s open communication, but at the same time, you introduce controls,” he ex-plained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also al-

lows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models.

For physicians, the community setting lets providers who might not be geographi-cally connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to be-come more aligned. “They were able to co-ordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographi-cally diverse set of practitioners,” Dixon said.

Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an in-tranet community allows for easy commu-nication and collaboration. Using the same types of business tools employed in exter-nal communities, staff members can easily review documents, communicate informa-tion broadly across geographic locations, vote on policy, and share ideas.

Security“Security has to be built in as a core set

of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social

business tool provider makes sense.”He added, “Any enterprise-class social

business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”

Avoiding Information OverloadDixon said email is in danger of be-

coming less and less useful because of in-formation overload. The same caveat also applies to information imparted through social business tools. “If you don’t imple-ment properly, you risk making that prob-lem worse,” he said.

However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even fur-ther, there are generally options within the channel to refine what information the subscriber receives and how.

The Bottom LineWith accountable care organizations

and patient-centered models, support-ing patients and colleagues by providing timely, pertinent information in an easily-accessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most pa-tients and keep the most patients … those who don’t will find the opposite.”

Manatee-Sarasota-Charlotte Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2012 Medi-cal News Communications. 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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m e d i c a l n e w s . c o m MAY 2013 > 11

GrandRounds

NurseLineMD Launches Anytime, Any Place, Any Device Efficient Medical Communications

NurseLineMD is announcing the na-tional launch of DoctorDirect, a new com-munication system for healthcare service. DoctorDirect by NurseLineMD improves office efficiencies and allows the medical staff to spend more time with patients. Patients can simply log-in to enter a mes-sage, and be notified immediately when a nurse or doctor replies. Likewise, doc-tors and nurses are alerted when a patient has an inquiry or urgent need.

Created for use in various medi-cal environments, DoctorDirect can be implemented and accessed simply, through the easy to use interface and cloud architecture.  The system enables patients to communicate at their conve-nience about any medical or billing is-sue, as well as to notify medical staff of changes and updates to their personal information and insurance, eliminating many cumbersome administrative du-ties for the nursing staff.  It also enriches the patient/provider relationship by en-abling patients’ access to quickly and easily communicate with their provider at any time. The DoctorDirect solution was created out of a personal experi-ence with a high risk pregnancy.

Physician of the Year Announced at Doctor’s Hospital

Brian Angsten, MD has been named as the 2013 Physician of the Year at Doctors Hospital of Sarasota. The annual Phy-sician of the Year winner is chosen by the employees of Doctors Hospital through an anonymous nomi-nation process.

Dr. Angsten attended the Univer-sity of Miami School of Medicine. Upon graduation with his medical degree in 1995, Dr. Angsten completed his resi-dency at the Kalamazoo Center for Med-ical Studies in Michigan. Dr. Angsten is Board Certified in Critical Care Medicine, Internal Medicine and Pulmonology.

The 2013 Top Ten Physicians are Brian Angsten, MD; Michael Barron, MD; Sean Dingle, MD; Thomas Duden-hoeffer, MD; Scott Elsbree, MD; Jeffrey Lyons, DO; Frederick Romano, DO; Mi-chael Schandorf-Lartey, MD; Gino Se-dillo, MD; Frederick Yturralde, MD.

Dr. Brian Angsten

medical services you can count on ...

right here in our community

8340 Lakewood Ranch Boulevard Bradenton, FL 34202

raelyn calendine, mdFamily Medicine PhysicianBoard Certified in Family MedicineTreats children age 5 and above, adolescents, adults and older adults

Suite 350 For an appointment, please call 941.907.0588.

sheryl Okuhara, dOInternal Medicine Physician Board Certified in Internal MedicineSpecializes in internal medicine for adult patients

Suite 390 For an appointment, please call 941.782.2800.

Herbert Pegues ii, md, FaaFPFamily Medicine Physician Board Certified in Family MedicineTreats children age 5 and above, adolescents, adults and older adults

Suite 350For an appointment, please call 941.907.0588.

christina Knauer, arNPAdvanced Registered Nurse PractitionerSuite 350Monday, Tuesday, Friday: 8:30 a.m. – 5 p.m. For an appointment, please call 941.782.2800.

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.

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