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Foundation events » Jooma & boses » Spotlight on SEbring office » Radar Screen
Summer 2014
THE MAGAZINE
The Future of
Oncology
is Here
Drs. Lucio Gordan & Mark Rubin
Summer 2014
1
We Support the Health of your Practice
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To learn how ION Solutions enables community oncology practices to improve operational efficiency,
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visit ourcommunitycounts.org.
2
FCS The Magazine
editor's
FCS
THE MAGAZINE
letter
Message from
Dear Colleagues,
President
William N. Harwin, M.D.
“Making predictions is hard; especially about
the future.”
— Yogi Berra
Assistant Managing Partner,
Director, Executive Board
Stephen V. Orman, M.D.
Medical Director
Scientific Director of Clinical Research,
Director, Drug Development Program
Lowell L. Hart, M.D.
Director of Research Operations
Robert C. Whorf, M.D.
Executive Management
Chief Executive Officer
Brad Prechtl
Chief financial Officer
Libby Slater
Chief Operating Officer
Todd Schonherz
General Counsel
Tom Clark
Chief Marketing & Sales Officer
Shelly Glenn
Chief Human Resources OfficeR
Sharon Dill
Senior Vice President, Radiation/Radiology and
Partnership Services
Ed Mercado
Vice President of Revenue Cycle
Sarah Cevallos
contents
Scott Tetreault, M.D.
Physician leadership
Mark S. Rubin, M.D.
summer 2014
At a recent COA meeting, I saw the future. Or, I
should say, I saw a small part of the future of a small part
of the oncology patient’s experience. Dr. John Peabody
from UNC described his process of isolating circulating
tumor cells from peripheral blood of cancer patients and
then sequencing the key genomic drivers of the disease so
that a patient in the future can be staged and get started
on personalized treatment within three or four days with no other biopsy necessary. We
already do this with CML and CLL so perhaps solid tumors and blood cancers are more
alike than different.
In this issue we look forward with Drs. Lucio Gordan and Mark Rubin to the future of
community cancer care. Mark was instrumental in the design and development of Onco
EMR and Lucio has helped Mark and the Altos team to expand the functionality of the
system and take it from a “computer system” to a full virtual cancer universe.
The future will also see our patients actively participating in directing and managing
their own treatments. Dr. Nuruddin Jooma and Sarah Boses have embraced this with
their unique integrative oncology program, and I think you will enjoy meeting them and
learning about their exciting program.
John Hodson and the central lab and the Sebring office round out our highlights so, as
always, enjoy — and keep those ideas and suggestions coming.
Vice President of Clinic Financial Services
Christina Sievert
Senior Management
Jeff Esham
Jeremy Behling
Tara Ruska
Jeffrey Rubin
Ray Bailey
Lois Brown
Melody Chang
Rich dyson
Michael essik
Inga Gonzalez
Katie Goodman, RN, BSN, CCRP
Christopher Houser
Sue Kearney
lois poel
Denice Veatch
Samantha Watkins
IN PARTNERSHIP WITH
PRODUCED BY
Scott Tetreault, M.D.
Editor, FCS The Magazine
in this issue
Departments
8
12
14
15
30
16 Foundation Events
Insurance Tips
D
octor & Nurse Spotlight:
Nuruddin Jooma & Sarah Boses
Integrative Medicine
The Radar Screen
News Updates
Spotlight
Legislative Soundbites
20 Office Spotlight: Sebring Office
26 Research Spotlight: Central Lab
Features
4Profile: Drs. Gordan & Rubin
Future of Oncology
Summer 2014
3
Profile
The Future of
Oncology is Here
FCS proves community-based oncology
can lead the way to a cure with a culture
that encourages innovative thinking
By Zandra Wolfgram
T
“ We all need to
always be on the
lookout for better
ways to help
people
he best defense in the ever-changing
world of health care just may be a
good offense. The rapid expansion
of Florida Cancer Specialists &
Research Institute (FCS) is part of a longterm strategy to maintain FCS’s competitive
advantage so it can continue to realize its
.”
mission of providing world-class cancer care in
— Dr. Mark Rubin
community-based settings close to home. “We
grew the size of the organization to protect it.
Size brings leverage to nearly every aspect of our
business, from negotiating with insurance carriers to reducing expenses,” says CEO Brad Prechtl.
Not to mention attracting some of the best minds in medicine and medical research. Mark
Rubin, M.D., who practices out of the Bonita Springs office, and Lucio Gordan, M.D., based in
Gainesville, are two of over 170 excellent physicians.
Rubin joined FCS in 1994, bringing more than 15 years of clinical experience and an
internationally recognized track record in cancer research.
As a Research Fellow at Sloan-Kettering from 1991 to 1994, Rubin worked alongside Dr. John
Mendelsohn, who was president of MD Anderson Cancer Center at the time. In this role, Rubin
helped to pioneer the concept of targeted anti-receptor therapy as a new form of cancer treatment.
Antibody 225 — known commercially as Erbitux — was approved by the FDA in 2004 for colon
cancer and in 2006 for head and neck cancer.
On a hunch, and with support from his former colleagues at Sloan-Kettering, Rubin took a
chance with a young female patient who had colon cancer. “As luck would have it she was someone
we could consider,” he says. Erbitux worked. She had dramatic improvements in her condition
and the tumor shrunk considerably. “It was so unexpected,” Rubin recalls. The discovery made
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FCS The Magazine
Summer 2014
5
Photo by Scott Holstein
Profile
I take care of the
quality, content and
controls of the EMR,”
Gordan explains. “I
don’t put the engine
together, but I make
sure it is running well.”
headline news worldwide and landed Rubin on “Good Morning
America.” He credits much of this successful breakthrough to FCS’s
corporate culture.
“FCS has an innovative spirit. I am here because this company is
committed to community-based practice and finding solutions to
problems that are not found only at major centers,” Rubin says. “We
all need to always be on the lookout for better ways to help people.”
Technology is “making lives better”
A day in the life of today’s doctor is a whirlwind. The day begins
early and often ends late. It is filled with the pressures of seeing patients
and trying to be in several places at the same time, managing all sorts
of complicated situations, from coordinating lab results to managing
frontline, administrative, financial staffs and nursing teams — not to
mention patients and their families.
Rubin quips that the working environment at FCS is like the GE
slogan “making lives better.” And in 2005, he continued to do just
that. While his wife, Anne, was hospitalized late in her pregnancy with
twins, Rubin used his time at her bedside to write the protocols for an
Electronic Medial Record (EMR) suited for oncologists like him. He
partnered with Altos Solutions to create a web-based software program
that streamlines the many disparate components of patient care. The
result was revolutionary.
“OncoEMR is like an orchestra in sync. We have more productive
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FCS The Magazine
— Dr. Lucio Gordan
staff, and the ability to provide the right treatment to the right patient
at the right time … and now we can’t live without it,” Rubin says.
Beyond efficiency, Rubin sees OncoEMR as an equalizer. By
allowing doctors to share industry-wide practices and expertise, all
doctors can be “experts” no matter what their background or where
they practice. “If you don’t live near Sloan-Kettering or MD Anderson,
you do not need to be excluded from treatment,” he says. “I believe in
community oncology. We have to take care of everyone.”
That means constant care and OncoEMR allows more of it.
“Cancer doesn’t stop or take a holiday,” Rubin says. “With tools like
OncoEMR, we are able to treat three and four times more patients in
a more efficient and consistent manner.”
OncoEMR is yet another example of FCS’s commitment to finding
solutions to problems that many may think are only found in a major
cancer center. “It’s a tribute to the environment we work in here at
FCS,” Rubin says.
Medicine meets The Information Age
Dr. Lucio Gordan, based in Gainesville, who joined FCS in 2010,
along with Rubin are medical directors for the Integrated Clinical
Services and Medical Informatics Committee. He serves on the
executive board, bringing nearly 20 years experience as an oncologist/
hematologist. His work is widely known and only recently he was
presented with the prestigious Physician Frist Award, which honors
Hospital Corporation of America employees and volunteers who work in
“a spirit of love, with humility and understanding.”
Gordan, who worked in computer software programming prior
to entering medical school, readily offered up his services and skills to
help take the company to the next level. For the past four years, this
43-year-old’s main focus has been utilizing the FCS’s technology tools,
like OncoEMR, to deliver the best care possible to patients.
“I take care of the quality, content and controls of the EMR,”
Gordan explains. “I don’t put the engine together, but I make sure it is
running well.”
That means meticulous information management of everything from
what kind of chemotherapy treatments are provided at what intervals to
what medication is appropriate to dispense for each patient.
The evolution of OncoEMR has impacted the company on many
levels, from safety to quality of care. And then there is the bottom line.
With less staff required and reduced time to bill there is cost savings. Plus,
enhanced documentation has strengthened FCS not only from a medical
standpoint, but also from a legal and compliance perspective.
Still more technology trends are on the horizon that will directly involve
patients. “Important things are coming in the very near future,” Gordan
says. “Significant enhancements to our patient portal, ‘See Your Chart’.
We expect to see more patients accessing their records and connecting
with physicians and staff from iPads or computers from in the waiting
room or from home.”
“Telemedicine,” as Gordan calls it, is the future. He envisions screento-screen connections similar to programs like Skype and Facetime that
link patients directly to their doctors. “If they have concerns or questions
of medications, they will have better access in real time.” The idea is giving
patients access to more information will give them a better understanding
of their health, which ultimately means better management of their care.
“Basically we want to know the mechanics of ‘gear shafts’ that cause
cancer to grow. We can literally stick gum in these gears, so to speak, and
cause the wheels to grind to a halt. We can therefore interfere with the
critical growth pathways — we call them molecular switches. And I tell
patients we are fast and furiously learning how to turn them off,” Rubin
explains.
According to Rubin, a “tremendous explosion of knowledge” in recent
years has helped to make advancements in designing effective drugs. We
have gone from two to 20 “switches” that are now being targeted with
drugs designed to turn them off. At this rate, it could be “lights out” for
cancer very soon.
The second idea is to ask: How do we activate the very potent immune
system and channel it to cancer cells?
“It’s the magic bullet question we’ve asked for 100 years,” Rubin
concedes. “But recently, we may have a better shot at understanding why
the immune system is not focusing on cancers.
“We’ve discovered cancers have an antennae that work like a cloaking
device,” he explains. “They can be like a stealth bomber, they are not
recognizable and deceive the immune system by flying below the radar.
Well, we now have drugs that destroy these antennae and uncloak cancer,
and so the immune system can turn on and eat the cancer, just kill it.”
The problem is some drugs do not always just uncloak the cancer.
Rubin says a key challenge is to figure out how to uncloak the cancer
cells, make the immune system aware of them and then restrict the attack
so the battle is fought just against the cancer cells not the normal cells.
Rubin says he doesn’t know if breakthroughs will be slow or very fast,
but he suspects it will be fortuitous, just like the young patient who took
Erbitux.
Will a cure be found? Rubin says it all depends on how we approach it.
Uncloaking targeted solutions
The health care industry is experiencing the most tumultuous time
in its history. Costs are rising and so are the expectations for quality
and quantity of care. At the same time, when many medical facilities
are merging instead of specializing, FCS is thriving. Part of its success
is undoubtedly due to providing research-based physicians like Rubin
and Gordan with the latitude and motivation to continue to ask the big
questions. Like, what is the future of oncology?
There is much we don’t know, but Rubin is encouraged by the strides
medicine has made in recent years. For this optimist, the future of
oncology is simply about targeted medical solutions. There are two ideas
Rubin looks forward to exploring. The first is the opportunity to better
understand the biology of cells.
“We at FCS, or somebody else, will have that opportunity, but if you
don’t lay the seed, lay the infrastructure and support it, it’s not going to
happen.”
As FCS marks its 30th year, there are many milestones to celebrate.
While we may not have all the answers yet, FCS is clearly taking the lead
when it comes to creating an environment that encourages the best minds
in medicine to keep exploring creative solutions. In that way, the future of
oncology is here and now. n
Summer 2014
7
foundation
Phil Fest 2014
April 5, 2014

events
Top: Dr. Hano playing guitar in his band, Delusions of Grandeur
Bottom Right: Gus Bilirakis with Stan & Veronica - Philip A. Bryant
Melanoma Foundation. Veronica is an RN at our Bardmoor office.
8
FCS The Magazine
foundation
SPINARAMA Livestrong
April 12, 2014

events

FCS patients spin to raise funds for Livestrong Program at the YMCA of Greater St. Petersburg.
Page 8, Bottom: FCS patients (left to right) Dr. Knipe's patient Pat Hirschman (breast cancer - undergoing treatment) and Dr. Ziegler's patient
Kim Miller (breast cancer - remission)
Top Right: Pat Hirschman
Left: Kim Miller
Summer 2014
9
foundation
events
FCS 30th Anniversary Celebration 2014 
The FCS procurement department celebrates the company's 30th anniversary.
Front Row: Rose Ann Meyers and Cathy Marsden-Moffo
Second Row: Dee Sands, Barbara Cox, Colleen Miller, Chelsea Jones and Kelly Albrecht
Third Row: Cindy Miller, Lois Schaffer, Rich Dyson and Amy Bohn
Back Row: Mike Pino, Elaine Laney and Diane Riley
National Medical Laboratory Professionals Week April 21-25, 2014 
During the week of April 21-25, the Pathology and Central Laboratories celebrated National Medical Laboratory Professionals Week. Along with
enjoying daily catered lunches sponsored by vendors, daily themed dress up days and raffles, employees participated in several games to win prizes.
One of the games, dreamed up by Flow Cytometry Manager Silvia Fernandez, was called Harwin's Hair. With Dr. Harwin's approval, all laboratory
employees were given a photo of Dr. Harwin onto which they were to create an interesting hairstyle. Ten entries were submitted and judged by Beth
Bush, Shelly Glenn, Todd Schonherz, Brad Prechtl and Dr. Harwin himself. Michelle O'Hara of the Central Lab took first prize with her pink and black
creation. Dr. Li of the Pathology Lab won second prize with her stippled style. National Medical Laboratory Professionals Week originated in 1975 to
increase public understanding and appreciation for clinical laboratory personnel.
10
FCS The Magazine
foundation
events
Dr. Peles' Fundraiser at
Cantina Laredo 2014 
Top Left: Karen Minder and Dr. Shachar Peles
Bottom Left: Dr. and Mrs. Shachar Peles
Top Right: Group photo
Middle Right: Dr. Augustin Schwartz III and Dr. Shachar Peles
Bottom Right: Dr. and Mrs. Neal Rothschild and Dr. and Mrs. Shachar Peles
Summer 2014
11
insurance
tips
Lawrence D. Share
President
Lawrence D. Share Company Inc.
Do You Multitask? So Does Today’s Life Insurance.
If you’re pondering where your retirement income might come from you may have missed a
source you already have: your life insurance policy.
Today’s life insurance policies may have outpaced the perception of the public: they multitask.
Traditional use of a life insurance policy meant buying it to help protect the financial interests
of surviving family members. In addition to the death benefit, today’s life insurance can help
provide supplemental income and long term care protection.
The Lawrence D. Share Company has
been built with the same characteristics
as successful members of the medical
profession —
­ professionalism, respect
and personal care.
A long-standing commitment to
building relationships with our clients
has been the determining factor in our
success. For the past 40 years, we have
provided quality insurance coverage
tailored specifically to members of
the medical profession. Lawrence D.
Share Company representatives are
top producers with many highly rated
companies that offer solid insurance
products that provide protection
designed for your needs.
Today, more than 5,000 physicians
and health care professionals
throughout the United States depend
on us for comprehensive insurance and
solid financial products.
Lawrence D. Share Company, Inc.
1200 South Pine Island Road, #400
Plantation, FL 33324
(800) 329-5011 | LDShare.com
[email protected]
Using Your Life Insurance Policy For Retirement Income
What most folks don’t know is that cash withdrawn from a life insurance policy is accounted
for as the cost basis coming out first, not the gain. Taking a simplified example, if you had
$250,000 of cash value in your life insurance policy and you paid $150,000 in premium since
it was issued, you would have a nominal increase in the cash value of $100,000 within the
policy. The entire accumulated amount within the policy may be withdrawn to use as retirement
income tax free, as long as the policy owner is careful to keep the policy in force. That’s a valuable
way to supplement your retirement income. Withdrawals of earnings or other taxable amounts
are subject to income tax and, if made prior to age 59½, may be subject to an additional 10%
federal tax penalty. Early withdrawals reduce the death benefit and may be subject to surrender
charges. The reduction of the death benefit may be more or less than the actual amount of
the withdrawal.
Covering Long Term Care Risk Through Life Insurance
Life insurance has always offered a death benefit for survivors. It can also now serve as
financial vehicle to help counter perhaps the biggest financial risk facing retirees — long term
care costs. Some policies are now available with an optional long term care insurance rider. The
rider involves some additional questions and separate underwriting and is available only at policy
issue for an additional fee. It functions as an accelerated death benefit rider, reducing the death
benefit dollar-for-dollar of benefits used. Many Baby Boomers who expect long term care costs
to skyrocket as more people demand such services at the same time 20-30 years from now are
using life insurance to help hedge this risk.
As an example, let’s say you had a $1 million life insurance policy with a long term care rider
and at any point after the policy was issued the insured needed long term care, perhaps at home
or in a facility. Assuming the policy owner chose a 2 percent option, 2 percent of the death
benefit would be available per month to pay for long term care expenses until the policy limit
is exhausted. That’s up to $20,000 per month during the benefit period toward long term care
expenses paid by your life insurance policy — tax free!
Innovative Cash Accumulation Features
The way cash value can be accumulated in some permanent life insurance policies may also
surprise you. Policies are now available which are linked to an index, such as the Standard &
Poors 500 Index, but with, for example, a 10 percent ceiling and a 0 percent floor. Policy owners
cash value is protected from negative returns, but are capped at the 10 percent crediting rate,
which may change during the duration of the life insurance policy. Therefore, the policy owner
enjoys the opportunity to be credited for the growth of this index to potentially grow the cash
value in the policy.
Today’s permanent life insurance policies are innovatively designed to multitask — just like
their owners. And unlike yesterday’s life insurance, you may find there’s more of an opportunity
to use the benefits of your policy without the need to die first.
Creditor Protection
In Florida, life insurance policy owners may benefit from an additional feature of their life
insurance policy, which isn’t even offered by their insurance company — it’s a benefit codified
in Florida state law. The cash value of life insurance (which includes annuities) is protected from
creditors. Properly structured, this protection may extend to the cash value from a life insurance
policy even after the cash is distributed from the policy and may also extend to beneficiaries after
the death of the policy owner. Doctors and other specialized professionals, for example, often use
thoughtful financial planning techniques to protect the assets they have accumulated over their
career from unexpected risks. Life insurance and annuity contracts provide the peace of mind
that these assets are beyond the reach of prospective creditors.
And unlike yesterday’s life insurance, today’s permanent life insurance policies are innovatively
designed to multitask — just like their owners.
Most insurance policies contain exclusions, limitations, and reduction of benefits, surrender charges and terms for
keeping them in force. Your representative can provide you with costs and complete details. 513-20140515-186368
This is an insurance solicitation. An insurance agent may contact you.
12
FCS The Magazine
 Individual Disability Insurance
 Business Overhead Expense
 Group Disability Insurance
 Group Health Insurance
 Variable Life Insurance
 Universal Life Insurance
 Term Life Insurance
 Long Term Care
 Medical Malpractice Insurance
 Legal Defense Insurance
Lawrence D. Share Company, Inc. & Professional Casualty Corporation
1200 South Pine Island Road, Suite 400
Plantation, FL 33324
www.ldshare.com
www.professionalcasualtycorp.com
Phone: (954) 473-5011Toll Free: (800) 329-5011Fax: (954) 472-3982
Summer 2014
13
the radar
screen
What’s on Your Radar?
MEDICARE SAYS NO TO
LUNG CANCER SCREENING
Surfers know the feeling of looking
far off into the slowly approaching swells and
spotting the “one”—the small rise of reflected
sunlight heralding the coming of a huge surfable wave. There are several big waves coming
to the “Oncology Beach” in the next few
years and one of the most interesting is the
lung cancer screening movement. Most of
our hospitals are staffed with heart surgeons
who occasionally perform lung cancer surgery
as an additional specialization. But USPFT
recently recommended lung cancer screening
as part of routine preventive care in highrisk people ages 55 to 70. This is important
because starting in January 2015, under the
Affordable Care Act, private insurance plans
are required to cover lung cancer screening
based on the USPFT recommendations,
and these private insurers are not allowed to
require a co-pay from the patient for these
scans. Common sense, and the hard data,
dictates that these heart surgeons are going to
have a lot more lung cancer work in the next
few years as lung cancer diagnosis shifts from
late stage to early stage.
By Scott Tetreault
✚
It is ironic then that last week the CMS
National Coverage Determination Panel said
that Medicare would NOT cover lung cancer
screening. They cited the fact that in patients
65 years and older, the major trials showed
only a 13 percent — non-significant —
mortality benefit for screening.
compared with controls of similar pre-bypass
BMI who had not undergone the surgery.
Add cancer prevention to the list of benefits.
✚
BRCA MUTATIONS:
DON’T JUST TAKE OUT
THE OVARIES
Another retrospective abstract presented
at the same meeting by Dr. Catherine
Shu demonstrated that in women with
BRCA mutations undergoing risk reducing
gynecologic surgery, removing only the
ovaries while leaving the uterus in place
results in a much higher risk of eventual
aggressive uterine cancer. She followed
525 BRCA patients who underwent only
LAP BAND PREVENTS
CANCER
At the Annual Meeting on Women’s
Cancer in Tampa recently, Dr. Kristy Ward
reported on her retrospective study of 7.4
million inpatient admissions that women
who had undergone bariatric surgery had a 70
percent lifetime reduction in uterine cancer
✚
14
FCS The Magazine
REFER TO XRT?
So your patient had a mastectomy
and had one positive lymph node
and a small tumor. You gave her AC—Taxol
and she’s done, she did great. You start
Arimidex and see her in three months, right?
Ummm, not so fast. A huge meta-analysis of
22 trials, just published in the Lancet by UK
Cancer Research, demonstrates that patients
with 1 to 3 positive lymph nodes benefitted
significantly, both from disease free and overall
survival, with the addition of radiation therapy.
I’m sure that the FCS breast cancer docs will
find a lot not to like about this study, but you
can’t ignore it. It’s probably sensible to have
all node positive women see the radiation
therapist — lumpectomy or not.
✚
oophorectomy for five years and saw 14
times more aggressive biology uterine
cancers (carcinosarcoma, serous cancer,
leiomyosarcoma) than SEER data would
suggest. It doesn’t seem sensible to leave the
uterus in place in these patients.
DID YOU KNOW?
According to the NCCN
Guidelines, ALL women diagnosed
with Endometrial Cancer before the age of
50 should be tested for Lynch syndrome by
germline testing (Myriad, Ambry, Labcorp,
Quest). It’s true.
✚
news
updates
FCS and ION Solutions
Expand Partnership
Welcome to a new “FCS The
Magazine!” We’re pleased to announce
that Florida Cancer Specialists & Research
Institute (FCS) is broadening its long-term
partnership with ION Solutions to deliver
practical clinical, practice management,
and advocacy information alongside stories
about the people who embody FCS. This
alliance will help the magazine become not
only a tool that fosters connections but also
enhances patient care.
✚
FCS became a member of the ION
Solutions group purchasing organization in
1999. As the largest oncology GPO in the
nation, ION has extensive knowledge of
the community oncology market and offers
solutions that enable community oncology
practices to improve operational efficiency,
financial performance, and quality of
care. Through its Community Counts
advocacy campaign, ION advocates on our
behalf so that we may realize our mission
of providing world-class cancer care in
community-based settings close to home.
FCS Selects Oncology
Supply
FCS will now be sourcing all
of its chemotherapeutic and supportive
therapy products from Oncology Supply,
a unit of AmerisourceBergen, one of the
largest global pharmaceutical sourcing and
distribution services companies.
✚
"We're very pleased with the new
contract and continuing our long-term
partnership with Oncology Supply and
ION Solutions," said Dr. William Harwin,
founder, president, and managing partner
of FCS.
The new agreement builds on an existing
15-year collaborative relationship between
these two industry-leading organizations.
The expanded partnership enhances
existing supply chain efficiencies by
consolidating all injectable, infusible, and
oral purchases into one supplier.
“Our decision to transfer our oral
chemotherapy to Oncology Supply
expands an integral relationship,” said
Brad Prechtl, chief executive officer of
FCS. “Because the majority of adult cancer
patients throughout the country are treated
in a community oncology setting like
FCS, it is critical that our physicians and
clinicians be able to provide all necessary
treatments immediately and close to home.
Working with Oncology Supply allows
FCS to have all necessary chemotherapy
treatments readily available to cancer
patients in the communities we serve.”
“Our relationship with Florida Cancer
Specialists is one that shares expertise and
drives innovation,” said AmerisourceBergen
Provider Solutions President Dave
Leverette. “The AmerisourceBergen
organization helps clients shape healthcare
delivery with unparalleled knowledge,
reach, and partnership. We’re excited FCS
chose to expand our relationship.”
TRUE
Warrior
R
FLO
ANCER SPECIALISTS SALU
I DA C
TES
A
Karen Warmack is not only ghting her own personal battle
with cancer, but is speaking out on behalf of others battling
the disease. She recently testied in support of “The Cancer
Treatment Fairness Act” before Florida lawmakers. Her
testimony led to the enactment of the law.
Florida Cancer Specialists Medical Oncologists
Scott Tetreault, MD • Viralkumar Bhanderi, MD • Paresh Patel, MD
Tallahassee Location
1600 Phillips Road, Suite 300
Tallahassee, FL 32308 | (850) 877-8166
Tallahassee North Location
2626 Care Drive, Suite 200
Tallahassee, FL 32308 | (850) 219-5830
FLCancer.com
Summer 2014
15
Doctor & Nurse Spotlight
Dr. Nuruddin Jooma &
Sarah Boses, R.N.
Integrative Medicine
A complement to traditional remedies that helps
patients through treatment and beyond
By Lynda Belcher
A
cancer diagnosis brings about a flurry of thoughts
about the course of treatment — chemotherapy —
and the ways in which the patient’s life is about to
drastically change. Often, further down the list, other
elements are considered: dietary changes, living healthier, relaxing
more and other components of an emerging
field of treatment known as integrative
oncology.
At Florida Cancer Specialists &
Research Institute (FCS), the Integrative
Oncology and Wellness Services program
is the umbrella term for an array of
treatments that range from massage therapy
to acupuncture to yoga and beyond. They
are often used as a complement to standard
cancer remedies. This is something that
Dr. Nuruddin Jooma and his nurse,
Sarah Boses, have discovered to great
success. Working out of the Pinellas and
Hillsborough County FCS offices, Jooma
and Boses are the driving force behind this
innovative concept.
"Integrative medicine allows us to treat
the whole patient,” says Jooma. “Every
little bit helps. We are able to customize a
complementary program based on what
type of cancer they have, what type of
therapy they are receiving and what side
effects they are having from treatment.”
Integrative medicine
allows us to treat
the whole patient,”
says Jooma. “Every
little bit helps. We
are able to customize
a complementary
program based on
what type of cancer
they have, what type
of therapy they are
receiving and what
side effects they
are having from
treatment.” — Dr. Jooma
The Integrative Oncology and Wellness Services directive
incorporates a number of components. Patients have access to
16
FCS The Magazine
massage therapy to manage muscle and bone pain and improve
anxiety and fatigue; acupuncture or acupressure to mitigate
neuropathy or decreased appetite; yoga for stress reduction and
insomnia; nutritional counseling and cooking classes to reduce any
need for dietary supplements; exercise for quality of life; meditation
for physical relaxation; music and
art therapy for stress reduction and
more. Benefits of integrative medicine
include the fact that patients are
encouraged to be hopeful and think
positive, which are instrumental to
successful outcomes. Moreover, it
promotes a sense of wellness before,
during and after cancer treatment and
reduces the emotional stress of the
process.
Jooma and Boses both found
their path to integrative medicine after
working in more generalized fields of
medicine.
Jooma initially started his career
with little interest in oncology until a
clinical rotation changed everything.
In a move that changed his professional
perspective, Jooma says that one clinic
— in which he worked with cancer
patients — ended up with a realization
of what he wanted to do with the rest
of his life. As he delved further into
his oncology work, Jooma found that his interest in integrative
medicine continued to grow. Despite the fact that his education
hadn’t intensely focused on this area of medicine — he cites just one
Summer 2014
17
Doctor & Nurse Spotlight
lecture on nutrition in three years of residency — he knew it could
help his patients.
She joined us and it has really taken off. She is the ideal person to
run this program and work with these patients.”
"Once you talk to patients about their diagnosis, they
immediately want to know about lifestyle changes,” he says. “They
bring you a box of supplements to try to ‘cure’ the cancer. I found
that we could instead supply them with standardized, evidencebased information so they are not getting ripped off or using
products that are unproven.”
Boses actually brings a personal background in integrative
therapies to the team. She says that homeopathic therapies have
always been a part of her personal care routine. In fact, she successfully
utilized acupuncture to help with childhood allergies versus
medicinal remedies.
As Jooma moved in this new direction, he began to work
more closely with Boses, who was working as a chemo nurse at the
time. “This program is fortunate to have Sarah,” he says of Boses.
“When others saw the benefit of what the program could do, and
it continued to grow, I knew we needed someone to coordinate it.
18
FCS The Magazine
Like Jooma, Boses had targeted a much different direction for
her career in medicine. She initially wanted to work in a hospital
but, after a short stint, found she had much less time with her
patients than she would have liked. After taking an opportunity
in oncology, Boses found that this was the environment in which
she could make a difference. She could take the time to sit and talk
What we teach the
patients here is what
can be done to play a
more active role. They
begin to feel like what
they are doing gives
them some control.”
— sarah boses
with her patients. Moreover, she was able to assess the fact that they were not okay, physically or emotionally. Through her work in oncology,
Boses found she could address the emotional part of their journey, the physical components of the disease and their general wellness.
In fact, the ideal integrative medicine approach focuses on the wellness of the patient from the time of diagnosis into survivorship. It
teaches them how to make optimal lifestyle decisions. According to Boses, many cancer diagnoses can be prevented through healthier choices.
Moreover, proper treatment can guard against recurrence. The program focuses intently on this with survivors as well as those currently
struggling with the disease. “We can’t control everything,” says Boses. “What we teach the patients here is what can be done to play a more
active role. They begin to feel like what they are doing gives them some control.”
As the concept gains traction within FCS, Jooma points out that this is just the pilot stage. Citing statistics that say the risk of cancer
can be reduced by as much as 67 percent through lifestyle changes alone, his goal is to show this through integrative techniques. Through
continued patient successes, there are plans to add a dietician with oncology experience to the team and integrate the program into other
FCS offices.
"Many of our cancer patients are living longer,” says Jooma. “We want to help them make those lifestyle changes that are going to be just
as important to them even beyond treatment.” n
Summer 2014
19
office Spotlight
20
FCS The Magazine
Sebring is Central to its
Rural Community
Sebring grows its ‘Big City’ services
to small rural towns
By Zandra Wolfgram
C
heery light blue walls and warm wood-framed artwork
that depicts comforting naturescapes of refreshing
rivers flowing through lush forests and soothing sunset
scenes await patients at
Florida Cancer Specialists’ (FCS) Sebring,
Florida location.
Centered in the Sunshine State two
hours south of Orlando, Sebring is also
called “The City on the Circle” in reference
to its circular drive in the center of the
town’s historic district. Founded in 1912,
it was named after George E. Sebring, a
pottery manufacturer from Ohio who
developed the city. It is a rural community
and this FCS site services Highland and
Polk counties. But being situated in a
small town does not necessarily mean the
pace is slow. This FSC site is experiencing
its greatest growth since merging with the
practices of Drs. Syed Ahmed and Amit
Shah to become an official FCS center in
July 2010.
practice to increase its infusion chairs from 12 to 21. “We
really like the space, we have a lot more room and we are
getting a great response from our patients,” says office manager
Heather Burke.
We really like
the space,
we have a lot
more room
and we are
getting a great
response from
our patients.”
— Heather Burke
In March, local dignitaries gathered to cut the ribbon
on the expansion, which doubled the size of the office from
4,000 to 8,000 square feet. The extra space enabled the
And it has not gone unnoticed by
local leaders. Mayor George Hensley
heralded FCS and its new office during
the ribbon-cutting ceremony, saying,
“The physicians and staff at Florida
Cancer Specialists are devoted to
their patients and passionate about
community-based oncology. For many
patients fighting cancer, the ability to
receive the most advanced treatments in
a setting close to home is beyond measure
and I want to recognize FCS for their
ongoing service and commitment to the
Sebring community.”
Burke, 35, is a Lakeland area resident
and a 14-year veteran of the health care
industry. She joined the Sebring team in
2012 and says the expansion allows this
FCS office to better serve its market. “We’re essentially the only
FCS practice centrally located between Orlando and Lakewood
Ranch, and our patient demand was increasing. We are averaging
Spring 2014
21
office Spotlight
22
100 patients a day between our office and our mobile PET.
Unfortunately, oncology is growing all the time. This expansion
allows us to meet the growing needs of our patients in the area.”
we are a rural community. We know people here on a first name basis
so it’s even more important to us that we are closely connected with
our patients.”
Though the physical makeover of the office certainly elevates the
healing atmosphere of Sebring, the patients will likely tell you that
the secret to Sebring’s success is a caring staff whose single priority
is keeping them first in mind. “We are big on building relationships
with our patients,” Burke says. “We know their names. We joke with
them. We bond with them.” For this team it’s simply part of the
culture to operate with a can-do attitude to be sure each patient not
only receives the best care but also has the best possible experience.
Sebring makes first impressions a top priority. The front line
staff makes it a point to learn as much as they possibly can about
each patient to put them at ease. “From the moment they arrive to
the time they leave, our team is working so that by the second visit
there are no questions. We know their name, their family and we
clearly understand why they are here,” Burke says. “They may come
in scared, but they often leave with laughter. If we make them smile,
it’s a success.”
From the receptionist taking note of each family member’s
name to physicians making personal phone calls to worried patients,
Burke says the entire Sebring team makes a conscious effort to treat
every patient as a VIP. “Every employee here goes out of their way to
be sure a patient is satisfied — from securing a financial counselor
to customizing an appointment to better fit their schedule, we
make every effort to personalize each visit to our patients. We will
move appointments, come early or stay late, whatever it takes.”
Bigger doesn’t necessarily mean better when it comes to patient
care. Sebring is a community of just over 10,000, but the office is
proud to say it “upholds” the FCS vision and mission every day. “We
make patients feel at home,” Burke says. “We are not a big metropolis,
Though Sebring has state-of-the-art technology for maintaining
online records and tracking patients’ progress, for these caregivers
nothing is more powerful than basic human contact when someone’s
life may be at risk.
FCS The Magazine
"We have patient reminders by computer, sure, but that’s not
enough,” Burke insists. “We also contact patients from the office. We
think it’s important that an actual person answer all of their questions
before they arrive for their appointment. When they come, they are
fully prepared, they know what to bring, they know how long they’ll
be here … they know what to expect.”
Patients can also expect deep expertise. Together, Ahmed and Shah have been practicing
oncology for nearly 50 years; the nursing staff has 40 years of collective caregiving. Along
with making themselves accessible by sharing personal cell phones and donating time to
various charities and causes in the community, for these oncology physicians every outreach
is an opportunity to heal.
"Medical treatment is obviously critical, but at the same time the supportive care from
their own family members and our nursing and office staff is equally important. We not
only treat their medical condition, but help them spiritually … and with just general well
being,” says Dr. Shah.
And with the expansion comes an increased capacity for Sebring to help and heal
even more. n
We are not a big
metropolis, we are a
rural community. We
know people here on a
first name basis so it’s
even more important
to us that we are
closely connected
with our patients.”
— Heather Burke
Summer 2014
23
Cancer Cuts by the Numbers
cancer patients in the United States receive care at a
community-based cancer clinic or local doctor’s office.
If sequestration forces those clinics to close, those
patients would have to travel farther for their care.
Tell Washington to
#SaveCancerCare
Urge Washington to repeal
sequestration cuts to cancer care for
Medicare patients now!
Learn more and take action at
www.ourcommunitycounts.org
research Spotlight
FCS Central Lab
Keeping it cool and calm at Central Laboratory
By Zandra Wolfgram
W
hat is on your to-do list? If it includes five
million items, you likely work at the Fort
Myers-based Florida Cancer Specialists
(FCS)
Central
Laboratory, which supports over 70
FCS locations with testing anything not
handled onsite.
Five million is the annual
benchmark lab manager John Hodson
has set. “Last year we processed only
4.98 million tests and I was pretty
upset,” he concedes. What will he do if
he reaches his big goal? “Raise it,” he says
without hesitation.
Hodson says the daily challenges of
the Central Lab make it a “dream job,”
and with six years of training — he is
a specialist in Hematology, a Medical
Technologist, a Medical Technician and
holds a bachelor’s degree in Medical
Technology from the Florida Institute of
Technology — he is well qualified.
It’s all about
accuracy and
not getting
overwhelmed,
and if you
expect the
worst you
are really
disappointed.”
The 3,000-square-foot laboratory is an open, airy space
with benches resting under long worktables dotted with
laptop computers. Other than the constant whirring sound
of analyzers, it’s fairly low key … somewhat like the eye of a
26
FCS The Magazine
hurricane. Hodson, 54, is a calm, cool and collected character.
He has to be. In his line of work, accuracy is mandatory and
it isn’t about his reputation for being right; lives may depend
upon it.
"It’s all about accuracy and
not getting overwhelmed, and
if you expect the worst you are
really disappointed,” the technical
expert says evenly.
Here, everyone feels the need
for speed. Every effort is made to
begin testing within four hours
of receiving a sample and turning
around results within 12. The lab
realizes time is of the essence when
someone is waiting on medical
test results for what could be a lifechanging event.
Being methodical, careful and
detail oriented is how this team
tackles each test. “Staying in
the box” is a good thing when
it comes to following precise lab procedures. The process
is fairly simple. Doctors order tests in the EMR system,
which transfers the order to the lab system. A machine
reads the bar code, sees the test and conducts the test.
— John Hodson
Summer 2014
27
research Spotlight
You focus on what
you are doing to help
patients. If you can
help someone get their
results quicker, so they
are not worrying, that
is something.”
The Central Lab runs up to 12,000 tests in a day on 3,500
samples, all of which center around analyzing blood and serum and
running chemistry analyses.
That may seem like a lot, but they actually have a capacity
to do even more. “In theory, we can do 11,000 tests an hour,”
Hodson says. “All we have to do is get them on the machine. If
you tested glucose you could do that many, but when you switch
back and forth between various tests, you invariably do less.”
The most common test performed is CMP (comprehensive
metabolic panel), which is a group of blood tests that provide an
overall picture of the body's chemical balance and metabolism — how
the kidneys and liver are working; blood sugar, cholesterol and calcium
levels; electrolytes.
Once a test is completed and results are generated, the lab team
checks them and the info is electronically relayed from the Central
Lab back to the physician who ordered it. The physician receives an
alert within the EMR registering normal, abnormal or critical alert.
If something doesn’t add up, Hodson’s team takes another look and
repeats the process if needed.
"We have about a 3 to 4 percent repeat rate. With cancer
sometimes the results are really funny, but usually even when we repeat
the tests they are what they are,” he says.
28
FCS The Magazine
— Michelle o'hara
Working well under pressure is part and parcel of the job. And
the entire team takes things in stride.
A closely-knit team of six keeps the place humming. Reporting
to Hodson are a quality assurance analyst (Michelle O’Hara), two
medical technologists (Adam Feikert and Mark Sibold), a medical lab
technician (Elaine Van Horn) and an aide (Chris Brightbill). They
banter and share a sense of camaraderie, but they keep highly focused.
Michelle O’Hara handles quality control and has worked in the
lab for FCS for 10 years. She loves the atmosphere and says Hodson
is a big reason why. “He’s the best boss ever. He doesn’t micromanage
anyone,” she says, adding, “I think that everyone that works here feels
really lucky. We get so much stuff done, but there’s no stress. Everyone
loves coming to work. Turnover is small, because no one wants
to leave.”
Knowing you may be the bearer of bad news to several
patients every day could be depressing for some. This team
keeps a positive perspective. “You focus on what you are
doing to help patients. If you can help someone get their
results quicker, so they are not worrying, that is something,”
O’Hara says. n
Summer 2014
29
legislative
soundbites
Stopping the
Destructive Sequester
Cut to the Payment of
Cancer Drugs
Our country has been struggling with
the effects of sequestration since its
implementation last year. Cancer care has
been hit extremely hard during this process
due to the inappropriate manner in which the
Center for Medicare and Medicaid Services
(CMS) applied the sequestration to cancer
drugs. The decreased reimbursement, in
many instances, doesn't even cover the cost
of the medications given in our community
cancer clinics. As a result, patients are either
being shifted to the hospitals for their care
(which is more expensive for the patient and
taxpayer), or clinics across the country are
closing their doors or merging with hospital
systems.
✚
Advancing Payment
Reform that Enhances
Quality and Increases
Efficiencies
Community Oncology Alliance has been
championing the development of the
Oncology Medical Home payment reform
model for cancer care delivery. The model
establishes defined measures of cancer care
quality, rewards providers that provide the
highest quality of cancer care, is budget
neutral and evolves to a shared savings with
bundled payments for episode of care. The
oncology community has the best developed
sub-specialty health care delivery model that
optimally meets the requirements from the
Affordable Care Act and was designed to
ensure patients receive state of the art, quality
driven health care with a focus on value.
✚
Achieving Payment
Parity for the Identical
Services Regardless of
the Site of Delivery
Outpatient chemotherapy can be
administered in community cancer clinics or
in hospital outpatient facilities. Two different
reports (one from Milliman, the other from
Moran) published in 2013 demonstrated that
✚
30
FCS The Magazine
cancer care delivered in hospital outpatient
facilities cost 25-to-50 percent more than the
exact same medications given in a community
cancer clinic. This disparity will be increasing
since the Center for Medicare and Medicaid
Services decided to increase payment for
chemotherapy administration to hospital
outpatient facilities for 2014.
Reigning In and
Refocusing the Out-ofControl 340B Program
The 340B Program was intended to help
✚
provide economic resources to those hospitals
that see a disproportionate amount of
uninsured patients. This program has minimal
restrictions and oversight has been exploited
by many institutions and has become a major
source of revenue. Studies have shown that
80 percent of the indigent patient care is
provided by 20 percent of the hospitals that
have been designated as a 340B. The overall
effects of this out of control program have
resulted in increased insurance premiums,
increased expense to taxpayers, increased cost
of pharmaceutics and increased shortages of
generic medications.
Getting patients the critical medications and therapies they need
at the moment they need them takes more than packing trucks. It
takes a global healthcare solutions leader dedicated to enhancing
patient care through end-to-end solutions for manufacturers,
pharmacies and providers. It takes security, accuracy and consistency.
It takes horsepower and brainpower. It takes AmerisourceBergen.
ItTakesAmerisourceBergen.com
Summer 2014
31
A cancer diagnosis
changes everything.
Fighting cancer is a long journey. Florida Cancer Specialists
Foundation helps make the road a little easier.
We deeply care about our patients and their struggles. Florida Cancer Specialists Foundation was created
to help patients who need fi nancial assistance while undergoing treatment. The Foundation allows those
fighting their battle with cancer to concentrate on recovery rather than their overdue rent, mortgage,
electric or water bill.
Please visit our website for ways to donate. Florida Cancer Specialists Foundation is a 501(c)(3) non-profit organization.
1600 Phillips Road, Suite 300 | Tallahassee, FL 32308 | (850) 877-8166
Foundation
2626 Care Drive, Suite 200 | Tallahassee, FL 32308 | (850) 219-5830
foundation.flcancer.com