» VA Care for Women

When Peggy Mikelonis returned from serving as a nurse in Vietnam in the 1970s, she landed a job at the VA — but she didn’t get her own medical care there. In those days, there simply weren’t a lot of services available to women, she recalls.

Four decades later, women veterans are the fastest-growing segment of the veteran population, and the VA is making women veterans’ health care a top priority. “We have lots going on in all of our facilities,” says Mikelonis, the Women Veterans Program manager for the VA network serving veterans in Florida, south Georgia and the Caribbean.

All main facilities in her network have onsite gynecologists, and by the end of this year, all will also offer onsite mammography. For four years now, the VA has also been conducting weeklong training sessions for health care providers called “mini-residencies” that focus on the health care needs of women. The VA is also committing more research to women’s veterans health, says Mikelonis, particularly as it relates to post-traumatic stress disorder and the issue of military sexual trauma.

“Early on, the things we were worried about were whether we could get pajamas for women and sanitary dispensers. Now we’re looking more at the clinical outcomes, the care we provide for women,” says Mikelonis, who now receives her own care at the VA.

 

» Telemedicine

Since 2007, Consult A Doctor has offered consumers 24/7, on-demand access to its nationwide network of physicians who can consult and write prescriptions via phone, email or videoconference.

This summer, the Miami-based company launched MyPractice 24/7, which allows private practice doctors to use the company’s telemedicine technology to provide after-hours care exclusively to their own patients. Participating doctors can customize their price plans but typically charge their patients a monthly subscription fee for access to MyPractice 24/7, as well additional fees for diagnostic consultations. Consult A Doctor, which provides its telemedicine platform free to participating providers, gets a fee for each consultation.

Douglas Smith, a Minnesota internist who is chief medical officer for Consult A Doctor, says the service provides a great opportunity for additional revenue stream for physicians. “With this model, they get to capture a lot of that revenue that goes to urgent care, retail clinics and the ER — and it also binds the patient more tightly to your practice.”

 

» The Cough Doctor

For most people, a cough is just a temporary nuisance that comes on quickly because of a common cold or other viral infection and goes away within a week or two. But for others, a cough can become a chronic problem that lingers for months or years and interferes with their daily life.

“It’s a debilitating problem. These patients, when we interview them, say, ‘I’m depressed. I’m anxious. I don’t want to go out or attend church or go to the theater because I’m afraid I’ll cough.’ So this isn’t just a nuisance — it really has significant consequences,” says Dr. Mandel Sher, who has expanded his practice by creating a niche treating patients suffering from chronic cough and throat clearing.

A specialist in asthma, allergy and immunology as well as pediatric rheumatology, Sher says he uses an interdisciplinary approach to treating patients who come to his Center for Cough in Largo. He says he can do virtually all the same tests that a pulmonologist, gastroenterologist or ENT would do in trying to diagnose a chronic cough patient.

Sher says chronic cough is usually caused by one or two underlying problems, the most common of which are asthma, postnasal drip, gastro-esophageal reflux disease and ACE inhibitors, which are a type of blood pressure medication. Some people — women, in particular, he says — are also “hardwired for coughing” because they have a heightened cough reflex. Identifying the causes and treating each one, he says, is the key to getting long-term relief. Depending on the cause, treatment can range from medication to diet changes, other lifestyle changes and voice exercises.

Sher says he sees several patients each month at his Center for Cough, housed within his allergy practice, but says it’s gaining traction primarily through the internet and word of mouth. Most important, he says, his patients are seeing results. Most report a cure, or at least significant improvement, within one or two visits, he says.

 

» Domestic Violence Screening

There were 111,681 reported domestic violence offenses in Florida last year. It’s estimated, however, that more than 25% of all cases of domestic abuse go unreported.

“Most of the time, the patients who are victims are not telling because they are afraid and you can see it in their body language,” says Ademola Adewale, an emergency medicine physician at Florida Hospital, which has partnered with Harbor House of Central Florida, an Orlando shelter for victims of domestic abuse, in launching a domestic violence screening app that will help health care personnel identify people in danger or at risk of being harmed.

The R3 app uses four screening questions to assess whether a patient may be a victim of abuse. Adewale says Florida Hospital plans to incorporate the app into the triage process in the ER when medical personnel are taking down a patient’s history and that it will eventually be built into the hospital’s electronic medical record system.

Patients who are identified as being at-risk can then be referred to the appropriate community advocacy services for help.

 

» Mental Health Focus

Mat Robie, director of strategic alignment at United HomeCare, one of south Florida’s largest home health agencies, says hospitalizations and “avoidable” hospital readmissions tend to be more prevalent among patients suffering from depression.

To try to combat the trend, United HomeCare is taking a more holistic approach to patient care by incorporating tools and programs that focus on the mind-body connection. The non-profit’s home health aides, for instance, are trained in yoga therapy, and the organization has also implemented a Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) program that teaches case managers to identify depression in at-risk seniors and help them get treatment. The agency is also using telehealth devices to screen for depressive symptoms in patients. While most patients prefer home care to nursing home care, it’s also considerably cheaper.

Robie estimates that in Miami-Dade County, nursing home care costs $90,000 per year, on average, whereas home care costs approximately $15,000 a year.

 

» Concierge Service

When Florida Trend wrote about the concierge medicine trend six years ago, MDVIP, a Boca Raton-based management company that helps doctors convert to a concierge practice, had contracts with 100 physicians covering 33,000 patients. Today, the company has more than 550 physicians caring for more than 185,000 patients.

Under MDVIP’s concierge model, patients pay $1,500 to $1,650 a year to the doctor. That entitles them to extensive wellness screenings, in-depth appointments and counseling with the doctor. They also get the ability to reach the doctor at any time and appointments that are promised to start on time. MDVIP physicians, meanwhile, agree to care for only 600 patients, as opposed to the 2,400 or so a typical physician sees.

Andrea Klemes, medical director for MDVIP, says that Medicare patients cared for by MDVIP physicians in 2010 were admitted to the hospital 79% less frequently than other Medicare patients and that patients with private insurance were admitted 72% less. “We had better diabetic outcomes, better cardiovascular disease outcomes — our outcomes beat the top 10 benchmarks,” Klemes says. “We saved the government $300 million last year in decreased hospitalizations.”

 

» AIDS Aid

The University of Miami has partnered with Magic Johnson Enterprises and Clear Health Alliance, a managed care Medicaid specialty plan for HIV/AIDS, to reach the growing HIV/AIDS population in south Florida with services. Miami ranks first nationally in new AIDS cases per capita and Broward ranks second. UM Miller School of Medicine doctors created a team to provide managed care to Medicaid AIDS patients. Clear Health, offered by Coral Gables-based Simply Healthcare Plans, a managed care company, says it eventually will expand to other Florida cities and nationally.

 

» Post-Stroke

Riviera Health Resort in Coral Gables got its start at the site of an early Miami-Dade nursing home, built in 1952, that served as the location for the Cocoon movie sequel. That 50-bed nursing home was torn down several years ago, and developer Richard E. Stacey Sr. spent $40 million to build a new, for-profit 223-bed facility for short- and long-term care, particularly for post-stroke patients and those who have had hip or knee replacements. A floor is set aside for international medical tourists.

 

» Help Wanted

Three-quarters of Florida hospitals report difficulty filling the following positions:

Position	Vacancy Rate
Occupational Therapist	10.4%
Radiology Therapist	9.8
Pharmacy Technician	7.7
Speech Pathologist	7.2
Physical Therapist	6.3
Pharmacist	6.2
Certified Surgical Technician	6.0
Medical Transcriptionist	5.4
Medical Records Coder	5.2
Medical Technologist	4.6
Ultrasound Technologist	4.4
Nuclear Medicine Technologist	4.4
Cardiovascular Technician	3.7
Medical Laboratory Technician	3.5
Respiratory Therapist	3.3
Radiologic Technologist	3.3
Computer Tomography Technician	2.5
Mammography Technician	2.2
MRI Technician	1.7
Source: Florida Hospital Association

 

» Senior Well-Being

A goal of senior care is to move beyond simply providing drugs and treatment of immediate illness toward prevention and well-being. At the two Healthy Living Centers opened this year by Leon Medical Centers, a for-profit Medicare HMO in Miami, for instance, seniors take yoga, Pilates, stretching and Latin dance and have access to a gym where patients can track their work on individual machines on a thumb drive. The centers, two more of which are opening this year, also provide Skype, computer classes and social media, all offered to keep age from equaling marginalization.