Karen M. Burdash, MBA, is retiring this month after 28 years of providing financial management expertise to the USF Health Morsani College of Medicine (MCOM), its departments and its practice plan, the USF Physicians Group.

Working across the three missions of USF Health – education, research and clinical care – Burdash spent a career advising deans, chairs and directors on best practices for managing budgets, offering strategic planning for both tough economic times and times of careful growth, and acting as the go-to person for a range of special projects for USF Health leadership.

In looking back over a career of staying immersed in budgets and spreadsheets, she is quick to use a classic accounting joke: “There’s nothing humorous about finance.”

Burdash, who is associate dean for finance for MCOM, joined USF in 1989 when she was hired as practice administrator for the Department of Anesthesiology. Since then, she has managed the finances, offered financial analysis, forensics, self-audits, and process improvements to nearly every area across the medical school and practice plan. More recently, she focused her time on faculty and program performance, process improvement, and faculty outreach, using metric-driven evaluation processes.

She also served as a resource to the MCOM executive leadership team, including Harry van Loveren MD, professor and chair of the Department of Neurosurgery and Brain Repair in MCOM, vice-dean of Clinical Affairs for USFPG, and CEO of the Byrd Alzheimer’s Center and Research Institute.

“Karen Burdash has always been one of my ‘heroes’ in the USF Administration,” Dr. van Loveren said. “Some people give you all the information you ask for but Karen always gave me all the information I truly needed when I wasn’t smart enough to ask for it. She was the one I could sit down with and ask ‘Karen, what’s really going on here?’ and she would calmly tell me the truth, the whole truth, and the history behind the truth. I will miss her wise counsel but I refuse to relinquish her friendship.”

That feeling of support and good counsel is shared by Jerome Yankowitz, MD, professor and chair of the Department of Obstetrics and Gynecology for MCOM.

“There are certainly few with Karen Burdash’s experience,” Dr. Yankowitz said. “She has been a staple at USF Health for 28 years and I have had the honor and pleasure to know her for the last 6 of those. She is the person I would often go to, to get the final and true word. She was the source of endless and accurate data. Her integrity is unquestionable. Given the peculiarities of available data at USF, she was a master at ferreting out the kernels of truth and thus it will be a challenge for others to be more able at what she did. Karen truly gave of herself to this institution and deserves a great, happy and long retirement.”

Paula Knaus, associate dean of Faculty Affairs for the College of Public Health, also appreciated working with Burdash.

“I worked closely with Karen for the 10 years that I served as the associate vice president for Faculty Affairs and can say without hesitation that Karen is one of the brightest individuals I have had the pleasure to work with at USF,” Knaus said. “Karen is a consummate professional with a strong work ethic and impeccable moral standards and will be sorely missed at USF Health. Congratulations to Karen for an outstanding career. It is now time for Nick (husband) and her wonderful family – and, of course, her prized sheepdogs!”

Reflecting on her time and service at USF Health, Burdash is quick to offer some primary lessons she has learned: identify knowledgeable people to be your mentors and listen closely to their words of advice, and if you’re not committed to your job go find another one.

“Be open minded, tenacious, committed and flexible,” she added.

She was quick to acknowledge three individuals who were instrumental in contributing to her success at USF Health.  Joann Strobbe, her “boss” for many years, friend, and anchor.

“No matter what the assignment across Health, Joann gave me strength, encouragement, and my home department,” Burdash said.

Also, Stewart Slayton and Ted Ascherfeld, her employees for many years.

“They were not just a key part of my team, they were MY go-to experts, my rocks, colleagues, and ultimately, friends,” she said. “As you can tell, a 28 year career relied on team work and developed strong friendships.”

In her retirement, she will spend more time on her other hobbies, like sailing, fishing (she’s teaching her granddaughters, ages 6 and 8), stained glass, gardening, traveling, and flying – she is a licensed pilot.

“Years ago, I used to do a lot of photography, so I hope to also pick that back up,” she said.

And, of course, she will spend more time training and showing her Old English Sheepdogs, Beau and Gracie. Burdash has trained many who have earned champion titles at dog shows winning a Best in Show and a Best in Specialty Show with her Grand Champion Eric.

Friends and colleagues from across USF Health gathered July 10 to wish Burdash off to a good retirement.

Tampa, FL (May 24, 2016) –  Tampa Bay Health Alliance, LLC, (TBHA) today announced its formation as a new partnership of five leading medical groups, creating a clinically integrated network designed to provide accessible, higher quality and more efficient health care to Tampa Bay area patients and their families while controlling costs.

The five members are Florida Medical Clinic, Florida Orthopaedic Institute, Pediatric Health Care Alliance, Women’s Care Florida, and USF Physicians Group. While the partnership sets in motion a new collaborative relationship among these five members, each group will continue to operate independently. Collectively, the five groups total more than 1,300 health care professionals caring for more than 750,000 patients throughout the Tampa Bay region.

In agreement to launch the TBHA are, from left, Dr. Chandresh Saraiya of Florida Medical Clinic, Dr. Ira Riemer of Women’s Care Florida, Dr. Edmund Funai of USF Physicians Group, Dr. Roy Sanders of Florida Orthopaedic Institute, and Dr. Karalee Kulek-Luzey of Pediatric Health Care Alliance.

“We have amassed physicians and care providers who understand the changing health care environment and who are willing to work in a cohesive, collaborative way to drive positive changes for the Tampa Bay community,” said Chandresh Saraiya, MD, Chairman of the Board for TBHA. “As TBHA evolves in the Tampa Bay region, it will serve as a model for true population health.”

With more than 1,300 primary and specialty care physicians and health care practitioners, TBHA is well positioned to meet the challenges of a health care industry transitioning from today’s expensive fee-for-service system that tends to encourage excessive treatment to a value-based model of care emphasizing better health outcomes at lower overall costs.

In concert with new efforts and requirements to reduce costs and improve care for entire populations – population health – patients will likely benefit most from this collaborative partnership, said Daniel B. Vukmer, TBHA’s Chief Executive Officer.

Daniel Vukmer, CEO of the Tampa Bay Health Alliance.

“By connecting and coordinating our care systems into a larger, integrated network that shares resources, measures health care utilization and enhances coordination of care, TBHA is poised to greatly increase the efficiency and quality of care offered to patients,” Vukmer said.

Clinically integrated networks (CINs) are networks of providers who, together, can have greater impact on managing population health and improving patient outcomes, as well as optimizing costs and meeting quality metrics.

Each of TBHA members will focus on providing value-based health care services in their existing service areas, including Hillsborough, Pinellas, Pasco and Manatee counties.

# # #

Florida Medical Clinic is a physician owned multi-specialty practice comprised of a team of nearly 300 highly skilled providers representing over 35 medical disciplines. Florida Medical Clinic provides care in over 50 locations throughout Florida’s Hillsborough and Pasco Counties. Established in 1993, FMC remains true to the core belief: to make patients the first priority and to continue to develop as a high performing medical group that focuses on value based programs for area communities.

Florida Orthopaedic Institute, founded in 1989, is one of Florida’s largest orthopedic groups and provides expertise and treatment of orthopedic-related injuries and conditions, including adult reconstruction and arthritis, chiropractic services, foot and ankle, general orthopedics, hand and wrist, interventional spine, musculoskeletal oncology, orthopedic trauma, physical medicine and rehabilitation, physical and occupational therapy, sports medicine, shoulder and elbow, spine, and orthopedic urgent care, among others. Comprised of 150 providers, including 43 board-certified physicians, the organization treats patients throughout the Tampa Bay area and beyond across ten locations, including Bloomingdale, Brandon, Brooksville, Citrus Park, Northdale, Palm Harbor, South Tampa, Sun City Center, North Tampa, and Wesley Chapel.

Pediatric Health Care Alliance (PHCA) is the largest single-specialty pediatric group on the West coast of Florida. Comprised of 41 board-certified pediatricians and six board-certified ARNP and PA providers at 12 neighborhood locations, PHCA provides a comprehensive network of primary health care for over 75,000 children in Tampa Bay. PHCA is nationally recognized as a Patient-Centered Medical Home by the National Committee for Quality Assurance, and has developed a pediatric population health management program to enhance quality and patient outcomes. Established in 1997, PHCA is strongly committed to local growth in Tampa Bay and to preserving independent ownership by our pediatricians.

Women’s Care Florida is a multi-specialty, women’s health, physician group offering patient care services in obstetrics, gynecology, gynecologic oncology, urogynecology, gynecologic and breast pathology, breast surgery and maternal-fetal medicine. The group has over 150 providers in over 20 outpatient locations, including a women’s services laboratory and a breast center.

The USF Physicians Group is the faculty practice plan for the USF Health Morsani College of Medicine. As part of an academic health center and with more than 650 health care professionals in 32 specialties seeing patients in more than 30 specialty clinics and locations across the Tampa Bay region, the USF Physicians Group is the largest practice plan on the west coast of Florida.

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

Reams of information helped him determine what college he would attend and which residency programs to apply for. Statistics help him know which medications are the most effective for his patients. And archived scientific literature helps him conduct his own research.

So Nishit Patel, MD, knows data is useful.

//www.youtube.com/watch?v=0RUukBCqBz8

But what he has come to discover in the few years since becoming a doctor is that big data will, in the very near future, help researchers find cures – big cures, like for cancer and Alzheimer’s.

Dr. Patel is a dermatologist for the USF Physicians Group and was recently named the chief medical information officer for data analytics for USF Health. In that role, he will work with USF Health Information Systems and USFPG leadership to oversee the business intelligence platform and ensure that data reported from the system is both meaningful and credible. In addition, he will help guide the expansion of the newly developed research data warehouse.

Pulling from such vast amounts of data will help the USFPG improve patient care, from streamlining how quickly a patient can get in to see a USF health care provider to – the ultimate goal – improving health outcomes.

***

Big data is more than collections of demographics and shopping patterns and political bents. In science, big data looks at the tiniest of details in an enormous sample size. Even cellular functions, mutations, secretions, and bindings can play out across the million-fold and reveal trends that, in smaller sample sizes, might seem like outliers and oddities.

Dr. Patel had his own ah-ha moment for just how impactful data can be for improving patient care. And it pushed him to start a dermatology clinic focused on a patient population in need of that expert care.

In his training, he had learned that organ transplant patients are at a much higher risk for developing skin cancer, but there is little research on how to significantly reduce this risk and little indication that the bulk of these patients are getting intensive, personalized dermatology care.

“In looking at skin cancer and solid organ transplant patients, this is an area where there is very little research currently that can help change how we take care those patients,” he said. “Patients who’ve had organ transplants are at very high risk compared to the average population for skin cancer. In fact, they can have a 65 times higher risk for squamous cell skin cancers. Right now our treatment paradigm is that we try to detect early, we try to do what we can in terms of prevention, but at the end of the day there are lots of patients in that transplant population experiencing 5, 10, 15 skin cancers a year.”

Seeing an opportunity to fix a problem, Dr. Patel worked with Tampa General Hospital’s transplant team to design a dermatology clinic specifically for transplant patients and part of the post-surgery care.

“There was an incredible need because transplant patients were not being optimally managed for skin cancer prevention, detection, and treatment,” he said. “By creating and building this clinic from the ground up, we had a chance to capture all these patients so that, as soon as they get their organ transplant, they are automatically seeing us in the dermatology clinic. We get a chance to sit down with them and talk in very frank language: this is what your risk is for skin cancer and you’ve survived a lot to get your organ transplant so let’s make sure that you don’t have a bad outcome because we didn’t catch or treat a skin cancer early enough.”

The result is that transplant patients, who already beat death by getting a transplant and are beating organ rejection, are now beating skin cancer. Since opening in October, he has seen 230 patients. At the 100^th patient mark, Dr. Patel said, they had discovered more than 50 squamous cell skin cancers, basal skin cancers, atypical moles and melanomas on those patients and destroyed countless pre-cancers.

Aside from these good statistics, it was a thank you from a patient that gave him a true feeling of success.

“Within the first few months of starting the clinic, a patient returned for a follow-up from a biopsy for a squamous cell skin cancer in his scalp,” he said. “As we were walking out of the room, he paused and said ‘Thank you so much for starting this clinic. If it wasn’t for this program I would have never gone to the dermatologist.’ It’s very likely that his skin cancer in the scalp would have continued to grow and potentially spread. But because of this program, we found that cancer, we’re treating that cancer, and his life expectancy won’t be adversely affected by it. That is more rewarding than anything else. That is the whole point.”

Data presented the trend that drove the vision for the clinic that improved patient outcomes.

***

In addition to being an assistant professor of medicine in the Department of Dermatology and Cutaneous Surgery, he is also associate program director for USF’s Dermatology residency program. So, he’s a teacher to new physicians, and he’s helping them learn from the start how to input data and use data to practice better medicine.

“My mentors tell me they used to practice medicine in a way that was eminence-based, meaning that when the person they trained under said ‘that’s how it’s done,’ well, that’s how it’s done,” he said.

“Well, over the past 10 years, especially over the past few years, there has been a shift from eminence-based to evidence-based. That is such a powerful change in terms of how we care for patients and to do that, of course, you have to have good evidence, which means you have to have good data. Look at where we have gone with transitioning from paper records to electronic medical records to really aggregating pools of different sources of data. We have this amazing opportunity in terms of the next few years to look at data in a completely different way than we have in the past.”

At USF Health, that means electronic health records, but also a soon to be released research data warehouse built by USF Health Information Systems.

“Here at USF Health, we are developing a really great research database as a resource for clinicians and researchers, whether they’re bench researchers, translational, or in clinical medicine, to very easily access a pool of data they’ve never had the opportunity to pull together before,” Dr. Patel said. “Providing tools like Epic or our data warehousing efforts means we are building the giant infrastructure and the toolkit for all of our researchers to use and to develop that next great drug, to treat severe disease, and design that next great prevention strategy. I’m really optimistic about where we’re going and I think we can continue to transform how we practice medicine and to do it in a smarter way than just how we’ve been trained.”

***

It seems to be all about data, but Dr. Patel is quick to note the constant need to stay focused on the patient. The data will help, but not at the cost of direct, focused care.

“In looking at the bigger picture of a patient’s entire medical record, or of every patient in an entire health care system like USF and the inpatient data with the integrated medical records data we have with Tampa General, you’re going to find trends that you would otherwise never even realize were there,” he said.

“That’s when the power of data improves patient care. The beauty is, by creating that infrastructure for experts to look at a huge aggregate pool of data from their lens and offer analyses together, we can really change how we’re doing things in the clinics and how we can take the best care of that patient in front of us right now.”

Story by Sarah Worth, photos and video by Sandra C. Roa, USF Health Communications.

A newly formed Family and Patient Advisory Council is helping the USF Physicians Group hear directly from patients on ways to improve patient experience at USF Health.

Made up of about a dozen current patients, the group will meet quarterly to provide input and perspective on USFPG initiatives, including sharing ideas directly with USFPG leaders and members of the health care team, who also attend meetings.

Top row, from left: Phil Cox, Ray Morganti, Norman Williams, Mike Bates, Rich Sobieray (CEO, USF Physicians Group), Walter Niles, Hiram Green. Bottom row, from left: Maureen Murray, Shoukry Maged, Joyce Becker, Ellen Gross, Gary Hunt

“Often times, patients are the most knowledgeable people on health care teams,” said Phillip Cox, Esq., LHRM, associate vice president for Quality, Safety and Risk. “And it’s that perspective – the patient viewpoint – that will help us identify more precisely the needs of patients and their families. Collectively, this board will act as a catalyst for change and its feedback on our processes and systems will be invaluable for helping us create a better, caring patient environment.”

The Council is in tandem with several efforts for gauging patient opinion, the largest of which is a patient satisfaction survey through Press Ganey, a national firm specializing in measuring patient satisfaction and patient delivery. At the group’s first meeting, members were introduced to more detail about the USF Physicians Group that they might not be aware of, including the breadth of the practice’s specialties and locations, said Maria Garces, MT(ASCP), MBA, director of Operational Efficiency for USFPG.

Garces said the first two questions put before the new Council were “What is a ‘wow’ patient experience?” and “What is the #1 thing we need to do as an organization to create a ‘wow’ patient experience for our patients?” This early feedback already revealed three key characteristics of a positive experience: access to doctors, good bedside manner, and a great overall patient visit. Several solutions were proposed for helping USFPG better and more uniformly attain those components.

“Our goal is to start fairly small and build across time with the practice,” Garces said. “As the USF Physicians Group rolls out facilities, programs and initiatives, this council will be tapped for feedback on a range of areas, like the flow of new spaces and usefulness of signage.”

The USFPG Family and Patient Advisory Council meets again in June, when it will assign a chairperson and co-chairperson of the group. Members will look into options for communicating and discussing proposed improvements among themselves and with USFPG leaders and providers.

Photo by Eric Younghans, USF Health Office of Communications

In its continued effort to make the best use of patients’ time during their visits, the USF Physicians Group is opening Patient Labs in the Morsani Center for Advanced Healthcare and the South Tampa Center for Advanced Healthcare.

The two Labs will provide patients with on-site phlebotomists who will collect blood and urine samples, helping patients not only get their labs taken faster but also get their results sooner, allowing for faster decision making for treatment plans and better patient outcomes, said Jed Varanelli, JD, MBA, Laboratory Business Manager for the USF Physicians Group.

“So many of us tend to procrastinate getting that lab work done because it’s an extra errand in our already busy lives,” Varanelli said. “Now, when our health care providers prescribe lab work, our patients will only have to come the first floor of either USF Health site.”

Each Patient Lab is in newly remodeled space with components designed for comfort, as well as efficiency.

Patient Labs in the newly remodeled space in the South Tampa Center.

Initially, the Labs will provide services on a first-come, first-served basis. In certain cases, such as when it’s a hardship for a patient to get to the first-floor Lab, specimens can be collected by USFPG providers in the exam rooms or on the clinic floors. Phlebotomists will be trained across specialties, including pediatrics.

In the South Tampa Center for Advanced Healthcare, the Patient Lab is on the first floor, down the main hallway, beyond the elevators and toward the Imaging Center.

In the Morsani Center for Advanced Healthcare, the Patient Lab is located on the first floor, just behind the reception desk and next to the waiting area.

The goal of the new service, Varanelli said, is to streamline and expedite laboratory processing for USFPG patients.

“It’s a one-stop-shop, one-experience approach,” he said. “And it’s another way we’re making life better for our patients.”

From left, Amber Grooms, who is based at the South Tampa Center, Marcela La Rosa , who is based at the Morsani Center and Jed Varanelli.

Photos by Eric Younghans, USF Health Office of Communications

The USF Physicians Group is taking multiple steps toward improving the patient experience. One of the primary focuses is on bolstering its Call Center with more staff, technology and support to help them better field the thousands of calls coming in to the USFPG every day.

Some of the Call Center team that fields USF Physicians Group’s 3,000-plus calls each day are, clockwise from lower left, Marissa Soto, Carol Schuster, patient access superviser Ola Wilson (standing), Rhia Bish, Ronetta Lewis, Amber Townsend, Alicia Taylor, Ragan Jennings, DeSean Platt, and David Style, with Joyce Peterson (walking).

While there is more work to be done, these recent improvements are already having a positive impact on patient experience with shorter wait times, fewer transfers and faster answers, said Valerie Williams, RN, MBA, associate executive director of USF Physicians Group.

“We are committed to making it easy and convenient for patients to interact with us, whether by phone, in person, or through our patient portal” Williams said. “We want patients to be confident that we are easy to reach and will respond to their needs quickly.”

A record number of calls came through the USFPG earlier this month – more than 3,700 in one day – the most ever received. Even with such a dramatic increase, these early improvements produced impressive results with calls being answered in under one minute.

Patty Rhodes, director of the Call Center, has seen tremendous growth in call volume in her 21 years with the USF Physicians Group.

Among the changes for the Call Center are:

• The team will be relocated to the UPC on Fletcher Ave. The entire western side of the fourth floor as been renovated to provide ample space to hold the combined central and departmental agents, as well as accommodating additional growth of agents and clinical staff to support new services.
• Coverage hours have expanded by 50% to provide our patients’ access outside of traditional hours.
• Call agents will receive continued training to fine tune how they accept and route calls for all specialties.
• There are now on-site clinical nurses in the Call Center to help resolve patient concerns related to symptom management, refills, test results, etc.
• New functions in current technology will be used to create better workflows for the agents, further reducing patient wait times and offering patients various contact options, such as text and email. Patients will also be able to leave a voice message for follow up contact without losing their places in the call queue.
• A more effective training and monitoring system is being developed to include staff training during agent on-boarding, active listening to calls providing real-time feedback on performance, and daily reporting that will monitor overall performance on key metrics such as volume, time-to-answer and abandonment rates.

Improving our patients’ experience is a top priority that includes improving how well we communicate with them and how accessible we are to them, Williams said. But these improvements are only a start.

“While we are making great progress, we are not yet satisfied,” she said. “There is more work to do.”

Photos by Eric Younghans, USF Health Office of Communications.

When a USF Health faculty member publishes a book, some 30,000 people throughout the Tampa Bay area hear about it.

That’s because Gina Rathbun, director of Physician and Community Relations for the USF Physicians Group, has built a book program that includes a steadily growing email list for sharing the news about our published faculty. The robust program also provides an ongoing collection of texts for the Shimberg Health Sciences Library, thanks to generous donations from the faculty authors.

Rathbun has promoted more than 70 titles since starting the program in 2011 – this month marks the fourth anniversary of the program. The effort is a win/win/win/win, she said.

“It helps the faculty promote their books and it helps the library archive the work of our faculty,” Rathbun said. “It also lets patients know we have many knowledgeable physicians who really know their specialty. Published work helps give them added credence. If you’re a patient, then wow! A book says this doctor has published in their field of work. I come from a strong corporate business background, so I know this sort of effort can help build patient volume, as well.”

The fourth “win” is for the students, she said.

“I’ve received emails from students saying they were so glad to have access to these resources at our Shimberg Library and that the texts really helped them,” she said.

The authors agree that the impact on students is gratifying.

“When you edit a book you not only create an opportunity for writing but you also mentor the young students and faculty to crystalize their ideas and help them grow in their career,” said Yashwant Pathak, MPharm, EMBA, PhD, professor and associate dean for Faculty Affairs in the USF College of Pharmacy and author of several books in Rathbun’s program.

Starting the book program was a natural effort; Rathbun is an author herself; she wrote Silenced by a Mission Statement: An Organization’s Cloak of Ambiguity, a paper published for the field of organizational communications while she was in graduate school. Rathbun holds a master’s degree in health and organizational communication, a bachelor’s degree in communication (both from USF), and a bachelor’s degree in business management (from National Louis University).

So Rathbun knows the excitement you can feel when your work is finally in print and considers that feeling when she shares the work of others, a trait the faculty authors greatly appreciate.

“It’s wonderful that Ms. Rathbun has spearheaded this effort to highlight our faculty’s work,” said William S. Quillen, DPT, PhD, FACSM, professor and director of the School of Physical Therapy & Rehabilitation Sciences.

“I am grateful for Gina’s leadership in making this project happen for faculty,” said Lennox Hoyte, MD, professor and director of the Division of Urogynecology and chief medical information officer for USF Physicians Group.

“The opportunity to share my book with my colleagues at USF Health was great!” said Rebecca M. Lopez, PhD, ATC, CSCS, assistant professor and director of the Post-Professional Graduate Athletic Training Program in the Department of Orthopaedics and Sports Medicine in the USF Health Morsani College of Medicine. “We are all busy, and we don’t always have a chance to share the projects we are working on with our colleagues.  Gina’s faculty book program is a great way for USF Health faculty to share the great news when a book is finally complete!”

Before joining USF, Rathbun spent 10 years working for the Tampa Port Authority, marketing the fledgling port and selling commercial real estate throughout the port, downtown and channel areas of Tampa. As director of cruise marketing, her efforts are credited for the increase in passengers coming to Tampa’s port (from 250,000 to more than 800,000 over five years), and for bringing Royal Caribbean cruise line to Tampa’s port.

Topics for the USF Health faculty book program run the gamut. Most dive into the details of our bodies from head to toe. A few branch out a bit, offering test strategy, even poetry.

“Our physicians have contributed a wealth of information over the past several years.” Rathbun said. “When I came here, I wanted to showcase the depth and breadth of knowledge in our health care providers. It’s really a celebration of their scholarly and artistic talents.”

Photos by Eric Younghans, USF Health Office of Communications

Move strengthens cardiovascular services at region’s only academic health center

Tampa, FL  (Feb. 13, 2014) — Florida Cardiovascular Institute, a leading private cardiology practice, has joined forces with USF Health, creating the largest clinical cardiology practice in Tampa at the region’s only academic health center.

“We’re thrilled Florida Cardiovascular Institute is with us. When we looked at all the pieces, it was a natural fit,” said Jeffrey Lowenkron, MD, CEO of the USF Physicians Group.  “The attractiveness of the scope of services and expertise we offer is higher with the addition of FCI.”

Sitting, l to r, Dr. Arthur Labovitz, chair of the Department of Cardiovascular Sciences at the USF Health Morsani College of Medicine, with Dr. Fadi Matar, acting director of the department’s new FCI Division. Standing, l to r, Dr. Bengt Herweg, director of electrophysiology and arrhythmia services at USF Health with the FCI cardiologists who, along with Dr. Matar, have joined USF Health: Drs. J. Thompson Sullebarger, Joel Fernandez, Dany Sayad, John Ramirez and Olga Kuteyeva.

Adding six FCI cardiologists increases to 18 the number of full-time clinical cardiology faculty members in the USF Health Morsani College of Medicine’s Department of Cardiovascular Sciences.  FCI also brings 7,500 patients and 33 full and part-time nurses, medical assistants, ultrasound technicians and administrative staff to the USF Physicians Group, the largest multispecialty practice on Florida’s west coast.

The group will continue to provide care at its current South Tampa location, 509 S. Armenia Ave. USF Health has leased the 10,000-square-foot, second-floor space occupied by FCI, and in March a new co-branded sign will appear on the building.

“These physicians are all high-quality clinicians who add depth and will enrich our overall practice,” said Arthur Labovitz, MD, professor and chair of the USF Health Department of Cardiovascular Sciences and an acting director of the USF Health Heart Institute.  “They will be a catalyst for advancing our department’s growing presence in the community. We will be better positioned to meaningfully affect how cardiovascular medicine is practiced in the Tampa Bay region.”

FCI was established in 1999 by founding physicians Fadi Matar, MD, and J. Thompson Sullebarger, MD, after they left USF’s medical school to go into private practice.  Dr. Matar, medical director of the cardiac catheterization laboratory at Tampa General Hospital, and Dr. Sullebarger, chief of cardiology at TGH, now return to academic medicine as associate professors in USF’s newly created Division of Florida Cardiovascular Institute. Dr. Matar serves as the division’s acting director.

FCI considered several larger groups in the Tampa Bay area as potential partners. But, Dr. Matar said, the private practice’s longstanding interest in research and education and its work at Tampa General, the university’s major teaching hospital, made USF Health “the best fit.”

Dr. Labovitz and Dr. Matar

“We feel good about the move. We’re growing our family from six cardiologists to 18, and they are all colleagues we’ve worked well with in the past,” Dr. Matar said. “Being part of an academic group on the cutting-edge of studying and offering new therapies makes us better doctors who can provide the highest-level care to our patients.”

The transaction highlights a growing national trend of independent physician groups merging with larger partners as doctors seek to avoid being squeezed by shrinking insurance reimbursement rates, control expenses, and adjust to changes in the health care delivery system driven, in part, by the Affordable Care Act.  What cardiologists and other specialists are getting paid for certain procedures or visits is in many cases declining, while the expense and complexity of running a practice are increasing.

“There’s been downward pressure on payment,” Dr. Lowenkron said, “so if you’re in a bigger place it’s probably true you’re a little bit safer.”

USF and FCI say that the move made sense for more reasons than the financial advantages of building a bigger practice. There was alignment between the two groups in several key areas, including:

–          Like-minded patient-centered care philosophies.

–          A shared perspective on the importance of USF Health’s academic missions of education and research in making health care better.

–          The desire to train future cardiologists for the challenges and opportunities of a changing healthcare system

Dr.Matar speaks with a patient. He and his FCI colleagues have a keen interest in teaching future cardiologists and engaging in clinical research.

Together the two physician groups can offer patients a fuller spectrum of cardiovascular subspecialty services than either could alone.  For example, Dr. Lowenkron said, FCI will help cover USF’s gaps in interventional cardiology, while USF’s strength in electrophysiology appealed to FCI.

The university’s research infrastructure, including support for grant writing, biostatistics and outcomes research, and the opportunity to participate in investigator-driven studies also appealed to FCI, Dr. Labovitz said.

FCI adds about a dozen industry-sponsored clinical trials to USF’s mix of 24 federally-funded, private and pharmaceutical-sponsored trials testing new cardiovascular drugs or devices and evaluating standards of care.  That means USF Health cardiology patients have access to an impressive array of clinical studies involving heart failure, hypertension, arrhythmias and other cardiovascular diseases, as well as the first genomics trial, in partnership with the American College of Cardiology, examining the link between genetic information and the risk of developing these diseases.

In addition to Dr. Matar and Dr. Sullebarger, the other FCI cardiologists to join USF Health are Joel Fernandez, MD; Olga Kuteyeva, MD, John Ramirez, MD; and Dany Sayad, MD, all assistant professors.

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Photos by Eric Younghans, USF Health Communications

Media contact:
Anne DeLotto Baier, USF Health Communications
(813) 974-3303,  or abaier@health.usf.edu

The USF Physicians Group is the only academic medical center on the west coast of Florida.

So when the opportunity to lead USF’s practice plan came up, Jeff Lowenkron, MD, jumped at it. After working for the Mid-Atlantic Permanente Medical Group of 1,000 physicians, he considered it a wonderful challenge to help the USF group of more than 400 physicians to function more like an integrated multi-specialty group.

What intrigued him more was the chance to help drive the continued growth by demonstrating the value of the academic medical center to health and well-being of the Tampa community.

“Growing into the largest medical practice plan is all fine and good, but size isn’t necessarily a competitive advantage,” said Dr. Lowenkron, a practicing internist who joined USF in January as CEO of the USF Physicians Group.

“Our competitive advantage is that we are an academic medical center.  We have to be successful on each of the three axes: education, research and clinical.

“Dr. Lowenkron’s work at Kaiser Permanente is exactly the level of experience our physician’s group requires to not only weather the current economy, but to propel us into the healthcare environment to come,” said Dr. Stephen Klasko, CEO of USF Health and dean of the USF College of Medicine.

DEFINING ADVANTAGES
What separates the USF Physicians Group from other multi-specialty practices in the Tampa Bay area is that it is part of an academic medical center, a connection that benefits both patients and the community it serves.

National studies show that patients tend to fare better at academic medical centers, which typically treat some of the sickest patients and toughest medical cases. In addition, patients have access to the newest treatments that are provided by clinics and hospitals linked to a college of medicine. And, the communities served by an academic medical center feel a huge economic impact due to a center’s hiring, buying and building power.

The USF Physicians Group serves patients from throughout Florida – even some from outside Florida – but most come to USF from the 15-county region surrounding Tampa. Its position, both geographically and professionally, stood out to Dr. Lowenkron in a big way.

“It’s an exciting time with incredible challenges and fabulous opportunities,” he said. “We are linked to the community in a way where our commitment to success mirrors the needs of Tampa for us to be successful.”

PLANS FOR THE USF PHYSICIANS GROUP
Dr. Lowenkron said that when he visited USF last fall, he noted one apparent characteristic in everyone he met: an incredible sense of optimism.

“Most institutions are trying to figure out how to batten down the hatches and weather the storm,” he said. “But at USF, they are looking ahead and designing their own future. I definitely want to help design the future of health care.”

Dr. Lowenkron said that, although there is a multi-specialty group in place, there is room to improve our system, to one that better coordinates care across departments and is more patient centric.

“There are systems in place, but there are also systems missing, and others that require modification,” he said. “Departments are trying to grow services, focusing on revenue generation, but not understanding the true cost of providing those services.

“There has to be some re-tooling that works toward a more cohesive whole. Form must follow function. We will assure alignment with the mission of USF Health and of the university. There are decisions to be made that cut across the entire group, including building new systems, fine-tuning service delivery, assessing service lines, continual development and evaluation of new business, and measuring quality outcomes.”

Dr. Lowenkron said he sees a strong patient-experience at USF, but wants it to improve “to make the care experience delightful for both patients and families as well as for those who deliver the care.”

“People go into healthcare because they want to help,” he said. “So let’s let them help. Healthcare doesn’t happen in an administrative office.”

KAISER PERMANENTE
Over his 17 years with the Permanente Medical Group, Dr. Lowenkron held increasingly greater leadership roles, including spearheading Mid-Atlantic’s process improvement efforts for patient access, scheduling, patient flow, service excellence, and communication and messaging. Prior to that he was the area medical director for the District of Columbia and the suburban Maryland regions, where he was responsible for a medical group (similar in size to the USF Physicians Group) in two hospitals, 12 medical centers and a skilled nursing facility.  Kaiser Permanente of the Mid-Atlantic States provides health care to about 500,000 people throughout 30 medical centers in Washington, DC, Maryland, and Virginia.  Kaiser Permanente is one of the nation’s largest not-for-profit health plans serving nearly 9 million members.

Dr. Lowenkron earned a bachelor’s degree from Johns Hopkins University in Baltimore, MD, and a medical degree from Creighton University School of Medicine in Omaha, NE. He completed his residency and chief residency in internal medicine at Georgetown University Hospital in Washington, DC, where he also earned a master’s degree in public policy. Dr. Lowenkron was also trained in the executive leadership program at Harvard University School of Business in Cambridge, MA.

PERPETUAL PROGRESSION
Dr. Jeff Lowenkron has a tremendous desire to have broad-based impact improving the health and well-being of the community in which he works.  He believes that care delivery is a team sport and will require incredible effort across the program for us to succeed.

“When you stop feeling challenged, it’s time for a change,” Dr. Lowenkron said.

Story by Sarah A. Worth, Photos by Eric Younghans, USF Health Office of Communications

For years, Sarah Maloney’s definition of “planning ahead” meant figuring out how to get through another day.

From the time she was 13, Maloney, now 22, struggled with depression – cycling in and out of therapy and trying just about every anti-depressant on the market. Unable to cope or hold a job, she made several attempts on her life.

In March 2011, suicidal and desperate for help, Maloney voluntarily checked herself into Tampa General Hospital’s emergency room. This time, things would be different.

As a patient in the psychiatric services unit, Maloney came under the care of William Upshaw, MD, assistant professor in the Department of Psychiatry and Neurosciences at USF Health. She told him about her years-long battle with depression; about her family’s history of mental illness; about her inability to function; and the anti-depressants that never changed anything.

An alternative treatment option

Dr. Upshaw understood. He told her about a procedure that often works when other treatments have failed. During the procedure, called electroconvulsive therapy (ECT), electric currents are passed through the brain, deliberately triggering a brief seizure. While researchers do not fully understand how ECT works, they do know the seizure activity causes changes in the brain’s chemistry that can reverse the symptoms of certain neuropsychiatric illnesses, especially treatment-resistant depression, during the course of treatment.

For Sarah Maloney, ECT treatments were life changing.

“At first, I thought he was out of his mind; but then he explained it to me after I had calmed down,” Maloney recalls. “It sounded extreme, but at that point I was so desperate not to be depressed or suicidal.”

ECT is the best-known of the neurotherapy procedures – procedures that stimulate areas of the brain using magnetic fields or electrical currents to relieve symptoms associated with certain mental health conditions. ECT was first introduced in the 1930s, and gained widespread use in the 1940s and 1950s. At the time, however, treatments were delivered without anesthesia, using high doses of electricity and often resulting in serious side effects.

Today, ECT is a vastly different and safe procedure using lower doses of electricity administered under full anesthesia. According to Jamie Winderbaum Fernandez, MD, assistant professor and chief of the USF Electroconvulsive Therapy Program at Tampa General Hospital, the results are indisputable.

“ECT is unmatched for short-term relief of major depression. It gets people better when nothing else has,” she says. “There is nothing more satisfying than seeing people get their life back.”

Before consenting to the treatment, Maloney spoke to patients on her floor. “They told me it was great,” she says. And she spoke at length with her boyfriend; her sisters, one, a physician; her father, a nurse; and her mother, a nursing student. “They convinced me it was extremely safe and extremely humane. I was scared, but confident.”

Carefully controlled

ECT patients typically undergo an initial acute series of nine to 12 treatments administered three times a week over three to four weeks. After the initial acute phase, treatment is carefully tapered off over several months. Occasionally, patients will come back for infrequent treatments, called maintenance or continuation ECT, to maintain the benefits they received during treatment.

During the procedure, which lasts about five minutes, the patient is given anesthesia to sleep as well as an intravenous muscle relaxant to paralyze the body. Stimulating electrodes are carefully placed on the scalp, leads are placed on the forehead and neck to monitor brain activity, and a blood pressure cuff, which restricts the flow of the paralytic to the foot, is placed on the lower leg, allowing the treatment team to monitor motor seizure activity. Next, a brief electrical charge is applied to the scalp inducing a seizure that lasts about a minute and is accompanied by a release of chemicals from neurons in the brain. Within about 20 minutes, the patient awakens.

Maloney with Dr. Jamie Winderbaum Fernandez, chief of the USF Electroconvulsive Therapy Program at Tampa General Hospital

For Maloney, the results were near-immediate.

“I was exhausted, but felt mentally better after the first treatment,” she says. “The deep pit in my stomach and heavy feeling in my chest that I had since I was 13, were gone. I wanted to live.”

Dr. Fernandez had seen it before. During the course of her professional career she has administered more than 1,000 ECT treatments. “I have literally seen it bring people back to normal life after years spent coping with debilitating, chronic mental illness,” she says.

Even so, ECT treatment does have side effects, such as disorientation following the procedure, short-term memory loss and physical side effects including nausea, headache and jaw pain.

The treatment’s effectiveness is contingent on continuation therapy – antidepressants or other medications and/or psychological counseling. “You must do something to sustain the benefit,” Dr. Fernandez stresses.

New service at Tampa General

Dr. Fernandez joined USF Health in 2008 after receiving her medical degree from Cornell University Medical College and completing a residency in adult psychiatry at Stanford University Hospital and Clinics. She holds a Master of Science degree in Medical Sciences with a concentration in Clinical and Translational Research. She is board certified in adult psychiatry and certified in ECT.

Despite having a large psychiatry practice, Tampa General Hospital had no ECT service when Dr. Fernandez came on board. Convinced of the need and aware of the benefits, she teamed with her department chair, Francisco Fernandez, MD, and worked with her colleagues, Dr. Upshaw, Patrick Marsh, MD and Michael Bengtson, MD, to lobby TGH to make the treatment available.

Maloney with Dr. Jamie Winderbaum Fernandez

By September of 2010, the treatment was being offered at Tampa General Hospital. Since the service began, Dr. Fernandez estimates that she and her colleagues have administered about 1,200 ECT procedures to patients, many high-functioning adults who have battled depression for years. “There is a tremendous need for it in the area,” she says of the growing practice.

Candidates for ECT range in age from 18 to over 100 years, and suffer with conditions ranging from major depression, bipolar disorder and schizophrenia to catatonia, Parkinson’s disease and delirium. Some, Dr. Fernandez explains, have medical co-morbidities that preclude them from being on medications such as lithium. The treatment can be safely administered in all stages of pregnancy, and in fact, is considered safer than medications in the first trimester.

A new lease on life

For Maloney, the treatments have been life-changing. Today she is a full-time office secretary, lives in her own apartment and is planning a wedding with the boyfriend who stood by her side through it all. She has completed 25 ECT treatments since she first checked herself into Tampa General Hospital in March 2011. Her treatments now are scheduled monthly.

Maloney is eager to talk about her experience. “I want to take away the feeling of embarrassment that people with mental health problems have. I want to help take away that stigma.”

But most of all, she is eager to plan her future.

“For the first time in my life I am actively planning a future,” she says. It’s exciting to have a life and want to live it.”

Story by Ann Carney.  Photos by Eric Younghans/USF Health Communications

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Improving the Symptoms of Depression and other Neurological and Mental Health Conditions

Electroconvulsive therapy (ECT) is one of four neurotherapy procedures – including transcranial magnetic stimulation (TMS), deep brain stimulation (DBS) and vagal nerve stimulation (VNS) – offered at USF Health’s Neurotherapies Clinic at Tampa General Hospital. The procedures stimulate brain cells electrically, rather than with medications, to treat depression and other mental health conditions.

TMS – Using pulsed magnetic fields, Neurostar TMS therapy stimulates the part of the brain thought to be involved with mood regulation. The short, non-invasive, non-systemic procedure is performed on an outpatient basis and typically consists of five treatments per week over a four- to six-week period. The treatment is an effective alternative for patients who cannot tolerate the side effect associated with anti-depressant medication. TMS therapy does not have the usual side effects including weight gain, sexual dysfunction and nausea. Patients are awake and alert throughout the entire 37-minute procedure, and can transport themselves to and from treatment.

DBS – Using a surgically implanted medical device, similar to a pacemaker, DBS delivers carefully controlled electrical stimulation to target areas of the brain, continuously or intermittently, to treat neurological disorders such as essential tremor and Parkinson’s disease (PD) and anxiety disorders such as obsessive compulsive disorder (OCD). The stimulation is delivered to areas of the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms and helping reduce the symptoms associated with OCD.

VNS –  Approved for use in treatment-resistant epilepsy and treatment-resistant depression, VNS therapy uses an implanted pacemaker-like device to deliver mild, intermittently pulsed signals to the left vagus nerve, which in turn activates various areas of the brain. Stimulation to the left vagus nerve has been shown to induce widespread effects in areas of the brain thought to be responsible for seizures and mood disorders. The treatment is approved as an adjunctive therapy for reducing the frequency of seizures in adults and adolescents over age 12, and as an adjunctive, long-term treatment for chronic or recurrent depression for patients 18 years and older who are experiencing a major depressive disorder and have not had adequate response to other anti-depressant treatments.

To learn more about the USF Neurotherapies Clinic or to make an appointment, visit www.health.usf.edu/medicine/psychiatry/neurotherapy or call 813-259-0920.