In my last article, I wrote about the modern company which effectively operates like a Shamrock. This means that core services are delivered by core associates in the main part of the company. The second leaf involves other services such as legal, tax, IT, even janitorial, waste management and several other services that are “outsourced” as contracts. The third leaf is the “just in time” segment of the operation where services are needed for special projects and may involve contracted staffing and outsourced recruiting or training.

For 2009 outside recruiting may take a back seat as some organizations “rightsize” to face economic pressures. Using outsourced recruiting can make economic sense. There are three major types of firms servicing the South Florida healthcare market. Retained firms still specialize in senior level positions. Fees are paid upfront, during the search and when the new hire starts. Contingency firms are very cost efficient in that fees are only paid upon the start of a new hire. Essentially, clients get free looks at talent, without up front costs. The third type of firm is an “engaged” firm. This means that a small monthly “engagement” fee or retainer is paid and then a reduced fee for each placement. The advantage of this type of agreement is for budget purposes and the fact that you are “top of mind” for the engaged firm if they want to ensure a continuation of the engagement. In addition, executive search firms offer replacement guarantees, something which is not possible with in-house staff.

While a typical in-house recruiter has access to one or two job boards and must depend on responses to ads, a good Executive Search firm may have access to 5 or more boards and in our case have direct recruiting and referral sources far deeper than the average in-house recruiter can possibly have. In addition, the firm must hustle to source, recruit and present the top candidates for a given search. And in south Florida, given restrictions and license issues, an outside firm manages the process effectively to ensure results.

So when faced with business uncertainty, and economic pressures, using outsourced “just in time” Executive Search firms makes sense.



Mark Shachner, M.D.

On staff at Broward Health Coral Springs Medical Center (CSMC) since 1992, Mark Shachner, M.D., is the Medical Director of the Women’s Diagnostic & Wellness Center, and a renowned and well respected surgeon, not only for his clinical expertise, but also for his role in our community. He has taken his passion for helping breast cancer patients beyond the operating room and into the community by making his mark in the fight against breast cancer. With a compassionate heart and his advocacy for breast cancer prevention, Dr. Shachner has been instrumental in educating the community over the years through community lectures and educational events. But it is his dedication beyond the typical community lectures and health fairs that sets him apart.

In 2003 when CSMC opened its Women’s Diagnostic & Wellness Center, Dr. Shachner was instrumental in the development of a Women’s Advisory Council. The council is a diverse group of community women who meet bi-monthly and provide feedback on the Women’s Diagnostic and Wellness Center’s services and outreach. This led to the development of the CSMC Enlightened Women’s Membership Club and lecture series, both providing a message of health promotion and prevention. But Dr. Shachner was not content with just providing preventative information, he wanted women to take action and beat the odds against cancer with early detection.

In 2006, the rise in breast cancer combined with the rise in the number of uninsured patients in the area was the impetus behind the formation of the Race for Women’s Wellness, a 5K run/walk. Dr. Shachner and Dr. David Silver, a gastrointestinal and internal medicine physician, co-founded the race in an effort to raise funds for women who were unable to afford screening mammograms and advanced high quality breast imaging and biopsies.



It’s hard to imagine a volunteer opportunity more rewarding than one that brings smiles to children who are seriously ill.

Just ask Denise Israel. Since December, Israel and her canine companion Samson McDoodle, a 60-pound Goldendoodle, have been visiting young patients through the pet therapy program at Miami Children’s Hospital.

“It’s all about the pure and simple joy of sharing and connecting,” says Israel. “It’s very fulfilling for everyone involved.”

Over the past 25 years, hundreds of volunteers like Israel and Samson have helped make the program a success.

“We now have 21 dogs, and offer pet therapy daily to patients ranging in age from birth to 21 years,’’ says Lynn Heyman, director of community and volunteer resources at the hospital . The dogs run the gamut of ages, breeds, and circumstances – from a Great Swiss Mountain named Chester who comes dressed in costume, to Lance, a Short-Haired Dachshund confined by paralysis to a wheelchair.

To qualify for the program, both the owners and their dogs go through a thorough approval process. The owners take part in an orientation, an interview, and a workshop that prepares them for working with children who are ill. Their dogs must be healthy and fully immunized, and certified through Therapy Dogs, Inc., an international organization that provides registration, insurance, and support to its members.

Denise Israel (left) and Samson visiting patients at Miami Children’s Hospital.

Israel says that to earn certification, the dogs must prove that they like human contact, and are well-mannered enough to not only be in a hospital setting, but also around other dogs. This is determined through a test, and three to four on-site visits where the dog’s behavior is closely observed.

Israel notes that Samson has another credential – a canine “good citizen” award. While the award is not mandatory to do pet therapy, it does put another feather in Samson’s professional cap. “The dogs attend classes, which are offered at local community colleges,” says Israel. “It’s basic obedience training—learning to heel, stay, and pass by other dogs, for example –that’s recognized by the American Kennel Club.”

When Israel first got Samson, pet therapy never crossed her mind. But when she saw how good he was with children, she says, “I knew he was meant to do this…He’s sensitive to their feelings, and he doesn’t bark, whine, or lick,” she adds. “Plus, he looks like a big, cuddly stuffed animal, which the kids love.”

Israel and Samson volunteer once a week, unless Israel’s job takes her out of town. Generally, she spends an hour or more doing her rounds, making both scheduled and random visits.

Watching the children light up when Samson enters the room is priceless, says Israel. “Some get up and hug him, others are just all smiles. I especially remember one little boy who was recovering from facial surgery … He was absolutely beaming, and that made his mother ecstatically happy, too.”

Heyman says that pet therapy does benefit both patients and parents alike. “The purpose of our program is to bring unexpected joy and comfort to the children,” she explains. “When parents see that, when they see their kids laughing and having fun, they gain a sense of hope.”

At the end of each visit, Israel leaves a memento for each child: a small photo of Samson with a note that says something like, “Hi! Thank you for making my day special.”

Besides spreading cheer in the patient rooms, Israel and Samson stop in the areas where parents are anxiously waiting for their children to come out of surgery. They round, too, with the nurses. Additionally, once a year, the hospital hosts a “Pet Therapy Day,” so that all employees can experience the program.

Israel‘s passion for dogs, children, and her community drew her to volunteer at Miami Children’s. “It’s been so enriching,” she says. “Giving in this way has made me feel connected to others…It’s also tightened the bond between me and Samson. Seeing him in this new role has definitely strengthened our relationship.”



Electronic Medical Records (EMR) has captured the attention of practitioners, insurers and policy makers for years. With the enactment of The American Recovery and Reinvestment Act of 2009 which provides billions of stimulus dollars along with Medicare bonuses over the next 5 years, for those physicians that implement EMR systems, the interest has escalated.

EMR systems are a part of the larger patient safety debate and seen by some as a key component of any patient safety solution. EMR is a responsive effort by providers in search of new efficiencies in their medical operations. Many believe that EMR systems are essential to better clinical integration and health information sharing along with e-prescribing, a functional subset of many EMR systems.

What is an EMR? A collection of electronic health information that provides immediate access by authorized users. EMR may involve knowledge and decision support tools that enhance safety as well as support of efficient processes for health care delivery.

On January of 2004, President Bush first publicly threw his support behind EMR systems. Since then Washington and President Obama’s administration have been working to make widespread, interoperable EMR systems a reality through regional record exchange organizations. That same year the federal government’s EMR vision of a national policy effort to standardize and implement a network of health information exchanges that will enable electronic health records to be shared widely in real time by physicians and others materialized.

As is often the case with cutting edge technology, the law lags behind. To those who have endeavored to implement electronic health records that can be shared with other clinically integrated practitioners, or more widely, it will come as no surprise to learn that many legal barriers to sharing electronic health records are still being debated.

  • The Anti-kickback Statute.
  • The Stark anti-referral rules.
  • Concerns about enhanced malpractice exposure.
  • HIPAA’s privacy and security regulations.
  • In some contexts, the anti-trust laws.

The above legal issues may or may not be barriers depending upon the circumstances of any implementation of an EMR. Regulation of medical records is still based upon rules created in the era of paper records. There have been recent changes to the Department of Health rules governing hospital records written in the 1970s which neither permitted electronic records nor prohibit them. Therefore, none of these rules address the issues of the electronic era such as what is the “original record” or how does one authenticate entries.

The Anti-kickback Statute, and its relevant safe-harbors, is a barrier to implementing EMRs because it prohibits remuneration in exchange for referrals in most cases. Such as when a hospital wants to make its EMR available to its medical staff and offers equipment and software that will incline physicians to refer to the hospital in exchange for the EMR.

Many EMRs will facilitate referrals between hospitals and referring physicians that could implicate the Stark rules on compensation relationships. However, the Stark rules offer interesting exceptions, if a hospital provides to its medical staff hardware to support access to the hospital’s EMR, and it was wholly dedicated to the use, there would not be a Stark problem. The Stark rules also provide for an exception for community wide health information systems. This Stark exception protects “remuneration” in the form of hardware and software used in these information sharing systems.

HIPAA’s privacy and security standards present one of the more formidable barriers to the deployment of EMR systems as envisioned by the federal government; that is, regional networks of record sharing organizations through which completely unrelated physicians can locate, request and obtain the medical records of patients. The clear bias of Privacy Rules favors disclosure and downstream use of medical information along familiar lines of medical practice and health care delivery. Sharing EMR data between a medical staff and a hospital is workable under the Privacy Rule. However, nothing in the Privacy Rules anticipates the kind of wide open, unrestricted sharing of information among completely unrelated health care providers that the federal vision embraces. The technical challenges of authentication of parties to requested sharing are substantial and maintaining the integrity of vital content cannot be over-emphasized.

One final legal barrier to shared EMR systems is seen by some in the anti-trust laws, which prohibit anti-competitive behavior, including price fixing. In the case of EMR, the anti-trust issue involves largely the content of EMR systems and what is being shared. Many proponents of EMRs expect them to include clinical information as well as related payment information. Sharing payment information could enable competing providers to collude on prices and therefore violate the anti-trust laws. Further concerns arise relating to exclusionary agreements among providers. Some anti-trust analysts believe that among competing providers, EMRs will be used to include only those who would seek to dominate a market while also excluding those who are seen as competitors.

When an EMR implementation moves out of the stand-alone model and into sharing EMR data between clinically integrated practitioners, more legal barriers arise. Here the Anti-kickback and Stark prohibitions become of paramount concern because of the underlying referral relationships. However, these concerns may improve with the development of more realistic safe harbors and exceptions to Stark. Privacy and security issues are far from negligible, but they are manageable in this still relatively closed information sharing system. The federally envisioned world of region-wide sharing of EMR systems presents most of the above issues and challenges given the complexity of this as yet-to-be-fully-defined undertaking.



Each year, the month of November is designated “National Family Caregivers Month” as a time to thank, support, educate, and empower family caregivers.

Caregivers are anyone who provides unpaid assistance to a chronically ill, disabled or elderly family member, friend or neighbor. Caregivers are often the primary source of care and are viewed as an unpaid extension of the U.S. healthcare system.

Caring for someone who is progressively ill can be an enriching and fulfilling life event for the caregiver. However, it is well-documented that the process can also be physically and emotionally stressful. Caregiving can take a toll on relationships, work performance, health and well-being.

Caregiver Comfort Circles meet twice a month and are co-facilitated by Janet Siniscalchi, R.N., and Stefanie McKee, Ph.D (upper right.)

Today’s caregivers are balancing multiple roles, including working full-time and having young children at home. In doing so, they often neglect their own physical and emotional health and are at risk of becoming ill themselves. They miss personal physician appointments, lack proper nutrition and exercise, and are deprived of sleep.

Multiple studies have demonstrated the many negative consequences of caregiving, including immuno-suppression, coronary heart disease, hypertension, anxiety, depression, exacerbation of chronic illnesses, and even premature death. These risks are exacerbated when the caregiver is elderly and the family member receiving the care is progressively ill. Without care and support for the caregiver, an environment is often created that is hazardous to both the caregiver and care recipient. In response to continued and increasing evidence documenting these concerns, the Centers for Disease Control has identified caregiving as a “public health priority.”

Family, friends, and neighbors take on the responsibility of caregiving because of their love for and relationship with the person who is ill. However, their strong personal commitment to this role is all too often compromised by their lack of medical knowledge, inadequate support and inability to focus on their own health and wellness. In order to preserve the vital role caregivers play in our healthcare system and to decrease the likelihood of becoming ill themselves, caregivers need resources, information, skills training, and their own self-care and support services.

Complementary Therapy practitioner, Janet Siniscalchi, R.N., provides a Reiki session for a caregiver.

With more than 30 years experience supporting family caregivers of its hospice patients, Hospice by the Sea, Inc. understands the important, yet often unrecognized, role that caregivers play in our healthcare community. They have developed the Aloesea Caregiver Program to empower caregivers with the educational resources and support they need to better care for their loved ones and themselves. The nurturing qualities of the Aloesea Caregiver Program are represented in its name, “Aloesea,” which is derived from the healing properties of the Aloe plant, and from the Sea’s capacity to calm and revive.

The intent of the Program is to improve caregiving skills, increase wellness and reduce stress, and decrease feelings of isolation and loneliness among caregivers. The program consists of the following components:

  • The Sylvia Wolens Caregiver Education Program provides skills training workshops on basic tasks and techniques associated with caregiving; offers a step-by-step skills training DVD, “A Lifeline for Caregivers”; provides information on community resources; and offers lectures on self-care topics.
  • Complementary Therapies are offered to reduce stress, restore energy, and nurture the mind, body and spirit of caregivers. Complementary therapies offered include: Reiki, Healing Touch, Guided Imagery, Meditation, Yoga and Drum Circle.
  • Caregiver Support Groups allow caregivers to come together to share experiences, gain new knowledge and establish supportive relationships with other caregivers. Caregivers learn self-care strategies and the importance of taking time to care for themselves.
  • Caregiver Respite is available to give caregivers a needed break from their caregiving role. Caregivers can use this time to focus on themselves. For example, to attend Aloesea Program activities, have lunch with friends, attend their own doctor’s appointments, or go grocery shopping. The Program has trained volunteers available to provide respite care.

The Aloesea Caregiver Program recognizes the importance of supporting, educating and empowering caregivers during National Family Caregivers Month and throughout the year.