Mount Sinai Medical Center is proud to offer comprehensive and compassionate mental health services in a newly renovated, state-of-the-art Adult Behavioral Health Services Unit, located on the main medical center campus in Miami Beach. The 19-bed facility addresses the needs of acute or chronic patients who require stabilization in a secure treatment environment.

“At Mount Sinai, we are dedicated to providing a continuum of outstanding healthcare services that meet not only the community’s physical needs, but the psychological needs as well,” said Steven D. Sonenreich, president and chief executive officer of the medical center.

(l-r) Thomas Mahle, Director, Behavioral Medicine; Saki Sacdalan, Nurse Manager, Behavioral Medicine; Steven D. Sonenreich, President & CEO of Mount Sinai Medical Center.

The program serves voluntary and involuntary patients for diagnosis and treatment of psychiatric symptoms. A team of mental health professionals works together to offer patients a comprehensive approach to care, including: individual and group therapy, occupational and recreational therapy, psycho-education, and psychiatric nursing. The hospital also offers specialized care for elderly patients diagnosed with Alzheimer’s disease, dementia and other disorders.

In addition to treatment, the renovated psychiatric unit provides a quiet, safe and supportive setting that fosters healing and growth for all patients. The result is a therapeutic atmosphere in which patients’ daily activities and environment are directed toward his or her return to the community and an independent life.



Every day, advances are being made in the field of cardiac care. From new medications to treat heart problems to less invasive ways of diagnosing the disease, patients are benefiting from the strides made by cardiovascular researchers.

“Within the field of cardiology, there have been advances made in many different areas,” explained Dr. Gervasio Lamas, director of Cardiovascular Research and Academic Affairs at Mount Sinai Medical Center in Miami, Florida. “There have been advances made in device therapy, like pacemakers and defibrillators; advances in catheter-based therapies; and advances in pharmacology, or the drugs used to treat heart disease.”

According to Dr. Lamas, one of the most exciting potential advances in the device therapy field is a new pacemaker-like device that is used to strengthen the heartbeat of patients with heart failure. “It’s a very novel therapy that has been used in pilot studies with a small number of patients,” he said. “This high-output pacemaker stimulates the heart as it is beating, which appears to make the heart beat more strongly.” Mount Sinai, which is the only south Florida hospital currently involved in this multi-center trial, is still looking for patients with heart failure to participate.

Continually evolving technology is making a difference in catheter-based treatment, including the use of different filtering devices to catch the debris that accumulates in the bloodstream as the result of having a stent implanted. “There have been seminal advancements made in terms of intercoronary stents and drug-eluting stents,” said Dr. Lamas. “Where before we were seeing revolutionary advances, now we are seeing evolutionary advances.”

“Within the next two to five years, I also see a real change in the way we diagnose coronary artery disease,” he added. “The computer technology of CAT scans has improved so much that the pictures we get from this non-invasive method are equal to the ones we get when we use a catheter and squirt dye directly into the coronary arteries. I think that in the future, catheters will only be used for therapeutic reasons, like closing a hole in the heart or opening an artery.”

On the pharmacological side of things, stem cells are being used to regenerate heart tissue lost after a heart attack or viral infection of the heart. “This is looming out there as a major advancement,” said Dr. Lamas, “though this technology is not yet ready for primetime.” In the next two months, Mount Sinai also plans to participate in a drug therapy trial in which an oral antithrombin agent will be substituted for Coumadin, a potent anticoagulant that can cause complications in some patients.

Dr. Lamas is also spearheading a clinical trial at Mount Sinai to test chelation therapy, an alternative medical treatment for coronary artery disease. “Though rejected by mainstream cardiologists, chelation therapy has been used since the 1970s by alternative medicine physicians,” explained Dr. Lamas. “More than 1 million chelation infusions are given in the U.S. yearly, without clear evidence of benefit or harm.” Chelation therapy uses a man-made amino acid, called EDTA, to grab heavy metal molecules in the blood and excrete them from the body.

At A Glance
Dr. Gervasio A. Lamas
Director of Cardiovascular Research and Academic Affairs
Mount Sinai Medical Center

Education:
B.A. in biochemical sciences (cum laude), Harvard College
M.D., New York University School of Medicine
Internship, residency, and cardiology training: Brigham and Women’s Hospital of Harvard Medical School

Honors:
Served as president of the Miami Chapter of the American Heart Association
Served as District Counselor for the American College of Cardiology
Named Latino of the Year in 2005 by the Latin Business Club of America

Proudest Career Accomplishment:
“I’m proudest of the role I played in the development of ACE (angiotension-converting enzyme) inhibitors for high-risk heart attack patients in studies performed at Brigham and Women’s Hospital. This medication has resulted in a 20 to 30 percent reduction in the rate of death from a heart attack in the sickest patients.”

Most Valuable Lessons Learned:
“In medicine, so-called truths or classic teachings are not true unless they have been proven. Until you do your homework, experiment, and perform clinical trials, you really don’t know the answers. A healthy skepticism is the best scientific attitude.”
“Most of the time, if you listen to a patient, they will tell you what’s wrong with them.”

Dr. Lamas designed a trial to test the therapy, and has currently given more than 30,000 infusions to the 850 patients enrolled. “Sometime in the next two to three years, we’ll know if this therapy works,” said Dr. Lamas. “If it does, it will benefit patients by causing a reduction in coronary and other vascular events, in turn reducing the rates of death, stroke and hospitalizations. It could also open up the door to a lot of other alternative therapies.”

Even with all of the advancements in the field, however, Dr. Lamas says he expects to see cardiologists continue to be in demand in the near future. “We are seeing the incidence of premature heart attacks in young people decreasing in proportion to having their cholesterol and hypertension treated, and because fewer people are smoking,” he said. “Yet Americans continue to be obese and sedentary, including children as they enter adulthood. Until people stop smoking, lose weight, exercise and take care of their cholesterol, we cardiologists will not enter that exalted state of unemployment.”

One benefit of these new technologies as they become available is that they will enable doctors to try to help patients take control of their futures, added Dr. Lamas. “We will be able to diagnose problems much earlier because of the technology, which means I will be able to tell a 35-year-old inert, overweight man that I see plaque and fatty deposits already forming on his arteries,” he explained. “I will be able to tell him that the process has started and that he’s on track for a heart attack in his 50s. Hopefully, with that ammunition in hand, he will change his behavior.”



Docs resilient after Wilma, but what about your billing service?

One pediatrician in Palm Beach County was lucky enough to get his power back one week after Wilma. But the building where his billing service was located had no power for two weeks, and managers locked out the tenants. The result: The pediatrician was forced to see patients amid chaos and uncertainty with no support and sporadic communication from his vendor.

Another doctor, a nephrologist in Dade County, didn’t have power but wanted to see patients as soon as possible after the hurricane. His billing service was in contact with him immediately after the storm, and they hand delivered to his office a hard copy of his appointments and superbills for every patient. The doctor saw as many patients as possible and his back office maintained control – even without power.

It’s this new generation of more sophisticated companies that will make it easier for medical offices to bounce back quickly after the inevitable next storm.

Keeping big promises

Hurricane Wilma was a reality-check for companies that provide medical offices with Internet-based practice management software (also known as application service providers, or ASP-model software). Billing and collection services and other firms that serve physicians were also put to the test. These companies all make big promises to protect your practice data, to provide reliable software, to protect your billing, and to support your office during and immediately following a storm like Wilma.

By most indications, the promises were kept and the planning paid off for those ASP-model companies who were prepared. Their client practices in the hardest-hit areas of South Florida had access to data from office and from home, and there was reliable customer support immediately after Wilma passed. Internet reliability and security also scored well. Practices outside the tri-county area saw patients the same day Wilma hit, Monday the 24th, without a single flicker in service.

Still, for practices that use billing services or Internet-based software, some important early lessons emerged from the days that followed Hurricane Wilma:

Seven Lessons

Lesson 1: Beware owner/operators! Your vendor must have a clear management hierarchy

For any vendor your practice deals with, but especially a billing service, there should be clear responsibilities to the clients and defined lines of communication at all times – it’s even more crucial following a natural disaster. Be wary of vendors where the owner is also your main point of contact within the company, or worse, when that person also is doing most of the work for your practice. After the next storm, chances are this owner/operator will not be focused on your practice’s needs.

Lesson 2: Your billing service must have a real, rehearsed Business Continuity Plan.

Power outages were widespread after Wilma. Was your vendor prepared, or was their office closed for two weeks? What happens if power returns to your medical office, but your vendor’s place of business is without power? What plans are in place for the billing company to continue serving you even if their workplace was damaged?

Lesson 3: Your vendor must have the resources to support you when conditions are worst – that is, in the immediate hours and days after the next storm.

Don’t forget the chaos that followed Wilma, when everyone was trying to re-open businesses under less than perfect conditions (i.e., power or phone is out, employees impacted, traffic nightmares). What can your billing service or software supplier do to help you? What kind of team is in place, is their staff motivated and responsible?

Lesson 4: Your appointment schedule and superbills are “mission critical”.

Even under the worst conditions, you may still be able to see some patients and thus generate revenue – but you must have your appointment schedule, and you need superbills for each patient. How can your vendor help you with these? Without them, your office can’t run effectively, so make sure your vendor is there to support you.

Lesson 5: Generators are easy to set up and cheap to run, so consider buying one.

A small generator (5 KW) and 10 gallons of gas per day is enough to power a 1-2 doctor office (computer, a few lights, a small fridge, a couple of fans). If you can, buy one now and be prepared.

Lesson 6: Internet-based software comes in handy when doctors or employees must do some work from home.

The Internet, for the most part, passed its first big natural disaster test in South Florida. From most reports, the Internet came back with the electricity, although a couple of local DSL dark spots remained. A strong ASP-model billing service will be prepared for any possible scenario. Make sure your vendor can help your office see patients and continue effective, error-free claims submission.

Lesson 7: Protect your practice data.

Most practices are familiar with the ritual of the nightly back-up, but where are the tapes kept? Although I heard few reports of damage to computer servers located in medical offices that contained patient data, Hurricane Wilma should remind you that office buildings are designed to be comfortable for patients, not to protect computer equipment and data. A properly set-up ASP-model vendor will have your practice data stored on servers in a secure, professionally managed facility.



A requirement in the delivery of equitable access to healthcare services is the need to address and consider language diversity. It is important to ensure the same standard of care to Limited English Proficiency (LEP) speaking patients as to those who are English speaking. With the use of interpretation services in healthcare systems these language barriers are obstacles overcome.

A growing number of administrators are responding to the healthcare needs of diverse populations. In turn, restructure and use of language services become integral in these organizations.

Healthcare providers and patients who speak different languages obtain understanding through interpretation. This becomes necessary for appropriate treatment and accurate diagnosis. In addition, information pertinent for illness management should be understood by the patient. It is their right to negotiate their priorities and expectations of care. In some instances where information is not communicated in the patient’s language and an interpreter is not utilized, a patient’s inability to manage their illness as a result can be found to be non-compliant. Therefore, if a health provider and patient relationship fails in lieu of an ineffective communication of illness management or consent, the patient could incur further health implications, which in turn may cause the healthcare system or insurer to sustain added costs.

Not everyone is able to act as an interpreter in a healthcare environment. Omissions, summarizations, additions, and lack of knowledge in technical healthcare terminology, among other variables, have been committed by untrained interpreters including family members and healthcare staff when communicating between the patient and healthcare provider. Confidentiality issues concerning the patient’s medical history and ethical concerns arise when a family member or non-healthcare experienced interpreter is utilized. The burden and expectation that the patient and family will provide their own interpretation adds to the economic difficulty of the non-English speaking families.

Legal consequences of inadequate interpretation, which are associated with incompetent care, must be of interest to healthcare administrations and insurers. It is each organization’s duty to have by policy in each patient’s medical records an informed (meaning fully understood) consent. If the language barriers are not breached with successful communication the hospital or insurer could be liable for an invalid consent to treatment.

In California the state Department of Managed Health Care is drafting regulations for Senate Bill 853, sponsored by Senator Martha Escutia, D-Montebello. The bill passed in 2003 and will require health insurers to provide interpreters by next year. Therefore the proposed rules state that health plans must have language assistance in effect by July 1, 2007 and written communication must be provided in Spanish and other languages by October 1, 2007.

With the assistance of trained medical interpreters, patients who speak a different language than their healthcare providers are able to ensure quality correspondence. The legal liability and ethical concerns surrounding patients in clinical situations or illness management require accurate language services. Whether it is Sign Language, Turkish, Italian, or any other language, organization and implementation of language services is needed to facilitate language diversity in healthcare systems.



Do you make your own paper clips? No, because you can’t make them efficiently or at a cost less than you can buy them. This same principal holds true for other areas of your business, including payroll processing. Payroll is a critical business function, but not one that brings value to shareholders or improves service to customers. You have the best understanding of your core business and should focus on its growth and success, and not having to worry about payroll tax due dates and compliance. Outsourcing payroll processing can free up a substantial amount of human and capital resources – resources that could be better used for developing and implementing value-adding strategic initiatives.

Many business owners underestimate the cost of processing payroll internally. They fail to account for all of the man-hours spent by anyone in the organization that touches the payroll from the point of data collection and entry to the balancing and filing of the quarterly payroll tax returns. This is on top of the obvious costs of maintaining payroll software and purchasing annual tax updates. The largest cost of them all is the cost of mistakes. The IRS has reported that forty percent of small businesses that perform their own payroll duties are fined for inaccurate returns, and the average fine is $845. There is also employee dissatisfaction that can result from inefficient payroll and benefits processing, which can certainly effect employee retention, thus becoming a competitive disadvantage.

Outsourcing payroll also gives the small business owner options that are not otherwise available. Payroll companies now have a wide range of outsourcing options not available to the in-house processor, including workers’ compensation “Pay As You Go” and employee self service. There are also numerous reporting abilities not typically found with internal payroll software programs. In many businesses, timely, accurate and specific payroll reports are key to labor cost control by alerting managers of problem areas.

When selecting a payroll provider there are a few keys in finding the right one. Look for a company that has payroll as its central function. Ask the provider about services they provide to other companies that are in a similar industry to yours. Get a clear picture of the price by asking for an approximate annual cost rather than being distracted by introductory offers. Most importantly, look for a company that can provide you with personal customer service. Larger payroll companies are not always the best.

Payroll is a vital function of any business. Outsourcing to experts is not only cost efficient, it’s a wise and sensible move for businesses of any size. Once payroll functions have been outsourced to a reputable company, you can sit back and concentrate on your real business.