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North Miami Beach Based Primary Care Group Practice Launches Telemedicine Platform Print E-mail
Written by Jeffrey Herschler   
Thursday, 26 March 2020 09:19

CCMS-ACO, a Primary Care Group Virtual Practice based in North Miami Beach, launched its new telemedicine platform earlier this week. With the ongoing COVID-19 health crisis creating unprecedented demand for telemedicine services, this new option could not have come at a better time. The company provides HIPAA and HITECH compliant, online access to licensed clinicians. accepts Medicare, Medicaid, commercial insurance and credit cards. Cash pay patients can receive their initial consultation for $59.95; this price is reduced from $79.95 due to the crisis.

“Once the COVID-19 situation accelerated, we realized it was our duty to get this up and going as quickly as possible,” states Mario Espino, CEO of CCMS-ACO. “Successful deployment of telemedicine services is critical in coping with the crisis,” he adds. “Telemedicine keeps people out of busy medical facilities and contributes to the goal of social distancing.”

Telemedicine has been a fast-growing industry for at least a decade, but it’s always been held back by tradition and regulations. The government and other payers feared fraud and abuse. Practitioners feared out of state competition and patients often preferred the traditional face-to-face encounters. But now all of that has changed. The Trump administration on Tuesday, March 17 announced expanded telehealth benefits for Medicare beneficiaries, giving the country's older population access to medical care without having to leave their homes during the outbreak of the Coronavirus causing COVID-19. The black swan event of Coronavirus has now accelerated the pace of telehealth adoption dramatically.

At CCMS-ACO the original intention was to offer telehealth services in conjunction with meeting regulations based around Transitional Care Management. However, it was decided that a fully integrated platform that most resembled the experience of a real practice visit with electronic prescribing, security, and the ability for patients to access their information through a portal was necessary. “It had to integrate with our EHR,” states Mr. Espino. The platform automatically enters the video and audio consultation into the patient’s health record. Diagnoses are added to the record in real time. “We can coordinate all of the various medical records and then run the algorithms before creating the care plan, when we are doing chronic care management,” he states.

“We are not just a telemedicine company, we are primary care providers and a technology company,” states Mr. Espino highlighting the differences between his current venture and others in the telemedicine space.

And telemedicine will be a big part of CCMS-ACO’s strategy long after the COVID-19 crisis resolves. 

“There is propensity to be more vulnerable when visiting doctors’ offices or medical facilities – it’s very stressful,” he asserts. “These people are frail, immunocompromised. What you can’t quantify is: How many patients become sick because they went to the doctor’s office, emergency room or urgent care?”

Mario Espino has been in healthcare in one way or another for over 30 years and it looks like he is just getting started!


To learn more, please visit or

Last Updated on Thursday, 26 March 2020 10:18
Telehealth: Get ready for big changes in healthcare Print E-mail
Written by Paul D. Kivela, MD | KevinMD   
Tuesday, 17 March 2020 17:17

The year 2020 might bear witness to a significant shift in control of health care from the providers, insurers, and the government to actual healthcare consumers. First, it was the politicians, then the tech conferences and promises of 5G, and now global pandemic scares are all signaling the demand for remote healthcare. The delivery of healthcare has been in the hands of hospitals and physicians for nearly a century. The government really started to exert their control when Medicare and Medicaid started in the 1960s. Large private insurance companies started to significantly exert their control in the 1970s. With the coming of Obamacare almost exactly a decade ago, the structure of health plans changed as their profit model counted on greater patient responsibility through high deductible and co-pays. The failure of hospitals, physicians, pharmaceutical companies and insurance companies to be able to work together has caused consolidation.

Last Updated on Tuesday, 17 March 2020 17:44
How to care for someone with dementia Print E-mail
Written by AHHC News   
Thursday, 13 February 2020 08:30

The majority of us take our good memory for granted. It’s easy to recall a recent conversation with a friend. However, for patients suffering from dementia, even remembering the name of a loved one can pose as an overwhelming challenge. Stringing together words into complete sentences is a form of communication we practice daily with ease. A person who has developed dementia, however, struggles to even find words, if their condition enables them to speak at all.

Dementia damages brain cells and takes its toll on the minds of many older adults. Depending on what area of the brain is affected, the changes impair memory, thinking and social function, enough to hinder normal, daily function. Dementia is not a specific disease. Rather, dementia is an umbrella term used to describe a variety of symptoms, like the loss of memory, thinking and other mental abilities.

Alzheimer’s is the most prevalent type of dementia. Healthcare professionals estimate that 60 to 80 percent of dementia cases are classified as Alzheimer’s. Parkinson’s disease is a common form of progressive dementia, where sufferers experience difficulty with movement. Huntington’s disease, also categorized as dementia, affects patients who have a defective gene in a certain chromosome. Patients with Huntington’s disease experience abnormal involuntary movements, mood disturbances and an overall decline in the ability to think and reason. Dementia covers a range of other brain diseases, as well, like vascular dementia, mixed dementia and frontotemporal dementia, among others.

Patients with dementia suffer from stages of the condition, ranging from mild to moderate to severe. The three stages of dementia, as they progress, carry with them increasing losses of memory and function. No matter what type of dementia an elderly individual has, dementia care is necessary to help the patient live as comfortably as possible.

Preparing the home with safeguards is essential to managing complications associated with dementia. The living environment, however, is secondary to communicating empathetically with a person suffering from a degenerative condition, like dementia.

Connect Positively

Communicating with a loved one with dementia becomes stressful without key strategies that improve the relationship. Tips to ease communication include the following:

• Speak slowly, clearly and use simple sentences.

• When asking questions, phrase the question to encourage either a yes or no response.

• Redirect the conversation or change the environment if the loved one becomes agitated.

• Serve up good humor whenever possible. Even a person with dementia enjoys a hearty laugh.

• Inquire about the loved one’s fond memories. The patient’s short-term memory will yield a blank, but they will remember with ease what happened four decades ago.

Limit Wandering

Wandering is often a symptom of dementia. Patients with dementia may walk aimlessly for a number of good reasons, including to find the toilet, to overcome boredom, to cope with medication side effects, to “search” for someone or to simply exercise. Whatever the trigger, a caregiver can take steps to manage the unpredictability of wandering:

• Reduce the possibility for restlessness by scheduling daily exercise.

• Install key locks on doors, preferably not at eye level (where most dementia patients will look).

• Consider installing a home security system specifically designed to monitor patients with dementia. You’ll easily keep a close eye on your loved one.

• Make sure your loved one wears an ID bracelet in the event he or she is missing.

Reduce Emotional Disturbances

Often associated with the downward spiraling stages of dementia are irritability, aggression and sleeplessness. Agitation results from the patient feeling a loss of control, stress, fatigue or fear. Handle emotional outbursts with compassionate tactics:

• Establish daily routines to inspire feelings of comfort and security.

• Limit noise and clutter in the home; also keep the number of persons in the room to a minimum.

• Support your loved one’s independence, allowing him or her to accomplish as many self-care tasks as possible unaided.

• Avoid confrontation. Distract the patient from any unpleasant situation with snacks or an activity.

Ensure Eating and Drinking

Dementia patients’ memories do not include a timetable for meals and proper hydration. They literally forget to eat and drink. A lack of nutrition is unhealthy, leading to weight loss, sleeplessness, irritability, disorientation and bowel problems. Keep your loved one’s food and drink intake steady with these tips:

• Portion five to six small meals per day rather than three large ones.

• Support independent dining. Finger foods are preferable to traditional etiquette. You may also want to pre-cut food and replace drinking glasses with plastic cups.

• Share mealtime with your loved one and offer caring companionship.

• Give the dining environment a soothing atmosphere with flowers and music, for instance, to make mealtime special.

Promote Good Sleep Patterns

Day and night can become confusing events for a person with dementia, especially if their biological clock has become impaired. Counter the effects of sleeplessness with a good plan:

• Increase daytime physical activities, which will lead to a better night’s rest. Avoid napping midday.

• Take safety precautions at home: add a gated barrier to staircases, lock kitchen doors and put away dangerous items.

• Emphasize quiet, structured activities later in the day that promote rest, such as listening to relaxing music, playing card games or going for a leisurely stroll.

AHHC News is published by Assisting Hands Home Care. With offices in Kendall and N. Miami, the organization works with families throughout Miami-Dade County to develop the most optimum care plan to keep their loved one safe and engaged at home. Qualified caregivers are trained to provide non-medical care for all three stages of dementia. Families feel a sense of ease in knowing that their loved one is receiving reliable service. Assisting Hands Home Care serves the elderly populations with skill, compassion and dedication. To learn more visit 

Last Updated on Friday, 14 February 2020 17:57
Why physicians should acknowledge the validity of second opinions Print E-mail
Written by Don S. Dizon, MD | KevinMD   
Tuesday, 04 February 2020 16:41

One of the most valuable jobs I held following fellowship was working as a full-time deputy editor at UpToDate. My "territory" was breast, gynecologic, and genitourinary oncology, and I helped launch cancer survivorship and palliative care. I learned to really and critically read the literature, and how I could summarize it quickly so that my audience-whether colleagues or my own patients-could understand what we learned, and the limitations of those results

Part of what I learned was to use the terms "recommend" and "suggest" with care. At UpToDate, only those findings backed by the strongest evidence and results were called recommendations. The upshot being that whatever the action, it should be done as standard of care. So, when I wrote a topic on HER2-positive breast cancer, there was overwhelming evidence that trastuzumab was useful. Therefore, I wrote, "For women with newly diagnosed HER2-positive breast cancer, we recommend adjuvant trastuzumab."

The continuing battle between the emergency department and radiology Print E-mail
Written by Cory Michael, MD | KevinMD   
Tuesday, 31 December 2019 13:31

I overheard a disappointing phone call while supervising a radiology resident recently. I could tell that the resident was struggling in a conversation with an emergency department physician, so I asked him to switch over to speakerphone. Eventually, I heard the emergency physician say, “Listen. This is how it works. A patient points to what hurts. Then I have that part scanned, and you tell me what is wrong.”

Disheartening as it sounds, patterns like these have worsened in recent years. I try to teach radiology residents and ordering providers alike what the most important imaging tests are given clinical concerns, yet the amount of information given to the radiologist declines, and the number of scans continues to grow while the payment for these studies has leveled off or decreased in some cases. I even find out that providers are sometimes dishonest in the history provided just to get a study performed. The county hospital I am affiliated with has a large number of patients who can’t pay. Not only does the system eat the cost, but many of these studies involve potentially harmful radiation.

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Dollar General isn't doing enough to bring healthy food to low-income Americans Print E-mail
Written by FHI's Week in Review   
Monday, 23 December 2019 00:00

Darya Minovi reports for CNN Business on December 20, 2019
75% of Dollar General stores are located in communities of 20,000 or fewer people. What's more, these locations are typically at least 15 miles away from a full-service grocery store, leaving families with limited options for food... Dollar stores are able to sell products at unbeatable prices because of their simple business model. Operating costs are kept low by employing only a handful of people to stock aisles and limiting the amount of cold storage, which is necessary for fresh food. This is a business model that promotes nutritionally poor food and beverages to low-income customers. Dollar General opens stores in communities that grapple with gaps in food access that need to be addressed. But the retailers' approach to growth is rapid saturation, effectively boxing out the competition... <Meanwhile> People with low incomes face a significantly higher burden of diet-related diseases, like type 2 diabetes and high blood pressure, than those with higher incomes and tend to have less access to quality medical care to prevent or address those health conditions.
Read more in the current issue of Week in Review>>

Last Updated on Tuesday, 24 December 2019 15:17
A perk of Medicare for all: More time for doctors and patients Print E-mail
Written by FHI's Week in Review   
Monday, 09 December 2019 18:01

Rani Marx, MD and James G. Kahn, PhD offer an interesting commentary in KevinMD on Dec. 6:
...discussions of health care financing miss one critical issue that patients and providers desperately care about: sufficient time to communicate with each other. Presidential candidates focus on cost, policies, and logistics of implementation. But no one talks about how proposed plans will fix a big problem in the doctor's office: the amount of time doctors must spend attending to the computer - the electronic health record (EHR) - rather than the patient.
Read more in the current issue of Week in Review>>

Last Updated on Monday, 09 December 2019 18:17
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