Review from our interview with Liz Craven

Many seniors reach a point in their lives where they simply cannot manage their daily tasks alone. When that day comes, for most families the best move is to help them find a quality senior living facility where they can make a new home. It is a hard decision and the stakes are high. You want your loved one to be happy, and many seniors are resistant to the idea. What makes it even more difficult is when said loved one is not capable of making that decision.  According to Alzheimer’s Association one in ten people ages 65 and older has Alzheimer’s dementia. You may be reading this blog and you either know someone that is going through this transition or are personally going through it as we speak. Well fear not, we recently sat down with Liz Craven of Pro Ad Media and she just may have the solution you may have been looking for.

If There is a Need There is a Way:
Upon graduating from Florida State and going to work in corporate America, Liz Craven met her husband Wes, and both were in the retail environment. After the two were hitched they decided very quickly that retail management was not how they were going to live their married life together. They then decided to move to Lakeland to be close to Wes’ family.  Mabel, Wes’ grandma had Alzheimer’s and once she was diagnosed they knew part of the solution was to move closer to help. Mabel’s journey through Alzheimer’s was hard for the whole family. It wasn’t a time when you could just hop on computer and find google answers to everything that you wanted had a question about. Resources were something you really had to seek out. At some point Mabel fell, she ended up in the hospital. Needed to go rehab after her release. According to Liz the folks at the hospital gave the family a list of phone numbers for potential rehabs and that was all they had to go on. Liz’s husband’s mother was working full time as a teacher at the time so it was up to Liz and Wes as 20 somethings to figure out how to help Mabel. They  had no idea where to turn, and so knocking on doors and hitting the library and calling anyone  who would answer is how they did their research. It became quite a passion for Wes who wanted to make sure that his grandmother was well cared for. In the end they found a great care for her. The rest of that journey is another story in itself because Alzheimer’s can be quite a devastating disease. But through that experience they recognized that if they needed this information that other people did too. So Liz and Wes decided to do something about that to make sure that they could help and provide some access of information and some help the people in crisis. Families that did not know where to turn. Wes continued his research and they put together in a book format. They asked the Lakeland community for its support and here they are 25 years later with Polk Elder Guide Care still being a cornerstone of resource that is used for the senior population here in Polk County.

About the Polk Elder Care Guide
The Polk Elder Guide is an annual publication for seniors and their family members throughout Polk County who want to learn what resources are available in the county. Every year they make sure all the providing information is current. Even a year down the road you will see lots of items coming in and out. You’ll have new organizations appear you will have other organizations change hands. You will have some companies that such as homecare that come and go. There are a lot of companies that come and go, and they make sure that everything is updated on a regular basis. The community resources are something that they are constantly discovering. It is probably by far the most difficult task they have is identifying resources that are available for people. Some of that is because those who know of them want to hold them dear so that when they need to refer to those resources that they are available because non-prophets can become very overwhelmed by the demand they are faced with locally. That can be an issue. They have a lot of incredible people in this community who are addressing that issue and working on that. They got some exciting things coming here in Polk county area in that respect.

What Makes the Polk Elder Care Guide Useful?
The checklist is what makes the elder guide useful. There are a few things that are important that will never change in this guide. Number one, educate people. You will also find that it is a color-coded directory and each section for example the assistant living section starts with education. Someone can go though there and understand what assistant living means by the time they read through those few pages. After they read about it they are going to know what is available, so they have a complete directory. What neat is regardless of whether organizations are advertised with Polk Elder Care Guide they are listed in there. Liz and Wes want you to know every assistant living facility or community available to you locally, so they provide that information and the phone numbers. The Checklist can help you go through the long lists of facilities. The Checklist is two pages of questions including how much this is going to cost me and how is the food, and what do I see when I walk through the building are the residents engaged. Things to look for. When you are in that situation trying to make that choice is very difficult to remember all those bits. All those little pieces to check on. And so, providing it in the check list format it will allow someone to walk through a facility and preview it by highlighting the questions they really need answered and use that as a guide to tour different facilities. The checklist gives you an opportunity to compare three different choices. By the end they should be able to make a very educated choice and we have checklists like that also for the nursing home section and the home care section.

Do I Have to Pay for The Polk Elder Care Guide?
Absolutely not! The guide is distributed FREE each year in paper form. The information may also be accessed on their website:

We hope you enjoyed this month’s blog post! Stay tuned for roundtable discussion with Liz Craven, Jorge Geraldo, Tasha Saca and Randall Munsters.

The Four Killer ‘Bs’ of Health

Do you know your health numbers?  There are four numbers that can help paint a better picture of your health, and this is something you should be discussing with your primary care physician. We like to call them the “Four Killer Bs”— but don’t be scared!  When kept in check with proper preventive steps, these Killer “Bs” can help save your life.

The Four Killer “Bs” are:

  • Blood Sugar (or Blood Glucose)
  • Blood Cholesterol
  • Blood Pressure
  • Body Mass Index

Blood sugar is the amount of sugar (glucose) in the blood.  Those living with or at risk for diabetes already know the importance of monitoring sugar levels in the blood, but it can be useful for anyone to keep track of this information for health monitoring purposes.  Blood pressure is the force the blood exerts against the walls of the arteries as the heart beats.  Blood cholesterol is a measure of the waxy substance produced by the liver.  LDL (low-density lipoprotein) is what’s known as “bad” cholesterol, and HDL (high-density lipoprotein) is what’s called “good” cholesterol.  The ideal body mass index is determined by gender, age, height, and frame, and is a good indicator of whether or not you are at a healthy weight.

Here at Peak AWC, your Annual Wellness Visit will not only measure your Four Killer “Bs,” but it will go even further to paint a complete picture of your health and help you determine what steps you can take to attain and maintain your maximum quality of life.  Call our office today to schedule your appointment, which is free to Medicare patients.

This column is sponsored by Peak Annual Wellness Center.

BIO: Jeffrey Epstein, MD is board-certified in geriatric and internal medicine.  He is passionate about helping seniors stay healthy so they can maintain a high-quality lifestyle.  Dr. Epstein has practiced general internal medicine and geriatric medicine for 20 years before transitioning to a role as Hospital Medical Director and Physician Advisor in 2011.  Peak AWC was founded to provide Annual Wellness Visits to seniors and empower them to avoid vulnerabilities that could cause great harm.  It is the goal of Dr. Epstein and Peak AWC to provide better care at a lower cost by focusing on keeping individuals healthy and out of the hospital.

See Your Doctor Once A Year To Stay Happy and Healthy!

If someone asked you how your most recent visit to your doctor was what could you tell them? Wait, you haven’t been to your doctor recently? It might surprise you, but you’re not alone! Perhaps you consider yourself a generally healthy individual, or you find yourself without much time in your busy schedule. Maybe you’ve avoided seeing a doctor because you were afraid of incurring undesired medical costs. Whatever the reason, as you mature in age it is crucial to take advantage of your Medicare benefits. At no cost to you, simple regular check-ups can extend or even save your life!

The Importance of a Physical Exam
The foundation for improving your health is based on an idea: “prevention is better than having to cure.” You may already know that eating healthier and exercising more will get you on your way to preventing illness and disease. However, regular check-ups not only help in identification of diseases that have hidden symptoms but also help in increasing the chances of cure. For example, fatal diseases such as cancer, when discovered late makes it impossible for a cure. A regular check-up also helps in identifying recovery progress for an already existing condition. These benefits are yours only if you take the time to do them!

Medical check-ups have various benefits for any given person, especially since overall life-expectancy has gone up which means people are generally living longer. If your doctor identifies that you have a life-threatening disease during a check-up, they have the ability to give you the proper steps to cure it. Medical check-ups have the added benefit to both researchers and yourself. The documentation of medical check-ups plays a huge role in identifying the success of various government policies and medical intervention. From an individual’s perspective, these check-ups play a basic role in helping to identify undetectable ailments.

Perhaps the most sought-after check-up is for cancer. Progression and identification of cancer symptoms are usually realized in it’s late stages, which in most cases is not treatable. Surprisingly, most people haven’t paid much attention on the relevance and success of medical check-ups. Check-ups play a significant role in detecting illness and disease early, lower the rate of re-hospitalization and lead to a healthier lifestyle.

The Importance of an Annual Wellness Visit
The Annual Wellness Visit (AWV) is designed for Medicare patients 65 and up. This visit allows Medicare patients to get a birds-eye view of their health as it is now, and then to chart a path for their wellness into the future. The preventive strategies can lower their number of hospitalizations, adverse drug reactions, unnecessary emergency room visits and re-admissions. Ultimately the outcome of the AWV results in a healthier and happier life.

The AWV consists of a number of non-invasive steps and screenings that can help identify gaps in your healthcare. For example, screening for immunizations and cancer can help in uncovering an illness that was not identified at an earlier stage or during a routine check-up. During the visit patients are screened for a number of items including cancer, dementia, hearing loss, family medical history, home safety and more.

Unlike other models such as regular check-ups or the yearly physical, the AWV comes with multiple activities that promote both the patient and their home environment. As it turns out, not many people have had to access this visit simply due to lack of knowledge. Research conducted by Novus Healthcare in 2015 showed that the Annual Wellness Visit reduced hospitalizations by 40%. This means that 80% of seniors who did not get an AWV were at risk of hospitalization!

After their visit, patients receive a written Wellness Report, a 5-Year Wellness Plan and a 90-day action plan in order to give them a roadmap to staying healthy. They can bring the written Wellness Report to their primary care doctor to review any gaps that may have been missed or not communicated during an earlier check-up.

Physical Exam or Wellness Visit?
You might be saying to yourself, “That all sounds great Doc, but which visit should I be scheduling?” The answer is both! At Peak Annual Wellness Center our mission is for you to stay healthy, live longer and enjoy life! Think of us as a free second opinion. After having a consultation with you at our office you will be equipped with a Wellness Report that your primary care doctor will be able to review for any additional care you may need. We believe that this type of partnership with patients and physicians benefits everyone involved in the process.

In 2009, research conducted by the National Center for Chronic Disease Prevention and Health Promotion showed that medical check-ups were an indispensable element of prevention that had positive healthcare impact. The research identified that in the US, over the past two decades, we witnessed tremendous progress of effective cancer prevention strategies by early detection. Additionally, immunization was observed as part of preventive health.

With regard to immunization, the study identified that infants and adults experienced fewer hospitalizations for the flu and pneumonia because they had been immunized. The studies showed that vaccination could be up to 43% effective in the prevention of influenza-related pneumonia and approximately 70% effective in the prevention of hospitalization for influenza and pneumonia for older persons.

Benefits of having a Primary Care Doctor and a Wellness Coach
The added benefit of the Annual Wellness Visit is like having an extra coach in your corner looking out for your success! Medical check-ups provide a platform that increases your chances of identifying and treating an undetectable illness with the hope of increasing your survival chances. There are varying illnesses such as unhealthy body mass index, high blood pressure, diabetes, and prostate cancer; all these illnesses are life-threatening but can be missed or overlooked during a routine medical check-up.

If you are 65 or older, or if you know a friend or family member who is, you can prevent the preventable by taking just a few minutes to schedule an Annual Wellness Visit. This free consultation could help prevent unwanted health burdens if caught early on. Let us help you to stay healthy, live longer and enjoy life! Visit to schedule your appointment today.

The Importance of the Annual Wellness Visit

Going to see your doctor for your Annual Wellness Visit (AWV) shouldn’t be something you avoid.  Instead, making an appointment for an Annual Wellness Visit for you or for someone you love is a simple way to take control of your health again.

This one simple appointment known as an Annual Wellness Visit is actually known to cut hospitalization rates by 40 percent! Wouldn’t you rather make an appointment on your own time and ensure you’re healthy than find out about an issue after you’ve already landed yourself in the hospital?

Before you or your loved ones end up in the hospital from something that might have been prevented, make sure you are following up with your doctor for this specific kind of appointment.

What can I expect from my Annual Wellness Visit? 

Doctors will be most likely checking in with you on where you are with your own health and fitness goals. At the time of the Annual Wellness Visit, your doctor will ensure you are up to date on your immunizations, take the time to schedule any cancer screenings, and assess your risk for falling, the status of the health and safety at your home, any signs of early onset dementia, depression, or substance abuse. Finally, your doctor will review your medical history with you to make sure there is nothing outstanding that he or she should be aware of.

Annual Wellness Visits keep patients out of the hospital because in these appointments, immunizations and cancer screens are checked.  Through proper screening, cancer can be detected much sooner. The sooner cancer can be caught, the better chance an individual will have in getting a head start on the road to recovery.  When the AWV finds a gap in recommended immunizations, giving that immunization can prevent a hospitalization for influenza, pneumonia or even shingles.

Especially in regards to the elderly population, the doctor assessing the potential for a possible fall and encouraging the individual and their family members to take the appropriate measures can help keep someone who is vulnerable much safer. Physical and cognitive health are given the care and attention they deserve, as well.

For more information about the importance of an Annual Wellness Visit, please visit our website at You will find our short two-minute video on our homepage. If you’re ready to schedule your Annual Wellness Visit with Peak Annual Wellness Center, please contact us through the Contact page on our website.

Be well!

Jeffrey E. Epstein, MD is the Medical Director for Peak Annual Wellness Center in Lakeland FL.  Peak AWC’s mission is to help our seniors stay healthy so they can enjoy a high quality of life for as long as possible.   For more information,  

PEAK Annual Wellness Center: Helping to Keep Our Seniors Healthy, Robust & Strong

The senior citizens living in our community have worked hard to get where they are today and they deserve the best, most attentive, all-encompassing care that can be provided.  Most of them are enjoying retirement and their health, above all other things determines how well they move about, interact with their friends and family, and participate in their community, which is very important.  At Peak Annual Wellness Center, we understand that although it seems very simple, providing senior citizens with thorough annual wellness exams can make a difference in their future health and the future health of the community.

What is the goal?

The physicians at Peak Annual Wellness Center have one goal:  To keep the senior citizens in our community healthy and to identify any gaps in their care.  Believe it or not, even if someone sees their primary care physician on a regular basis, diagnosis and health concerns can still fall through the cracks.

How does it work?

When a senior citizen from the community attends a wellness exam at Peak Annual Wellness Center, the physicians slow down, take their time, listen to the concerns of the patient and aim to understand where you are in your health and fitness journey. By taking their time and creating a personable, comfortable environment for your visit they are more likely to catch a gap in your care that could lead to a bad case of the flu, or even cancer. Any documents and information that you receive at your visit can be transferred to your primary care doctor for follow up.

Who is it for?

Literally, everyone over the age of 65 is the perfect candidate for a visit to Peak Annual Wellness Center.  Take Jane Smith for example.  Jane came into the center as a perfectly healthy 68-year-old woman.  While at the center, Jane received attentive care and was attended to by some of the best physicians in the area. Jane learned that she was in need of a DEXA scan, shingles shot and that she was a fall candidate due to a previous injury.  Overall, Jane left the appointment more aware of her health and what she needed to do to take better care of herself. As a result, Jane will be on her way to a healthier future in no time.

When should I come in?

If you are a candidate for a visit to Peak Annual Wellness Center or know someone who is, you should call to make your appointment right away.  There is no time to waste when it comes to your health.  Your friends, family, and community need you to stay healthy, robust and strong so that you can live the life you deserve and have always dreamed of.  We can’t wait to meet you.

Reporting MIPS, Medicare’s “Merit-based Incentive Payment System” is Easier Than You Think


MACRA-MIPS has been with us since January and this year’s data will determine your penalty/bonus in 2019.  This applies to all your outpatient Traditional Medicare revenue.  The penalty starts at 4% and increases to 9% over the next 5 years.  For a practice with $200,000 in Medicare revenue, this would be $8,000 this year to $18,000 in 2023.

Many doctors have accepted the penalty because they don’t want to spend time and money addressing another burdensome government regulation.  They feel the money is not worth the effort and stress to comply.  They are overwhelmed with all the changes occurring in healthcare and they have chosen to ignore this particular burdensome regulation.

In June 2017, CMS updated the MACRA-MIPS regulations, and one of the most important measures was to allow providers to report only Quality data, this year, to avoid the penalty.  In this article, I will show you how to report that data and then how to develop a plan for 2018 to protect money for 2020 and forward.

MACRA-MIPS has four components, Quality, Advancing Care Information (ACI), Clinical Practice Improvement and Utilization  

The Quality requirement is similar to PQRS, ACI is similar to Meaningful Use (MU) and Clinical Practice Improvement is new.  Utilization is determined from billing data which you submit through your billing service.

Quality Data can be reported using a service like MDinteractive.  For $199 per year, they provide all the tools and information you need to handle MIPS.  They are the number two CMS Qualified Medicare Registry, and they provide one- stop shopping for submitting Quality, Advancing Care Information, and Improvement Activity data to CMS to fulfill requirements of the Merit-based Incentive Payment System (MIPS).  I would recommend finding a service like this to use as your reporting platform.

Why is avoiding the penalty so easy?

Because you are probably already doing what MIPS requires and all you have to do is report it.  The quality requirement is 6 quality measures that you select from a menu of 50 choices.  Your six simple quality measures can include HgA1C and Eye Exam in diabetics, ACE/ARB in heart failure patients and Flu Shot, Mammogram and Colonoscopy for all patients.  There are many others to choose from and you should choose what you already do and chose metrics that will be simple and easiest for you to report.

In our next article, we will discuss Advancing Care Information, Clinical Practice Improvement Activities and Utilization metrics.  Right now, your best use of time would be to study the quality metrics and see if you can report something for 2017 to avoid the penalty this year.  Look into a qualified Medicare registry like MDinteractive to help. Remember that MIPS is graded on a “curve”, so all you have to do is be better than your peers.  In 2017, this will be easy since most doctors are ignoring MIPS.  Good luck!

Jeffrey E. Epstein, MD is double boarded in geriatric medicine and general internal medicine.  For the last 7 years, he has been a hospital medical director working in the area of documentation, compliance and operations.  He has studies MACRA-MIPS in great detail and is staring a company that does Annual Wellness Visits on Medicare Patients.  His company partners with physician practices to get the AWVs done.  Once an AWV is done, all elements of MACRA-MIPS can be reported for maximal bonus and physician’s professional reputation soars because of the quality reporting that the do.

Keeping Our Seniors Healthy: 40% Reduction in Hospitalizations

Did you know that 80% of our seniors have not received the AWV which means that 80% are still at an increased risk of hospitalization?

In a study of 17,000 Medicare patients, done in 2015, Novus Healthcare found that the Annual Wellness Visit (AWV) reduce hospitalizations by 40%.

How does the AWV reduce hospitalizations?

There are many thoughts about this, but most agree it is a combination factors.  Double checking the immunizations and cancer screens can turn up something that was missed, and closing that “gap in care” can prevent that condition which would likely lead to hospitalization or worse.  Screening for fall risk, home safety and memory loss, especially in those getting weak and forgetful, is also critical to preventing hospitalizations from accidents.

The Annual Wellness Visit (AWV) is a much more comprehensive visit than the “yearly physical” and it is tailored to find patients with “gaps in care”, who are at higher risk for hospitalization because of undetected vulnerabilities. The AWV is essential to have each year, in addition to the “yearly physical”.

Finally, the AWV Report is a written consultation, with summary charts that encapsulates the individual’s current health condition, identifies “gaps in care” and serves as a map for the care going forward. Individuals can share this report with any provider to help inform that provider of their overall health condition.

The best part of the Report is that it is a stimulus for important conversations between the patient and their family doctor. Part of staying healthy is about avoiding the avoidable and preventing the preventable.

Live well and live long. Get your Annual Wellness Visit each year to make sure your back is covered and your vulnerabilities are addressed.

Jeffrey E. Epstein, MD is the Medical Director of Peak Annual Wellness Center in Lakeland Florida. Peak AWC’s mission is to help our seniors stay healthy so they can enjoy a high-quality life while living long and healthy for as long as possible. The visit is free. No copay or deductible. Peak AWC only does Annual Wellness Visits. We make sure individuals follow up with their primary care physicians to discuss the “gaps in care”.  For more information, go to