FOCUS TOPICS DIABETES/WOUND CARE ICD-10 PAIN MANAGEMENT
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PHYSICIAN SPOTLIGHT PAGE 3
Frank Jordan, MD ON ROUNDS
Making the Transition to ICD-10 Change is coming soon to the West Tennessee medical community By EMILy ADAMS KEPLINGER
ROI on Healthcare Workforce Diversity Embracing cultural competency
Last month, healthcare leaders gathered in Nashville for the Council on Workforce Innovation’s symposium on trends and resources impacting healthcare workforce diversity and cultural competency in the delivery of quality healthcare ... 4
On the first day of October this year, the ICD-9-CM code sets that currently are used to report medical diagnoses and inpatient procedures will be replaced by ICD-10. The nagging question is, will the West Tennessee medical community be ready for the change? Since so many people and organizations will be affected, that question is indeed an important one. The users of the codes include practitioners, insurance carriers, government regulatory bodies and healthcare research personnel. Other entities that will be impacted include hospitals, pharmacies, physical therapy providers, home healthcare providers and skilled nursing facilities. Additionally, ICD-10 will affect everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The one exception is the CPT coding for outpatient procedures. Ready or not, the change is coming. Mary Ann Lucas is in a position to judge the degree of local readiness. She trains others in the processes involved in medical coding and is a medical coder herself. An independent medical compliance analyst and board member of the local chapter of the American Academy of Professional Coders, Lucas said, “Some of our coding com(CONTINUED ON PAGE 8)
HealthcareLeader
Addressing Obstacles on the Road to Diabetes Control
Susan Breeden CEO, Baptist Memorial Hospital - Huntingdon
What is the best way to get … and keep … diabetic patients actively engaged in the lifelong selfmanagement of their condition? ... 5
ONLINE: WESTTN MEDICAL NEWS.COM
By SUZANNE BOyD
Take a staff accountant in a small hospital that realized in her first year she had a passion for healthcare, add to that managing the business office and the result is an administrator. That is the equation that has afforded Susan Breeden her role for the past 17 years as administrator of Baptist Memorial Hospital in Huntingdon.
“I have a B.S. in Business Administration with a concentration in accounting and began my career as a staff accountant in a small hospital then was promoted to the business office manager. In 1988 I moved to Baptist – Huntingdon to manage the business office and ultimately worked with Baptist Health Care Corporation entities troubleshooting business office issues,” said Breeden. “In 1989, I left for
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How to Prevent Diabetes and Its Complications By Ebenezer Nyenwe, MD, Endocrinologist at The Jackson Clinic
Inability to Make Enough Insulin Causes Diabetes Diabetes is a disorder that elevates blood glucose levels. Carbohydrates are broken down to glucose, which is absorbed into the bloodstream. Glucose enters the cells from the blood and is used to make energy. The hormone insulin is required for glucose to enter the cells. People with diabetes are not able to make enough insulin; therefore, glucose accumulates in the blood and overflows into the urine.
Nearly 26 million people in the U.S. have diabetes. As an incurable disease, prevention is the only option diabetes patients have to stay healthy.
Patients with type 1 diabetes (T1D) require an insulin injection to survive, while patients with type 2 diabetes (T2D) often can survive without insulin. T2D accounts for 90-95 percent of all cases of diabetes. People with T2D also have insulin resistance in which the tissues of the body — especially muscle, fat and the liver — are unable to use insulin effectively. Risk factors for T2D include family history of diabetes, ethnic minority groups, obesity and age more than 45 years. Other factors are pregnancy, a baby weighing 9 pounds or more at birth, high blood pressure, high cholesterol, physical inactivity, polycystic ovarian syndrome and dark, thick and velvety patches of skin around the neck or armpits. T2D is usually preceded by pre-diabetes, in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Pre-diabetes is estimated to affect 79 million Americans. Research Shows Lifestyle Changes More Effective than Medicine The Diabetes Prevention Program (DPP) research project evaluated the effect of diet and exercise and the diabetes drug Metformin to prevent T2D in people in the U.S. with pre-diabetes.
Pre-Diabetes Patients Should Embrace Exercise, a Healthy Diet We can reduce diabetes by maintaining a healthy lifestyle and ideal body weight. Thirty minutes of exercise three days a week will accrue some benefit, but you should start slow and then increase the frequency and time of exercise. You should discuss with your physician before embarking on an exercise regimen. Reducing daily calorie intake by 500 calories may lead to 1-2 pounds of weight loss weekly. A simple way of planning a healthy meal is to use a 9-inch plate; make half of the plate non-starchy vegetables, one-fourth of the plate starchy food, especially whole grains and one-fourth lean protein. A Healthy Lifestyle Can Prevent Diabetes Complications If you have diabetes, you should vigorously pursue prevention of its complications. Diabetes is a leading cause of kidney failure, lower-limb amputation, blindness and heart disease among U.S. adults. Controlling diabetes, high blood pressure and high cholesterol can prevent complications. Your hemoglobin A1c level correlates with complications. A1c estimates diabetes control by measuring glucose attached to red blood cells. The Diabetes Control and Complications study in the U.S. showed that keeping A1c below 7 percent reduced diabetes, eye, kidney and nerve disease by about 60 percent, and heart disease by over 40 percent in people with T1D. The Look AHEAD study evaluated the effects of weight loss through diet and exercise on heart disease in overweight people with T2D in the U.S. The study showed significant improvement in quality of life and risk factors for heart disease, such as blood pressure, glucose and cholesterol. Lifestyle modification also resulted in less insulin use and diabetes remission in some patients. A healthy diet, exercise and weight loss can prevent diabetes and its complications.
The first group received intensive intervention in diet, exercise and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss. The second group took 850 mg of Metformin twice a day. The third group received placebo (inactive) pills. The Metformin and placebo groups also received information on diet and exercise, but no intensive intervention. Over the three years of the study, diet and exercise reduced the chances that a person with pre-diabetes would develop diabetes by 58 percent compared to 31 percent in people who took Metformin. According to a follow-up study, diabetes was reduced by 43 percent in the lifestyle group, and 18 percent in the Metformin group 10 years later.
2863 Highway 45 Bypass • Jackson, TN 38305 • Hours: M-F 8am - 5pm 731-664-1375 • www.jacksonclinic.com
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PhysicianSpotlight
Frank Jordan, MD By SUZANNE BOYD
For a college student, getting drafted may not be the conventional way to discover what you want to do with your life but for Frank Jordan, MD, a pain management specialist with Comprehensive Pain Specialist, it led him to pursue a career in medicine. Jordan was one of the first in West Tennessee to provide pain management services and 25 years later, he continues to provide the latest techniques and modalities to help patients across West Tennessee find relief from pain. A native of Dickson, Tenn., Jordan began his college career taking general science courses at Austin Peay State University in Clarksville, but left before finishing. “The Vietnam War was going on and I decided to join the Air Force after a couple of years in college,” said Jordan. “My training in the Air Force was as a hospital lab technician. That really sparked my interest in medicine as a career, so when I returned to Austin Peay, I knew I wanted to go to medical school.” In 1976, Jordan began medical school at St. George’s University School of Medicine in Grenada. He completed his medical degree at the University of Tennessee Health Science Center in Memphis where he also completed his residency training in internal medicine. While working on the UT staff as an internist, Jordan found he enjoyed intensive care therapy, which resulted in his decision to pursue anesthesiology. He remained at UT to complete a residency in anesthesiology as well as worked on the anesthesiology staff at UT. In 1988, Jordan joined an anesthesia group in Jackson Tenn. “When I came to Jackson I found I was doing a lot of injections for spinal pain since no one else was really doing it. The more I looked into pain management, the more interested I became in it,” said Jordan, who is board certified in internal medicine, anesthesiology and pain management. “I also saw there was a tremendous need for pain management in West Tennessee and felt that I needed to get further training so I could best treat my patients.” Because there was no advanced training for pain management in West Tennessee, Jordan went to Houston, Texas for additional study in the fellowship program at the Baylor Center for Pain Management. When he retuned, he established a pain management center as a part of his group practice. “I was the only one the area doing pain management and that was really all I was doing,” said Jordan. “In 1999, I decided to go out on my own and established the first full time pain management practice in rural West Tennessee.” westtnmedicalnews
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The field of pain management as a sub-specialty was relatively new when Jordan received his training at Baylor. “The field really got started in the late 1980’s, and even when I trained at Baylor in the early ‘90s it was a fairly young subspecialty. There were not many people who had much expertise in it and there was no board certification for it as there is now,” said Jordan. Jordan says the field has changed quite a bit since he first got into it. “Twenty years ago, no one but a few neurosurgeons were doing interventional work,” he said. “The field of pain management is much more in depth about the actual study of pain, the mechanisms that work and individual techniques that can be used to treat it. There is still a lot of continuing education required of the subspecialty although it is not evolving at the rate it was ten years ago.” Roughly 80 percent of Jordan’s practice is related to back pain. “Often times people develop chronic back or nerve pain from a variety of reasons and have usually seen multiple physicians for relief before coming to a pain management specialist,” said Jordan. “Once the pain becomes ingrained in a patient, it is hard to eradicate completely.” Pain, says Jordan, is a personal issue and everyone has a different tolerance for it. “It is my job to determine the source of the pain and the best treatment for it. We have a wide range of treatment op-
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Subscribe to tions including medications as well as medical, psychological and/or surgical support,” he said. “With some patients we see great success and they never hurt. In others if we can give them 40-60 percent reduction in their level of pain that is good.” In 2013, Jordan joined the Nashville based group, Comprehensive Pain Specialists, which has more than ten pain management specialists and has offices in multiple states. In West Tennessee, the group has clinics in Jackson, Savannah, Bartlett, Union City and Paris. Jordan provides coverage to all five of these clinics with the assistance of nurse practioners and physician assistants. Jordan spends his downtime with his family, which includes wife, Celia, their two daughters Rachel and Shelby, son Frank Jr. and granddaughters, Miles and Madeline. His other passion is hunting and fishing, especially big game hunting. “From moose to elk to caribou to deer, I love to hunt it whether it is around West Tennessee or out in Montana. I try to get outside and either hunt or fish when I can,” said Jordan.
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ROI on Healthcare Workforce Diversity Embracing cultural competency By CINDy SANDERS
Last month, healthcare leaders gathered in Nashville for the Council on Workforce Innovation’s symposium on trends and resources impacting healthcare workforce diversity and cultural competency in the delivery of quality healthcare. Opening the half-day summit, Cathy Childs, event co-chair and director of Human Resources for Cumberland Consulting, noted, “One thing I’ve learned in my 15 years of healthcare HR is employee engagement and cultural competency go hand-in-hand.” Organizer Jacky Akbari, board chair of the National Organization for Workforce (NOW) Diversity, welcomed Waller Chairman John Tishler, JD, to introduce the first speaker, Nashville Mayor Karl Dean. “Karl has done many wonderful things for our city,” Tishler said, “but among the best involves protecting and promoting the rich diversity of our community.” He added the mayor was instrumental in helping defeat an English-only proposal in 2009. Taking the stage, Dean thanked NOW Diversity for keeping the dialogue going. He noted the time is right to have these conversations as Nashville becomes more diverse. “In fact,” he said, “by the year 2020, the majority of Nashville’s population … 50.1 percent … will be people of color. By 2030, that number will be 59 percent, and by 2040, it will be 68 percent.” He added nearly 12 percent of the city’s population was born outside of the U.S. “As these numbers illustrate, the face of our city is changing rapidly.” Dean remarked that when urban researcher Richard Florida, PhD, spoke to the Nashville Chamber of Commerce last fall, he cited ‘three Ts’ that are essential to a city’s success … technology, talent and tolerance. Dean pointed to recent media coverage touting Nashville as one of the country’s hottest cities. However, he said, “If we’re going to continue to build on the success our city is experiencing right now, we must continue to be a welcoming city that opens its doors to anyone and everyone who wants to be here and to be part of
Nashville Mayor Karl Dean and Memphis Mayor A C Wharton chat after speaking at the 2014 Healthcare Diversity Forum held last month in Nashville.
our growing community.” He added, it isn’t enough to simply respect tolerance but said tolerance must be actively promoted. Dean said, “We all know businesses that embrace diversity do better in the marketplace than those that don’t.” He noted the strength of the healthcare industry is inextricably linked to the success of Nashville as the city’s largest and fastest-growing employer. “Nashville strengthens the healthcare industry. The healthcare industry strengthens Nashville. And diversity strengthens us all,” he summed up. Taking the podium, keynote speaker Memphis Mayor A C Wharton, Jr. talked about the impact healthcare workforce diversity has on Memphis. “I can think of no better topic to bring us together than celebrating diversity,” he opened. “What profession is better positioned to talk about diversity than the healthcare profession? When it comes to healthcare, it is a universal need.” Likewise, he said those who deliver healthcare are in the best position to see the world from a universal viewpoint. Walking through an Emergency Department in Memphis recently, Wharton noted one man had on a three-piece suit, another appeared to be homeless, but both were cared for based on triage protocols. “Wouldn’t it be great if our whole world could just operate that way every day?” he asked.
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Continuing the analogy, he said it would be nice if society could hone in on an individual’s needs at a particular point in time without regard to religion, race, gender, wealth, or any of the other characteristics used to make quick assumptions. “I applaud you for saying, ‘We’re going to step out and lead where others dare not tread,”” he said of the day’s event. “This is something that’s going to transcend the boundaries of your profession,” he predicted. Wharton said that like Nashville, healthcare is a huge force in the economy of Memphis, employing approximately 85,000. St. Jude, he said, is an excellent example of “an institution that transcends all lines.” He also applauded the major hospitals in Memphis that have chosen to stay in the core city when so many other businesses and industries moved out, and he noted the acute care facilities have been models when it comes to inclusionary business practices. “There is so much that our hospitals and healthcare facilities do beyond the technical provision of healthcare. They are our anchor institutions in so many ways,” Wharton said. From a clinical standpoint, he noted the industry has moved to the broader definition of health as being more than just an absence of illness but instead an overall state of well-being. “Because of the representation of diverse members in our healthcare operations, we’re now much more sensitive to the fact that it takes more than a doctor and some pills and some medicine and an X-ray machine to bring about health,” Wharton noted. He added in many cases the greatest threat to health is environment rather than a heart attack. Wharton said it didn’t matter how many times healthcare providers patched someone up or got them stabilized, if those individuals were returned to unhealthy, unsafe neighborhoods — plagued by violence, pollution, absence of fresh food, or other barriers to healthy living — then all the hard work of the healthcare industry really goes for naught. “Diversity is the best way to make sure that our hospitals … that all of our facili-
ties … are attuned to the needs outside of the hospital,” he said. Wharton added that in Memphis … and probably most communities, a significant number of hospital employees come from neighborhoods facing these issues and have valuable input to share. “They are in the best position to tell the folks inside the hospital exactly what the real world is like,” he said. Wharton also stressed the critical importance of being able to communicate across ethnic and religious lines. He was quick to add, this doesn’t mean a black patient must have a black provider or a Muslim patient a Muslim physician, but it does mean providers need to be sensitive to cultural and ethnic norms and not view everyone filtered solely through the lens of their own personal background or experiences. ‘Diversity,” Wharton said, “is a mind thing.” He added it’s a mistake to count the number of individuals in any particular group and think of that as diversity. “It is not a quantitative … it is a qualitative … matter. I always say, when we view it through the prism of numbers, all you have to do is look at the first four letters in the word ‘numbers,’ and what does it spell?” His final point spoke to the array of research happening in Memphis through St. Jude, the University of Tennessee Health Science Center and the city’s large medical manufacturers and the recognition that research must include different populations. “Diversity does matter,” Wharton said. “Diversity does pay … not merely to the fiscal bottom line but to the overall welfare of your community. It is an investment well worth taking.” Also during the morning, the 2014 Healthcare Innovation Awards were handed out. Tatum Hauck Allsep, founder and executive director of the Music City Health Alliance Foundation, was presented with the Healthcare Employer award. Kennard Brown, JD, MPA, PhD, FACHE, executive vice chancellor and chief operations officer for the University of Tennessee Health Science Center, was named Healthcare Educator. Following the breakfast, a panel discussion was held delving deeper into healthcare workforce diversity and challenges to delivering culturally competent care. Moderated by Nashville NewsChannel 5 Anchor Vicki Yates, the panel included Vaughn Frigon, MD, chief medical officer for TennCare; Leslie Wisner-Lynch, DDS, DMSc, executive director of BioTN Foundation; and Terrell Smith, MSN, RN, director of Patient and Family Engagement at Vanderbilt University Medical Center. The summit wrapped up with a luncheon highlighted by comments and insights from Andre Churchwell, MD, associate dean for Diversity Affairs at Vanderbilt, and luncheon keynote speaker Robert Frist, CEO of HealthStream. Shannon Goff Kukulka, an attorney with Waller, also presented a summation of her white paper, “Workforce Diversity: Driver for Equality of Access to Healthcare.” westtnmedicalnews
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Addressing Obstacles on the Road to Diabetes Control By CINDY SANDERS
What is the best way to get … and keep … diabetic patients actively engaged in the lifelong selfmanagement of their condition? The individual or institution that comes up with a definitive answer to that question will surely be remembered in the history books in the same manner as Jonas Salk. After all, diabetes is a pervasive condition of epidemic proportions in much of the world. According to the latest statistics from the National Institutes of Health, 25.8 million Americans have diabetes … roughly 8.3 percent of the nation’s population. Additionally, it is estimated another 79 million American adults have prediabetes, putting them at high risk for developing the condition without active intervention to stop the progression toward disease. Keenly aware of the toll diabetes takes on the body, healthcare providers routinely talk to patients about the threat of comorbid conditions ranging from heart disease, stroke and kidney disease to blindness and amputation. Yet, there continues to be a disconnect from what a patient seemingly hears and understands in the office and what actually transpires on a daily basis. “We talk about diabetes all day long with patients, but they have to go about their business of living with the disease,” noted Elizabeth S. Halprin, MD, associate director of Adult Diabetes at Joslin Diabetes Center, an affiliate of Harvard Medical School. Elizabeth A recent study con- Dr. S. Halprin ducted by Joslin researchers looked at obstacles present among patients with poorly controlled diabetes. Halprin, a board certified endocrinologist and instructor at Harvard Medical School, said the reasons for poor management vary hugely and are specific to individuals and their own personal circumstances. Are there financial issues that make office visits cost prohibitive? What about transportation or geographic barriers that make it difficult to get to an appointment? Perhaps an individual is working multiple jobs or caring for everyone else in the family with little time left over to address their own needs. Halprin said the study also revealed some interesting perceptions about the healthcare system and providers. “They find the whole healthcare system impersonal,” she said of the study participants. “They think we’re not listening and that we suggest things that aren’t practical.” To a physician, telling a patient to ‘increase physical activity’ seems like a highly appropriate, straightforward step toward westtnmedicalnews
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better diabetes management. To a patient who struggles financially, a gym membership is out of the question and strolling through an unsafe neighborhood could be more dangerous to their health than the disease, itself. “Diabetes is a very time consuming disease to have, but it’s also a very time consuming disease to treat,” Halprin pointed out. “The healthcare system doesn’t always permit the time for exploring and looking at each person’s individual needs.” To address that, Joslin is investigating the addition of care coordinators to work with high-risk patients. The coordinator becomes the point person who initiates a follow-up call after an appointment to see if the patient understood recommendations and to make sure prescriptions are being filled. The coordinator might also reach out to remind the patient when it is time for their diabetic eye or foot exam. This is the individual who is more likely to know about medication assistance programs, area outlets for safe activity, and other resources to overcome obstacles. Although the concept isn’t novel in healthcare, it is one that has been difficult to fund under the current payment system. Changes in reimbursement models, such as the patient-centered medical home, make it more feasible to add a care coordinator to the team approach that Halprin used at Joslin. In addition to the physician, the team includes a nurse practitioner, nutritionist, exercise physiologist, registered nurse, psychiatrist and diabetes educator. Through a joint project with Beth Israel Deaconess Medical Center, Joslin has launched the Diabetes Practice Liaison Program to share collaborative strategies with primary care providers and their office staff in the region. Just as one provider doesn’t hold all the answers, it’s unlikely one approach will meet everyone’s needs. Halprin pointed to another study among Joslin’s older patients that had encouraging outcomes. “A highly structured education program with specific tasks and cognitive behavior strategies resulted in better A1c control, which was maintained for at least a year,” she noted of the intervention that worked well with older patients up to age 75. However, she continued, that program didn’t show the same promise among middle-aged patients. Race and ethnicity are also important variables in how information is received, perceived and acted upon. Joslin has initiatives for Asian, African-American and Latino patients that take into account social and cultural traditions. Considering the risk of diagnosed diabetes in comparison to non-Hispanic whites is 18 percent
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an opportunity at another facility as the chief financial officer but realized the grass is not always greener on the other side. In 1993, I returned to BMH-Huntingdon as the CFO and to work with affiliated physicians’ offices. In 1997, I took over the role of administrator.” Coming from an accounting background, one may think Breeden is all about the numbers when it comes to managing the 70-bed hospital staff that includes 195 employees, four of which are senior leaders and 17 directors. While she definitely has a grasp of the business aspect of the healthcare arena, she bases her philosophy on treating others with the respect they deserve and puts patients first. “If we treat others as we want to be treated and consistently make sure patients come first, everything else will fall into place,” said Breeden.” I believe the quality and safety of the care you give patients must be the top priority along with maintaining a focus on the staff providing the care. Our purpose for being in the healthcare industry is to care for our patients as if each is our family member.” Because she came from the business side, Breeden acknowledges that initially in her career, understanding and learning the language of healthcare was a challenge. “Medicine has its own terms and acronyms,” she said. “It was something I had to work on to understand the terminology but after 20+ years, I have it down pat.” Being in a small rural area, Breeden has opportunities as well as challenges. Her biggest challenge is recruiting physicians to Carroll County followed by reimbursement and healthcare reform. On the flip side, Breeden sees that communication is better. “Recruitment is our number one battle but we have reimbursement issues which cause us to have to be smarter in terms of the types of services we can provide,” she said. “It is important that as a rural facility, we understand what healthcare reform will mean for rural healthcare and who we need to be based on what that reform will mean for us. It is my goal to be the best we can for those we serve and at the forefront of healthcare.” Baptist Memorial Healthcare is in the
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process of implementing its fully integrated electronic health record program, Baptist OneCare, system wide. Baptist OneCare gives patients the power to access their own records, refill prescriptions, make doctor’s appointments and even consult with the physician’s office from any computer or mobile device. For the provider, the EHR means a seamless continuum of care when it comes to treatment, imaging, lab and referral services. “The program is being implemented in phases. We are less than a year out from implementation at our facility but have already implemented it in our doctor’s offices. We have four credential trainers that will be working with others who have already gone live with the program so that we can draw on the lessons they learned,” said Breeden. “We are working on our process to make it easier with the ultimate goal of having a smooth transition.” Baptist OneCare offers the patient a secure portal to access information about their healthcare online from virtually anywhere. Patient records are interchangeable among healthcare providers, which allows for timely exchange of information. “Baptist OneCare is one more way Baptist Memorial Healthcare is keeping the patient at the forefront. It also allows for family centered care,” said Breeden. “When it is appropriate to involve family members in the care of a loved on, the EHR, will be a great step towards facilitating that involvement.” Under Breeden’s leadership, BaptistHuntingdon has been recognized on the state and national level for the care they provide. In 2013, the facility was a Top Performer on the Key Quality Measures for pneumonia care as designated by the Joint Commission. Baptist Home Care and Hospice-Huntingdon has consistently ranked among the top home care agencies in the nation in the HomeCare Elite rankings. The HomeCare Elite list identifies the top 25 percent of home care agencies in the United States based on quality of care, quality improvement and financial performance. Baptist Huntingdon is also a recipient of the prestigious Tennessee Quality Commitment Award. While Breeden has many goals she wants to realize before she says goodbye to her career in healthcare, she does hope that retirement will afford her the opportunity to enjoy some of her passions in life, her kids, her garden and fishing. “I used to be an avid horseman, but I leave the riding these days to my daughter who is a senior at UT-Martin and is s barrel racer,” said Breeden. “My son will start high school next year and will be playing football so that keeps me busy in the fall.” Breeden feels fortunate to work for a faith-based organization that’s mission has allowed her to grow her leadership abilities. “I encourage feedback about opportunities that I can develop from those working beside me and accept the feedback with an open mind,” said Breeden. “In addition, I truly believe if we reach a point in our career that we don’t believe we can improve the care of our patients or leadership given to our staff, we should find another career.” westtnmedicalnews
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Expanded Uses for Hyperbaric Chamber Oxygen Some are not yet approved, but a variety are available in Memphis By GINGER PORTER
Hyperbaric chamber therapy is gaining usage in Memphis, as in other cities, and its applications are expanding. Its latest approved use is for a type of sudden aural disability called idiopathic sudden sensorineural hearing loss (ISSHL). Though off-label uses for hyperbaric therapy such as post traumatic stress disorder have been reported nationally, and fervent oxygen enthusiasts can build their own chambers by tutorial on YouTube, the Memphis medical community sticks to the basics. Memphis offers a spectrum of Undersea and Hyperbaric Medical Society (UHMS)-approved treatments, Medicare-approved applications and current technologies. Stephen King, MD, associate professor in the department of plastic surgery, University of Tennessee Health Science Center, and chief medical information officer at Regional One Health, explained that scientists are looking at hyperbaric chamber oxygen (HBO) for uses in stroke patients, multiple sclerosis and acute traumatic brain injury – but those uses are not yet approved.
For now, uses include idiopathic hearing loss, air embolism, carbon monoxide poisoning, gas gangrene, necrotizing soft tissue infections (flesh-eating bacteria), decompression sickness (also known as “the bends”), delayed radiation injury, compromised grafts and flaps, problem
wound care and acute traumatic ischemia. They also accept referrals from Divers Alert Network for treating sport and commercial diving accident victims in the Mid-South. Regional One Health has the only multi-place chamber in the area with
the capacity to hold 12 patients at a time, King said. It has had a multi-place chamber since 1992, but the technology has been updated to remain current over the years. King describes today’s unit as “more patient friendly,” with places to sit/ recline and watch TV or movies with a “head tent” on to optimize oxygen usage. Since the whole chamber is not pressurized, fire risks decrease. This arrangement also provides the ability to treat critically ill patients such as those with carbon monoxide poisoning, necrotizing soft tissue infections and air embolisms. A critical care nurse can accompany the patient and monitor him or her while in the chamber. Last year, Regional One rendered 654 hyperbaric treatments. The most prevalent diagnosis for Regional One hyperbaric patients is delayed radiation injury, according to King. Some of these referrals come from places such as St. Jude Children’s Research Hospital and some come years down the road from radiation treatment. Reduced blood flow to certain areas can kill tissue or bone. In osteoradionecrosis, the mandible is compromised and begins to die. Some radia(CONTINUED ON PAGE 9)
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Making the Transition to ICD-10, continued from page 1 munity has been trained and has already retested to affirm their professional status, certifying that they are proficient in ICD10. But only some. “And even though the new system goes live on October 1, all of the professional coders do not have to be recertified by that date. They have up to another year to prove they are qualified. In general, the United States is way behind when it comes to adopting the new coding system. Our think tank personnel and researchers cannot talk to the rest of the world because we are not yet using ICD-10. The new coding is the lingua franca that allows systems to work in a global sense.” Other reasons for the transition are based on the outdated terms of the 30-yearold ICD-9 code set. Not only is ICD-9 not consistent with current medical practices, but its five-digit numeric coding is very limited in terms of the number of new codes that can be created. In fact, many ICD-9 categories are full. ICD-10 will utilize sevendigit alpha and numeric codes, offering a much larger number of codes that can be created. And their significance cannot be overstated. Although the format of the two code sets is similar, ICD-10 codes are much more specific and detailed. Worst case scenario, there is one ICD-9 orthopedic code that will translate into 1,550 new codes in the ICD10 system. While there isn’t a direct one-toone exchange between the two codes, most coding changes will not be so extreme and will result in simpler recombinations. Lucas explained, “They translate medical diagnoses into machine-friendly codes that enable insurance carriers, regulatory bodies and researchers to run the information through computer programs. For researchers, it streamlines the amounts of data. For insurance companies, the information is vital — they cannot make payments without codifying the medical records and terminology.” As vital as the new coding is said to be, Lucas estimates that most of the Memphis medical community is not ready for the transition. And she says it is not just the
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certified coders who aren’t prepared for the change. Additionally, there are code users like physicians, physician assistants and nurse practitioners who also need to be retrained, although not tested, on how to write their notes so that their information can be correctly converted into ICD-10 codes. And this simply isn’t happening. “Most physicians are so overwhelmed trying to do their work with the time and resources they have available that they just haven’t been able to make the time to prepare for this coding system change,” Lucas said. It is six months until the “Go Live” date. If all were well-prepared to meet that time frame, Lucas feels that some entities should have already made the conversion. Companies like Aetna or Blue Cross Blue Shield COULD have already made the switch; they don’t have to wait until October 1. But to date they have not made the transition. Lucas estimates it will be government entities like Medicare and Medicaid that will be the first to convert, and she suspects that even they will not convert until the final deadline of October 1. And while the new codes will not be defining claims until then, companies are likely to begin accepting the codes before that date. So if you are not ready for ICD-10, what should you do? Lucas suggests that each individual affected by the change should check with their professional organization(s) to determine proper protocol. As mentioned, physicians do not have to be tested to use the new codes, they only have to be exposed to the new code set as they are working along, and each practice will provide oversight for retraining its own staff. Intensive “boot camps” that last two or three days are being offered, and online, self-paced programs are available for retraining purposes, too. Donna Martin, owner of Codes Unlimited Healthcare Academy and a coding instructor, said, “There are so many people who are afraid of change. They keep hoping that the change isn’t going to happen, but it is. The good news is that there is still time
to be prepared. Existing coders are likely to make a smoother transition because about 80 percent of the guidelines for ICD-9 are similar to, or the same, as the guidelines for ICD-10. However, coders should also brush up on their knowledge of anatomy and physiology because the ICD-10 codes incorporate that information. Existing coders are advised to start their retraining in the specialities of the code set with which they are already familiar.” For those who want to ensure their coding proficiency by the October 1 launch date, here’s a general guide: Six months – All users should check with their professional organizations to determine protocol. Three months – Although the details will differ per profession, users ought to be able to recognize the changes between the two code sets that will affect them. Users should use this stage to prepare a checklist of what they don’t know, then use it to guide them in gaining a clearer understanding of the new system. Two months – All unknowns should be cleared up and users should be able to locate correct codes in both systems. GEMs (General Equivalent Mapping) is the system used to determine the codes in ICD-9 and ICD-10. These equivalent codes are available on the website of the American Academy of Professional Coders, AAPC.com. One month – Users should begin running trials with “parallel” systems; using ICD-9 and matching up the respective ICD-10 codes. Those wanting additional information should call 901-7251879 or 901-336-3677.
Diabetes, continued from page 5
higher among Asian Americans, 66 percent higher among Latinos, and 77 percent higher among non-Hispanic blacks, reaching these specific populations in a meaningful way is critical. Halprin, a member of Joslin’s Latino Diabetes Initiative, noted there is a support group that meets regularly at the diabetes center to knit and chat. A staff psychologist joins the group to guide conversation and answer questions. “They bring food so that’s an opportunity to discuss what is a good choice or a not-so-good choice,” Halprin said. “Nutrition is a huge part of diabetes care, but it’s also a huge part of the Latino culture,” she noted, adding nutritionists on staff try to make suggestions that are culturally appealing or that revamp traditional meals to lighten the carbohydrate load. Additionally, education classes are conducted in Spanish and materials have been translated. Providers with the Latino program also are piloting group medical visits with four-eight participants. All of these efforts combine to make the healthcare clinic less intimidating and more welcoming of natural conversation and questions about living with diabetes. In fact, Joslin hosts a number of programs in a group setting including DO IT, a four-day intensive outpatient program designed for those who have gotten off track with their self-management; Why WAIT, a combined weight reduction and management program with a focus on nutrition, physical activity and behavioral support; and interactive games like CarbChallenge where participants test their knowledge of carbohydrate containing foods. “Diabetes can be a very isolating condition,” Halprin said. “It’s good for people to be in a group and know other people are struggling with similar issues.” What’s good for patients is also good for providers. Halprin’s colleague, Robert Gabbay, MD, the chief medical officer for Joslin Diabetes Center, is slated to give the keynote speech at The American Journal of Managed Care annual meeting. “PatientCentered Diabetic Care: Putting Theory into Practice” is the 2014 theme of the April 10-11 conference in Princeton, N.J. “Our meeting will occur as the first waves of newly insured consumers are accessing the healthcare system, including many who will learn for the first time they have diabetes or other cardiometabolic conditions,” said Brian Haug, president of AJMC. “This is an important time for healthcare professionals to be engaged with leaders in this field.” By working collaboratively, utilizing diverse technologies and education offerings, and leveraging the theories embedded in new reimbursement models, the hope is patients and providers will work together to overcome the obstacles to effective diabetes self-management. For More Information on the Upcoming AJMC Conference, please go online to ajmc.com/meetings/diabetes
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Expanded Uses for Hyperbaric Chamber, continued from page 7 tion can cause brain tissue to die. HBO therapy stops the necrosis and promotes healing. It even causes new small blood vessels to grow into the area, increasing blood flow. “HBO is an expanding form of therapy,” King said. “We provide a valuable service and treat a lot of different patients with a lot of good medical outcomes. In some conditions, hyperbaric oxygen therapy increases the effectiveness of standard therapy. For many of the conditions we treat with hyperbaric oxygen therapy, there is no alternative treatment.” Both Delta Medical Center and Methodist North have two monoplace chambers. At Delta, hyperbaric therapy is included in its wound center, and both chambers are 36-inch, the largest constructed. Although patients are seen with conditions ranging from diabetic foot ulcers to osteomyelitis, arterial insufficiency, skin grafts, thermal/chemical burns, plastic surgery scars, carbon monoxide poisoning, cyanide poisoning, smoke inhalation, air and gas embolisms and osteoradionecrosis, HBO serves 15 percent of wound care patients, according to Delta’s Sandy Eckhoff, LPN, CHT, safety director, hyperbaric unit. Sessions there are 90 minutes long Monday through Friday. Depending on the diagnosis, infectious disease specialists might get involved and all wound care hyperbaric treatment is done in conjunction with regular protocols. “We’ve had multiple patients avoid amputation, either from osteo, arterio or diabetic,” Eckhoff said. “It is an amazing treatment. You have patients come in with large wounds that are extremely difficult and patients do treatments, go home and the wounds are totally closed.” At Methodist North, the monoplace hyperbaric chambers are part of the Comprehensive Wound Healing Center. The patient can listen to music, watch TV or a DVD and talk to the technician via a twoway phone. They are also able to drink water from a sports bottle, or just go to sleep. Based on the diagnosis, conditions might require 20 to 40 treatments, since HBO therapy is cumulative. One to two treatments a day for 60 to 90 minutes a day, five days a week, is the usual treatment period. Primary conditions seen at Methodist North for hyperbaric oxygen include chronic refractory osteomyelitis, diabetic wounds of the lower extremities, osteoradionecrosis, soft tissue radionecrosis and preservation of compromised skin grafts and flaps, according to Sandy Deimund, BSN, clinical director. People excluded from therapy at Methodist North due to contraindications are those taking certain medicines or chemotherapies, those with poor lung function and those with decreased lung capacity (i.e., emphysema).
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Hey Doc, Try Patient-Centered Social Media By TIM NICHOLSON
The secret of a successful social media strategy starts with who is in the middle. And that’s not any different than the philosophical and practical approach any successful physician or clinic takes to his/her efforts. Well, at least when the patient is the one at the center of the effort. I recently read an excerpt from Dr. Toby Cosgrove’s book “The Cleveland Clinic Way” that reminded me how challenging it can be to put the patient at the center of our work. And simultaneously, how imperative it is that we do just that. You may know Cosgrove as the President and CEO of Cleveland Clinic. Early on in its efforts toward being “patient centered,” Cleveland Clinic had decided to reassign the reserved parking spaces near the front of its buildings to patients, not doctors. One physician complained, “What’s this, patients first and doctors last?” Other physicians wondered whether reform promoting kindness and compassion was necessary. They said, “Dr. Smith is kind of mean to people, but he’s a great surgeon” as if that were enough. Being a great surgeon is about being technically proficient and treating patients well. Cosgrove recognized that we live in a time when technology has leveled the playing field with respect to the outcomes patients might receive at competing hospitals. But Cleveland Clinic could differentiate itself by treating its patients well and creating a true healing experience. Through conversations with patients and their families, the clinic learned that many were frustrated by access to medical records. So, they made them accessible. They learned that patients found visit-
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ing hours to be a major irritant. This info with data they had on the role of family in healing, drove a decision to open visiting hours to “whenever…and to spend as much time as they like” with the exception of the intensive care unit. Look, you’re not reading this to learn what the Cleveland Clinic did or is doing but it seems a fitting metaphor for the things we talk about with social media. Like the issue with the parking spaces, many think that practice social media policies should revolve around the doctor’s convenience. A policy wherein doctors aren’t directed to share health information via an occasional tweet might be convenient. But it’s not improving patient health outcomes for those with chronic conditions whose Twitter newsfeeds are filled with hash tag rich tweets concerning their disease from every source but you. Oh sure, there’s always the risk that the “mean doctor” will be exposed via social media through something he says that demonstrates indifference. But in all likelihood, patients and families who share their feelings about “customer satisfaction” on Facebook pages, Yelp and Angie’s List have already exposed him. Help him improve his bedside manner one post
or tweet at-a-time. Yeah, bedside manner. Smartphones have become as common on the nightstand as grandma’s dentures. And many – maybe even your grandma – are using social media first thing every day and last thing they do at night. And then there was this, a clinic team enlisted a designer to create an alternative to the traditional open back gown. Their goal was to address the frequent patient complaints about the indignity and discomfort they suffered when wearing them. Good for them. But, I couldn’t help imagine how much fun it would have been to engage patients in developing a solution via a simple Pinterest board. So I googled “hospital gowns on Pinterest” and got 279,000 results. Come on, Doc. Let’s be social. By the way, the Cleveland Clinic is a great model for that, too. They’re @ClevelandClinic on Twitter. Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email tim@gobigfishgo.com
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GrandRounds Medical Specialty Clinic Opens Gastroenterology Satellite In Camden
Medical Center EMS Director Joyce Noles presents statewide EMS award to Dr. Mike Revelle.
Tenn. Ambulance Association Presents Award to Dr. Mike Revelle
The Tennessee Ambulance Service Association has presented a prestigious state wide award to Dr. Mike Revelle of Jackson-Madison County General Hospital. Revelle received the “Medical Director of the Year” award at the annual TASA conference held in Gatlinburg this month. Medical Center EMS Director Joyce Noles presented the award. Dr. Revelle has been medical director of Medical Center EMS since 2004 and is presently medical director of Haywood County EMS as well.
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Gastroenterology services are now available in Camden through the Medical Specialty Clinic of Jackson. Medical Specialty Clinic opened a satellite clinic specializing in Gastroenterology this month to better serve the needs of the Decatur County community. Melissa Bolton, ACNP will be seeing patients at the Camden Family Medical Center at 186 Hospital Drive the second Wednesday of every month. Bolton will offer new patient evaluations and follow up visits Melissa Bolton for patients who need colonoscopies or have G.I. related illnesses. Bolton received a Bachelor of Science in Nursing from the University of Tennessee of Martin and a Master of Science in Nursing from Vanderbilt School of Nursing. Dr. Brittain Little will be performing colonoscopies and other GI procedures at Camden General Hospital on the third Wednesday of every month. Dr. Little is a board certified G a s t ro e n t e ro l o g i s t and specially trained Dr. Brittain Little for the treatment of digestive disorders. He received a Bachelor of Science and graduated Magna cum Laude from Lipscomb University in Nashville.
Local Oncology Practices Relocate to the Kirkland Cancer Center
Several local oncology practices recently have relocated to the Kirkland Cancer Center. They are seeing patients and providing care within the Medical Clinic located on the third floor of the Kirkland Cancer Center. The third floor Medical Clinic provides dedicated space for physicians and office staff. Having physicians and other providers on site at the Cancer Center encourages collaboration and offers patients the added convenience of being able to access all major cancer treatment services in a single location. Physician practices and their staffs that have recently relocated to the clinic include Radiation Oncologists Anastasios L. Georgiou, M.D. and Jeffrey J. Kovalic, M.D., Clyde E. Smith, M.D., Hematology/ Oncology, West Tennessee Medical Group; Jackson Clinic Hematology and Oncology Department, including Eugene P. Reese, Jr., M.D.,
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GrandRounds Dwight Kaufman, M.D., Ph.D., and Anita Gul, M.D., and nurse practitioners Nekayeh P. Carothers, MSN, APRN, FNP-BC and Mary McMillin, APRN, FNP-C, OCN. The Kirkland Cancer Center has been designed to provide a unique healing environment for patients and also to encourage a team approach to treatment.
Methodist Fayette Hospital Associate wins DAISY Award
Mary Priest, Methodist Fayette Hospital registered nurse, was recently recognized as the 2014 first quarter DAISY award winner. She was selected by the Methodist Le Bonheur Healthcare Nursing Awards & Recognition Committee for her clinical competence and the compassionate care she gives to patients. In addition to being recognized at Methodist Fayette, she received a certificate, DAISY award pin, and hand-carved stone sculpture entitled, “A Healer’s Touch.” The DAISY Foundation, which sponsors the award, was established in 2000 by the family of J. Patrick Barnes who died of complications of an auto-immune disease at the age of 33. DAISY is an acronym for Diseases Attacking the Immune System. His family was so appreciative of the care their son received during his hospital stay that they decided to create a foundation in his honor to recognize extraordinary nurses who make a difference in the lives of their patients. The DAISY Awards are made possible with the strong support provided by UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company that has donated more than $84,000 to The DAISY Foundation since 2006. Methodist Le Bonheur Healthcare joins 58 other hospitals where The DAISY Award is sponsored by UnitedHealthcare.
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