Louisiana Medical News August 2014

yOUR PRIMARy SOURCE FOR PROFESSIONAL HEALTHCARE NEWS AUGUST 2014 / $5

SOU TH LOU ISIANA ED ITION PHYSICIAN/HOSPITAL ALIGNMENT

On Rounds Physician Spotlight

Partnering in a New Paradigm

By CINDy SANDERS

Dr. John Sledge Son of a sailor At age 5, John Sledge, III, started sailing the coastline of his hometown of Marblehead, Mass., with his family ... page 3

There’s no question healthcare delivery is in the middle of a transformational period highlighted by unprecedented consolidation.

While there are a number of factors impacting alignment decisions, Paul Keckley, PhD, boiled the equation down to its simplest terms, “Economics drives behavior.”

Keckley, managing director for Navigant’s Center for Healthcare Research & Policy Analysis, said physicians are having to assess their practices in light of a new reality that requires efficiency, effectiveness and contracting clout to survive.

“If you’re of a view that the economics favors you being independent for the rest of your practice, you go that route,” he stated.

However, the noted healthcare expert who has published three books and more than 250 articles on the industry and health reform, said that practice model is becoming increasingly rare.

(CONTINUED ON PAGE 4)

Understanding the Power Shift in the New Health Economy HRI shows why the industry is ripe for picking; players compete to be healthcare’s new Amazon.com In 2010, CellScope was birthed in tech-savvy San Francisco with the mission of creating a home medical kit of smartphonefriendly devices ... page 6

Louisiana Passes Law to Protect ED Workers The maximum penalty for an attack is $1,000 and up to 15 days in jail if the injury doesn’t require medical attention. If the injury requires medical atLouisiana recently became the 31st state to make tention, the maximum fine is $5,000 and five years it a felony to attack an emergency nurse, but the law in prison. is just one of the steps needed to prevent workplace “Right now if you were to assault a police ofviolence, Emergency Nurses Association (ENA) officer or firefighter, you’re arrested. You go to jail,” ficials said.

O’Connor said.

“To begin with, we have to educate our nurses But until the new law passed, punching an Emerthat workplace violence is not part of the normal gency Department nurse didn’t trigger a specific law environment,” said Tammy O’Connor, Emergency enforcement action, she said. The law provides ED Department director for St. Elizabeth Hospital in Tammy O’Connor nurses with a course of action.

Gonzales and an ENA member. “I think a lot of ENA President Deena Breecher said attacks on emergency times as ED nurses, we feel like that just kind of comes with the territory.”

(CONTINUED ON PAGE 10)

By TED GRIGGS

Read Louisiana Medical News online at www.louisianamedicalnews.com To promote your business or practice in this high profile spot, contact Scott Cavitt at Louisiana Medical News. scott@louisianamedicalnews.com • 337.235.5455 PRINTED ON RECYCLED PAPER

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2 • AUGUST 2014

Louisiana Medical News

Physician Spotlight

Dr. John Sledge Son of a sailor

By LISA HANCHEy

At age 5, John Sledge, III, started sailing the coastline of his hometown of Marblehead, Mass., with his family. His dad, orthopedic pioneer Clement Sledge, showed him the ropes. John continued to sail during the summers and, at 14, qualified for and competed at the pre-Olympic trials in sailing. Although he didn’t make the America’s Cup team, he did race on the America’s Cup 12-meter boats for one summer.

While sailing, the Sledges’ libations of choice were tequila and rum. “When we traveled through the Caribbean, any chance there was to go to a rum distillery, we always went,” he recalled. John’s taste for rum led to his eventual co-ownership of Rank Wildcat Spirits, LLC. As the son of an orthopedist, Sledge’s career path was pre-destined. “My father was Chief of Orthopedics at Harvard, founder of the Orthopedic Research Society, and Chief of the American Association of Orthopedic Surgeons,” he said proudly.

“If you look at the six godfathers of orthopedics in the United States, he was one of them. Being a physician was the only acceptable alternative, the only thing I knew.”

After graduating from Wesleyan University in Middletown, Conn., he went to the University of Rochester School of Medicine and Dentistry. Following his internship in general surgery at Massachusetts General Hospital, Sledge remained in Boston for his residency in orthopedics at Harvard’s Combined Orthopaedic Program. He served as chief resident in orthopaedics at Brigham and Women’s Hospital in Boston.

In 1990, John married Isabella, a Brazilian-born internist and founder of Tides Medical. After John finished his medical training, the couple sailed around the Caribbean for six months. While islandhopping, Sledge sampled the local rums, buying bottles along the way. “I have around 80 bottles of rum around the house with just a shot missing,” he said.

After sailing the islands, it was back to reality. Sledge was selected for the Maurice E. Muller Fellowship in Orthopedic Spine in Europe. Following his work in Switzerland, England and Italy, Sledge returned to Massachusetts, where he served as assistant professor of orthopedics at Boston Medical Center for five years. Afterwards, he worked at Sports Medicine North in Lynnfield, Mass.

While serving on a medical advisory committee, Sledge met Dr. John Cobb, a well-known orthopedic surgeon from Lafayette, La. Early on, Cobb had offered Sledge a job at his bustling practice, Lafayette Bone & Joint Clinic. But, the Massachusetts-bred boy wasn’t budging.

In 2011, Cobb reached out to Sledge again. At that time, Cobb had become

ill. Wanting to leave his patients in good hands, he asked Sledge to reconsider. During Labor Day weekend of 2012, Sledge and his family made the trek to Lafayette to check out the practice and the community.

They were sold.

Since January 2012, Sledge has practiced orthopedic surgery at Lafayette Bone & Joint Clinic. “It’s fantastic,” he said.

“The medical community here has been very supportive.”

Two years ago, John was in the OR talking about rum when Barry Faciane mentioned some high school buddies who were opening a distillery. Through Faciane, John and Isabella met the rum makers, David Meaux and Cole LeBlanc. At the time, the two landmen had just built a stainless steel and copper still, Lulu. John joined the venture, Rank Wildcat Spirits, along with Meaux, LeBlanc, Kevin Guarino and David Buchholz, helping them to

make improvements and tweak the rum recipe.

Today, Sledge serves as one of the distillers for Rank Wildcat’s rum batches.

“My role is to produce the best rum possible off of the still, and monitor the aging and blending process,” he explained. “I try to optimize the rum that we are making.”

Each week, Rank Wildcat produces about 10 cases of rum, which consumers can find at Albertson’s, Rouses, Pamplona Tapas Bar and Restaurant, Social Southern Table & Bar and Don’s Seafood & Steakhouse. In the past two years, Rank Wildcat’s Sweet Crude white rum has won two national awards: a silver medal in the 2014 International Craft Awards Competition and a Washington Cup in the 2013 Washington Cup Competition. The company plans to launch a dark rum this holiday season.

Besides making rum, Sledge has been

able to return to sailing. Two years ago, he raced in the Brisbane to Gladstone race in Australia, placing second in the multihull division. Last year, he navigated his team to third place in the Transpacific Yacht Race (Transpac), racing 12 days from Los Angeles to Hawaii. “Seamanship is a skill like anything else – once you learn it well, even if you forget it, you can review, and it all comes back to you,” he said.

Now that he has settled in Lafayette, his goal is to spend as much time as possible with his family – son Jake, age 13, and Alexa (Aly), 17. He serves as coach for his son’s Lacrosse team and is the program director of Lafayette Hurricanes Lacrosse.

“My goal is to be able to participate more and more on a daily basis with my family’s life, and particularly my son’s while he is home, to make sure that I am home very night for dinner,” he said.

Louisiana Medical News

AUGUST 2014 • 3

PHYSICIAN/HOSPITAL ALIGNMENT

Partnering in a New Paradigm, continued from page 1 For many, Keckley said practice decisions take a step-wise progression. Option A finds two small practices within a specialty banding together. Option B brings multiple specialties together to form a large group. Option C has physicians or practices joining forces with a hospital or payer under some type of employment, joint venture, or managed services organization (MSO) agreement.

“I think most doctors are past Option A. I think most doctors realize circling the wagons around a single specialty isn’t

realistic,” said Keckley.

“Two out of three primary care doctors have already cast their lot,” he continued of aligning with hospitals, payers or very large groups.

“Frontline specialists Dr. Paul have already gone to bigKeckley ger groups. Now they are moving to the next option … most look like they’re going to hospitals,” he added of orthopedists, ENTs and OB/GYNs. As

for other specialists, he said the decision to remain independent, merge or consolidate is all over the board and is specialty dependent.

Going forward, Keckley said, “I think we’re going to end up with a very few private doctors in practice independently.”

He predicts seeing a few more very large, multispecialty practices. “I think the majority end up employed in the hospitals because of these new payment mechanisms.”

In fact, he noted, “It’s been incentivized for the hospitals to hire physicians.”

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4 • AUGUST 2014

Louisiana Medical News

Clinical integration, outcomes-based reimbursement and bundled payments have created an environment where hospitals and doctors are increasingly co-dependent.

Although hospital administrators and clinicians have always had to work together, Keckley said this new closeness highlights areas that must be addressed to maximize effectiveness. Three key stressors are administrative decisions, clinical performance, and … of course … allocation of money.

“There’s always going to be tension around operations,” he said of administrative decisions. “Each presumes the other’s operating is simpler than it really is,” he continued of the chasm between blue suits and white coats.

With reimbursement tied to outcomes, he said physicians and hospitals face tougher decisions around strategy.

One issue is how to address physicians not practicing effectively. “The hospital suits don’t do a very good job of changing the behavior of doctors. It takes peers,” he noted.

The biggest cause of tension is expected to be around allotting payments to each of the partners in a vertically integrated delivery system. “And then you get down to money, and that’s where it gets ugly,” Keckley stated. However, he continued, too often the perception among administrators is that it’s all about the money when it comes to physicians. “If it was just about money, there are a lot of better ways to make money … and easier, by the way. Most doctors don’t go into it to be wealthy. It’s hard work. The average medical career is 30 years, and it’s a hard 30 years.”

That said, he added physicians do want to be successful, have a sense of satisfaction around their career choice and be well compensated for their work.

However, Keckley noted, “There’s such a difference between the way doctors think things should be and the way they are.”

Keckley said too many physicians tend to dismiss data as unreliable or believe their patient is an outlier. Yet, he added, “The table stakes are you’ve got to have data. You can’t just have a bunch of opinions.” To bridge that gap, Keckley said he believes it is going to take physicians willing to step into the hot seat and take criticism from their colleagues as the profession adapts to new economic realities.

“I think physician leadership is probably going to be a theme over the next 10 years,” Keckley said. “The medical profession is well respected and well compensated … that doesn’t change … but how that profession plays in the delivery system is very much a work in progress.”

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PHYSICIAN/HOSPITAL ALIGNMENT

Physician Practices Ally with Other Healthcare Providers

By TED GRIGGS

More than 40 percent of medical practice executives plan to informally integrate their practice with other healthcare organizations or already have, according to the Medical Group Management Association.

The results were drawn from responses to the association’s seventh annual Medical Practice Today: What Members Have to Say research.

The arrangements include clinical integration with a hospital or health system; forming or joining an accountable care organization or ACO, a physician/hospital organization or PHO, or an independent practice association or IPA. “I think what you’re seeing in Louisiana and in other parts of the country is that folks are really determining and finding out that no one size fits all,” said Ken Hertz, principal, MGMA Health Care Consulting Group, in Alexandria.

Ken Hertz “There are different cultures in a community.

There are different situations with hospitals and the practices.”

Physician practices are looking for different structures in different ways of serving patients, said Hertz, whose consulting practice involves just as much work outside Louisiana as inside the state. Those approaches depend on a lot of external dynamics and the medical community culture.

Hertz said there is no single issue that jumps out as the No. 1 motivator for why physicians seek informal arrangements.

“I think as much as anything it’s the fact that externally there are so many changes going on in healthcare: ICD-10, reimbursement issues, revenue-cycle management issues, coordinated care, the notion of accountable care,” Hertz said. “All of these are requiring very sophisticated administrative and business structures to support the clinical side of the practice to provide the best care for the patient.”

According to 542 respondents in the MGMA survey, the most applicable and intense challenges of running a group practice include preparing for the transition to ICD-10 diagnosis coding, dealing with rising operating costs, and preparing for reimbursement models that place a greater share of financial risk on the practice.

Respondents also cited “engaging patients to improve outcomes” and “leveraging new technologies to enhance patient communications through patient portals, emails, websites and video conferencing” as highly applicable in running a medical practice.

Hertz said what the healthcare industry is really seeing is an increased emphasis on the coordination, cooperation, or collaboration – whatever label one places on it – between the business side, administration, technology, financial and the clinical side.

“Pulling together in either informal or more formal structures is helping practices and practitioners continue to elevate the level of service to patients and continuing to meet the increasing requirements for the new healthcare,” Hertz said.

Despite the increasing pressures on physician practices, only 27 percent of respondents indicated that they have or plan to formally integrate by merging with another physician-owned practice or by selling practice ownership to a hospital or health system.

“I don’t think it was totally surprising. It’s a relatively significant number, for sure,” Hertz said. “But at the same time I think, and we continue to think, that there will be independent practices, private practices.”

Those practices are going to have to align in some way with other healthcare organizations, he said. Physician practices are going to have to be part of something in some way.

“It may be through contracts. It may be through a variety of, frankly, new undiscovered models and arrangements,” Hertz said. “But as the requirement increases for coordinated care, for value, for access, for maintaining cost control, for population management, working together is going to be one of the great keys to success.”

Hertz said while technological advances may offer physician practices better tools to provide better care, interoperability and care coordination, those developments have often been accompanied by increased complications.

For example, all of the new payment models require physicians to re-evaluate a lot of what goes in their practices, he said.

“I don’t think we’ve gotten to the point where we’re making things simpler,” Hertz said. “I think what we’re trying to do is continue to elevate the care, meet the needs of the patient and at the same time be able to manage and control the costs, coordinate the care at a much higher level, and then work together in a variety of models.”

MGMA conducted the research between Jan. 2 and Jan. 24. The association invited members via email to participate in a web-based questionnaire. Respondents rated 28 issues and identified which challenges were most applicable and intense to their daily work. Participants rated the degree of challenge on a five-point scale; 1 = no challenge; 2 = low challenge; 3 = moderate challenge; 4 = considerable challenge; and 5 = extreme challenge.

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Primary Care - New Iberville Medical Complex OCHSNER HEALTH SYSTEM is seeking BC/BE Family Medicine and Internal Medicine Physicians to practice in our new 40,000 square foot Ochsner Iberville Medical Complex in Plaquemine, LA, scheduled to open for patients Dec. 1, 2014.

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To lead a total of three healthcare providers including two primary care physicians, and one nurse practitioner or physicians’ assistant. Clinical leadership skills are required.

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Physicians directly from residency training or with experience are welcomed to apply.

The medical complex will feature a free-standing 24/7 emergency department with an anticipated yearly patient volume of 10,000 – 12,000, an adjoining full service health center providing primary care, and have capacity for one OB/GYN or certified nurse midwife and two rotating specialists. Other features include: 22 patient exam rooms, lab services, and radiology services including X-Ray, CAT scan, MRI, Ultrasound and Mammography.

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Louisiana Medical News

AUGUST 2014 • 5

Understanding the Power Shift in the New Health Economy HRI shows why the industry is ripe for picking; players compete to be healthcare’s new Amazon.com

By LyNNE JETER

In 2010, CellScope was birthed in tech-savvy San Francisco with the mission of creating a home medical kit of smartphone-friendly devices. Its debut offering – Oto, an otoscope that takes digital images of the ear canal – was promoted as a ently, and to many new players. way to reduce up to 30 million office visits Consumers, spending more of their own annually for ear infections in the United money, are exerting greater influence and States. Oto represents an early wave going beyond the traditional industry to of players threatening to bulldoze the find what they want and need. In the New healthcare landscape in the $2.8 trillion, Health Economy, purchasers increasingly consumer-slanting New Health Economy. will reward organizations providing the “We’re our own construction workers best value, whether it’s an academic mediand we can do our own contracting jobs. cal center, a tech company with We’re our own travel agents. a great app, or a healthcare We’re our own movie proshopping network.” ducers. We’re accepting At play: At play: Sharp all of these technoloSharp new recruits versus new recruits versus gies to do things for healthcare incumbents. healthcare incumourselves and …

Potentially disruptive entrants bents.

Potentially healthcare is the to the playing field include welldisruptive entrants next frontier,” Cellestablished companies outside to the playing field Scope CEO Erik the industry expanding to include well-estabDouglas told the the medical field, and nonlished companies Health Research Intraditional companies outside the industry stitute (HRI) for the creating new modes expanding to the medrecently released reof care. ical field, and non-tradiport, “Healthcare’s New tional companies creating Entrants: Who will be the new modes of care. industry’s Amazon.com?”

Case in point: At the JP Morgan “Dramatic change has been preHealthcare Conference in January, Waldicted for the healthcare industry many green CEO Gregory Wasson, a Purduetimes over,” wrote HRI. “This time, the trained pharmacist, reminded investors environment is finally ripe for that transthat “hardly anyone went to a drugstore formation. Revenue will circulate differ-

for a flu shot” five years ago.

Now it’s a mini-healthcare center.

Another example of the ripple effects of slight shifts in the $2.8 trillion pie: If half of all patients choose new alternatives for some dozen medical procedures, such as an at-home strep test, it could impact roughly $64 billion of traditional provider revenue, according to a December 2013 HRI-commissioned consumer survey.

Here’s the rub: Even though the U.S. healthcare system is known for piloting life-saving medical interventions, it’s failed in attempts to produce efficient business models to deliver outcomes proportionate to cost. The trend leaves an opening for power players traditionally outside the medical sector. For example, of the 38 Fortune 50 companies listed in 2013 with a major stake in healthcare, 24 are new entrants. Of those, 14 are traditional healthcare organizations, seven are retailers, five are technology companies, four are financial firms, three are telecommunications companies, and two are automakers. One of those is developing services such as chronic condition management while driving.

Companies that already possess impeccable consumer credentials, such as Walgreen, with its active customer base of 74 million, are poised to upend the health sector via cost-saving products and services: Apple was issued a U.S. patent in 2013 for a “seamlessly embedded heart

If half of all patients choose new alternatives for some dozen medical procedures, such as an at-home strep test, it could impact roughly $64 billion of traditional provider revenue, according to an HRI study.

rate monitor” for iPhone and other devices.

AT&T opened its mHealth platform to developers in 2012, hoping to become the essential component in healthcare’s game-changing apps. Nasrin Dayani, executive director for AT&T ForHealth Solutions, told HRI, “We believe the ultimate jury … is the consumers themselves.

It won’t be decided by the providers or payers.”

CVS Caremark, a 7,600-store chain, made a splash in February with a revised strategy to brand itself a healthcare company that includes having tobacco-free pharmacies by year’s end.

Google last year rolled out Calico, a company with expertise in both healthcare and consumer-oriented technology that focuses on aging and associated illnesses.

Samsung unveiled its new Galaxy S5 smartphone earlier this year, with a builtin heart rate monitor.

Time Warner Cable recently revealed a “virtual visit” pilot project with Cleveland Clinic caregivers to interact with patients via telemedicine.

Who’s going to grab the biggest slice of the lucrative market?

“Is it going to be some random startup or … your doctors?” Target CMO Joshua Riff, MD, questioned. “You have the infrastructure. You have the knowledge. You have the experts. You need to be leveraging these technologies.”

Read Louisiana Medical News Online: LOUISIANA MEDICAL NEWS.COM 6 • AUGUST 2014

Louisiana Medical News

Compete or Partner?

The New Health Economy poses major dilemma for traditional providers

By LYNNE JETER

The New Health Economy poses a major dilemma for traditional providers: compete or partner?

In its recently released report, “Healthcare’s New Entrants,” the Health Research Institute (HRI) discussed ways to move healthcare entities to the forefront of this labyrinth and highly-regulated new ecosystem, with the as-yet-undefined third-party payment system as a significant barrier.

In a nutshell: Understanding market needs, consumer desires, regulatory requirements, and reimbursement complexities are required to succeed. Perhaps a hospital with a value-based care contract may find it cost-effective to dispatch patients to local retail clinic partners instead of surgeons to have post-operative stitches removed.

The New Health Economy is spinning off innovative collaborations with sometimes unlikely players. The Health Council of East Central Florida (HCECF) is working with the Viera VA Outpatient Clinic to secure pilot funding for Chronic Care Brevard, a model built around the Poly-Chronic Care Network (PCCN). It provides communities with a safety net boost for residents with multiple or poly-

chronic diseases and represents only one of various HCECF-initiated programs to help communities in its four-county service area – Brevard, Orange, Osceola, and Seminole – adapt to the New Health Economy.

“We’re exploring innovative ways to improve the health of populations and the patient experience of care, all at a reduced per-capita cost as we move along the ecosystem journey,” said HCECF executive director Ken Peach. “For example, we’re working on another program, predicated on one underway at the Satellite Beach Ken Peach Fire Department, where they’ve successfully reduced hip fractures by up to 50 percent. In their community of 12,000, paramedics on the fire department staff follow up with recently hospitalized residents and, with their permission, survey their homes to assess fall risks inside and out. Most women fall inside a home; the majority of men fall outdoors. It’s important to take the entire property into account. Their program has been successful for a number of years.”

HCECF, Osceola County Health Department, Florida Hospital, and Com-

munity Vision are developing a promising, new “Phone to Home” program for Osceola County.

“When appropriate, every time the EMS responds to a call, the paramedics give the person a healthcare guide linking all Osceola County support services,” explained Peach, noting the health council picked that area because of the higher number of incomplete runs. “If a person refuses transport, there’s no reimbursement, so hopefully this can reduce those incomplete runs, and therefore reduce costs.”

Among the overall suggestions from the study: Start with the consumer and work backwards. When health organizations fully comprehend patient needs, they might require an overhaul of operating hours, clinician availability via digital devices, and pricing and quality transparency. For example, one-third of Walgreen’s immunization traffic takes place outside traditional office hours.

Focus on the business model. Base it on value-generation in the New Health Economy.

Understand that not all innovation is created equal. “Aspire for disruptive leaps as patients reward truly transformative services and products. Embrace a fast, frugal,

frequent, failure model to quickly develop and test ideas,” noted HRI. Be flexible. Healthcare organizations should develop strategies for productionbased and value-based models.

Engage risk management early. Traditional rules of healthcare still apply. Involve regulatory, legal and compliance counsel early in the process. For example, Airbnb took a calculated risk by launching its travel rental business in 2008 before many communities had determined whether it fit local ordinances; today, the company serves more than 11 million guests in 192 countries.

Collaborate. Blend the best of emerging ventures and incumbents, filling skill and asset gaps.

Think bigger than a website. Healthcare’s next-generation consumer is mobile and thrives online. “It will take more than a website and a grip on social media services to thrive in the New Health Economy,” noted HRI. Don’t go solo. Success in the new reign will require intrinsic knowledge of the complex and fragmented healthcare system, technological expertise and strong consumer ties. “Few organizations possess all of these,” according to HRI. Integrate. Consumers haven’t em(CONTINUED ON PAGE 10)

Louisiana Medical News

AUGUST 2014 • 7

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8 • AUGUST 2014

Louisiana Medical News

Risks associated with EHRs/EMRs. A patient presented at the ER on the main campus of a multi-campus healthcare system for back pain. The only drug allergy listed in the chart was Lortab. She was given Dilaudid. She was admitted and later that same day she had an episode of respiratory distress. She was given Narcan and the Dilaudid was put on hold. Later in the admit the Dilaudid was continued, but at a reduced dosage.

After a short inpatient stay, she was discharged without further problems or complications.

The day after discharge she presented at the ER on a different campus, but in the same healthcare system; again for severe back pain. She was moaning and yelling.

She was given Dilaudid and Phenergan IM. She was monitored and there were no problems for 90 minutes so orders were given for discharge. At one point just before discharge the nurse entered the patient room and found her unresponsive and in PEA. She was coded for a relatively lengthy period and then transferred to ICU with significant anoxic injury. She was taken off life support two weeks later.

The issue: Alarm/Warning fatigue; the responsibility of hospitals and physicians in responding to “pop-up” warnings of potential drug interactions and how to properly document both the warning and the response. Presumably, a person with an allergy to Lortab might have a problem taking Dilaudid when administered in conjunction with Phenergan. In any event, when the warning popped up the physician was allowed to over-ride the warning by selecting one of several options for the over-ride. The warning that popped up was not part of the chart and cannot be re-produced by the hospital and this has caused the plaintiff attorney to think the hospital is hiding something.

The interesting issue that this case presents is that the “alert” information that is now present in the records was not previously a factor in paper records of the past. Previously, the information regarding potential drug-drug or drug-food, drug allergy, or cross sensitivity was not alerted to the physician through documentation that would be contained in the medical record.

Although this information in the electronic record definitely draws the attention of a plaintiff’s attorney, it’s not all bad. Documenting the physician’s thought process for doing what he did is a prudent risk reduction measure. Although it could potentially be damaging to a case, it could also help in the defense strategy.

In the case of CPOE, Risk Manag-

ers need to be aware of how this type of issue could raise risks and take steps to work with physicians to ensure that the risks are minimized. Since an alert override draws the attention of attorneys, it is important to make sure that proper consideration is given when an alert pops up and that appropriate documentation exists when the decision is made to over-ride the alert. Often, physicians are bombarded with alerts and notifications through the electronic system making the alerts almost invisible when they pop up. A study by Isaac, et al (2009) indicated that 230,000 potential drug interaction alerts were sent out for 233,537 medication alerts that were evaluated between January 2006 and September 2006. Many physicians indicate that they over-ride or turn off the alerts since they rarely add value to the patient care indicating that some of the alerts may not be getting proper consideration before being bypassed.

Risk Reduction Recommendations: a) Include the physicians in development of the alerts in order to ensure the alerts add value to them for patient safety. b) Evaluate over-rides, especially the most common ones, and determine that they are relevant and correctly categorized according to their urgency.

In addition, determine if some of the over-rides should not be over-ridden and require physician education. c) Create an alert system that is useable and reliable by working with the EHR vendor. d) Ensure that the physicians are educated about the use of the alerts and that the alert does show up in the medical record and creates a permanent record of the reasoning behind the over-ride making it important for them to consider and acknowledge the alert.

What this real event tells us is that the Electronic Health Record will continually evolve and there is a need for the hospital to constantly monitor, evaluate and implement processes and controls to ensure that clinical staff and physicians understand the functionality of the system; and when warranted, consult with the EHR/EMR vendor for possible revisions of the system.

Risk Management is a recurring series of writings covering claims & risk management topics of interest to healthcare professionals. Content is provided by risk management professionals of the Louisiana Hospital Association Trust Funds and is informational in nature. Louisiana Medical News, LLC is not responsible for the accuracy or appropriateness of any advice or recommendation(s) contained herein.

Taking Your Breath Away How do cities fare in the latest annual asthma report?

By LyNNE JETER

A thriving city rich in history, perched on the brow of the picturesque James River, has once again captured the uncoveted title as the most challenging place to live with asthma.

For the second consecutive year, and four of the last five years, Richmond, Va., took the title perch, with worse than average ratings for prevalence factors (crude death rate for asthma), risk factors (annual pollen score, poverty rate, the uninsured, and public smoking laws), and medical factors (emergency room visits for asthma).

Medical News markets located across the South and Midwest were represented in “Asthma Capitals 2014,” the 11th annual research project released by the Asthma & Allergy Foundation of America (AAFA).

Boston Scientific Corporation (NYSE: BSX) sponsored this year’s report.

Medical News market rankings, with 2013 rankings in parentheses: No. 2: Memphis, Tenn. (3) No. 6: Chattanooga, Tenn. (2) No. 22: New Orleans, La. (24) No. 26: St. Louis, Mo. (55) No. 27: Little Rock, Ark. (31) No. 38: Nashville, Tenn. (32) No. 41: Knoxville, Tenn. (10) No. 42: Jackson, Miss. (47) No. 48: Birmingham, Ala. (23) No. 49: Orlando, Fla. (62) No. 50: Tampa, Fla. (57) No. 55: Lakeland, Fla. (60) No. 64: Daytona Beach, Fla. (76) No. 65: Baton Rouge, La. (79) No. 75: Sarasota, Fla. (87) No. 81: Raleigh, NC (91) No. 87: Charlotte, NC (86) Most Metropolitan Statistical Areas (MSAs) in Medical News markets improved over 2013, collectively dropping 45 spots. The St. Louis market showed the least improvement, moving up 29 spots among the most challenging places to live with asthma. The most improved MSAs for easier asthma living: Knoxville, Tenn., sliding down 31 spots, followed closely

by Birmingham, Ala., which dropped 25 spots.

Methodology Analytical data from the 100 mostpopulated MSAs in the United States determined the ranking system. Researchers

The national burden of 25 million Americans with asthma costs more than $50 billion annually in healthcare expenses, missed school and work days, and deaths. Yet, asthma rates have continued to climb since the late 1980s across age, gender and racial lines, now affecting nearly 10 percent of the U.S. population.

and medical specialists focused on three primary areas – prevalence, risk, and medical factors – that include 13 unique factors, with non-equal weights applied to each data set in individual factor groups. Total scores were calculated as a composite of all factors, reflecting each factor’s relative impact on exposure to asthma triggers, quality of life, costs and access to care.

Prevalence factors included the predicted population with asthma, self-

reported population with asthma, and recorded death rates for adults and children from asthma. Risk factors included comprehensive annual pollen measurements, average length of peak pollen seasons, outdoor air quality, poverty and uninsured rates, state school inhaler access laws, and smoke-free public laws.

Medical factors included ER visits for asthma, rescue medication use, controller medication use, and the number per pa-

tient of board-certified adult and pediatric allergists and immunologists, and pulmonologists.

ER visits represent a significant chunk of asthma care-related costs.

“Many ER visits are from people with severe asthma, but not all of them,” said Mario Castro, MD, professor of medicine and pediatrics at Washington University School of Medicine in St. Louis, discuss(CONTINUED ON PAGE 10)

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Louisiana Medical News

AUGUST 2014 • 9

Louisiana Passes Law to Protect ED Workers, continued from page 1 nurses have gone on for decades. And Breecher’s not talking about behavioral health patients, the vast majority of whom are not violent.

“While there are some behavioral health patients who are violent, there are a lot of people who are violent in the Emergency Department Deena Breecher that are not there for behavioral health emergencies,” Breecher said.

Despite the knowledge that ED violence is a longstanding problem, it’s only in the past few years that attitudes have begun to shift, and efforts to protect nurses and other emergency workers have gained traction.

The association hopes laws like Louisiana’s and education efforts can make a difference on an issue that Breecher has said no one wants to discuss, admit is happening or acknowledge their responsibility in perpetuating it.

“The most important thing to change is the culture … so that everyone from ED nurses to hospital administrators say that this is not OK,” Breecher said. “This is not part of the job.”

But it is all too common.

An ENA survey of ED nurses found that half of the respondents had experienced a physical or verbal assault in the last week. ENA research also shows that a third of the ED nurses who are victims of workplace violence leave their jobs or their profession. A January study by the Institute of Emergency Nursing bears the title Nothing Changes, Nobody Cares. Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care.

Breecher said workplace violence does more than just hurt its victims. It also affects patient care, quality and increases hospital expenses. The average cost to train and replace an ED nurse is around

EDWIN G. PREIS, JR. ROBERT M. KALLAM FRANK A. PICCOLO JOHN M. RIBARITS CATHERINE M. LANDRY JAMES A. LOCHRIDGE, JR. CHARLES J. BOUDREAUX, JR. DAVID L. PYBUS DAVID M. FLOTTE LEAH NUNN ENGELHARDT EDWARD F. KOHNKE IV JENNIFER A. WELLS JONATHAN L. WOODS M. BENJAMIN ALEXANDER KEVIN T. DOSSETT KENNETH H. TRIBUCH MARJORIE C. NICOL MATTHEW S. GREEN EZRA L. FINKLE JEAN ANN BILLEAUD JOHN F. COLOWICH JOHN L. ROBERT, III WILLIAM W. FITZGERALD DARYL J. DAIGLE CAROLINE T. WEBB MANDY A. SIMON NATHANIEL C. PITONIAK THOMAS H. PRINCE RACHAL D. CHANCE CRAIG R. BORDELON, II JARED O. BRINLEE KELLYE E. ROSENZWEIG KARNINA D. DARGIN

10 • AUGUST 2014

$65,000.

There are an estimated 180,000 to 200,000 ED nurses nationwide. Roughly 40,000 are members of ENA. Breecher said the association doesn’t have data showing how many nurses leave their jobs each year because of workplace violence or the number of episodes it takes before an ED worker quits.

It takes seven violent incidents for some to leave an abusive relationship, Breecher said. The average may be similar for ED workers.

One nurse Breecher knows left her job but not because of the violence. She left because of the way she was treated after she insisted on reporting the episode.

O’Connor said part of changing the culture of acceptance is educating nurses about what constitutes violence. In addition to physical assaults, violence includes verbal abuse, threats and harassment.

Although Louisiana’s new law does not include mandatory training to help nurses deal with or defuse potentially violent situations, ENA would like to see hospitals require it. The association has partnered with the federal Occupational Safety and Health Administration on a free, two-hour education workplace violence prevention course.

ENA also recommends mandatory reporting when workplace violence occurs.

The association has found that some hospital administrators don’t want to report episodes to the police because of the bad publicity that results, Breecher said. Even when nurses want to report the episodes, it may be difficult to get law enforcement to take a report or a district attorney to prosecute.

Often a district attorney will excuse the attack because someone was drunk or upset about a family member being in the ER, Breecher said. The end result is that very few incidents are reported.

But research has shown that organizations that require mandatory reporting

for violent episodes also experience fewer episodes of violence, she said. Implementing mandatory reporting and deescalation training, teaching people how to keep themselves safe, creates the safest environment for the nurses, patients and their families.

Compete or Partner? cont. from page 7 braced electronic health records, perhaps because of privacy and security concerns.

Integration and accessibility of data will be pivotal in the design of a seamless, coordinated health system.

Compete in cyberspace. Even though half of American adults own a smartphone, 80 percent of young adults (aged 18 to 34) do!

Developing efficient, affordable solutions for healthcare delivery to consumers’ devices will be a critical step in the overhaul.

For traditional healthcare organizations, the industry transformation necessitates the consumer at its core, and requires evaluating all processes from operating hours to clinician availability via digital devices to transparency of pricing and quality. It also requires them to “figure out what matters most,” such as commodity revenue versus new revenue models rooted in core capabilities while also investing in new ones, noted HRI. New entrants should focus on two primary goals: getting paid, and knowing the stakeholders. The industry transformation also requires them to develop a new consumer-focused value equation, and emphasize quality via innovative approaches like virtual networks of second opinion experts.

“Within a decade, healthcare will feel very different,” concluded the HRI report.

“The players will be different, with partnerships between new entrants and traditional organizations. And this New Health Economy will have … its Amazon.com.”

Your Partners in Healthcare Your Partners in Healthcare

Taking Your Breath Away, continued frompage 9

ing the average of more than 2,300 visits to ERs for asthma in each U.S. city, with one in four admitted to a hospital. “Many people with less severe asthma show up to the ER, too. But much of this is avoidable with new treatments for severe patients and better prevention and care for those with less severe disease.”

Making Strides Earlier this year, the Supreme Court upheld the U.S. Environmental Protection Agency’s (EPA) Cross-State Air Pollution Rule, which aims to reduce the amount of pollution drift from certain states into others, prompting health issues for residents in those states. The Supreme Court also noted the rule is an effective way to control emissions, and melds with the EPA’s mission under the Clean Air Act. The AAFA is collaborating with state chapters to mandate or improve on the requirement of stocking epinephrine in schools for severe allergic reactions. For example, California is considering legislation to strengthen its existing epinephrinestocking law to require schools to stock the medication and train a volunteer to administer it. Illinois is considering legislation to require, rather than simply allow, schools to stock epinephrine. All states in Medical News markets have epinephrine-stocking school policies in place, with the exception of North Carolina, which at press time had pending legislation.

The AAFA has banded with other national health advocacy groups to support increased research funding, which includes lobbying against proposed budget cuts for the National Institutes of Health, Centers for Disease Control and Prevention (CDC), Agency for Health Resources and Quality, and other agencies with research relevant to asthma and allergic diseases.

For example, the CDC’s National Asthma Control Program has helped decrease asthma mortality rates by more than 45 percent since its inception in 1999.

“There are many things that we can improve now to make life better for people with asthma,” says AAFA spokesperson and asthma patient, Talisa White. “Our Asthma Capitals report helps to shed light on the asthma burden in each city, but it also provides a roadmap for improvements.”

Fast Facts about Asthma Every day in the United States,

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44,000 people have an asthma attack; 36,000 kids miss school due to asthma;

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Louisiana Medical News

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27,000 adults miss work due to asthma; and 9 people die from asthma.

SOURCE: AAFA.

Legislative Affairs

BY CINDY BISHOP

The Work After the Legislative Session Often times, I am asked, “now that the session is over, what do you do the rest of the year?” It’s an appropriate question to ask a lobbyist. As a registered lobbyist, when the legislature is in session, my legislative team and I are present at the Louisiana State Capitol every single day watching the legislative proceedings and doing our part to influence the outcome of many House and Senate Bills on behalf of the organizations we represent. Additionally, my firm provides association management services, so throughout the year, we are engaged in membership recruitment and retention efforts, board development and convention planning.

Once the Louisiana Legislature has adjourned and state lawmakers return to their home districts, the regulatory process kicks into high gear.

Once a bill is enacted into law, the state agency responsible for implementing or enforcing that particular bill typically promulgates an administrative rule (or regulation) to govern its’ implementation. There are many steps in the administrative rule making process. Simply put, a state agency typically publishes a Notice of Intent and solicits public comment. Sometimes, a state agency will conduct a public hearing on a Notice of Intent to gather public comment and input. If the agency decides not to make any changes to their original Notice of Intent, they re-republish the proposed rule as Final Rule. If the state agency decides to make substantive changes to the Notice of Intent, they republish a new Notice of Intent. After a designated period of time, the new rule or regulation goes into effect. These proposed rules and regulations are published in the Louisiana Register (also referred to as the State Register).

The Louisiana Administrative Procedures Code also provides a mechanism for state agencies to promulgate emergency rules and regulations. If deemed appropriate, a state agency will promulgate an emergency rule that goes into effect immediately.

However, after publication of an emergency rule, the state agency must then promulgate the rule in the usual manner they would follow by publishing a Notice of Intent in the State Register.

The Louisiana Register comes out in print edition after the 20th of each month.

We subscribe to the State Register and notify the organizations we represent of any proposed rules or regulations that impact their profession.

Now that session has ended, and the time period has lapsed for the Governor to act upon bills that were enacted during the recent legislative session, we have compiled a comprehensive listing of all the measures,

along with the Act Numbers assigned to these new laws. If you would like a copy of this compendium of legislation enacted during the 2014 Regular Session of the Louisiana Legislature, please shoot me an email at destiny362@aol.com Last week, I got a phone call from someone who had read my legislative column in last month’s Louisiana Medical News. He was inquiring about a bill that had passed during the legislative session.

We laughed about the fact that in my July column, I stated that the legislative session was over and the dust had settled. He intimated that the dust never settles. That is often true. If you come across a healthcare related bill that you have a question about, you are always welcome to contact me. The best way to reach me is at (225) 933-5435.

I love learning about healthcare issues that challenge our readers and/or their business or the organizations in which they are involved. Sometimes, it is akin to assembling a puzzle. There are many intricate related and unrelated pieces that make up the legislative process and the legislative instruments that are ultimately signed into law.

Here are two emergency rules that were published in the June 20th State Register: Department of Health and Hospitals Disproportionate Share Hospital Payments - Louisiana Low-Income Academic Hospitals, effective May 24, 2014 Department of Health and Hospitals - Early and Periodic Screening, Diagnosis and Treatment – Personal Care Services Removal of Parental Availability, effective June 1, 2014 To view Emergency Rules on our website, go to www.doa.louisiana.gov/osr/ emr/emr.htm The Office of the State Register will publish the following Emergency Rules in the July 20, 2014 issue of the Louisiana Register: • Department of Health and Hospitals – Minimum Disinfectant Residual Levels in Public Water Systems effective July 5, 2014 • Department of Health and Hospitals – Added Controlled Dangerous Substances, effective July 3, 2014 Legislative Affairs content is provided by Checkmate Strategies, publisher of Health Care Information Services. All content © Checkmate Strategies and Louisiana Medical News, LLC. For more information, readers may contact Cindy Bishop at 225.923.1599 or P.O. Box 80053, BR, LA 70598, or send email to destiny362@aol.com. Our website is www. checkmate-strategies.com

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Louisiana Medical News

AUGUST 2014 • 11

NASS Takes a Proactive Approach to Evidence-Based Coverage Decisions

By CINDy SANDERS

In an effort to improve patient access to appropriate, evidence-based care, the North American Spine Society (NASS) recently released detailed policy recommendations for coverage of 13 common spine care treatments, procedures and diagnostics.

The first-of-their-kind reference documents outline when it is … and when it is not … appropriate to utilize each of the options based on an extensive review of current literature by a multidisciplinary team of experts.

William Watters, MD, president of NASS, said, “Maintaining patient access to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission. It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommendations as a reference to advocate for appropriate care for patients.”

Watters added the society was uniquely positioned to take the lead on such an extensive project because of the multispecialty nature of the organization, which includes the expertise of surgeons and allied health professionals. “We cover the full spectrum of spine care,” he noted.

Watters, who is a board certified orthopaedic surgeon in private practice at the Bone & Joint Clinic of Houston and a clinical associate professor at both the University of Texas Medical Branch in Galveston and Baylor College of Medicine, said the society already had experience weighing the evidence at the request of physicians, patients and payers. “NASS began a number of years ago becoming involved in third party payer coverage decisions,” he noted. However, he continued, the turnaround time was often tight and the number of studies to consider extensive.

“We decided to proactively create our own coverage decisions based on the best evidence available … and where evidence was lacking, based on the expertise in this group,” he explained. “We came up with what we feel is the most sound group of recommendations based on the best evidence available at this point and time.”

Watters continued, “One of the hopes that we have is that we bring a bit of uniformity to the whole process of spinal care.”

Christopher Kauffman, MD, health policy council director for NASS, concurred. He said allowed treatments and diagnostics vary by state and by payer.

Physicians’ health Foundation oF louisiana

These recommendations outline the scope and clinical indications for a therapeutic measure when a patient meets appropriate inclusion criteria. They also clearly state scenarios in which employing the measure is not indicated.

While not recommending payers reimburse for every procedure under every circumstance might be controversial among some providers, Kauffman said, “People who understand where medicine is going with outcome measures get it. So far, the response has been overwhelmingly positive.”

He added, “People may confuse coverage with medical appropriateness.

The two are not equal. People assume payment equals medical appropriateness. I can’t stress enough this isn’t true.

Payment equals treatments where the literature has reached a certain bar of evidence.”

Kauffman, a board certified orthopaedic surgeon in practice at Premier Orthopaedics in Nashville, said, “For everything we recommend, we think the evidence does reach the bar for coverage.

This is what we think should be covered by any payer.”

However, he continued, it doesn’t mean other treatments being employed don’t have therapeutic benefits. “You can’t ever throw out the art of medicine.” Yet, Kauffman noted, “If you’re falling outside the clinical guidelines, you have to expect that you’re going to do a peer-to-peer review, or it might not be a covered service.” He added the recommendations would be routinely revisited to incorporate new evidence.

In addition to the 13 coverage policy recommendations published in May, Watters said NASS is already in process or planning to create documents for 14 additional diagnostic and therapeutic modalities including annular repair, cervical

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Coverage Policy Recommendations To access the documents for each of the procedures listed below, go online to www.spine.org and click on the “Policy & Practice” heading.

Cervical artificial disk replacement Endoscopic discectomy Epidural cervical spinal injections Interspinous device without fusion Interspinous fixation with fusion Laser spine surgery Lumbar artificial dis replacement Lumbar discectomy Lumbar fusion Lumbar laminotomy Lumbar spinal injections Percutaneous thoracolumbar stabilization Recombinant human bone morphogenetic protein (rhBMP-2)

and lumbar radiofrequency neurotomy, cervical fusion, cervical laminectomy and laminoplasty, minimally invasive lumbar fusion, SI joint fusion and injections, DNA-based scoliosis test and electrical stimulation for bone healing, among others. “The remainder will be released within a year,” he said.

“The plan is to reassess the literature at least every two years,” he continued, emphasizing the need to stay current as new studies are published and new treatment options become available. “This has to be a living document.”

He added it’s a nearly impossible task to ask physicians, surgeons, nurses, therapists and other providers to wade through all the literature required to practice evidence-based, contemporary medicine. Having the committee go through the best, most soundly crafted studies to create each of the 5-30 page recommendations, which include supporting details behind the rationale and a thorough list of references, simplifies the process for practitioners and their patients. “These turned out to be remarkably educational documents,” Watters stated.

Both Kauffman and Watters stressed at the end of the day, the coverage recommendations are an effort to ensure patients have equal access to the best possible treatments.

“It’s making sure that good spine care is available for patients across the U.S.,” Kauffman concluded.

In the News Emily B. Grey Appointed AHLA Vice Chair BATON ROUGE- Emily B. Grey, an attorney partner at Breazeale, Sachse & Wilson (BS&W), has been appointed to the position of Vice Chair of Strategic Activities in the American Health Lawyers Association’s Hospitals and Health Systems Practice Group. At the AHLA Annual Meeting Emily was also recognized for her leadership of the Public Health System Affinity Group as Chair (2013-2014) and Vice Chair (2012-2013).

As BS&W’s Healthcare Section Leader, Emily is responsible for business development and strategic planning initiatives of the Healthcare Industry Team.

Grey is very active both professionally and civically, and has served in leadership roles throughout the Baton Rouge community.

The American Health Lawyers Association (AHLA) is the nation’s largest nonpartisan educational organization devoted to legal issues in the health care field. The Association’s more than 12,700 members practice in a variety of settings in the health care community.

Pegues Appointed LSUHSC Vice Chancellor For Administration NEW ORLEANS- Dr. Larry Hollier, Chancellor of LSU Health Sciences Center New Orleans, has appointed J. R. Pegues, MBA, Vice Chancellor for Administration. He serves as the chief operating and administrative officer of LSU Health Sciences Center New Orleans.

Mr. Pegues has the lead responsibility for the university’s successful business performance, including information technology, environmental health and safety, human resources and auxiliary enterprises. He is responsible for developing campus master plans, acquisition and maintenance of property, as well as construction, renovation, maintenance and repair of facilities. His duties include establishing standards of personnel and institutional performance, defining broad institutional goals and objectives and coordinating the reporting and analysis of operating, capital and financial budgets.

Before joining LSUHSC, Mr. Pegues was President and Chief Executive Officer of Coventry Health Care’s and Aetna’s operations in Louisiana, Arkansas, Tennessee, and Mississippi. In that role, Mr. Pegues had responsibility for all dayto-day operations and profitability of the organization.

University Health System Joins Health Information Exchange BATON ROUGE – The Louisiana Health Care Quality Forum has announced that University Health System, which includes hospitals in Shreveport and University Health Conway in Monroe, has enrolled as a participant in the Louisiana Health Information Exchange (LaHIE).

“By enrolling with LaHIE, University Health System soon will be connected with the larger health care community throughout the state, bringing a new level of care, safety and savings to the patients they serve,” said Cindy Munn, Chief Executive Officer of the Quality Forum. “University Health plays an integral role in health care in north Louisiana, and we are excited to provide them with access to a powerful, secure and comprehensive exchange solution.

We are very pleased to welcome them to LaHIE.” LaHIE is the mechanism that allows for the secure exchange of health information among authorized providers and organizations across Louisiana’s health care system to help improve patient safety, quality of care and health outcomes. Benefits of LaHIE include timely access to patient records, improved patient safety, increased security of records, better coordination of care and patient management, reduced health care costs, and improved public health reporting.

Marcus Hobgood, University Health Chief Information Officer, said that LaHIE meets federal requirements for meaningful use. LaHIE is a HIPAA-compliant pipeline that allows meaningful health information to be shared across state lines to make relevant records readily available when other providers need it.

“In addition to meeting meaningful use requirements, participating in LaHIE will allow University Health to provide improved continuity of care for our patients. University Health is excited to provide state-of-the-art technology to enhance patient care,” said Hobgood.

Orthopaedic Surgeons Join Louisiana Heart Medical Group LACOMBE- The Louisiana Heart Hospital (LHH) announced that it completed agreements for clinical integration with orthopaedic surgeons, Matti W. Palo Jr., M.D. and Timothy Devraj, M.D. These agreements represent another important step in the growth of the Louisiana Heart HosDr. Matti W. pital integrated delivery Palo Jr. system.

“We are thrilled to add such talented physicians as Dr. Palo and Dr. Devraj to our growing healthcare team,” said Steve Blades, CEO of the Dr. Timothy Devraj Louisiana Heart Medical Group and Senior Vice President for Physician Services for Cardiovascular Care Group (CCG), the parent company of LHH. “Their significant general Orthopaedic Surgery addition to our already nationally-recognized Spine Surgery program will dramatically expand our services to the community.”

Dr. Palo has practiced on the Northshore since 2004 and holds Certification

by the American Board of Orthopaedic Surgery. He received his medical doctorate from University of Alabama School of Medicine and completed his residency in Orthopaedic Surgery at Ochsner Clinic Foundation. He is a member of the American Academy of Orthopaedic Surgeons and holds the Oxford Uni-compartmental Masters Certification. Dr. Palo also has multiple patents pending for orthopedic devices.

Dr. Devraj has practiced on the Northshore for eleven years and is Board certified in Orthopaedic Surgery. He received his medical doctorate from The Medical College of Wisconsin in Milwaukee and completed his internship and residency in General Orthopaedics and Orthopaedic Surgery at Ochsner Clinic Foundation.

Drs. Palo and Devraj’s Orthopaedic practices are located at 70411 Highway 21, Covington, LA.

bana, IL, Dr. Dean-Colomb also earned a Ph.D. in Toxicology, as well as her Bachelor of Science degree in Biology, from Prairie View A&M University in Prairie View, TX. She completed her residency at the University of Illinois and her fellowship at M.D. Anderson Cancer Center in Houston.

UHC’s oncology department is currently serving as both a clinic and an infusion center. The clinic is supported through Cancer Center of Acadiana, which is accredited by the American College of Surgeons Commission on Cancer.

UHC accepts patients in the clinic two days per week (Tuesday and Thursday) from 8 a.m. to noon, with infusions scheduled Monday through Friday from 8 a.m. to 5 p.m. UHC sees approximately 200 patients in the oncology clinic per month, and performs approximately 300 infusions per month.

Four Louisiana Hospitals Complete Safety Training

Tulane Medical Center Appoints William Lunn, MD As CEO

BATON ROUGE- Emergency Medical Technicians from four Louisiana hospitals were recognized after completing a safety training program last month designed to improve decision-making skills in emergency response scenarios. The training program, Safety: Emergency Responder Vehicle Education (S:ERVE), was offered as a benefit of the LHA Workers’ Compensation Trust Fund.

The S:ERVE curriculum included online simulations and training on safe vehicle operation, as well as guidance on navigating different scenarios typical in emergency situations.

The four hospitals recognized were Hardtner Medical Center, LaSalle General Hospital, Natchitoches Regional Medical Center and North Caddo Medical Center. Each hospital was provided a luncheon by the LHA Workers’ Compensation Trust Fund in recognition of their EMT staff’s completion of the S:ERVE program.

UHC Names Director of Oncology and Oncology Research LAFAYETTE – Lafayette General Health announces that oncologist Windy Dean-Colomb, M.D., has been named Medical Director of Oncology at University Hospital & Clinics (UHC), as well as UHC’s Medical Director of Oncology Research.

Dr. Windy Dr. Dean-Colomb Dean-Colomb comes to Lafayette from the USA Mitchell Cancer Institute in Mobile, AL, and brings a highly decorated resume to her new position, including board certification from the American Board of Internal Medicine. In addition to being licensed in Louisiana, she has also been licensed in Texas and Alabama.

Earning her Doctor of Medicine degree from the University of Illinois in Ur-

NEW ORLEANS- William Lunn, MD, a Harvard fellowship-trained executive with 18 years of distinguished experience in roles leading high-profile academic medical centers and a major regional health system, in addition to private practice, has Dr. William been appointed Chief ExLunn ecutive Officer of Tulane Medical Center. Dr. Lunn assumes his responsibilities on August 11, 2014.

Since 2009, Dr. Lunn has served as Chief Operating Officer of Christus Health-Northern Louisiana in Shreveport, a $250 million regional non-profit Catholic health care system encompassing three acute care hospitals with a total of 350 beds, an inpatient hospice, a long term acute care hospital within a hospital, and two wellness centers.

Dr. Lunn was in private practice from 1996 – 2003 at Pulmonary Specialists in Tyler, Texas, a single specialty physician group that provided pulmonary and critical care services to two hospitals.

Dr. Lunn earned a Political Science degree from Tulane University in Business Administration and Medical degree from the University of Texas-Southwestern. He performed an internship in Internal Medicine at Presbyterian Hospital of Dallas; residency in Internal Medicine at Emory University; a Fellowship in Pulmonary and Critical Care Medicine at Vanderbilt University; and an Interventional Pulmonary Fellowship at Harvard Medical School. He also received a Certificate in Medical and Healthcare Management from the Jones School of Business at Rice University.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

Louisiana Medical News

AUGUST 2014 • 13

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In the News Castille Appointed Executive Director of Rural Hospital Coalition BATON ROUGE- Randy Morris, Chairman of the Board of Directors of the Rural Hospital Coalition, is pleased to announce the appointment of Charles F. Castille as the new Executive Director of the Coalition, effective July 1, 2014. Mr. Castille replaces Charles F. Castille the late Linda K. Welch, who passed away on April 29, 2014.

Mr. Castille’s experience includes 35 years of service with the Louisiana Department of Health and Hospitals (DHH) serving as General Counsel, Deputy Secretary and Undersecretary before retiring from DHH in 2010. More recently, Mr. Castille was with the law firm of Adams and Reese LLP as Special Counsel with their Governmental Relations and Health Law practice.

Ms. Brenda Lefebure, Ms. Welch’s former assistant, will join Mr. Castille and continue her service on behalf of the Coalition.

The Rural Hospital Coalition, with Mr. Castille as Executive Director, will build on the work of the late Ms. Welch to preserve rural hospitals in Louisiana by insuring the continued implementation of the Rural Hospital Preservation Act. The Rural Hospital Preservation Act,

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enacted by the Louisiana Legislature in 1997, affirmatively establishes that the policy of the State of Louisiana is to provide continued access to health care to its rural citizens through support of its rural hospitals.

The Coalition offices will be relocating from 14116 Denham Road in Pride, Louisiana to 450 Laurel Street, 18th Floor in Baton Rouge.

R. Mark Sayes, MD, Joins Baton Rouge General Physicians BATON ROUGE- Dr. R. Mark Sayes has joined Baton Rouge General Physicians group. Dr. Sayes specializes in family medicine and has more than 20 years of experience.

He earned his medical degree from Tulane University School of MediDr. R. Mark cine in New Orleans. He Sayes completed his internship at Quillen-Dishner College of Medicine at East Tennessee State University in Johnson City and completed his residency training at the University of Mississippi Medical Center in Jackson. He is board certified in family medicine and is a member of the American Academy of Family Physicians.

His office is located at 17520 Old Jefferson Hwy., Suite B, in Prairieville.

Advanced BranchedGraft Aortic-Iliac Implant Performed At Ochsner Medical Center NEW ORLEANS – On June 18, 2014, W. Charles Sternbergh III, MD, successfully implanted an iliac artery branched graft to treat aortic and iliac artery aneurysms, the first such procedure in Louisiana and Texas.

Ochsner is the only medical center in Louisiana to have access to this nextW. Charles generation advanced aor- Dr. Sternbergh III tic endograft technology.

Prior to the development of this device, patients with aneurysms extending into the iliac arteries generally required occlusion of the internal iliac artery during an endovascular aneurysm repair.

Blocking off the blood flow to this blood vessel can cause difficulty walking in 2530% of cases, and less commonly even more serious issues. This device allows for continued blood flow through this important blood vessel. This complex endovascular aortic procedure was performed percutaneously (without any incisions). The patient had minimal pain after the procedure and went home after a single overnight stay.

Ochsner’s section of Vascular and Endovascular Surgery provides cuttingedge treatment for patients with aortic and peripheral vascular disorders. Ochsner’s physicians are nationally recognized for their development and use of new technologies and Ochsner was re-

cently named #2 in the state of Louisiana for vascular surgery by CareChex®, a division of COMPARION.

Laura Lazarus, MD Joins St. Charles Surgical Hospital NEW ORLEANS– Doctors Frank DellaCroce and Scott Sullivan, founders of the Center for Restorative Breast Surgery (CRBS) and the St. Charles Surgical Hospital (SCSH) in New Orleans are pleased to announce that board certified general surgeon Dr. Laura Lazarus has joined their group of surgeons. Lazarus, together with breast surgical oncologist Dr. Alan Stolier, will work with the team of reconstructive surgeons including Dr. DellaCroce, Dr. Sullivan, Dr. Christopher Trahan, Dr. Whitten Wise and Dr. Craig Blum. Her expertise in the arena of BRCA risk reduction procedures and nipple sparing mastectomy, further enhance the progress of the groundbreaking and pioneering work that the facility in known for around the world.

Dr. Lazarus graduated with a B.S. in Biopsychology from Tufts University in Medford, Massachusetts and received her Medical Degree at Hahnemann University School of Medicine in Philadelphia. She completed her residency in general surgery at LSU Medical Center in New Orleans, followed by a fellowship in breast surgery at Northwestern University Medical School, Lynn Sage Breast Center in Chicago, and most recently worked as a breast surgeon at Greenwich Hospital in Connecticut.

Dr. Lazarus is a highly lauded breast surgical oncologist. She was named a Top Doctor in the New York Metro area for three consecutive years, 2012 – 2014, and received the Patient’s Choice Award in 2008 - 2009.

Prior to her time in the Northeast, Dr. Lazarus was a breast surgeon at Memorial Medical Center in New Orleans and received a grant from the Susan G. Komen Foundation for the development of a breast center for the underserved women of Louisiana and served as an Associate Professor of Surgery and Director of the Breast Center at the Medical Center of Louisiana. While in New Orleans, she was also a member of the Oncology Committee and the Chairperson of the Oncology Quality & Performance Improvement Sub-committee at Memorial Medical Center.

Dr. Lazarus is a fellow of the American College of Surgeons, a member and Mastery Participant in the American Society of Breast Surgeons and a SWOG affiliate member. She has served on the Oncology Committee at Greenwich Hospital for the past eight years; was recently nominated for the Greenwich Hospital Quality Award for exceptional contributions to service excellence; and received the Northeast Medical Group Award of Excellence for integrity, patient-centered, respect, accountability and compassion. Before returning to Louisiana, Dr. Lazarus was a member of the Greenwich Medical Society.

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In the News Thibodaux Regional Welcomes Dr. Andrew Gustavson, Neurologist THIBODAUX - Thibodaux Regional Medical Center is pleased to announce the addition of Andrew Gustavson, MD, neurologist, to the active medical staff.

Dr. Gustavson received his medical degree from the University Dr. Andrew of Texas Medical Branch Gustavson in Galevston, Texas. Additionally, he completed his neurology residency and additional sub-specialty fellowship training in behavioral neurology at UCLA in Los Angeles, California.

Dr. Gustavson is a member of the American Academy of Neurology and the Louisiana State Medical Society.

I’d rather be meeting with clients, jogging in Audubon Park, volunteering at my kid’s school,

CIS & LGMC Welcome Cardiologist Viral Lathia, MD LAFAYETTE— Cardiovascular Institute of the South (CIS) and Lafayette General Medical Center (LGMC) are proud to announce the addition of Dr. Viral Lathia to theirr cardiology team at University Hospital & Clinics (UHC).

Dr. Lathia is providing Dr. Viral Lathia world-class cardiovascular care to patients at 2390 West Congress Street, 7th floor east.

Dr. Lathia is board certified in internal medicine, cardiovascular disease, cardiovascular computed tomography and nuclear cardiology. He completed his internal medicine residency through Louisiana State University’s Graduate Medical Education Program in Lafayette and his cardiology fellowship at the Louisiana State University Program in New Orleans. He also earned his Bachelor of Medicine and Bachelor of Surgery at Padmashree Dr. D. Y. Patil Medical College in India.

PCF Med-Mal Rates Lowered for Physicians, Increased for Hospitals

BATON ROUGE- The Patient’s Compensation Fund (PCF) Oversight Board lowered surcharge rates for physicians and raised them for hospitals effective September 2014. Physicians will pay an average of 7.8 percent less, while hospitals will pay 9.7 percent more. Doctors continue to enjoy less frequency, while future medical payments and a larger number of employed physicians have put pressure on hospital rates.

Dentists had the highest increase at 14.1 percent, with CRNAs down 10 percent and nursing homes at negative 1.4 percent. These reductions continue a trend of lower rates for doctors, while the hospital increase ended a streak of lower or flat rates for the past 5 years. Rates must be actuarialy sound under the PCF statute, and recommendations are developed by a study performed by longterm PCF Actuary Jim Hurley of Towers Perrin in Atlanta GA

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Louisiana Medical News

AUGUST 2014 • 15