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PATIENT CARE MODELS
On Rounds Physician Spotlight
Quality Forum, Aledade Form New ACO By TED GRIGGS
Dr. Dani Bidros Exploring What We Don’t Know At age 9, Dani Bidros moved to Lafayette, La. from Syria with his family. Growing up, his role model was older brother, Rafi, who became a plastic surgeon. The younger Bidros followed in his footsteps on an almost identical path, diverting just a bit to become a brain surgeon. “It was great to have an older sibling to follow,” he confided ... page 3
Rural Hospitals Find ACO Help Two Louisiana hospitals are among more than 200 U.S. health systems that applied for $114 million in federal funds to help set up rural Accountable Care Organizations ... page 5
A Louisiana Health Care Quality Forum and Aledade Inc. partnership has formed a new Accountable Care Organization made up of independent primary care providers in small and mid-sized cities. The partners will begin with just 10 to 12 practices, focusing on those that have the technology infrastructure in place to capture clinical data and a large enough population of feefor-service Medicare patients, said Dr. Farzad Mostashari, Aledade CEO. The Quality Forum and Aledade will help the practices put the data to use, helping doctors improve prevention and care coordination for their patients. “If you have 500 patients, that’s too small for a contract with Medicare or a health plan,” Mostashari said. “The idea is to pool
patients from 10 or 12 practices and manage them together.” At 10,000 patients, an ACO can manage risk over that population. Medicare has estimated it will pay $100 million next year on care for 10,000 patients. “If we can together, as an ACO, reduce that by 10 percent, that’s $10 million that gets split between ACO and Medicare,” Mostashari said. The incentives are made possible by the Medicare Shared Savings Program, which rewards ACOs for slowing the growth in healthcare costs and meeting quality standards. Travis Broome, healthcare policy lead for Aledade, said the ACO is focusing on Medicare first. Large numbers of those patients have chronic conditions and there is an opportunity to keep those (CONTINUED ON PAGE 4)
PATIENT CARE MODELS
The Competing P’s: Provision & Payment
Changing reimbursement for new models of care By CINDy SANDERS
First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it. “Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.” (CONTINUED ON PAGE 4)
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Physician Spotlight
Dr. Dani Bidros
Exploring What We Don’t Know By LISA HANCHEy
At age 9, Dani Bidros moved to Lafayette, La. from Syria with his family. Growing up, his role model was older brother, Rafi, who became a plastic surgeon. The younger Bidros followed in his footsteps on an almost identical path, diverting just a bit to become a brain surgeon. “It was great to have an older sibling to follow,” he confided. As a high schooler, Bidros excelled in biology and sciences. Like his brother before him, Bidros attended the University of Louisiana at Lafayette (USL at the time his brother went), then LSU medical school in New Orleans. But, instead of pursuing plastic surgery, Bidros decided to concentrate on the brain. “With the human brain, there is so much that we know, but there’s so much that we don’t know,” he explained. “And, I always knew I’d do something surgical where I’d be working with my hands. Neurosurgery blended the two. The complexity of the work itself and the gratification of helping people, whether it was a brain or a spine issue, was just amazing.” Two months after starting his residency, Hurricane Katrina hit New Orleans. During the ensuing week, Bidros
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cared for his patients at Charity Hospital. Then, he and his fellow residents temporarily relocated to Baton Rouge for a few months. After returning to New Orleans in an attempt to rebuild the program, Bidros was recruited by the chairman at the renowned Cleveland Clinic to complete his residency and fellowship in neurosurgery. In Cleveland, Bidros learned from the very best about all types of neurosurgeries. “It was such a big facility and tertiary referral center, so we got to treat the most complex neurosurgical problems,” he recalled. “People were being flown in from
all over the state, the country – the world – to be treated. It was a great opportunity and great training.” Cleveland turned out to be a good move in another way – Bidros met his future wife, Maria, an ophthalmology resident, at the clinic. Several months later, the two married. While completing their residencies, the couple had two sons – Daniel in 2008, and Jacob in 2011. After completing their studies, the young docs moved to Maria’s home state, New Jersey, where Bidros landed a job at Princeton University. While living in the Garden State, they had another son, Samuel. “My wife is superwoman,” he confessed. “She definitely did the bulk of the work at home at that point.” Eventually, the couple became weary of the frigid winters and longed for a warmer climate. Bidros had the opportunity to move back home when Dr. Stephen Goldware, a retiring neurosurgeon, contacted him about joining his practice. In August 2013, the Bidros family moved to Lafayette. “I made the full circle coming back,” he said. Bidros joined Goldware’s practice, Lafayette Brain and Spine, in the professional office building at Lafayette General Medical Center. Four months later, Goldware retired, and Bidros took over the practice. He currently practices neurosurgery at LGMC and Our Lady of Lourdes Regional Medical Center. “I love it,” he said. “It’s everything I wanted to do. Everybody has been wonderful, from
the medical community to the patients.” Bidros performs general neurosurgery, treating brain, spine and peripheral nerve disease. The majority of his practice involves the spine, including degenerative cervical, lumbar and thoracic disease, neck and back pain and trauma. He also treats brain tumors, aneurysms, pain syndromes, traumatic brain injuries and peripheral nerve conditions. His subspecialties include spine oncology and brain oncology, for which he treats tumors both surgically and nonsurgically with CyberKnife and radiosurgery. Off-duty, Dani and Maria enjoy spending time with their three boys. “Sports activities, going to birthday parties, or just being at home with our kids is what we enjoy, first and foremost,” he said. “We also enjoy traveling with our kids to visit family in California and New York.” Bidros confesses that he is also a “sports fanatic,” particularly when it comes to tennis, soccer and NFL football. “I’m a huge Saints fan,” he said. “When I was in Cleveland and New Jersey, Cleveland was my team. And, I’ve been to several soccer games in Europe.” As for his practice, Bidros says that he gets the most fulfillment from getting to know his patients and their families. “When my patients come in, it’s great to get to know them, and make them feel at home,” he explained. “Neurological disease in general can be stressful for a patient, so you want them to feel comfortable. It’s also important to involve the families. So, we definitely make sure that the family is around to help with the treatment and the decision-making.”
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PATIENT CARE MODELS
The Competing P’s: Provision & Payment, continued from page 1 Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment. Value-based purchasing includes payments in categories two through four. The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.
“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.” Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to value-based payment. “There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election. The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he
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said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.” He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs. “The government … through statements around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how
to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.” It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow. “People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models. While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short win-
Quality Forum, continued from page 1 people healthier. For example, say a patient gets discharged from the hospital. Everyone knows that the first week afterward is a highrisk period, Mostashari said. The patients are elTravis Broome derly and may be weak. Their whole routine with medications may have been changed. The result is that within 30 days of being discharged, one out of seven seniors ends up back in the hospital. The risk is much lower for patients who see their primary care doctor within seven days of being discharged from a hospital, Mostashari said. The problem is that lots of times the primary care doctors aren’t notified that their patients have been admitted or discharged. That’s where the ACO comes in. Analytics can help practices prioritize the patients most at risk and identify frequent fliers and their health issues. Cloud-based tools help practices follow up with patients, track who has been contacted and the outcome of that call. The ACO will also help coach physicians in the key component of managing a population’s health: knowing where the patients are, being able to reach them, and bringing them in so they can be helped. “Patients are going to feel like their primary care practice knows more about what’s going on with them and is more available and accessible to them when (patients) are going through difficult periods,” Mostashari said. Broome said the ACO will use analytics and data, from the practices and other sources like the Louisiana Health Information Exchange to figure out which patients aren’t coming to the clinic but should be. With the claims data and analytics tools, the ACO can help practices build a holistic view of patients, he added. The Quality Forum has been a force
in reshaping health and healthcare in Louisiana. Among other things, the nonprofit established a Regional Extension Center to help providers adopt EHRs and reach the “meaningful use” standard. Quality Forum CEO Cindy Munn said the nonprofit supports the transition from a volume-based health system to one based on value and quality. Maryland-based Aledade was cofounded in 2014 by Mostashari, former National Coordinator for Health Information Technology. The company has ACOs in New York, Delaware, Maryland and Arkansas. Mostashari said the Quality Forum, with its strong connections to Cindy Munn Louisiana physicians, made it a natural choice for a partnership. Meanwhile, patients in the practices that join the ACO shouldn’t feel anything has changed in the relationships with their primary care physiDr. Farzad Mostashari cian, Mostashari said. Here’s what will change. If a patient isn’t feeling well, he or she should be able to get a same-day office visit. If a patient has to go to the hospital, someone from the ACO will contact the ER doctor and talk to him or her. If the patient is discharged from the hospital, someone’s going to reach out to him or her. If a patient needs specialty care, his or her primary care physician will help them navigate all the specialists and all the different information that entails. “Our goal, really, is to make these seniors feel like they’re getting concierge medicine for free,” Mostashari said. “And we believe that’s going to save the system money and save lives.”
PATIENT CARE MODELS
Rural Hospitals Find ACO Help By TED GRIGGS
Two Louisiana hospitals are among more than 200 U.S. health systems that applied for $114 million in federal funds to help set up rural Accountable Care Organizations. Lynn Barr, CEO of National Rural ACO, which is overseeing the grant program, said she could not disclose the names of those hospitals. But she added that it’s crucial that rural providers move to payment models based on population health. Until recently, rural Lynn Barr hospitals, health clinics and federally qualified health centers couldn’t take part in Medicare’s cost-and-quality incentive programs, she said. Excluding rural providers created a real disparity between rural patients and the rest of the country. The entire U.S. health system is working on ways to reduce waste, fraud and abuse, to cut the number of unnecessary hospital visits and to improve outcomes for patients with chronic diseases – except in rural areas, Barr said. “I think that’s a very serious situation,” she said.
The National Rural ACO was formed in 2013 to help change that. The CEOs of nine rural health systems got together to simplify the process of moving from feefor-service models to those emphasizing population health management. By focusing on care coordination, data and evidence-based medicine, the group was able to reduce the expense of forming an ACO, Barr said. That was important because while federal estimates place those costs at $4.2 million over the first three years, the CMS grants provide between $1.5 million and $2.5 million over that time. The NRACO model allows rural hospitals to form ACOs without exceeding the grant amounts. Hospitals that participate in NRACO and the Medicare Shared Savings Program will incur out-of-pocket costs of around $1,000, Barr said. “A lot of this is because we’re rural. We rely on rural health systems to grit their teeth, put on another hat, work a little harder, and not just hire a bunch of people to do this,” Barr said. The deadline to apply for the grants was May 1. The funding is for the 2016 Medicare Shared Savings Program year. Barr said the NRACO model offers rural providers another major advantage: it helps them aggregate enough Medicare lives to meet the minimum requirements
for a CMS grant. In order for CMS to approve a provider’s grant, the ACO must include 5,000 Medicare patients, Barr said. Since Medicare patients account for 10 percent to 15 percent of the population, to qualify by itself, a single health system would have to serve between 75,000 and 100,000 people. “That’s not rural,” Barr said. “So the only way we can make it work is to bring them together.” The first ACO that Barr’s group created included hospitals in California, Michigan and Indiana, she said. Those states have nothing to do with each other, but that’s where the hospitals were. The ACO is really a governance structure, she said. The Louisiana ACO applicants will have to combine with providers in other states to reach 5,000 Medicare lives. But Barr’s not sure which state or territory – Guam had one applicant – will be aggregated with Louisiana. The number of applicants varied by state. In Mississippi, 11 hospitals applied, enough to form two ACOs. In North Carolina, only two hospitals applied. Barr said like most quality programs, the ACOs are not expected to generate savings initially. A big part of managing population health is reaching out to patients and
bringing them in for visits. The initial part of the process is time-consuming and expensive. It requires a lot of one-on-one contacts with patients, helping them to navigate the healthcare system and to better manage their diseases. “It’s only over time that you really establish these processes and procedures and the costs start to go down,” Barr said. “And that’s why it’s so important for us to get the costs of this program paid for by CMS.” Under Medicare’s Shared Savings Program, ACOs are rewarded for slowing the increase in healthcare costs and meeting quality standards. Medicare estimates that annual costs for one member are around $10,000. On average, the Shared Savings Program pays $100 per Medicare patient per year for the first three years. Whatever ACO Investment Model funds the ACO gets in advance would be deducted from those payments. NRACO receives 10 percent of the balance, and clinicians a minimum of 20 percent. Barr said it’s unlikely that savings will be greater than costs during the first three years of the ACO’s existence. Taking a rural hospital that’s never managed care and thinking the facility is going to make money on shared savings in one, two or even three years is unrealistic, Barr said.
Louisiana Medical News
JUNE 2015 • 5
Capitation-Related Changes Emerging By JOHN PAUL NETTLES
The growth of capitation may represent a juncture for the healthcare industry. If the new funding structure rises as anticipated, a host of fundamental changes will emerge in the industry, including infrastructure shifts and new care tactics. This may result in a series of new business challenges and opportunities. Capitation is population-based healthcare. While most other funding models involve reimbursements for ser-
vices administered, capitation distributes lump sums for entire patient segments (diabetics, children, etc.). The payments are the same whether or not the populations actually use the services. For providers, the main difference is that they are incentivized for efficiency, rather than for maximizing service output. Capitation is not new, having experienced a fad-like boom and bust in the 1990s. Rising healthcare costs were a contributor to the lack of success. The discernable failure of capitation during
this time has lead to skepticism that it will work now. However, proponents argue that modern technological and process developments in healthcare will make capitation a success. Further, policy makers and payers are still eager for opportunities to control rising healthcare costs and see capitation as a possible solution. As such, capitation seems to be on the rise, and some planners think that capitation may be the future of healthcare. According to a 2014 survey of 39 health
plans conducted by Catalyst for Payment Reform, most healthcare providers expressed positivity about their capitated payment arrangements (Further, associate managing director for rating agency Moody’s Investor Service Lisa Goldstein said that she expects capitation in hospitals to grow, in a 2014 interview with Modern Healthcare. The AMA has not entirely embraced this new trend, but has expressed something between acceptance and support. “Engaging in capitation arrangements can be challenging,” according to the AMA’s published stance on capitation. “However, some physician practices have been successfully participating in capitated contracts for many years. Under the right conditions, physicians can make capitation work.” Large-scale changes are emerging where capitation has come into play. One area of change is in infrastructure. Since capitation incentivizes efficiency over service volume, hospitals are not as motivated to keep their facilities buzzing with people. Instead, capital expenditures are focusing more on streamlined, cost-efficient hospital campuses with integrated infrastructures, such as by having different departments closer together. Another way that capitation is changing the industry is by motivating the establishment of “care centers.” Physically, these business units are like the call centers used for administrative functions like billing. However, the main function of the centers is to eliminate unnecessary hospital visits, such as by providing medical information. The care centers also reduce sources of inefficiency, such as patient no-shows. So far, capitation growth has been moderate, but time will tell if the payment structure explodes or sputters out. But if capitation catches on, it is likely that a series of sweeping changes will affect the industry. Business planners should remain watchful of these new trends and react accordingly. John Paul Nettles is a business consultant and expert in health and human services technology, especially in call centers. He works with partners at GeauxPoint Business and Technology Consulting, a collaboration that advises clients on innovative business solutions. He can be reached at John@GeauxPoint.com.
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Legislative Affairs BY CINDY BISHOP, AND EARL MICHAEL WILLIS
A Report on Health Care Legislation Below is a report of the 112 health care related bills that are moving through the 2015 Regular Session of the Louisiana Legislature. It is a well-known fact that we are facing a $1.6 Billion budget deficit. From all accounts, the revenue measures, either through tax increases or cuts to tax credits, or anything in between, will not be finalized until close to the end of the legislative session. Lawmakers will adjourn sine die on Thursday June 11, 2015. If you are interested in healthcare policy, please stay tuned. In other words, things will go down to the wire. Health Care Information Services publishes an information packed newsletter once a week during session. Subscriptions are $200 for the entire calendar year. For an order form, send an email to Sarah Heath at sarah.heath@checkmate-strategies.com Last Action Taken as of May 2, 2015 HB 6, Honore Authorizes the use of medical marijuana in Louisiana. 4/13/2015 House -Referred to committee on Health & Welfare HB 77, Ritchie Levies an additional tax on cigarettes. 4/13/2015 House -Referred to committee on Ways and Means HB 83, Jefferson Provides for continuance of nutrition assistance for certain retirees. 4/13/2015 House -Referred to committee on Health & Welfare HB 158, Hoffmann Provides relative to promotion of smoking cessation programs and services. 4/30/2015 House -Finally passed by vote of 87 to 0 HB 159, Hoffmann Adds a fee at license renewal for pharmacists and pharmacies and dedicates proceeds to certain pharmacy education programs. 4/30/2015 Senate -Received in the Senate HB 165, Anders Provides relative to fees collected by the Louisiana State Board of Medical Examiners. 4/28/2015 House -Returned to the calendar subject to call HB 177, Whitney Provides relative to roles of human services authorities and districts in implementation of the Developmental Disability Law. 4/29/2015 Senate -Referred to committee on Health & Welfare
HB 186, Montoucet Requires that mammography and ultrasound reports provide information regarding supplemental breast cancer screening. 4/30/2015 House -Finally passed by vote of 88 to 0 HB 194, Moreno Provides relative to the examination, treatment, and billing of victims of a sexually-oriented crime. 4/13/2015 House -Referred to committee on Judiciary HB 210, Moreno Authorizes the prescribing or dispensing of naloxone to third parties. 4/29/2015 Senate -Referred to committee on Health & Welfare HB 247, Huval Provides relative to the disciplinary proceedings of the Louisiana Physical Therapy Board. 4/28/2015 House Scheduled for Floor Debate on 5/4/2015 HB 252, Montoucet Levies an additional tax on certain tobacco products and levies a tax on vapor products and electronic cigarettes. 4/13/2015 House -Referred to committee on Ways and Means
4/27/2015 House -Recommitted to committee on Appropriations HB 335, Burns, H. Adds registered dietitians under the medical malpractice act. 4/30/2015 House-Sheduled for Floor Debate on 5/5/2015 HB 370, Broadwater Establishes the Group Benefits Actuarial Committee and requires an annual actuary study on the premium rate structure and approval by the panel of recommended changes to the premium rates charged for members of the Office of Group Benefits. 4/13/2015 House -Referred to committee on Appropriations HB 375, Harris Exemption for certain ophthalmic drugs administered in a physician›s office. 4/13/2015 House -Referred to committee on Ways and Means HB 381, Jackson Exempts certain providers from licensure as behavioral health services providers. 4/29/2015 Senate -Referred to committee on Health & Welfare
HB 397, Pope Provides relative to prescription refills. 4/29/2015 Senate -Referred to committee on Health & Welfare HB 416, Barrow Provides relative to advanced practice registered nurses 4/13/2015 House -Referred to committee on Health & Welfare HB 436, Johnson, R. Provides for insurance reimbursement of certain provider fees paid by pharmacies. 4/13/2015 House -Referred to committee on Health & Welfare HB 440, LeBas Prohibits certain fees relative to the adjudication of pharmacy benefit claims. 4/30/2015 House -Engrossed, recommitted to committee on Appropriations HB 450, Schexnayder Creates the Home Health Agency Trust Fund and provides for the deposit of fines and penalties levied against home health agencies into the fund. 4/27/2015 House -Engrossed, recommitted to committee on Appropriations (CONTINUED ON PAGE 8) P1LAMN03/15
HB 257, Seabaugh Provides relative to healthcare provider credentialing. 4/30/2015 House - Scheduled for Floor Debate on 5/6/2015 HB 260, Williams, A. Establishes the Sickle Cell Patient Navigator Program. 4/13/2015 House -Referred to committee on Health & Welfare HB 270, Armes Provides relative to filing of Medicaid claims. 4/30/2015 House -Scheduled for Floor Debate on 5/6/2015 HB 304, Hall Provides relative to sharing of prescription monitoring program information with equivalent programs of other states. 4/28/2015 House -Scheduled for Floor Debate on 5/4/2015 HB 307, Jackson Provides relative to coverage and payment for services rendered to a person admitted under an emergency certificate 4/13/2015 House -Referred to committee on Health & Welfare HB 329, Armes Requires the state Office of Group Benefits to cover bariatric surgery techniques for the treatment of morbid obesity.
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A Report on Health Care Legislation, continued from page 7 HB 461, Simon Provides relative to the regulation of telemedicine and telehealth services. 4/13/2015 House -Referred to committee on Health & Welfare HB 486, Johnson, R. Provides relative to collaborative practice agreements between advanced practice registered nurses and physicians. 4/29/2015 Senate -Referred to committee on Health & Welfare HB 494, Willmott Requires ambulance services to establish protocols for transporting patients with cardiac and stroke emergencies. 4/13/2015 House -Referred to committee on Health & Welfare HB 498, Talbot Provides for transparency in health services pricing and health care quality measures. 4/13/2015 House -Referred to committee on Health & Welfare HB 517, Edwards Provides for expansion of Medicaid eligibility in conformance with standards provided in federal law. 4/13/2015 House -Referred to committee on Health & Welfare HB 560, Norton Requires that La. Medicaid eligibility standards conform to those established by the Affordable Care Act. 4/29/2015 House -Involuntarily deferred
State Board of Medical Examiners. 4/13/2015 House -Referred to committee on Health & Welfare
computer generated electronic signatures. 4/13/2015 House -Referred to committee on Health & Welfare
HB 602, Johnson, R. Provides relative to collection of coinsurance and deductibles. 4/13/2015 House -Referred to committee on Insurance
SB 10, Peterson Constitutional amendment to direct DHH to offer health insurance with essential health benefits to every legal resident of Louisiana whose income is at or below 138% of the federal poverty level. 4/13/2015 Senate -Referred to committee on Health & Welfare
HB 652, Hunter Requires the Dept. of Health and Hospitals to implement an equitable system of Medicaid reimbursement among certain hospitals. 4/13/2015 House -Referred to committee on Health & Welfare HB 683, Kleckley Requires the Department of Health and Hospitals to determine a methodology for reimbursement related to uncompensated care costs in Calcasieu Parish. 4/13/2015 House -Referred to committee on Health & Welfare HB 701, Whitney Prohibits abortion based on sex selection. 4/13/2015 House -Referred to committee on Health & Welfare HB 702, Thierry Requires health insurance issuers to cover contested healthcare services, including prescription drugs, during the appeal or review process. 4/13/2015 House -Referred to committee on Insurance
HB 568, Thierry Provides relative to the licensing and regulation of pharmacists. 4/13/2015 House -Referred to committee on Health & Welfare
HCR 4, Simon Expresses the intent of the legislature regarding the standard of care prescribed by law for the practice of telemedicine. 4/28/2015 House-Scheduled for Floor Debate on 5/5/2015
HB 573, Hazel Provides for the investigation and adjudication of violations by the Louisiana
HCR 10, Burford Suspends rules of the La. Board of Pharmacy that invalidate prescriptions with
SB 39, Mills Provides for the Louisiana Board of Drug and Device Distributors. 4/30/2015 House -Referred to committee on Health & Welfare SB 40, Nevers Requires the Department of Health and Hospitals provide health care coverage with essential health benefits to every legal Louisiana resident whose household income is at or below 138% of the federal poverty level. 4/13/2015 Senate -Referred to committee on Health & Welfare SB 68, Buffington Extends moratorium on additional beds for nursing facilities. 4/30/2015 House -Referred to committee on Health & Welfare SB 113, Gallot Provides relative to membership of the State Board of Examiners of Psychologists, qualifications of certain licensees, and maintenance of board documents and records. 4/13/2015 Senate -Referred to committee on Commerce SB 115, Mills Provides with respect to the practice of physician assistants 4/30/2015 Senate -Engrossed, passed to 3rd reading
SB 143, Mills Provides relative to prescribed marijuana for therapeutic uses and the development of rules and regulations by the Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners. 4/30/2015 Senate -Engrossed, passed to 3rd reading SB 158, Heitmeier Requires the reporting of malpractice claims paid by insurers or self- insurers on behalf of certain health care providers in an annual report to the Senate and House committees on health and welfare. 4/30/2015 Senate -Engrossed, passed to 3rd reading SB 163, Mills Provides relative to Medicaid managed care. 4/13/2015 Senate -Referred to committee on Health & Welfare SB 197, Chabert Provides for funding of state hospitals operated by the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College. 4/13/2015 Senate -Referred to committee on Health & Welfare SCR 17, Mills Directs the Department of Health and Hospitals to evaluate and report on the health benefits and costs of adding Krabbe disease to the list of madatory screenings performed on newborns under certain circumstances. 4/28/2015 House -Referred to committee on Health & Welfare SCR 18, White Authorizes and directs the Louisiana Emergency Response Network (LERN) to organize and facilitate a working group of healthcare providers who deal with victims of trauma to develop recommendations for a Level III Trauma Center in Northeast Louisiana. 4/14/2015 Senate -Referred to committee on Health & Welfare SCR 34, Heitmeier Requests the Department of Health and Hospitals, the Department of Education, the Medicaid managed care plans, and representatives of the Whole Child Initiative to work together to develop a plan to implement the Whole School, Whole Community, Whole Child model developed by the United States Centers for Disease Control and Prevention. 4/27/2015 Senate -Referred to committee on Health & Welfare
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
8 • JUNE 2015
Louisiana Medical News
Five Ways Millennials Have Shaken Up Healthcare They prefer alternative to single-source, PCP favored by older generations seniors. “The timely management of social media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a constant challenge for all practices. Getting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”
By JULIE PARKER
The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down. In a recently released survey commissioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, web-based diagnostic tools and research about treatment options have a role in healthcare decisions for millennials, replacing the single-source, primary care physician (PCP) favored by older generations. “As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital channels that are consistent with their experiences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially considering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility. Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fastpaced, technology-driven generation.” Growing trends among the millennials that are driving change in healthcare include:
macy chains. Millennials expressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”
Word-of-mouth marketing Nearly 50 percent of millennials and Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 percent of baby boomers and 28 percent for
Kick the tires online before buying Half of millennials and 52 percent of Gen X-ers checked online information about their insurance options during their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company representative (38 percent) before selecting their plan. Good faith, upfront estimates One of five people surveyed by PNC listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more inclined (41 percent) to request and receive estimates before undergoing treatment. Only 18 percent of seniors and 21 percent of boomers reported asking for or receiving information on costs upfront. Unfortu-
nately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate. “What we’ve found with our clients in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insurance coverage education due to the need to comply with healthcare reform requirements and for the sake of improving the profitability of the practice,” added Print.
Kicking care down the road. All age groups agreed that medical care is too expensive (79 percent) and healthcare costs are unpredictable (77 percent). But more than half of millennials (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent). “What we’ve found locally,” added Print, “is that with many patients neglecting their care due to costs, practices are addressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.” PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.
Speedy delivery When it comes to the drive-thru generation, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14 percent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 percent) visited their PCP significantly more than millennials at 61 percent. For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically. “Quick Care” availability has been recognized as a top priority by many healthcare organizations, and even large retailers and several pharREPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: subscribe@medicalnewsinc. com for information.
Louisiana Medical News
JUNE 2015 • 9
In the News New Medical Director to Lead BR General’s Mid City Behavioral Health Program
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10 • JUNE 2015
Louisiana Medical News
BATON ROUGE – Venugopal Vatsavayi, MD, has been named Medical Director for Baton Rouge General’s Inpatient Geriatric Psychiatric Unit and Outpatient Behavioral Wellness Center at the Mid City campus. Dr. Vatsavayi will lead BRG’s multi-dis- Dr. Venugopal Vatsavayi ciplinary clinical team of behavioral health experts with Associate Medical Director Terry LeBourgeois, MD. One of the region’s leading physicians proDr. Terry viding Electroconvulsive LeBourgeois Therapy (ECT), Dr. Vatsavayi oversees ECT therapy at BRG Mid City, which is the only program of its kind in Greater Baton Rouge. A member of BRG’s medical staff since 2011, Dr. Vatsavayi completed his residency at Cleveland Clinic Foundation and is certified by the American Board of Psychiatry and Neurology. Specializing in psychiatry for more than 15 years, Dr. Vatsavayi will also continue to provide outpatient clinic services at his new Mid City clinic location at3401 North Blvd., Suite 100. ECT therapy often works when other treatments are unsuccessful and can benefit pregnant women, seniors, patients with limited tolerance to psychiatric medications, and patients who are at a high risk of suicide. Depression is one of the most common mental disorders in the U.S. It affects more than 6.5 million Americans aged 65 years or older, and is estimated to affect about 10% of pregnant women in the U.S. In patients with major depression, ECT has been shown to have a 70-90% remission rate.* “Our focus remains on providing high quality mental health services for
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our community with special attention to the mental health needs of seniors and adult patients,” said Dr. Vatsavayi. “We are proud to provide our area’s only ECT therapy program, which is shown to be one of the most effective and safe acute treatment options for major depression.”
Mary Bird Perkins – OLOL Cancer Center Receives Outstanding Achievement Award BATON ROUGE- Mary Bird Perkins – Our Lady of the Lake Cancer Center (Cancer Center) was recently presented with the 2014 Outstanding Achievement Award by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). The Cancer Center, Louisiana’s only facility to receive this recognition, has received the award for two consecutive (three-year) survey cycles, the first time in 2011. In addition, the Cancer Center is one of a select group of only 75 U.S. healthcare facilities with accredited cancer programs to receive this national honor for surveys performed last year. The award acknowledges cancer programs that achieve excellence in providing quality care to cancer patients. “We are extremely proud of the Cancer Center’s physicians and team members for achieving such an esteemed recognition. We always aspire to a higher level of care for patients and the Outstanding Achievement Award validates our ability to sustain clinical excellence and overall patient experience,” said Linda Lee, Cancer Center administrator. “As the Gulf South destination for cancer care, we provide innovative and comprehensive services so that patients throughout the southeast can remain closer to home and access exceptional care throughout their cancer journey.” The purpose of the Outstanding Achievement Award is to raise awareness of the importance of providing quality cancer care at healthcare institutions throughout the U.S. In addition, it is intended to: • Educate cancer patients on available quality-care options. • Motivate other cancer programs to work toward improving their level of care. • Facilitate dialogue between award recipients and healthcare professionals at other cancer facilities for the purpose of sharing best practices. • Encourage honorees to serve as quality-care resources to other cancer programs. The Cancer Center was evaluated on 34 program standards categorized within one of the four cancer program activity areas: cancer committee leadership, cancer data management, clinical services and quality improvement. The Cancer Center was further evaluated on seven commendation standards.
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Our Lady of the Lake Announces Specialists at New Neurology Clinic BATON ROUGE– Our Lady of the Lake Physician Group is pleased to welcome Joseph A. Acosta, MD and Kevin J. Callerame, MD as specialists to its new Neurology Clinic at 5247 Didesse Drive in Baton Rouge. The Neurology Clinic Dr. Joseph A. Acosta provides the highest quality care related to the diagnosis and treatment of disorders of the brain and nervous system, including seizures, stroke, carpal tunnel syndrome, nerve disorDr. Kevin J. ders, Parkinson’s disease, Callerame dementia and nerve pain. Dr. Acosta specializes in general neurology, clinical neurophysiology and is trained in neurovascular ultrasound with a special interest in the treatment of stroke. He received his medical degree from the University of Texas Medical Branch in Galveston, Texas in 1989. Following his internship in internal medicine, Dr. Acosta completed a residency in neurology at Hahnemann University Hospital in Philadelphia, Pennsylvania, where he also served as chief resident of the program from 1992 to 1993. After his residency, he was fellowship trained in neurovascular disease and stroke at the University of Maryland Medical Center in Baltimore, Maryland from 1993 to 1995. Dr. Callerame is Board Certified in neurology, clinical neurophysiology and sleep medicine. He has a special interest in epilepsy, sleep disorders, EMG and the use of botox in neurological indications. He received his undergraduate degree in biomedical engineering, a master’s degree in public health, and medical degree from Tulane University in New Orleans, Louisiana. Dr. Callerame completed a residency in neurology at Wilford Hall United States Air Force Medical Center in San Antonio, Texas, followed by a Fellowship in epilepsy at the University of Miami in Florida. He completed his term with the United States Air Force at Wilford Hall Air Force Medical Center where he served as head of EEG and clinical neurophysiology. The addition of the Neurology Clinic adds to Our Lady of the Lake’s comprehensive offerings in neurological care. The Lake performs more neurosurgery procedures than any other hospital in the state, including innovative techniques for spine surgery. It is also the only acute care hospital in the Baton Rouge area with 24/7 trauma care, including neurosurgical and neurological coverage.
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