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SOU TH LOU ISIANA ED ITION
On Rounds Physician Spotlight
Hospitals Crush Quality Improvement Program Goals By TED GRIGGS
Dr. Teresa King Working Like a Dog Dr. Teresa King has always been an animal lover. Growing up, she rode and showed horses as a hobby. Eventually, she decided to change course and become a doctor. ... page 3
New Medicare Code Offers Promise, Revenue A new reimbursement code for chronically ill Medicare patients could allow the typical primary care physician to bill an estimated $250,000 a year ... page 4
In early 2012, when the Centers for Medicare and Medicaid Services launched the Partnership for Patients initiative, it had two major goals: Reducing preventable hospital-acquired conditions by 40 percent and hospital readmissions by 20 percent from 2010 levels. The vehicle chosen to perform this transformation was something called the Hospital Engagement Network. The regional, national and health system organizations had yet to be created but CMS had already given them the job of identify-
ing working solutions and putting them into the hands of hospitals and providers. The results in Louisiana outstripped CMS’s expectations. The Louisiana Hospital Association Research and Education Foundation Hospital Engagement Network (LHAREF HEN) improved care for more than 48,000 patients and sliced an estimated $335 million in healthcare costs from 2012-2014. Preliminary results show the HEN hospitals reduced avoidable patient harm by more than 40 percent and hospital readmissions by more than 35 percent. Those outcomes firmly placed LHAREF in the top tier of hos(CONTINUED ON PAGE 8)
ONCOLOGY
By the Numbers: The Latest Stats on Cancer Death rates down, more work awaits By CINDy SANDERS
Personalized Messaging A marketing manifesto
With better understanding of the human genome, physicians and researchers have opened up exciting new lines of personalized medicine ... page 9
As the ‘official sponsor of birthdays,’ the American Cancer Society (ACS) found a reason to rejoice in their latest report – Cancer Facts & Figures 2015. Since hitting a peak in 1991, cancer deaths have fallen 22 percent over two decades in the United States, which means more than 1.5 million deaths have been avoided … and more birthdays celebrated. An ACS infographic showed 3.3 million cancer survivors in the United States in 1973. Today, there are more than 14.5 million cancer survivors, and that number is projected to jump to 18.9 million by 2024.
(CONTINUED ON PAGE 10)
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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Louisiana Medical News
Physician Spotlight
Dr. Teresa King Working Like a Dog By LISA HANCHEy
Dr. Teresa King has always been an animal lover. Growing up, she rode and showed horses as a hobby. Eventually, she decided to change course and become a doctor. But, after years of training, something was missing. “I left my horse hobby, and I always had dogs. So, there was like a big hole in my heart from that perspective,” she said. Now, King and her husband of 13 years, Spriggs TeRoller, are the proud owners of two talented Goldendoodles, Lucy and Coco. Because King has allergies, she didn’t want a dog that shed. After considering several breeds, the couple settled on the poodle-golden retriever mix. “It’s a ‘fancy mutt,’” she said with a laugh. “The dogs just have wonderful temperaments and are very, very smart. And, a lot of them are therapy dogs.” King got involved with pet therapy through her alma mater, LSU, which offers the Tiger HATS (Human Animal Therapy Services) program through the Veterinary School. Both Lucy and Coco are now registered therapy dogs. At press time, they were trotting off to the vet school for an open house. “We’re going to let the kids love all over them,” King said. “It’s just a very rewarding experience. The dogs seem to really like it, too.” The Baton Rouge native has always been drawn to animals. As a youngster, she was “heavy into” horse riding and showing. Down the road, she ran a couple of horse farms and showed horses as an amateur on the national level. As her 30th birthday approached, she decided to go back to school and become a doctor. A Tiger through and through, King attended LSU, both for undergraduate
and medical school. Afterwards, she did her residency in otolaryngology at the University of Alabama School of Medicine in Birmingham. But, she missed having a furry companion. “When I started med school and then thereafter residency, I didn’t have any animals, because I figured I didn’t have time to take care of
one,” she explained. Deciding where to practice after completing her training was a no-brainer. “We kind of looked around at all of the different towns, and one of our big criteria was how easily we could get back to Baton Rouge for an LSU football game,” she chuckled. Luckily, one of her friends who worked at Ochsner let her know about an upcoming position in Baton Rouge. In 2007, King joined the staff at Ochsner, where she practices general otolaryngology and head and neck surgery. On her off-time, King brings her dogs for therapy visits at different facilities designated by her HATS rotation. Their current assignment is Baton Rouge General’s Pennington Cancer Center, where they do therapy twice a month. When King and the dogs arrive, a hospital representative escorts them to the assigned floor, where they visit with patients and family members. “Some just want to look at the dog, some want to pet the dog, some want the dog to get in bed with them, and some want the dog lick-
ing them,” she explained. “And that’s really cool to me – to see them touch other people’s lives, and to have somebody say, ‘You’ve made my night,’ or ‘You’ve made my week.’” The dogs have also made appearances on the LSU campus to ease students’ anxieties during finals and console them for homesickness. “It’s amazing how many parts of people’s lives you can change,” King observed. Recently, King introduced Lucy to dog agility training, a timed event which takes the pooch through a series of obstacles. For King, it was a return to her past as a horse trainer. “With both of these activities, agility and therapy, you are a team with your animal, much like horse showing was for me,” she said. “From the agility perspective, it’s fun to work with the animals and see them get the picture and enjoy it. And, it’s a lot more exercise than I realized. I’m running as much as the dog is.” Now that the Goldendoodles are in her life, King spends every spare moment with them. “I never thought that my dogs would take up most of my free time, but they do,” she said. “These are therapy dogs, but ultimately, they give me therapy every day. They are just absolutely wonderful. My husband and I are just smitten with the animals.”
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louisianamedical news.com Louisiana Medical News
MARCH 2015 • 3
New Medicare Code Offers Promise, Revenue By TED GRIGGS
A new reimbursement code for chronically ill Medicare patients could allow the typical primary care physician to bill an estimated $250,000 a year. Physicians whose patient base includes a higher percentage of Medicare patients, such as internal medicine doctors, could see even higher revenue, said Dr. Ron Ritchey, chief medical officer at eQHealth Solutions. “Medicare is using this charge as an incentive to reinforce some of the things
they want to see happen and have been interested in having happen for the past few years,” Ritchey said. The Centers for Medicare and Medicaid Services knows there Dr. Ron is an issue with manRitchey aging care for patients with chronic diseases, Ritchey said. The agency also knows the potential solution involves primary care physicians assuming global care of a patient, in a holistic
manner. Family care physicians have provided or tried to provide chronic care management in the past, but it wasn’t until this year that Medicare actually paid doctors for the service, he said. Under CPT code 99490, Medicare will pay around $42 a month for 20 minutes of non-face-to-face chronic care management services for each qualified patient. This represents a shift away from the standard evaluation and management code, where the physician sees a patient, lays on hands, makes a diagnosis and pre-
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scribes a treatment plan. The $250,000 top-line revenue estimate is based on a 3,000-patient practice, according to eQHealth. Nationally, Medicare patients make up 21 percent to 22 percent of the total; two-thirds of Medicare patients have two or more chronic diseases. In a typical practice, around 500 patients will qualify for chronic care management. The 99490 code provides around $42 a month for managing those patients’ care; for 500 patients, that works out to around $250,000 a year. Ritchey said he recently spoke to some internal medicine physicians, and Medicare enrollees made up 50 percent or 60 percent of their patients. While those sorts of practices might see much higher revenue, a single practitioner with fewer-than-average numbers of Medicare patients could see far less. “In any case, you can see that it becomes a substantial potential revenue source for practitioners,” Ritchey said. “And if you multiply it times a larger group, it becomes a significant amount of money.” However, the new code’s requirements are by no means simple. They aren’t even completely defined. And the regulations could change. Still, CMS expects the result will be healthier patients and fewer costly hospital admissions and Emergency Room visits. But doctors will have to jump through some hoops to collect the fee. Among other things, physicians must convince their patients to sign a form consenting to the services. Patients are also responsible for a 20 percent co-pay, although that will be covered by Medigap, Medicare Supplement or Medicare Advantage plans. It’s a small fee, but it could put off some patients, said Allison Brennan, senior advocacy advisor for Medical Group Management Association. And physicians have to make a good-faith effort to collect the co-pay. Allison Providers that habitually Brennan waive the co-pay may be violating Medicare’s anti-kickback statute. One practice estimated that it would spend $15 – time spent sending the bill, and collecting and depositing the check – for an $8 co-pay, Brennan said. A lot of physicians may decide it’s too much trouble. Ritchey said physicians should consider other expenses, such as staff-training expenses and infrastructure costs. For example, the provider must have an electronic plan of care based on physical, mental, psychosocial, cognitive, functional and environmental assessments. Patients also have to be able to communicate with providers by phone or secure messaging system. Both may require modifications to some practices EHRs or outsourcing the (CONTINUED ON PAGE 10)
4 • MARCH 2015
Louisiana Medical News
What’s Happening to our Safety Net? Changes, challenges of free clinics and covering the uninsured By JULIE PARKER
America’s free and charity clinics are undergoing a transformation, and not necessarily in a good way. According to a 2014 report by the National Association of Free and Charitable Clinics (NAFCC), patient demand has spiked 40 percent while donations have dropped 20 percent. “As soon as there was the perception of universal healthcare, the likelihood of receiving donations goes down,” Colin McRae, JD, told the Wall Street Journal in December. For the last two fiscal reports ending June 30, Orlando-based Shepherd’s Hope, one of the nation’s most successful free clinic networks, experienced a 22 percent increase in patient volume, seeing 16,973 patients in 2012-13, and nearly 21,000 patients in 2013-14. Based on trends, the free clinic expects patient volume to climb to 24,000 for the 2014-15 fiscal year. “It’s a concoction of the most toxic kind without the resources to resolve it,” said Marni Stahlman, CEO of Shepherd’s Hope, noting a May 2013 report by the Congressional Budget Office showed that even though the healthcare law is expected to reduce the number of uninsured by 25 million in 2023, 31 million Americans will
Dr. Kathryn Crampton performs free back-to-school phycical.
remain uninsured. “The role of the free clinic is more critical than ever.” Medicaid expansion, or the lack of it, lies at the heart of the problem. In Medical News’ coverage area, Arkansas and Kentucky are among 28 states that have expanded Medicaid. Alabama, Florida, Georgia, Louisiana, Mississippi, Missouri, North and South
Carolina, Tennessee, Texas, and Virginia are among 18 states that haven’t expanded Medicaid and aren’t likely to, with the exception of Tennessee, one of four states anticipated to possibly expand in 2016. David W. Strong, who will leave the University of North Carolina (UNC) Health Care system next month to take over as CEO of the expansive Orlando Health network in Florida, pointed out an aspect of Medicaid expansion that doesn’t get much press. “It’s important to note the bulk of every state’s Medicaid program is already funded by the federal government,” said Strong. “All states are relying on significant federal funds now. Unfortunately, by not expanding Medicaid, Florida and North Carolina are among the biggest losers in the country because of the population base. Ultimately, we all bear the burden for the lack of expansion because people will continue to seek care in our emergency departments and facilities.” Much national attention has been placed on Florida, the nation’s fourth most populated state with 18 million residents and the highest percentage of 65 and older adults. The sunshine state ranks 41st on the list of highest volume of uninsured residents nationwide. “What you have is a really bad sand-
wich. Without resources, insurance, or access to healthcare, many Floridians who’ve been captured in the healthcare coverage (Medicaid) expansion gap find themselves without anything,” said Stahlman. “There’s also a gap on the high end.” According to a 2014 Modern Healthcare report, the nation’s busiest emergency room is Florida Hospital, with 206,800 visits to emergency departments at Florida Hospitals in Altamonte, Apopka, Celebration Health, East Orlando, and Kissimmee – and Winter Park Memorial Hospital. Orlando Health’s Orlando Regional Medical Center accounted for the nation’s fifth busiest ER, including emergency departments at the Arnold Palmer Hospital for Children, University of Florida (UF) Health Cancer Center, Dr. P. Phillips Hospital, Lucerne Hospital, South Seminole Hospital and the Winnie Palmer Hospital for Women & Babies. “Florida is at a particular disadvantage because we have one of the highest uninsured rates in the nation, and a comparatively smaller percentage of residents on employer healthcare plans to absorb the cost,” said Florida Hospital CEO Lars Houmann. “Federal, state and local funding sources cover some but not all costs. And so the burden is passed on to insured patients (CONTINUED ON PAGE 6)
Louisiana Medical News
MARCH 2015 • 5
Shepherding a Flock
How Shepherd’s Hope bucked trend with innovative healthcare model and thriving network of free clinics By JULIE PARKER
During a critical time when free and charitable clinics for the uninsured in the United States are under increased economic pressure and in some cases closing, one nonprofit healthcare provider has adopted an unduplicated, recognized national model so highly regarded that its principal leaders were invited in 2012 to the White House as part of a delegation to discuss national intervention strategies for the uninsured. Founded in 1997 by Rev. William S. Barnes, PhD, Shepherd’s Hope has grown into a network of five free clinics in Central Florida that’s remained not only viable, but is flourishing. “We’re unaware of any free clinic in the country that takes the elaborate array of multi-faith, community, hospitals, and clinical and lay volunteers and weaves them all together with no one group’s agenda superseding the mission,” said Marni Stahlman, CEO of Shepherd’s Hope. At least in Florida, the nation’s fourth most populous state with 18 million residents and the highest percentage of adults 65 and older, “no other model has the intricate system of primary and secondary disciplines in place to provide the delivery of high-quality,
compassionate patient-centered care to this medically underserved and uninsured segment of the population.”
Responding to Community Needs Even though the original mission of Shepherd’s Hope was to serve the urgent health needs of the uninsured who were living at 200 percent or below the federal poverty guidelines, Shepherd’s Hope has morphed into the role of secondary/specialty care clinical provider. “Over the last few years, we’ve seen a new mix of individuals who find themselves entering the safety net community for healthcare services for the first time in their lives,” said Stahlman. “Some were even previous donors! Now they’re standing in line, telling us, ‘I’ve never not had a doctor, I have no idea what to do.’ We’ve become the alternative to the emergency department, hoping to mitigate the financial impact to our community.” For the last two fiscal reports ending June 30, Shepherd’s Hope has experienced a 22 percent increase in patient volume, providing 16,973 patient visits and medical services in 2012-13, and nearly 21,000 patient visits and medical services in 201314. Based on trends, the free clinic expects patient volume to climb to 24,000 for the 2014-15 fiscal year.
Roughly one-third of Shepherd’s Hope urgent care patients return for secondary specialty care services. “For example, we might have a female patient with upper respiratory problems who hasn’t had a mammogram in eight years,” said Stahlman. “We’ll refer them for a screening with our partners. Then if a breast cancer diagnosis is made, they’re referred to our other specialty partners.”
A Very Busy Landscape Central Florida is already one of the nation’s busiest metropolitan areas for urgent and emergency care. According to a 2014 Modern Healthcare report, the nation’s busiest emergency room is Florida Hospital, with 206,800 visits to emergency departments at Florida Hospitals in Altamonte, Apopka, Celebration Health, East Orlando, and Kissimmee – and Winter Park Memorial Hospital. Orlando Regional Medical Center accounted for the nation’s fifth busiest ER, covering emergency departments at the Arnold Palmer Hospital for Children, University of Florida (UF) Health Cancer Center, Dr. P. Phillips Hospital, Lucerne Hospital, South Seminole Hospital and the Winnie Palmer Hospital for Women & Babies. Both hospital systems, along with Central Florida Regional Hospital, are Shepherd’s Hope’s primary partners. Last year, the trio of healthcare networks provided the free clinics with nearly $22 million of in-kind contributions and services. Many of the more than 500 volunteer doctors, physician assistants, nurse practitioners and nurses at a Shepherd’s Hope clinic nightly are coming from work as an employee at one of these hospitals. “The average admission cost of an ER visit is roughly $4,600,” Stahlman
pointed out. “We reported roughly 21,000 patient visits and medical services last year, where we didn’t charge patients anything. Those visits are valued at $77. Do the math on that ($1.6 million), versus $4,600 times 21,000 ($96.6 million), you can easily see why it’s a good investment for Shepherd’s Hope to be here. Our hospital partners get it right away.” Momentum has prompted other healthcare providers to jump on board. In 2014, Shepherd’s Hope initiated a pilot project to attract more pediatric providers. “Only about 8 percent of our population is 18 and under,” Stahlman explained. “It’s not because they don’t come; it’s because we don’t have enough pediatric clinical volunteers. We approached Nemours in late July to streamline a process for uninsured children to get required school physicals at Shepherd’s Hope. With no primary medical home of their own, over two days, our two teams saw 108 children at two locations. That’s remarkable.” Last October, Shepherd’s Hope and Sand Lake Imaging aligned for a Pink October initiative, which garnered 219 free mammograms. And while other free and charity clinics across the country are floundering because of funding shortfalls and what some experts view as the misperception of universal healthcare, Shepherd’s Hope augments its operating budget with three successful, community-rooted annual fundraising events – Call to Hope Breakfast in April, Celebrity Golf Classic in July, and Famous Faces Masquerade Ball in October. “We’re very grateful for the support of the local physician and practitioner community,” she said. “Their support makes us very distinctive.”
What’s Happening, continued from page 5
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and their employers in what’s commonly called the cost shift … a hidden tax applied to premiums, co-pays and deductibles.” University of Florida economists predict $4.7 billion in Medicaid dollars will be sent to other states in 2016, including nearly $400 million to Ohio, where Republican Gov. John Kasich has reduced the state’s budget by $404 million over two years by expanding coverage. Despite previous opposition to the idea, recently reelected Florida Gov. Rick Scott announced more than two years ago that he supports a legislature-approved, three-year Medicaid expansion. However, Scott, a Republican, hasn’t marked it priority. Even with gubernatorial support, Tampa General CEO Jim Burkhart said Medicaid expansion won’t be an easy sell to state lawmakers. “It’s going to be a pretty heavy lift because there are lots of people who think they know a different way, or don’t think we should do it at all, or only believe we should do it for people that don’t match up
with what the federal government says you have to have in your criteria for the money to be made available,” he said. “At least discussion is ongoing. We’re hopeful it’ll continue and lead to something concrete.” Mississippi Gov. Phil Bryant, a Republican, has firmly said no, thanks. “For us to enter into an expansion program would be a fool’s errand,” in case Obamacare is repealed or altered in a way that forces states to foot the bill,” he told the Associated Press. “We’d have no way to continue the coverage.” While states continue to determine the best solution, ER visits are piling up. The average admission cost of an ER visit is roughly $4,600 versus the average cost of a visit to the free clinic valued at $77, said Stahlman, referring to 21,000 visits anticipated this fiscal year. “Do the math on 21,000 visits last year, each valued at $77 ($1.6 million) versus $4,600 ($96.6 million),” she said. “The role of the free clinic is more critical than ever.”
Use of InterStim Therapy Continues to Expand ®
Oxford physician leads region in InterStim procedures for OAB and FI sufferers By JULIE PARKER
When InterStim® therapy was FDAapproved in March 2011 for treating patients with fecal incontinence (FI) – 14 years after the federal agency approved it for use on overactive bladders (OAB) – only a scant number of specialty-trained urologists around the country began offering the innovative sacral neuromodulation therapy for bladder and bowel control. Even though it’s easy to assume the lion’s share of discovery and testing on the Medtronic device emanated from major metropolitan areas, much of the early work actually took place in the tiny city of Oxford, Miss., via urologist Doyle “Land” Renfroe, MD. Renfroe, founding partner of Oxford Urology Associates, has quickly become the “go to” doctor for InterStim, a reversible treatment that uses electrical pulses to stimulate sacral nerves just above the tailbone. He has arguably performed more InterStim procedures than any urologist in the southeastern United States.
Problem Solving “I first began studying severe cases of overactive bladder in the late 1990s.” said Renfroe, 52, who earned undergraduate and medical school degrees from the University of Mississippi, where he also ran track during college. “At that time, very few doctors in the United States were doing the procedure.” Chuck Secrest, MD, at Mississippi Urology in Jackson, Miss., introduced Renfroe to InterStim therapy. Medtronic’s bladder control therapy, delivered by the InterStim system, has been FDA-approved since 1997 for urinary incontinence (UI) and since 1999 for urinary retention and significant symptoms of urgency-frequency. Here’s how it works: The sacral nerves – generally S2, S3 and S4 – activate or inhibit the bladder, sphincter and pelvic floor muscles that contribute to urinary control. More specifically, S3 influences pelvic floor behavior. Electrical stimulation artificially excites nerve pathways that may activate or inhibit muscle action, depending on their normal function. Electrical pulses may stimulate somatic nerve fibers without prompting simultaneous contractions of the bladder. This may decrease the UI symptoms of urgency, frequency, urinary retention and urge incontinence. Implanting the InterStim neuromodulation system requires outpatient surgery with local and/or sedation anesthesia. The sacral neurostimulator is inserted under the skin via a small incision in the upper buttock. The long-term lead is implanted under the skin, with one end of the lead connecting to the neurostimula-
Dr. Land Renfroe has arguably performed more InterStim procedures than any urologist in the southeastern US.
tor and the other lead end placed in the sacral foramen adjacent to the third sacral nerve (S3). Generated by the neurostimulator and delivered by the lead, the electrical stimulation modulates nerve activity to improve bladder and bowel function in many patients who were often out of treatment options. Each patient undergoes a test phase prior to final implantation to ensure a positive response prior to implanting the permanent neurostimulator. This therapy is not an option for patients with a mechanical obstruction of the urethra or prostate.
InterStim, and to other groups regionally. “This procedure can absolutely restore a patient’s quality of life,” Renfroe emphasized. “Patients with overactive bladders and fecal incontinence will fre-
quently refuse to leave their homes for fear of not being able to quickly find a bathroom. It can become psychologically debilitating.” InterStim therapy is a treatment for patients with chronic, debilitating symptoms of voiding dysfunction who have been unsuccessful finding relief via medication or diet alteration. Because this type of bladder dysfunction can have a crippling impact on a patient’s social and personal life, effective therapy provides great potential for life-changing benefits. “For patients who have reached that point, this can be a life-changer,” Renfroe said, pointing out that success rates for InterStim therapy top 90 percent. Other specialists have noticed the impressive results. “Dr. Renfroe knows more about this procedure than just about anybody because he’s done more of them than anybody else in this part of the country,” said urologist Jeffrey G. Clark, MD. “Doctors seek advice from other doctors who have done certain procedures. Land is the guy to see about InterStim; there’s no question about it.”
Physicians’ health Foundation oF louisiana
Taking Off Renfroe completed his first InterStim procedure in 2002. A simple screening test to verify candidacy for the therapy has driven patients to Renfroe, whose volume of Medtronic’s bladder control therapy cases continues to increase. As a result of his success, Renfroe has spoken at the corporate offices of Medtronic in Minneapolis, Minn., discussing case studies and the benefits of
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MARCH 2015 • 7
Hospitals Crush Quality Improvement Program Goals, continued from page 1 pitals nationwide. “We’re proud of what we were able to accomplish, in putting this strategy together, in partnering and leveraging to get the results we did,” said LHA Vice President Ken Alexander. “But the credit goes to the hospitals. The credit goes to our leadership at LHA and the board….” The executives and board had the vision and insight to seize the opportunity when HEN was still a “what the heck is this, and what’s it going to be?” Alexander said. The leadership went all in when HEN was just the latest twist on the most terrifying words in the English language: They’re from
8 • MARCH 2015
Louisiana Medical News
the government, and they’re here to help. LHAREF provided training and resources to help hospitals under a subcontract with the American Hospital Association Health Research & Educational Trust in coordination with the federal initiative. But the hospitals had to put out the effort, had to dedicate staff time and resources, believing that participating would better the care for their patients and communities, Alexander said. “It was a huge lift …. It was a very big lift for a lot of people. It was a lot of work,” Alexander said.
LHAREF began with Alexander and Quality Project Manager Michelle Smith. Several months later, two nurses were brought in as quality improvement specialists. The nurses worked in the hospitals. Basically, the Louisiana HEN had to create the quality infrastructure from scratch. Alexander and Smith started by trying to figure out the best approach, realizing that hospitals were already trying to improve quality. The result was a hands-on, relationship-driven program tailored as much as possible to each facility. The HEN had to focus on culture change, engagement and
buy-in. Everyone, from senior executives to staff members, had to support the effort. The HEN team made multiple visits to each participating hospital. The nurses/ quality improvement specialists did the hands-on work, helping hospitals with data collection issues, questions, providing resources for improvements and helping hospitals find the tools to address sticking points. “A big piece of it was meeting the hospitals individually where they were at,” Smith said. “We didn’t try to bucket them all into the same timeline. By doing that we were able to do a personal, tailored approach and work plan for them.” Alexander said some hospitals were much further along than others. Some hospitals were parts of large health systems. Some had access to more support and resources and more sophisticated data capture. In the beginning, it was unclear what measures the hospitals had to collect for the areas of improvement and reduction of harm. The HEN suggested using the data hospitals were already collecting for regulatory purposes, which helped ease the burden. Ultimately, the national project moved in that direction, Alexander said. In all, the United States’ largest patient-safety and quality-improvement initiative involved more than 3,000 hospitals. Eighty-seven Louisiana hospitals participated in the LHAREF. Other LHA member hospitals also took part but under different contracts. For LHAREF, CMS only tracked the results of 73 acute care hospitals’ results. The preliminary results include a: • 94 percent reduction in early elective deliveries (non-medically necessary deliveries prior to 39 weeks); • 75 percent reduction in birth trauma that would have resulted in an injury to a neonate; • 74 percent reduction in potentially preventable venous thromboembolism (blood clots in an extremity); • 71 percent reduction in central line-associated blood stream infections in intensive care units; • 69 percent reduction in pressure ulcers; • 62 percent reduction in catheterassociated urinary tract infections; • 53 percent reduction in possible/ probable ventilator-associated pneumonia; • 51 percent reduction in excessive anticoagulation (blood thinning) with warfarin in monitored inpatients; • 47 percent reduction in falls with injury; and • 46 percent reduction in surgicalsite infection rate (within 30 days after procedure). Alexander said the total savings and quality improvements were undoubtedly higher, given the additional hospitals and providers, such as long-term acute care and rehabilitation facilities, that took part.
Personalized Messaging A marketing manifesto By CINDY SANDERS
With better understanding of the human genome, physicians and researchers have opened up exciting new lines of personalized medicine where providers deliver radiation with pinpoint accuracy and tailor treatments to fit a patient’s unique needs. While a highly scientific, very targeted approach is often used to promote improved outcomes, it is rarely employed when it comes time to promote a facility or provider expertise to improve income. If precision medicine has been shown to work, why not also utilize precision marketing?
A Call to Arms In his 2011 manifesto for transforming healthcare marketing, “Joe Public Doesn’t Care About Your Hospital,” author Chris Bevolo explored why the digital world had made it possible … and desirable … to change not only the message but also the manner in which it is delivered. His September 2014 follow-up, “Joe Public II: Embracing the New Paradigm,” offered practical strategies for making the move from mass marketing campaigns to much more precise digital and content marketing options. The norm, Bevolo pointed out, has been to take a shotgun approach via mass marketing. “It really was a call out to the industry to say, ‘This isn’t working … we need to stop this,’” he said of his first book. Change doesn’t come easily, pointed out Bevolo, executive vice president for healthcare marketing communications firm ReviveHealth. And just as the industry was beginning to get the hang of Facebook and Twitter, the digital landscape shifted again. “Social media is still important, although we’re beginning to see the limits of what it can do from a marketing standpoint,” said Bevolo. “Instead of a few big players, you’re seeing more and more players emerge,” he continued of the segmentation of social media. “It’s an important supportive tool, but I think there was a time when people thought it would totally revolutionize marketing.” Instead, it is one device in the bigger picture of digital marketing, which is revolutionizing the way providers and administrators reach their target audiences. Bevolo said ‘search’ should be a primary driver of how customers … also known as patients … find you and your message. Whether by purchasing prime real estate in popular search engines or effectively using tags, it’s certainly a competitive advantage to be among the first few sites that pop up when someone looks for “urologist, Saint Louis,” or “safest hospitals, Tampa area.” Additionally, emerging technologies allow practices and health systems to really drill down and target specific messages to specific populations in a way that is timely and useful. “It has to be relevant, and it has to be relevant to what they need in the moment,” Bevolo stressed.
Content is King Bevolo said there is no question that people are facing information overload, and he noted research has shown individuals are hit by thousands of marketing messages daily but can only process about 100 of them. “How do you become one of the 100 out of 3,000 or 6,000?” he asked. “The key is relevancy.” Bevolo continued, “That’s the challenge for any marketer, but it’s particularly challenging for hospitals. What they have to offer is not relevant to the vast majority of people at any given time.” Expecting consumers to hone in on messages that don’t apply to them isn’t realistic, he said. “If you’re not in need of a doctor at this moment, you don’t care about awards, service lines or how great a hospital’s doctors are,” he pointed out. “Yet, we try to do broad marketing. Not only is it silly, it’s a waste of money and time … and you don’t have time to waste, and you don’t have money to waste.” When patient volume is down, Bevolo said the gut reaction is to believe it’s because not enough people know about you and your wonderful services. The prevailing sentiment is that if you just get a message out there about how good you are, then people will a) hear it, b) care about it, and c) will take action on it. “All three are false, by and large,” he said. Bevolo continued, “That’s the fundamental breakdown in logic … that telling people how great you are will get people through your doors. I don’t care how good the billboard is, it’s not going to make me run in and have my gall bladder taken out if I don’t need it removed.” With limited resources, why pay to broadcast to a million people when only 30,000 need your message, he questioned.
However, Bevolo was quick to add, targeting the 30,000 doesn’t mean you are giving up on the other 970,000. Instead, he continued, you just have to rethink the messages. “You’re missing a lot if you don’t focus on people who do not need services today,” he said. “There’s an opportunity to connect with those people around something that is relevant to them.” Bevolo suggested using digital options such as blogs, channels, websites and apps to share messages about prevention, healthier living and other topical content. A young mother might not care that you are the top joint replacement hospital in the area, but she might really want to learn how to make quick, healthy lunches for her children. A retiree who isn’t interested in how many babies you delivered last year could be eager to learn about fall prevention measures. “That’s how you resonate with Joe Public … because you are the arbiter of health,” Bevolo shared. He said to think of consumers entering the system through a large funnel. Whereas hospitals and practices have typically tried to get to potential patients, who reside near the bottom of the funnel (right before they become your patient), the idea is to target them farther up the funnel. “Those people will need care one day; and if you are the resource they turn to when they are healthy, you’ll be the one they turn to when they do need services.” Of course, Bevolo noted that is often easier said than done. Delivering educational information in a non-sales way requires flipping a mental switch. “The reason it’s so hard is because it is a 180 degree shift from how it’s always been done and how physicians and operational leaders think it should be done,” he said. “It’s not just about marketers changing their approach … it’s about changing a whole industry.”
But When Can We Tell People About Our Awards? Okay … you are understandably proud of achieving or exceeding important quality, safety and outcomes benchmarks. Those awards do say something about your skill set and are important to specific segments of the population. While a seven-year-old with a broken arm might not care about your top-ranked cardiology program, you can bet it makes a difference to a 55-year-old in need of bypass surgery. Healthcare marketing expert Chris Bevolo said sharing information about awards as a secondary sales tool is appropriate in several promotional marketing outlets. Continuing with the cardiology award theme, the first good option would be to include that information in direct marketing pieces where you have pre-identified individuals with heart disease. Sharing accolades through your website is also appropriate. “If I’ve gotten to your cardiology section, I’m probably interested,” Bevolo pointed out. A third option is to take advantage of digital searches. Bevolo said it is a smart use of technology to target people through keywords like “top cardiologist.” Locally, you might buy the phrase so your ad would pop up when people in your geographic region initiated a search for a cardiologist. Writing meaningful content about cardiology topics and using tags at the end of your content could also help you pop up on national searches. And for those wondering about Bevolo’s accolades, there are plenty. The nationally recognized futurist is a frequent speaker on healthcare marketing and strategy. In addition to his “Joe Public” books, he has authored two other books and numerous articles. In 1995, Bevolo founded Minneapolis-based Interval to serve clients across the healthcare spectrum. Last year, Nashville-based ReviveHealth, which O’Dwyer’s ranks as one of the nation’s top 15 healthcare marketing firms, acquired his company. Bevolo serves as executive vice president of consumer marketing for ReviveHealth and continues in his mission to transform healthcare marketing.
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By the Numbers: The Latest Stats on Cancer, continued from page 1 Each year, the ACS compiles the most recent data on cancer incidence, mortality and survival using data from a variety of sources including the National Cancer Institute, National Center for Health Statistics and the Centers for Disease Control and Prevention. The most recent five-year data (2007-2011) showed the overall cancer incidence rate held steady in women and declined by 1.8 percent per year in men. The decrease in men was attributed to rapid declines in colorectal cancer (3.6 percent per year), lung cancer (3 percent per year) and prostate cancer (2.1 percent per year). During the same time period, the average annual decline in cancer death rates was 1.8 percent in men and 1.4 percent in women. Lung cancer, while still the deadliest form of the disease, has declined 36 percent between 1990 and 2011 among
men. Women have also seen double digit declines attributable to reduced tobacco use. On another happy note, breast cancer death rates for women are down more 35 percent from peak rates, and prostate and colorectal cancer deaths are down by nearly half (47 percent). Despite the good news, though, ACS officials also noted there is much more work to be done. “The continuing drops we’re seeing in cancer mortality are reason to celebrate, but not stop,” stated John R. Seffrin, PhD, chief executive officer for ACS, when the report was released in January. He added cancer was still responsible for nearly one in four deaths in the United States in 2011. Furthermore, Seffrin noted the country’s second leading cause of death overall is actually the top cause of death among adults ages 40 to 79. Looking to this year, the ACS has
President Obama’s Precision Medicine Initiative After first introducing the topic during the State of the Union Address, President Barack Obama held an event at the White House at the end of January to unveil details about the Precision Medicine Initiative, a major research push to pinpoint the best, most precise treatment options for individual patients considering genetic profile, environment and lifestyle. In a fact sheet created for the program, White House officials stated, “The Precision Medicine Initiative will pioneer a new model of patient-powered research that promises to Dr. Margaret Foti accelerate biomedical discoveries and provide clinicians with new tools, knowledge and therapies to select which treatments will work best for which patients.” While the move away from ‘one-size-fits-all’ medicine is not limited to cancer research, oncology is at the centerpiece of the initiative and a recipient of significant funding. If passed, President Obama’s 2016 budget includes a $215 million investment in the program including $130 million to the National Institutes of Health to develop a voluntary national research cohort of a million or more volunteers to propel the science forward and to create a model for responsible data sharing. Additionally, $70 million is specifically earmarked for the National Cancer Institute to scale up efforts to identify genomic drivers to various cancers, and a major objective of the initiative is to create ‘more and better treatments for cancer.’ In response to the Jan. 30 announcement, American Association for Cancer Research CEO Margaret Foti, PD, MD (hc), said, “We live in an extraordinary time when the scientific opportunities and our ability to translate this new knowledge into ways to both save and improve the quality of life of patients are simply astounding. This is why we are so excited about today’s event at the White House and specifically about President Obama’s major investment in the enormous potential of precision medicine, which is in the very early stages of transforming healthcare.” Similarly, the Pancreatic Cancer Action Network voiced their appreciation and support for the initiative. “The Pancreatic Cancer Action Network applauds President Obama for his new Precision Medicine Initiative and for making an important investment to advance cancer research and arm the scientific and medical community with the cutting edge tools and resources needed to fight cancer,” said Julie Fleshman, president and CEO of PanCAN. “This is especially welcome news for patients fighting pancreatic cancer who face a five-year survival rate of just 7 percent.” With personalized medicine for pancreatic cancer still in the early stages, she added, “We recognize, as President Obama highlighted, that the “one-sizefits-all” approach does not work for pancreatic cancer and recently launched Know Your Tumor, a personalized medicine service available through our patient services program. In addition to providing molecular profiling that may help a patient’s oncologist determine the best treatment options, we will collect tumor information from thousands of pancreatic cancer patients to assist with future research and development of new therapies and diagnostics for pancreatic cancer.”
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projected 1.658 million new cancer cases will be diagnosed in 2015, and 589,430 Americans will lose their battle with the disease. Of the new cases, the estimate is that men will account for about 848,000 diagnoses across all sites and women 810,000. Prostate, lung and colorectal cancers will account for about half of all cases in men with prostate cancer accounting for around 25 percent of all new diagnoses. Among women, it is anticipated the three most common diagnoses in 2015 will be breast, lung and colorectal cancers. Of those, breast cancer is expected to account for 29 percent of all new cancers for women this year. Of the 589,430 estimated deaths in 2015, the gender breakdown is 312,150 men and 277,280 women. The most common causes of cancer death are lung, prostate, colorectal and breast cancer with these four accounting for almost half of all cancer deaths. More than a quarter of all cancer deaths (27 percent) will be attributable to lung cancer. While death rates have declined, the report noted mortality improvements aren’t equal from coast-to-coast. In fact, cancer death rates vary by state and region with the Southeast being on the lower end of improvement scale (15 percent decline in overall cancer mortality) and the Northeast on the higher end (between 25-30 percent decline). The variation has been attributed to a number of reasons including risk factor patterns (such as the number of smokers), distribution of poverty, and access to healthcare.
Risk Awareness A recent survey by the American Institute for Cancer Research found there is an ‘alarmingly low’ awareness of key cancer risk factors, and many Americans put fear before facts. The Cancer Risk Awareness Survey, released on Feb. 4 in conjunction with World Cancer Day,
found Americans worry about factors over which they have little or no control … such as genetic risks or food additives … with less than half recognizing the correlation between an increased risk of cancer and alcohol, obesity, lack of physical activity and poor diet. The findings of the biennial survey give providers and other health experts an idea of whether or not cancer messaging is being heard by the American public. This year’s results were decidedly mixed. Only 42 percent surveyed were aware a diet low in vegetables and fruit increases cancer risk. This number has trended downward since 2009, when it stood at 52 percent. Only 43 percent knew alcohol increases cancer risk, an increase of five percentage points since the 2013 survey. And only about 1 in 3 Americans (35 percent) realized diets high in red meat have been convincingly linked to colon cancer. This figure has not changed since the survey was last conducted in 2013. Awareness that carrying excess body fat is a cancer risk factor is rising. In this latest survey, 52 percent realized obesity and overweight impact cancer risk, a rise of 4 percentage points. Awareness that being inactive increases cancer risk jumped 6 percentage points, from 36 percent in 2013 to 42 percent in 2015. There was a high recognition of several known risk factors for cancer including 94 percent of those surveyed correctly identifying tobacco use and 84 percent citing excessive sun exposure as risks. However, a significant number of those surveyed also worried about risks for which research has yet to provide a definitive answer. Pesticide residue on produce (74 percent), food additives (62 percent), genetically modified foods (56 percent), stress (55 percent), and hormones in beef (55 percent) were all cited as concerns.
New Medicare Code, continued from page 4 service. Either solution means an additional expense. Medicare also wants chronic care patients to have access to care 24 hours a day, seven days a week. The patient contact doesn’t have to be a doctor or a nurse practitioner, Ritchey said. But if the patient has a problem, he or she needs someone to contact, to set up an appointment, and the contact person has to have access to the patient’s electronic plan of care. Again, providing that service will involve additional expenses for many practices. “On the surface it glows pretty brightly. When you dive into it, it starts to look like a bit of a different scenario,” Ritchey said. Brennan said practices and physicians should also be very careful to document the time that goes into providing chronic care management. The new code isn’t a service that can be billed automatically every month, she
said. The documentation for that time should also be kept in good order in case of an audit. Ritchey said it might be better for physicians to think of the new code as a way to get Medicare to help pay for the infrastructure needed to make their practices medical homes. Being able to manage outcomes more comprehensively also makes a practice more attractive to insurers, who might be willing to pay differentiated fees for that capability, he said. Despite those obstacles, the chronic disease management code is one of the few that offers physicians a source of new revenue, Ritchey said. And eQHealth is offering a turnkey service to help – the Chronic Care Management Program – to help providers. The services includes communitybased care coordinators; a comprehensive electronic care plan management system; and a 24/7 nurse line option.
Proposed Penalties for Medicaid\ Medicare Overpayments Could Bankrupt Some Providers
False claims could cost $11,000 each plus three times the amount of the claim By BECKy GILLETTE
Medicare and Medicaid abuse by providers takes away billions of dollars of taxpayer money that is meant to provide vital medical care. But a new proposed regulation from the U.S. Department of Health and Human Services Office of Inspector General (OIG) implementing a portion of the Affordable Care Act (ACA) has caused alarm in the healthcare community because of the draconian penalties involved for failure to return alleged Medicare and Medicaid overpayments promptly. Some estimates of Medicare fraud alone are $80 billion per year. But the new rules could have unintended consequence including putting legitimate healthcare companies out of business for unintentional errors. “My understanding of the proposed regulation is that if an overpayment is not returned within 60 days of ‘identification’ by a provider, the overpayment is subject to false claims liability under the federal False Claims Act (FCA), which would allow recovery of up to Lynda M. $11,000 per claim, plus Johnson three times the amount of money received in payment of the claim,” said Lynda M. Johnson, an attorney with Friday, Eldredge & Clark LLP, Little Rock. “Certainly this is a severe penalty and could bankrupt many providers.” Johnson said the overwhelming majority of overpayments are received not due to fraud, but because of an honest mistake. The stiff penalties seem to come with the underlying assumption that all overpayments are a deliberate attempt to defraud the government. Johnson said the most important thing providers can do to protect themselves from potentially crippling fines is to implement effective compliance programs to focus on improving their billing practices. Most importantly, try to avoid billing mistakes, which can lead to overpayments being received. The atmosphere of declining reimbursements while providers are expected to improve quality and service has added a great deal of strain to manage-
ment of healthcare facilities. It takes attention away from focusing on patients. “Unfortunately, all resources are limited and any resources that must be devoted to additional compliance efforts may result in a decrease in resources available for patient care, a result which is not good for anyone,” Johnson said. “The providers I work with every day are trying to deliver the best patient care they possibly can with a continually shrinking stream of revenue from government payers, while, at the same time, dealing with more and more regulatory burdens.” Providers should be aware that the Department of Justice (DOJ) is closely monitoring these issues and recently intervened in an action filed in New York, said P. Delanna Padilla, an attorney with Wright Lindsey & Jennings, Little Rock. “The ACA has a P. Delanna defined 60-day period Padilla in which overpayments must be reimbursed to the government,” Padilla said. “A provider’s failure to so reimburse could lead to stiff penalty assessments and can be considered a violation of the FCA. This provision of the ACA is being taken seriously and will become of great concern to providers who repeatedly fail to reimburse the government for overpayments.” If providers fail to comply with the repayment rules under the ACA, they face the potential penalty of being banned from billing Medicare or Medicaid. Padilla said this would have catastrophic consequences to most providers. Additionally, the penalties themselves can stack up all too easily. While many consider the penalty amounts to be excessive, Padilla said providers should be prepared to pay those types of sums if they knowingly and willingly withhold repayment. There is concern that the new rule is an attempt to make healthcare providers settle cases rather than risk penalties that could bankrupt their organizations. Healthcare providers are keeping an eye on the first complaint under this proposed rule that was filed by the New York State Attorney General’s office charging Healthfirst with failure to return overpayments.
For more, visit: www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNProducts/downloads/ overpaymentbrochure508-09.pdf
Padilla said the big issue in this case is that the hospital network, Continuum, which accepted patients covered by the Healthfirst Medicaid managed care plan, did not repay 300 overpayment claims until it received a demand concerning the overpayment. The DOJ intervened in the case and took the position that Continuum intentionally and fraudulently delayed the repayments as Continuum had undertaken an internal review and uncovered more than 900 improperly billed claims totaling more than $1 million in overpayments. “Although Continuum had begun making repayments, the DOJ’s position was that the internal review occurred in February 2011 and repayments were not completed until March 2013,” Padilla said. “This amount of time is obviously well beyond the 60-day repayment period. The DOJ further alleged that Healthfirst, because of its billing practices, caused Continuum to submit erroneous
claims to Medicaid, which were the basis for the overpayments. When the DOJ intervened in this action, the maximum penalty under the FCA was requested ($11,000 for every improper overpayment, plus treble damages). Thus, the proposed amount of the fine was almost $30 million.” Providers need to initiate compliance programs, if they do not already have them, to ensure that the billing is performed properly and accurately. “Although the possible penalties could be astronomical, providers need to be able to trust that their billing is being performed accurately and timely,” she said. “If they have compliance programs in place, then generally this potential headache would be avoided. Providers and their employees need to be fully aware of the potential for audit, either under ACA or HIPAA. Compliance truly is no longer discretionary; it is mandatory.”
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`High Employer Liability for Employees’ Wrongful Use of Access Privileges to HIPAA Information negligence/professional malpractice, and liability under the principle of respondeat superior, a legal principle by which an employer may be responsible for the conduct (and misconduct) of its employees within the scope of their employment. After a four-day trial in July 2013, the jury found in Hinchy’s favor and determined that Walgreens and its pharmacist were jointly responsible for $1,440,000.00 in damages. Factors cited in support of this notable verdict amount included the sensitive nature of the information in question, the emotional harm Hinchy claimed she suffered as a result of her information being divulged (resulting in Hinchy beginning to take a stronger antidepressant), and the fact that the information was divulged to several people including Hinchy’s father. The significance of this damages amount being not only awarded, but also upheld by both the trial court as well as the appellate court (upon Walgreens’ appeal) should not be overlooked - essentially, the jury, trial court, and appellate court all recognized that Walgreens’ professional standard of care as a health care provider
By BRIAN C. EVANDER, ESQ.
In 2010, a Walgreens pharmacist accessed the prescription records of her boyfriend’s ex-girlfriend, Abigail Hinchy, for the purpose of gaining information related to Hinchy’s use of prescription birth control and potential sexually transmitted infection. That pharmacist divulged this information to her boyfriend, who subsequently shared the information obtained with multiple individuals. When Hinchy learned of the improper access and disclosure of her information and contacted Walgreens, she was initially informed that Walgreens was unable to track who had accessed her records through Walgreens’ computer system. After Hinchy again contacted Walgreens with further incriminating details regarding the pharmacist, Walgreens issued the pharmacist a written warning and required her to retake a HIPAA training program. Unsatisfied, Hinchy filed suit against both Walgreens and the pharmacist, including claims against Walgreens for negligent training, negligent supervision, negligent retention,
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included a duty of confidentiality, and that Walgreens’ breach of such a duty reasonably rendered the company jointly liable for more than $1.4 million, even without any allegation of physical harm or professional testimony supporting Hinchy’s claim of emotional harm. In its appeal, Walgreens argued that the trial court had erred by denying several of Walgreens’ dispositive motions. During the course of the trial litigation, Walgreens had filed motions for summary judgment and a directed verdict as to the respondeat superior claim, essentially asking the court to dismiss that claim by determining that the pharmacist’s misuse of her access to Walgreens’ computer system to view Hinchy’s information was outside the scope of her employment. The trial court denied these motions, and the Indiana Court of Appeals affirmed the trial court’s decisions. Importantly, the Indiana Court of Appeals found that denial of Walgreens’ motions was appropriate since much of the pharmacist’s conduct (using legitimate access to Walgreens’ computer system to view patient prescription history) was of the same general nature as her ordinary job duties and of the same general nature authorized by her employer. Further, the Indiana Court of Appeals noted that the fact that an employee is empowered to commit the tort because of their employment weighs in favor of respondeat superior. Although the true impact of this case may not be known immediately, the precedent set is undeniably significant. Walgreens was held liable for the wrongful use and disclosure of protected health information by its pharmacist, even though the pharmacist’s actions were in direct conflict with and violated Walgreens’ well-established policies and procedures addressing confidentiality. Healthcare providers have long been required by HIPAA (as well as other federal and state authorities) to implement policies regarding, and to train their employees on, the use and disclosure of health information. Walgreens Co. v. Hinchy appears to take this responsibility further by establishing that a healthcare provider’s compliance with these requirements through implementation of such policies and training their employees accordingly cannot reliably protect the provider from liability for the wrongful actions of its employees. Simply implementing the required policies and training your staff to comply
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with such policies may no longer be sufficient. Proper auditing of your employees’ access to patient information, coupled with regular monitoring and tracking of such access, should be instituted - not only to facilitate your ability to expediently identify wrongful access and/or misuse of privileges, but also to create a powerful deterrent to employees committing such violations in the first place. As further deterrent, policies and procedures should allow for, if not require, strong discipline such as suspension of access privileges while an employee’s potential misuse is being investigated as well as termination when such misuse is evident. Walgreens’ written warning and requirement that the pharmacist retake a HIPAA class was likely viewed by Hinchy as nothing more than a “slap on the wrist.” Finally, ensure that your policies and procedures sufficiently govern how patient complaints are received, recorded, and responded to. We will never know if Hinchy would have filed her suit had Walgreens handled Hinchy’s complaint differently and timely terminated the pharmacist for her wrongful access and disclosure of Hinchy’s information. In the end, one of the most effective methods of reducing the risk of finding yourself in a lawsuit similar to Walgreens’ is to treat patient complaints in a manner that the patient feels is both satisfactory and expedient.
One Last Take Away All Covered Entities and Business Associates covered by HIPAA should strongly consider obtaining insurance coverage for the defense of cases such as the Hinchy case, breaches of patient data, healthcare regulatory investigations, HHS/OCR matters and professional licensure investigations involving alleged breaches of patient medical records and privacy. A variety of policies are available including cyber liability, professional licensure defense, privacy and other types which can provide not only indemnity for damages and even administrative fines and penalties in some cases, but also payment of defense costs such as attorney’s fees, breach notification costs, expert witnesses and other associated expenses involved in the defense of civil lawsuits and government investigations/actions. If you have not evaluated your insurance coverage for such matters or contacted your insurance agent about such coverage, please consider doing so as soon as possible. Mr. Evander is an attorney with the law firm of Michael R. Lowe in Sanford, Florida. The firm represents physicians and other licensed healthcare professionals in the defense of medical malpractice cases and review of their medical malpractice professional liability insurance policies and coverage.
In the News Dolleen Licciardi, MD, Of River Ridge Assumes LSMS Presidency BATON ROUGE – Dolleen Licciardi, MD, of River Ridge assumed the presidency of the Louisiana State Medical Society (LSMS) during its annual meeting on Jan. 30th in Baton Rouge. The meeting was the beginning of the one year presidency of the New Orleans native. “When I realized that I wasn’t alone and that together physicians could affect change for the betterment of all physicians and their patients,” said Licciardi, “that’s when I became active in organized medicine.” Licciardi currently serves in the LSMS’ delegation to the American Medical Association and participates in annual congressional visits to Washington, D.C. on behalf of the LSMS. Licciardi is a tireless supporter of organized medicine and will approach the job of LSMS president with the same dedication she displays in every responsibility and activity she undertakes. Licciardi has been an active member of the LSMS since joining in 1994. She was elected vice president in 2013 after having served in the LSMS leadership as a member of the Board of Governors since 2006. She is also a valued member of the Jefferson Parish Medical Society, serving as president in 2006 and leading their organization through the challenges of rebuilding following Hurricane Katrina. Licciardi graduated from Tulane University, LSU Medical School and completed her pediatric residency at Vanderbilt. A board certified pediatrician, she is in private practice in Destrehan.
Jones Walker Welcomes Charles J. Boudreaux, Jr. LAFAYETTE – Jones Walker announced that Charles “Chuck” J. Boudreaux, Jr. joined the firm’s Business & Commercial Litigation Practice Group as special counsel in the Lafayette office. Mr. Boudreaux focuses his practice on healthChuck J. Boudreaux care issues and has extensive experience in medical malpractice litigation, risk management, and transactional and regulatory healthcare matters. He counsels healthcare companies on joint ventures, contractual, and compliance matters. Mr. Boudreaux has tried dozens of medical malpractice jury trials to conclusion, in both state and federal courts, and his representative clients include physicians, healthcare facilities, and allied health professionals. “We are thrilled to have Chuck join the firm. His wide range of experience in the healthcare industry will be an asset to our clients,” said Ian A. Macdonald, office head for Jones Walker’s Lafayette office. Mr. Boudreaux is Board Certified by the American Board of Professional Liability Attorneys and is a member of the American Society of Law, Medicine, and
Bioethics. He serves on the Medical/Legal Interprofessional Committee of the Louisiana State Bar Association and Louisiana Medical Society. Mr. Boudreaux is an active member of the Defense Research Institute (DRI) and serves as a member of the National Medical Liability Committee of the DRI. He has also served as the Louisiana State Liaison for the Medical Liability Committee of the DRI. Mr. Boudreaux is admitted to practice in all State and Federal Courts in Louisiana and the United States Supreme Court. He is rated AV by Martindale-Hubbell, which is the highest rating attainable.
Ochsner Applauded For Top Liver Transplant Program NEW ORLEANS – CareChex, a division of COMPARION, recently named Ochsner Health Systems as the No. 2 facility in the country for liver transplants. Ochsner was also named as the No. 1 liver transplant center in the state of Louisiana. It received a score of 99.9 out of 100 in the national rankings. More than 4,000 hospitals around the country were ranked in the Overall Hospital Care Category, which rates inpatient medical conditions and surgical procedures treated and performed by full-service hospitals, such as cancer care, cardiac surgery and spinal surgery, among others. Ochsner was also named No. 2 for kidney transplants. “As our transplant program continues to grow both regionally and nationally, we remain committed to providing the best service and care for our patients,” said Dr. Nigel Girgrah, Ph.D., Head of Hepatology, Medical Director of the Multi-Organ Transplant Institute, in an Ochsner press release. “We work with so many patients and families over long periods of time, so we know what a difference a successful transplant can make in someone’s life.”
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In the News Blue Cross Foundation to Grant $160,000 to Louisiana Angels BATON ROUGE- Blue Cross and Blue Shield of Louisiana Foundation will award $160,000 to Louisiana Angels who perform extraordinary work for Louisiana at-risk children. Nominations will be accepted for this award until Friday, April 3, 2015. Angel Award recipients will be recognized at a ceremony next fall. This award is granted to eight volunteers who assist in increasing awareness of children’s needs and providing resources to help address them. Once chosen, each winner will name a 501(c)(3) organization to receive a grant of $20,000. Since 1995, the Foundation has awarded more than $1.8 million to more than 160 individuals improving the lives of Louisiana children. Previous Angels represent all vocations and include retirees, students and everything in between. They were chosen for the countless hours dedicated to their organization, while fulfilling job requirements, studies and family duties. An online nomination form and more details about the Angel Award are available at the Foundation’s website at www. ourhomelouisiana.org or the Blue Cross website,www.bcbsla.com/angelaward. Nomination packets are also available by calling toll-free 1-888-219-BLUE (1-888-219-2583) or emailing Angel. Award@bcbsla.com. Nominators are encouraged to send supplemental information in support of the nomination, including testimonial letters, brochures, news articles, photos and videos. (Please note: These materials cannot be returned.) Individuals who themselves have been honored as “Angels” make up the committee that will decide this year’s winners.
Baton Rouge General Mid City Planning ER Closure, Transition BATON ROUGE – Baton Rouge General (BRG) is undertaking extensive community education and staff engagement efforts to help ensure an effective transition as the hospital moves forward with plans to close Emergency Room services at its Mid City campus this spring. The hospital is supportive of collaborative plans to identify expanded urgent and primary care services near the Mid City campus, in an effort to maintain access while promoting utilization of the right care, at the right time, and in the right place. The BRG website at www.brgeneral. org/midcity will continue to serve as an update center for information, frequently asked questions and calendar activities regarding changes to the Mid City ER. In addition, www.mycarebr.com, the website of the Better Access to Care Coalition (BACC), remains an important source of information for understanding how and when to access healthcare services for emergency, urgent, and primary/specialty care needs. “We’re making patient information 14 • MARCH 2015
Louisiana Medical News
available throughout the Mid City hospital, and we will have an information desk staffed every afternoon and early evening in the patient waiting area at the Mid City ER,” said BRG Mid City Administrator George Bell. The hospital also plans to coordinate with neighbors, area churches and civic organizations to get information into the community in preparation for the transition. BRG will also hold community and neighborhood information sessions next month to help patients and area residents understand how and where they can access healthcare services in the event of an emergency. “With community events beginning in March, we are committed to continuing our outreach among the friends, neighbors and supporters surrounding Mid City,” said Bell. “And making every effort to collaborate with local first responders, state agencies and the healthcare community, we are committed to making this transition effective and educational for everyone impacted by this change in our city’s healthcare.” BRG has also reached out to area transit providers so that residents and riders know how to access local hospitals, urgent care facilities and primary care clinics. BRG has also developed its own ambulance service to transfer hospital patients only between its Picardy Avenue and Florida Boulevard campuses, in an effort to meet inpatient needs in the most efficient manner possible, while reducing wait times and improving flow of inter-campus care and specialty services. While not able to respond to 911 calls, the hospital does anticipate that its transport preparedness efforts will support in easing transition needs resulting from its Mid City ER closure. “We’ve increased the inpatient bed count on our Bluebonnet campus and are reconfiguring the Bluebonnet ER and related processes. We’re committed to maintaining the high level of healthcare quality for which our hospitals are known, and we’re equally committed to offering the award-winning customer service our patients and community expect of the General,” said BRG Chief Executive Officer Mark Slyter, FACHE. “Though this transition is the largest operational change our organization has undertaken in many years, it does not change our mission and commitment to Mid City, or the pride we take in serving as Baton Rouge’s first and trusted hospital.” To ensure an equally seamless transition for its internal teams, BRG is carefully planning around anticipated volume increases at its Bluebonnet campus with efforts to minimize staffing reductions. “Dedicated employees across our system are working tirelessly on transition planning to ensure an effective transition,” said BRG Chief Nursing Officer Anna Cazes, RN, MSN, DNS. “We’re doing our very best to retain as many employees as possible, but for anyone whose position with us is permanently im-
pacted, we are committed to taking care of them with fairness and respect for the loyalty and service they have provided our patients and hospital.” Through BRG’s Employee Career Center, counselors will provide support services including opportunities for reassignment or transfer within the system, or if displaced, positions available among area employers with whom the hospital networks. In addition, the hospital’s Employee Care Center will provide assistance with social and wellness services, humanitarian aid, financial counseling, as well as spiritual and emotional support. BRG’s community outreach efforts are expected to continue in the spring, and beyond the anticipated closure of the Mid City ER. In addition, the hospital’s Affordable Care Act free enrollment assistance series, offered Monday through Friday from 9 a.m. to 9 p.m. on both campuses, will conclude once Open Enrollment ends on February 15.
DHH issues memo on timely filing for traditional Medicaid claims BATON ROUGE- The Louisiana Department of Health & Hospitals (DHH) issued a memorandum on Jan. 30, 2015 that states, effective Feb. 1, timely-filing requirements for Louisiana traditional Medicaid changed from 365 to 180 days for all claims from the date of service with a few exceptions. Details of exceptions are as follows: • Claims billed as interim claims (initial claim must be filed within 180 days); • Claims for patients who have Medicare and Medicaid coverage should follow Medicare guidelines for timely filing and submit to Medicaid within 180 days of Medicare’s EOB; • Claims for retroactive Medicaid members must be filed within 180 days of the date of eligibility determination; • Adjustments and voids that must be filed within 180 days from date of payment; and • Services billed to and reimbursed by Magellan. Any discharges through Jan. 31, 2015 will follow the 365 day timely filing guidelines. Claims with a date of service and/or date of discharge of Feb. 1, 2015 or later will follow the new timely-filing guidelines. Anyone with more questions is advised to visitwww.lamedicaid.com or contact Molina Provider Relations at 800-473-2783. The memorandum can be found online at http://www.lamedicaid. com/provweb1/Billing_Information/Provider_Memo_Timely_Filing.pdf 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.
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In the News Gregory LeBleu MD named Medical Director of Tri Parish Rehabilitation Hospital FRISCO, TEXAS- Maxim Management Group, a regional leader in specialty health care management, has named Dr. Gregory LeBleu, Medical Director of Leesville Rehabilitation Hospital and the Tri Parish Rehabilitation Hospitals. LeBleu will direct and lead the rehabilitation teams at Leesville Dr. Gregory Rehabilitation Hospital and LeBleu at the two Tri Parish Rehabilitation Hospital’s campuses – Rehabilitation Hospital of Rosepine and Rehabilitation Hospital of Beauregard. LeBleu brings more than 20 years of medical experience to the team. The announcement was made by Mark Harris, chief executive officer of Maxim Management Group. “Dr. LeBleu is a great fit for our facilities and for this leadership position. We are thrilled to have his experience in inpatient rehabilitation care, and we look forward to his contributions,” said Harris. “The LeBleu family heritage is local to the area. He has a true passion for successfully improving the lives of patients through inpatient rehabilitation services. He will ensure that we provide the best care possible at our hospitals.” LeBleu will be responsible for the overall quality of rehabilitation treatment at Leesville Rehabilitation Hospital and the Tri Parish Rehabilitation Hospitals. He will lead the interdisciplinary team, consisting of physical therapists, occupational therapists, speech therapists, respiratory therapists, social services, certified rehabilitation nurses and support staff. LeBleu returned to Louisiana to make a difference in the lives of the people who live in the communities that our hospitals serve. “I am excited and eager to return to Louisiana and contribute to the medical leadership of the teams at Leesville Rehabilitation Hospital and the Tri Parish Rehabilitation Hospitals,” said LeBleu. “I feel absolutely blessed for the opportunity to be a part of such exceptional programs. Together, we will provide much needed rehabilitation services to patients and families in our region.” LeBleu is a trained (PM&R) physical medicine and rehabilitation physician, also known as a physiatrist. He is a Diplomate of the American Board of Physical Medicine and Rehabilitation. He has served patients specifically in the field of rehabilitation for more than 15 years. In addition, he was a flight surgeon in the U.S. Navy. LeBleu graduated from Texas Tech School of Medicine and completed his residency in Physical Medicine and Rehabilitation at the University of Utah. He is a member of the American Academy of Physical Medicine & Rehabilitation, North American Spine Society, American Medical Association and Texas Medical Association.
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