yOUR PRIMaRy SOURCE FOR PROFESSIONaL HEaLTHCaRE NEWS OCTOBER 2014 / $5
SOU TH LOU ISIANA ED ITION
On Rounds Physician Spotlight
Federal Grants Mark New Cancer Research Era By TED GRIGGS
Dr. J. Dudley Atkinson IV Hamming it up During his lifetime, Baton Rouge native J. Dudley Atkinson IV has had several incarnations – petroleum engineer, Naval submarine officer, IT entrepreneur. But, deep inside, he harbored his true calling – physician ... page 3
Olive Oil Compound Could Enhance Chemo Someday in the not-too-distant future, cancer patients could see smaller, less toxic and more effective chemotherapy dosages thanks to a compound found in extra virgin olive oil and researchers at the University of Louisiana at Monroe ... page 5
Louisiana healthcare providers nailed down two of the 65 multi-million dollar research grants the National Cancer Institute awarded nationwide. The funding is expected to increase access to NCI clinical trials and cutting-edge treatment, particularly for the underserved. The grant amounts and recipients are: $5.6 million to establish the Gulf South Minority/ Underserved NCI Community Oncology Research Program. LSU Health Sciences Center New Orleans partnered with LSU Health Shreveport and Mary Bird Perkins Cancer Center in Baton Rouge to win the grant, one of only 12 of its kind funded by the National Cancer
Institute. $3.2 million to Ochsner Health System for an NCI Community Oncology Research Program. Ochsner was one of 53 grant recipients nationwide and the only provider in Louisiana, Mississippi and Alabama within the Community Site category to win funding. Both grants will be paid out over five years. Dr. Augusto Ochoa, director of the LSUHSC New Orleans Stanley S. Scott Cancer Center and the Gulf South grant’s principal investigator, said the program will provide access to high-quality research studies closer to patients’ homes. (CONTINUED ON PAGE 10)
REIMBURSEMENT
Reimbursement Revisit A Look at payment innovation By CINDy SaNDERS
While physicians and facilities have long had to keep up with different negotiated contract rates among payers, the reimbursement landscape has become much more varied over the last few years as a push toward payment innovation has ushered in a host of reimbursement options ranging from shared savings programs to bundled payments to carrot-and-stick compensation as applied to quality and efficiency metrics. Rob Lazerow, practice manager for Research & Insight at The Advisory Board Company, recently analyzed some of the payment changes providers are navigating as the healthcare system begins to shift away from a fee-for-service model. While the traditional payment method based on volume still makes up the (CONTINUED ON PAGE 6)
Read Louisiana Medical News online at www.louisianamedicalnews.com
2014 LOUISIANA HIPAA & EHR CONFERENCE October 20-21, 2014 Louisiana’s Prescription for Privacy, Security and Electronic Health Records
L’Auberge Casino Resort - Event Center | 777 l’Auberge Ave. Baton Rouge, LA 70820 PRINTED ON RECYCLED PAPER
PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357
Free your mind to think about something other than med-mal.
Since we’re singularly focused on medical malpractice protection, your mind is free to go other places. LAMMICO is not just insurance. We’re a network of insurance and legal professionals experienced in medical liability claims. A network that closes approximately 90 percent of all cases without indemnity payment. A network with a 95 percent policyholder retention rate. LAMMICO’s a partner – so that when you insure with us, you’re free to do your job better. And that’s a very peaceful place to be.
2 • OCTOBER 2014
Louisiana Medical News
Physician Spotlight
Dr. J. Dudley Atkinson IV Hamming it up
By LISa HaNCHEy
During his lifetime, Baton Rouge native J. Dudley Atkinson IV has had several incarnations – petroleum engineer, Naval submarine officer, IT entrepreneur. But, deep inside, he harbored his true calling – physician. His journey to med school was a long navigation. After graduating from Catholic High School in Baton Rouge, he studied petroleum engineering at LSU. During his junior year, he decided to become a submarine officer. He joined the Navy, finished college, and went to officer candidate school. For 15 years, Atkinson served as a submarine officer. While in the Navy, he attended the Naval Postgraduate School in Monterey, Calif., where he pursued master’s degrees in physics and engineering science focusing on space-based communications systems. There, Atkinson discovered ham radio. “The postgraduate school had a really strong ham radio club, and it kind of made sense, because you’ve got 2,000 naval and air force officers there for master’s degrees, and probably 80 percent of the students are in engineering,” he explained. At first, Atkinson used hand-held walkie-talkie equipment. Then, he became interested in HF radio – long-distance communications. Over the years, he progressively upgraded his licenses, achieving the highest level: extra class operator. He uses the call sign NO5L. “From my little house here in Baton Rouge, I’ve talked to China, Japan, Russia, Australia and New Zealand,” he said. During his stint in California, he became involved in a flying club, which had a fleet of 12 planes. “It sure was a lot of fun, and it was a beautiful area to fly around,” he recalled. A few years later, Atkinson was back at sea based in Norfolk, Va., where he began a startup internet service provider company. “Like most startups, it didn’t do very well at first, but then it really took off because the timing was right,” he recalled. He ended up selling his company and leaving the Navy to work for Bell Labs, building telephone company networks overseas. He became involved in another internet startup in Manhattan, which eventually was bought out by a Philadelphia-based company. Using the money he earned from the startup selloffs, Atkinson finally went to medical school – at age 38. While at Tulane School of Medicine, he was drawn to urology. “I liked urology because it provided an opportunity to really make positive changes for a lot of people,” he explained.
Residency was a combined five-year program at LSU School of Medicine in New Orleans. The month after Hurricane Katrina, he started practicing at Ochsner in New Orleans. “Everybody was going to Houston, and I talked my way into being able to do a lot of my rotations at Ochsner instead,” he explained. In 2012, Atkinson moved to Baton Rouge to practice at Ochsner. It was then that he discovered that his career had been predestined. Once home, his mother handed him a box of mementos including old photo albums and yearbooks. Among the long-forgotten items inside was a stub from his high school ACT test and
a career guidance questionnaire. “It had this grid with about a hundred jobs on it, and there was a circle around what they thought you should do,” he described. “I had a circle right over surgeon. So, the people who administered the ACT knew that I should have been a surgeon; I just took a while to get back to it.” As a practicing urologist, Atkinson treats urinary problems and kidney stones, and also performs robotic procedures. “Of all the various surgery specialties I was exposed to when I was a student, urology was just the one I identified with,” he explained. “And now that I do it, I really like it a lot. It’s the best job I’ve ever had.”
Atkinson had given up flying for 20 years, but decided to return to it when he moved back to Baton Rouge. He took some instruction, got his medicals up to date, and started flying small airplanes. At the end of last year, he decided to build his own plane, a Vans RV-14. “It might be the dumbest thing I ever did, but it sure is kind of fun,” he said. He hopes to complete the project in three years. In the meantime, he bought a Piper Arrow II for flying. “Flying is a great hobby, and lets you see a lot of the countryside from a different perspective,” he said. “The plane I’m flying is good training for the plane I’m building.”
Connrmed speakers: Gregory D. Frost and Clay J. Countryman from Breazeale, Sachse & Wilson, L.L.P.
Louisiana Medical News
OCTOBER 2014 • 3
Manners Matter
As the New Health Economy forces physicians to become patient-centric, customer service moves to the forefront By LyNNE JETER
For years, the primary care doctor was a trusted person considered almost family. From house calls to meeting a patient late at night or on weekends, physicians were known for their manners, going the extra mile for patients, and their trustworthiness. Media portrayed healers as wise professionals in movies and television shows. Yet lately doctors aren’t quite viewed the same way, especially as medicine is becoming consumer-driven. Patients often grumble about long waits while visiting their doctor; physicians who seem disinterested, rude, or arrogant; or a staff that lacks empathy. As a result, some folks say the family doctor doesn’t seem the same. What’s changed in healthcare? Have doctors become ruder or is it because of shortages in the medical profession that doctors no longer have as much time to provide individualized service? What should patients expect from doctors? What should doctors expect from patients? “Dr. Silverman and I have been in practice since the late 1960s, and we’ve noticed that doctors’ manners have deteriorated over the last few decades. Now you can see it in the popular media,” said Atlanta pediatrician Saul Adler, MD, who co-wrote “Your Doctors’ Manners Matter: Better Health through Civility in the Doctor’s Office and in the Hospital,” (BookLogix, 2014) with Atlanta cardiologist Barry Silverman, MD. “A certain percentage of the population is always shopping for new doctors. Maybe they move to a new town, or change insurance plans, or as the economy improves, people are moving out of their parents’ home and
EDWIN G. PREIS, JR. ROBERT M. KALLAM FRANK A. PICCOLO JOHN M. RIBARITS CATHERINE M. LANDRY JAMES A. LOCHRIDGE, JR. CHARLES J. BOUDREAUX, JR. DAVID L. PYBUS DAVID M. FLOTTE LEAH NUNN ENGELHARDT EDWARD F. KOHNKE IV JENNIFER A. WELLS JONATHAN L. WOODS M. BENJAMIN ALEXANDER KEVIN T. DOSSETT KENNETH H. TRIBUCH MARJORIE C. NICOL MATTHEW S. GREEN JEAN ANN BILLEAUD JOHN F. COLOWICH JOHN L. ROBERT, III WILLIAM W. FITZGERALD DARYL J. DAIGLE CAROLINE T. WEBB MANDY A. SIMON THOMAS H. PRINCE RACHAL D. CHANCE CRAIG R. BORDELON, II JARED O. BRINLEE KELLYE E. ROSENZWEIG NINA D. DARGIN
4 • OCTOBER 2014
establishing new households. The layperson can’t really evaluate his skills, but if the doctor treats you with respect, listens to you, addresses all your concerns, and you leave the office feeling this doctor is somebody who has your best interest at heart, then you’ve found a doctor you can work with and respect.” Maintaining the Health of Your Practice Nick Hernandez, MBA, FACHE, CEO of ABISA LLC, a Florida-based healthcare consulting firm that specializes in solo and small group practice management, said perhaps more than ever, physicians need to be focused not just on attracting more patients, but also on not losing the patients they have. Nick Aside from physiHernandez cian-specific interaction, Hernandez emphasized three areas of attention for practices, to prevent losing current patients: A disrespectful staff. “The correlation between respect and patient safety has been well-documented, but a disrespectful staff can also impact the health of your practice,” said Hernandez. “Whether it’s absent-mindedness or plain unprofessional behavior on behalf of your staff, these poor attitudes will lead to lost patients. No matter how small the staff, most practices could use a primer or refresher on customer service. Using words please, thank you, and you’re welcome can go a long way.” A dreary, dull office appearance. “There are many things your practice can do to overcome this without spending a lot
of money on remodeling,” said Hernandez. “Does your staff straighten magazines and tidy up throughout the day? How old is your reading material in the lobby and waiting areas? It’s a good rule to never have magazines that are a year old.” Hernandez noted other small changes to make a big difference. “When’s the last time your lobby received a fresh coat of paint? If you have a small operation and don’t have janitorial service nightly, then on the days without service, have your receptionist run a vacuum through the lobby area at the end of the day.” Elongated office delays. “Scores of data from patient satisfaction surveys show that patients are extremely frustrated when their appointment time is delayed significantly,” Hernandez pointed out. “While patient care is certainly not as programmed as an automated manufacturing line, many practices could run much more efficiently if they scrutinized the operational flow of the practice.” Sometimes, common sense and good manners should prevail, said Hernandez. “As time-impacting issues arise during the day, communicate that to your patients,” he encouraged. “They’ll be much more forgiving if they’re aware of the schedule. Remember, it’s highly unlikely this appointment to your office is the only thing they have on their agenda for the day.” Especially in the age of social media, word about poor service travels at lightning speed. “Patients still tend to assess provider quality in terms of service and access,” said Hernandez. “It’s the wait time, the rude staff, and the inability to stick to a schedule that anger patients. The key is
Your Partners in Healthcare
Fully Staffed Healthcare Practice Group 337.237.6062
Charles J. Boudreaux, Jr.
Louisiana Medical News
Head of Healthcare Practice Group
Medical Malpractice and Professional Liability Defense ~ Risk Management ~ Regulatory Healthcare Compliance ~ HIPAA ~ EMTALA ~ General Commercial and Healthcare Business Transactions and Contracts
Lafayette ~ New Orleans ~ Houston www.preisplc.com
to not have patients leave the practice because of poor office policies or simple misunderstandings.” Best Practices: Social Media Marketing In a recent column, “Big Fish,” Tim Nicholson, CEO of Big Fish LLC, a Memphis-based healthcare marketing firm, discussed Best Practices for social media marketing that involve enabling more voices. “It’s difficult to build community without conversation,” Nicholson explained. “Creating good content isn’t good enough. Invite trusted sources to guest post on Tim your page. Host a FaceNicholson book Q&A with a physician from your team. Get a conversation started. And don’t be afraid of what you hear. Helping people get it right makes you the most valuable voice in the community.” “Avoid broadcasting” means not limiting a social media presence to announcements regarding office hours, new staff members, and new services. If doctors’ social media connection doesn’t compel interaction, Nicholson said, “You’re Charlie Brown’s schoolteacher. Sure, she had important information to share, but all the kids heard was, ‘Wah, wah, wah.’” Patients also follow one of marketing’s golden rules: People are attracted to images of themselves. “Potential new patients are smart and have learned to use your Facebook wall as a place to find out who makes up your community,” said Nicholson. “If they don’t see people like themselves, they’ll be less inclined to connect. We’re clearly not advocating excluding anyone. We’re encouraging you to be intentional in your marketing. A grandmother who likes a pediatrician’s page is not nearly as good a match to a potential new patient as a young woman who does.” More than anything else, know what patients want, said Nicholson. “You can be a leader in empowering a healthcare community, who in turn advocates for your brand and sees you as among the best practices,” he said.
Read Louisiana Medical News Online: LOUISIANA MEDICAL NEWS.COM
Olive Oil Compound Could Enhance Chemo By TED GRIGGS
Someday in the not-too-distant future, cancer patients could see smaller, less toxic and more effective chemotherapy dosages thanks to a compound found in extra virgin olive oil and researchers at the University of Louisiana at Monroe. ULM student Katherine Gary, under the direction of Dr. Khalid El Sayed (PhD in pharmacognosy) recently became the first person to isolate the oleocanthol compound from olive oil with a 95 percent purity rate. Oleocanthol acts as a c-Met inhibitor. C-Met enhances cell growth, invasion, angiogenesis, metastasis, reduction of apoptosis and changes cytoskeletal functions of many tumors. “The c-Met is important … mainly affecting all biological cells and processors in cancers,” said El Sayed, professor of medicinal and natural products chemistry. Nature is still the single-most important Dr. Khalid El source of drugs and preSayed cursors, El Sayed said. Pharmaceuticals based on natural products account for around 58 percent of all drugs approved by the U.S. Food and Drug Administration.
Still, over the past 20 years, the FDA has approved only one c-Met inhibitor drug, El Sayed said. There are less than a handful c-Met inhibitors in clinical trials. El Sayed is hoping that research underway at ULM will change that. El Sayed’s research showed that five weeks of treatment with oleocanthol resulted in a breast tumor 2 millimeters in diameter. Meanwhile, the untreated control tumor had grown to almost 10 centimeters in diameter. The research grew out of findings that the Mediterranean diet correlates with lower incidences of cancer. El Sayed used computer-aided modeling to screen a library of natural products for c-Met inhibitors. The researchers downloaded the structure of the target and then looked at which naturally occurring compounds would bind properly to the structure Oleocanthol had one of the highest scores among the natural products library. El Sayed did further testing on breast and prostate cancer cells lines, published the results, and used that research to secure $452,000 in funding from the National Cancer Institute. The three-year grant ends in 2016. The next step will be to research oleocanthol in combination with chemotherapeutic drugs, El Sayed said. He and his research colleagues plan to submit a
second paper on that topic. El Sayed said the research will show the potential of oleocanthol to synergize the effect of chemotherapy drugs or to serve as an add-on drug in cancer treatment. “Most people die actually from the side effects of chemotherapy and/or metastases of the particular cancer,” El Sayed said. “We will be very glad to see oleocanthol used in the future as a supplement for people with cancer.” The compound can reduce the chemotherapy doses by at least 50 percent, while enhancing the cancer treatment’s effectiveness and reducing or minimizing the side effects, he said. El Sayed said he and some other colleagues in north Louisiana are discussing the idea of submitting a proposal by mid2015 for a small-scale trial of oleocanthol with chemotherapy. The clinical trial would likely take place in Shreveport. El Sayed is also looking to see whether a pharmaceutical company might be interested in screening oleocanthol through a drug discovery program or investing in the compound as a dietary supplement. The advantage of a supplement is that it wouldn’t require FDA approval to hit the market, he said. But first the researchers would have to find a partner/ investor, whether a pharmaceutical or industrial company. Eli Lilly, for example, has the Open
Innovation Drug Discovery Program, a collaboration with academia. The company has developed a panel of in vitro screening modules for strategic therapeutic areas. The assay modules are available to researchers. If researchers come up with compounds that the company is interested in, Eli Lilly may invest in them. El Sayed said it’s possible that within a few years, a cancer patient, or any other consumer, could stroll into a grocery store and buy oleocanthol supplements. For now, he recommends that people use extra virgin olive oil when cooking. “The darker the oil, the better the therapeutic effect. Because we were able to screen several batches of olive oil, we found the darker the batch the higher the content of oleocanthol,” El Sayed said. In the meantime, El Sayed said his goal is to continue working on the oleocanthol project until he sees the day when the compound, or a design-related analog, is approved as a drug. El Sayed said the researchers have several bioengineered analogs with much better anti-cancer activity – possibly four or five times as great – that can be made much less expensively than oleocanthol. El Sayed would like to see ULM establish a drug discovery center, like the National Center for Natural Products Research at the University of Mississippi, where he spent four years doing research.
Louisiana Medical News
OCTOBER 2014 • 5
Reimbursement Revisit, continued from page 1 majority of healthcare reimbursements, Lazerow said it appears the shift toward accountability models is picking up steam … albeit slowly. Lazerow, who is based in Washington, D.C., has created a ‘Field Guide to Medicare Payment Innovation’ (advisory.com). However, he was quick to note the transformation isn’t limited to the Centers for Medicare & Medicaid Services. “There is Rob Lazerow a lot of payment innovation happening right now, and it’s happening in both the public and private sectors,” he said. Lazerow added CMS, commercial payers, state Medicaid programs and employers are all experimenting with new payment models in markets across the country. While there is any number of subtle variations within the pilot projects, Lazerow said there are generally three big categories of payment innovation being rolled out at this time — pay-for-performance initiatives, bundled payments, and shared savings reimbursement models. Pay-For-Performance “It’s still a fee-for-service payment, but a portion is withheld and linked to predefined metrics, including process, outcomes and patient satisfaction measures,” he said. “Medicare has a lot of experience here,” Lazerow added of the Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program and hospital-acquired conditions (HAC) penalties. Lazerow said in some cases, it could mean hospitals must invest in performance software or additional manpower to provide the necessary outcomes data … effectively making it cost more to capture the same reimbursement rate compared to the pre-pay-for-performance world. However, as Lazerow pointed out, this isn’t a
‘request’ from CMS. These are mandatory programs for all hospitals that accept Medicare prospective payments with two of the three already in place and the HAC penalties set to begin in fiscal year 2015. “We’re seeing pay-for-performance in hospitals and physician practices,” Lazerow said, noting the reimbursement model has spread past the Medicare population. “The challenge then becomes having different payers with different metrics.” Even when broad categories of data collection apply to multiple payers, it isn’t uncommon for each to ask providers to drill down to different outcomes measures within the umbrella category. “As you can imagine, the reporting and compliance burden continues to grow,” Lazerow noted. Bundled Payments Lazerow said bundled payments offer a different take on volume-driven reimbursement by coordinating care among all providers responsible for a patient’s diagnosis, treatment and rehabilitation and inserting a level of accountability into the group dynamic. “In a traditional fee-for-service world, all these providers are paid individually and have no aligned incentives or mutual accountability,” he explained. Although bundled payments are still volume-based … the more you do, the more you are paid … Lazerow said the concept focuses on costs and outcomes. “A bundled payment drives efficiency and quality within a discreet episode of care.” For payers, Lazerow said the reimbursement model creates both savings and price predictability. The sum for the bundle of care is generally less than would have been paid individually to those involved. On the provider side, the reimbursement option helps drive efficiency and care coordination with a goal of having the patient receive the right care in the right setting to maximize outcomes and minimize costs.
While Medicare has a big program around bundled payments, Lazerow said this model has been adopted by the spectrum of payers including private employers. Wal-Mart, he noted, has established a bundled payment program around certain cardiac care and orthopaedic procedures. Although most current bundled payment programs are designed around specific procedures such as hip replacement or cardiac bypass surgery, Lazerow noted, “We’re starting to hear more interest around medical admissions, as well as the procedures.” Shared Savings Models Although bundled payments might be highly effective for unavoidable care, the concept doesn’t address preventive care. That’s where accountable care models … also known as shared savings … step in to apply population health metrics to mitigate potentially avoidable healthcare spending. The intent with these reimbursement models is typically to spend some in order to save more. “The big focus right now is on shared savings models,” Lazerow pointed out. He added providers work together against a pre-set annual spending target per patient. Unlike past payment experiments based on monthly capitated payments, the shared savings model combines existing fee-for-service payments with a reconciliation process at the end of the year. Providers then share in a percentage of the savings they generate. Best practices and quality metrics are a foundational element to ensure patients aren’t denied necessary care simply to save money. “The overall concept of the ACO is these providers are collectively accountable for the total cost and quality of care for populations of patients over time,” Lazerow stated. From Medicare Advantage plans to self-funded employers, the focus on population health has taken root across the country. While providers also seem to
embrace the evidence-based concepts and focus on chronic disease management integral to population health, the financial realities of such programs have proven problematic in some cases. Lazerow noted that of the 32 original participants in the CMS Pioneer ACO program, nearly onethird have left … with seven moving to Medicare shared savings programs, which have a lower risk profile for providers, and three dropping out altogether. “One challenge providers are facing is that sharing 50 cents on the dollar of volumes they are destroying might end up creating a negative financial outcome for the health system,” said Lazerow. “They’re not capturing enough of the savings they are generating.” The Bottom Line Lazerow noted he hears different sentiments from different providers as to which payment innovations they prefer. Some, he added, might like to stay in the traditional fee-for-service model, but that ultimately is unlikely given payer demands for more accountability, increased savings and improved efficiency. “Some providers right now, given their market dynamics, are in a watch and wait mode, but each year we see more and more payers and providers experimenting with accountable payment models,” Lazerow concluded.
Subscribe to
Online Medical News Free! Get the current online edition of Louisiana Medical News delivered to your desktop.
EMAIL NOTIFICATIONS
louisianamedical news.com 6 • OCTOBER 2014
Louisiana Medical News
CLEAR giving breast diagnostics a
advantage
eXPerienced sPeciaLists
advanced tecHnoLogY
aurora® 1.5t dedicated breast Mri sYsteM
BreAst MrI ALLOws us tO:
The Aurora® 1.5T Dedicated Breast MRI System offers significant
• screen women with a high risk of breast cancer
improvement in performance and diagnostic accuracy. This system
• Determine the extent of recently diagnosed cancer
is a state-of-the-art MRI scanner designed specifically to image breasts and is the only commercial, FDA-cleared dedicated breast
Refer your patients today to
• Monitor cancer therapy
imaging system available today.
• Assess cancer recurrence in breast cancer survivors
take advantage of our clearly advanced breast diagnostics.
• evaluate implant integrity
womensimagingcentre.com Philip Meyer, D.O. Board-Certified Diagnostic Breast Radiologist
5000 Ambassador Caffery Building 10, Lafayette, LA 70508 337.521.9182
Louisiana Medical News
OCTOBER 2014 • 7
Conducting Innovative Public Health Prevention Research By LYNNE JETER
TAMPA – Lexington Market-East End, a minimarket located in a historically black “food desert” neighborhood in Kentucky, was once considered an eyesore and unsafe place to shop. Now, it’s the centerpiece of a community driven by new and updated businesses and a stellar example of effective community-based prevention marketing (CBPM) for policy development. The successful overhaul, resulting from The Good Neighbor Store initiative, exemplifies only one project from an impressive track record that helped the Florida Prevention Research Center (FPRC) at the University of South Florida’s (USF) College of Public Health garner $4.35 million in federal funding over a five-year cycle from the Centers for Disease Control and Prevention (CDC) to conduct innovative public health prevention research among population health disparities.
8 • OCTOBER 2014
Louisiana Medical News
“We’re thrilled to receive funding for this particular grant, especially this go-round, because the field was highly competitive,” said Carol Bryant, PhD, distinguished USF Health professor and director of the FPRC. “Congress cut the funding level significantly for this cycle, dropping the number of recipients from 37
to 25. When we saw the recipient list, there were quite a few surprises. Harvard didn’t make it. Neither did the University of Michigan, which has a very strong program. The University of Texas, an original recipient with a terrific program, didn’t make it. This time, we competed against the University of Florida for the first time… such a stellar university.” The list of 24 academic institutions in 25 states became 26 schools when, at the last minute, the CDC added a second Pennsylvania system, making a second exception not to award two prevention research centers (PRCs) in the same state. (Two New York PRCs received CDC grants.) These PRCs will partner with communities to translate research results into effective public health practices and policies that avoid or counter the risks for chronic illnesses, including heart disease, obesity and cancer. (See the companion article listing the funded PRCs and their projects on page 9.)
“We worked tirelessly to have a very good proposal,” said Bryant, noting team members skipped vacations last summer and worked nights and weekends to finetune it. USF, whose FPRC program has been continuously funded since 1998, was the only Florida academic institution to make the final list. The USF center’s specialty niche: social marketing. The award “helps USF reinforce its brand equity as a leader in communitybased social marketing and gives us the credibility that allows us to be more effective,” said Bryant. Specifically, the FPRC’s award – $750,000 for the first year – will support research to promote colorectal cancer screenings among underserved populations initially in Hillsborough, Pasco and Pinellas counties, with plans to later expand to other regions of Florida. The project to promote colorectal cancer screenings among the underserved, selected by the Florida Department of Health, begins in October, Bryant explained. “This will be our first time for the center to work very closely with research colleagues at Moffitt Cancer Center, and (CONTINUED ON PAGE 10)
New State Law: Informed Consent Hierarchy by
Greg Waddell, Esq.
Healthcare professionals across the state should be aware of recently passed legislation involving Louisiana’s informed consent statue. Senate Bill 302 by Senator Fred Mills (R-Parks) affects the critical issue of patients who are unable to make healthcare decisions on their own, and addresses a scenario whereby the healthcare provider cannot locate a person in the standard line of consent. The measure, signed into law by Governor Jindal, adds two more classes of individuals who may consent on behalf of a patient who lacks the capacity to consent for them self. First, the legislation adds an “adult friend,” which is defined as “an adult who has exhibited special care and concern for the patient, who is generally familiar with the patient’s healthcare views and desires, and who is willing and able to become involved in the patient’s healthcare decisions and to act in the patient’s best interest.” Secondly, the legislation adds the patients’ attending physician when the following criteria are met: The attending physician shall document in the patient’s chart the facts that establish what medical decisions need to be made and why those decisions are needed without undue delay, as well as the
steps taken to obtain consent from the patient or another person authorized by law to give consent. The attending physician shall obtain confirmation from another physician, preferably the patient’s primary care physician if he or she is not the attending physician, of the patient’s condition and the medical necessity for such action as is appropriate and consistent with the patient’s condition and which cannot be omitted without adversely affecting the patient’s condition or the quality of medical care rendered. The confirming physician shall personally examine the patient and document his or her assessment, findings, and recommendations in the patient’s chart prior to the proposed surgical or medical treatment or procedures being performed. The Louisiana State Medical Society supported this bill during the recently completed legislative session. It addresses a growing problem many Louisiana hospitals experience - handling individuals who cannot make their own medical decisions, for whom no individuals can be found to make the decisions on their behalf.
Physicians’ health Foundation oF louisiana
Providing assistance with the identification, treatment, and monitoring of physicians who suffer from a physical or mental condition, in order to promote patient safety and to ensure the continued availability of skilled physicians
888-743-5747
www.phfl.org
Greg Waddell is and attorney and Vice President of Legal Affairs with the Louisiana State Medical Society
The cytogenetic laboratory and information resource of choice for physicians who demand accurate, timely, and state of the art cytogenetic diagnostic services for their patients.
• Chromosome Analysis • Polymerase Chain Reaction (PCR) • Fluorescence In Situ Hybridization (Fish) • Array Comparative Genomic Hybridization (Microarray) Genetics Associates Inc. is CAP accredited, CLIA and State of Tennessee Licensed. Our professional staff includes five American Board of Medical Genetics (ABMG) certified directors. 1916 Patterson Street, Suite 400 • Nashville, TN 37203 (615) 327-4532 • 1-800-331-GENE (4363)
Where advanced cytogenetic technology meets old-fashioned service www.geneticsassociates.com Louisiana Medical News
OCTOBER 2014 • 9
Federal Grants, continued from page 1
it’s CompliCAted...
We CAn Help The Louisiana Health Information Technology Resource Center, the state’s regional extension center (REC), offers a
Medicaid Specialists Program that includes education, technical and support services. you QuAliFy iF: • You are a specialty or sub-specialty physician, dentist, nurse practitioner or physician assistant. • At least 30 percent of your patient volume is attributed to Medicaid. • You are not currently receiving REC assistance.
to leArn more contact us at (225) 334-9299 or rec@lhcqf.org.
10 • OCTOBER 2014
Louisiana Medical News
lhcqf.org
A H e A lt H C A r e Q u A l i t y F o r u m i n i t i At i v e
Are you a specialty care provider who would like assistance meeting meaningful use objectives?
The program is “a major step” in addressing health disparities caused by cancer, especially minorities, and establishes new opportunities for cancer care in the region, Ochoa said. According to LSUHSC New Orleans’ Louisiana Tumor Registry, the incidence rates for cancers of all sites combined among white and black men as well as black women in Louisiana were significantly higher than those for their counterparts nationally. “We are excited to be one of the initial sites participating in this research effort. This is the first time we have a public private partnership such as this that will bring cutting edge cancer research treatments to the entire state,” said Glenn Mills, MD FACP, director of the Feist-Weiller Cancer Center on the campus of LSU Health Shreveport. The Gulf South program will create a new regional network that will serve Louisiana and parts of Mississippi. The comprehensive cancer management program creates a network of physicians, nurses and researchers from Louisiana’s and Mississippi’s major teaching and private medical institutions. The goal is to deliver the latest promising investigational treatments for cancer. The program will be open to all cancer patients, but the program’s focus is on minority and underserved patients. These patients suffer higher death rates from cancer than other people. The Gulf South NCORP initially included 25 clinical sites across Louisiana and Mississippi, although more will be added as the program develops. Those clinics cover 80 percent of the population in Louisiana and portions of the Mississippi Gulf Coast. In addition to the Feist-Weiller Cancer Center locations in Shreveport and Monroe, the regional network includes the Willis-Knighton Health System and Desoto Regional Medical Center. More sites will be added as the program develops. The regional network offers the possibility of both life-saving health benefits and a boost to the states’ economic health, with more jobs for physicians, nurses, researchers and other healthcare workers. Pharmaceutical companies will have
more opportunities to participate in the new biomedical and clinical research programs. It has been estimated that this kind of activity could bring in an additional $10 million over the grant period. Meanwhile, at Ochsner the NCORP funding replaces the Community Clinical Oncology Program grant, through which Ochsner has been continuously funded since 1983, and the National Cancer Institute Community Cancer Centers Program. Dr. Jyotsna Fuloria of the Ochsner Cancer Institute and principal investigator and site director for the NCORP award, said the NCI trials cover the whole array of cancer care. The NCI-sponsored trials include screening, early detection, treatment, supportive care and toxicity management, as well as cancer-care delivery research. “These trials will complement our other commercially sponsored and philanthropy-supported trials,” Fuloria said. Ochsner has more than 160 cancerrelated trials available for prevention, early diagnosis and treatment of all types of cancers including bone marrow, breast, colon-rectal, prostrate, pancreatic, ovarian, uterine, lung, and brain. Ochsner also has more than 690 federal, industry-sponsored or physician-initiated clinical studies underway. Ochsner is the largest clinical research center in the region and is leading the way in creating new strategies for prevention, early diagnosis, and treatment of diseases in the areas of cancer, among a host of other areas, said Sohail Rao, MD, MA, DPhil, Ochsner system vice president for research. Ochsner Health System President and CEO Warner Thomas said the prestigious NCORP award gives Ochsner’s physicians, nurses and other healthcare providers the opportunity to continue to offer innovative treatment opWarner tions to patients. Thomas The evidence-based data gathered from broad populations will be used to improve patient outcomes and reduce cancer care disparities.
Conducting Innovative, continued from page 8 state, regional and local partners, including the state health department, American Cancer Society, and many other community-based organizations in Tampa Bay’s tri-county region,” said Bryant. “Those partnerships will give us a fabulous interdisciplinary team. We’ll learn together how to think about applying social marketing to colorectal cancer screening by looking at the entire system.” The USF center will identify groups at high-risk for the disease that are most likely to respond to prevention marketing strategies with changes in behavior and therefore benefit from the tests that can find colorectal polyps or cancer. Colorectal cancer screening is the second leading cause of cancer deaths among
men and women in the United States, pointed out Julie Baldwin, PhD, professor of community and family health, who will become the FPRC co-director with Bryant this month as Bryant transitions to retirement in 2016. “Building upon established partnerships, we plan to identify, tailor, implement, and evaluate a multilevel intervention to increase colorectal cancer screening using community-based prevention marketing for systems change,” Baldwin said. “We’re very fortunate to draw upon our team’s expertise in social marketing and community-based participatory research, and our experience in developing and evaluating effective colorectal cancer interventions.”
3D Printing: Just What the Doctor Ordered By JUSTIN COUTU
For years we have seen 3D printing turn out a multitude of products; jewelry, jet engine parts, remote controls, sneakers. There are some that say this space-age technology also dances on the perimeter of creating items that can end a life, such as firearms. But the future of 3D printing isn’t about how it has the potential to hurt people but how it gives the medical community access to an emerging technology that can create physical objects from computer-designed blueprints – ears, jawbones, skull implants, mechanical devices that allow small children to use their arms, living human tissue and perhaps even actual human organs – all for the purpose of saving lives. Ever since the day Garrett Peterson was born, his parents have had to watch him suddenly just stop breathing. Garrett was born with a trachea so weak that the littlest thing makes it collapse, cutting off his ability to breathe. So the Petersons contacted Dr. Glenn Green at the University of Michigan, who specializes in conditions like Garrett’s. He teamed up with Scott Hollister, a biomedical engineer who runs the university’s 3D Printing Lab, to create a remarkable solution to Garrett’s problem — a device that will hold open Garrett’s windpipe until it’s strong enough to work on its own. First they took a CT scan of Garrett’s windpipe so they could make a 3D replica of it. Next they used the 3D printer to design and build a small, white flexible tube to fit around the weakest parts of Garrett’s windpipe. They quickly placed the first of two splints on one side of Garrett’s windpipe. It fit perfectly. So they got started on a second splint, which fit perfectly, too. After more than eight hours, both splints were securely in place. Then came the most important moment: What would happen when they let air flow through Garrett’s windpipe into his lungs? This time, Garrett’s windpipe stayed open, and his white lung turned pink. Garrett’s splint is designed to expand as he grows and eventually dissolve in his body as his own windpipe gets strong enough to work normally. But as amazing as this story is there was a moment when the doctors weren’t sure they were going to be able to pull it off. Not because neither they nor the technology was in question, but you can’t place something, legally, inside the human anatomy without the approval of the FDA, a stamp of approval that came at the last minute in the case of Garrett Peterson. As quickly as 3D printing and the medical field have embraced, the FDA has cast a wary eye from a distance. According to a recent report, the FDA treats 3D-printed devices the same way it treats conventionallymade medical devices. “We evaluate all devices, including any that utilize 3D printing technology, for safety and effectiveness, and appropriate benefit and risk determination, regardless of the manufacturing technologies used,” spokeswoman Susan Laine told LiveScience in an email. She added, “In some cases, we may require manufacturers to provide us with additional data, based on the complexity of the device.”
In order for a new device to receive FDA approval, its creators must either prove the device is equivalent to one already marketed for the same use, or the device must undergo the process of attaining pre-market approval. But according to the FDA, because 3D-printed products are made using different manufacturing methods than traditional medical devices currently used, they could require additional or different forms of testing. 3D printing isn’t only making an impact by creating parts to help the body from within; it’s also weaving its technological magic by helping patients adjust to everyday life from the outside-in. In this case, the Wilmington Robotic Exoskeleton (WREX), an assistive device made of hinged metal bars and resistance bands provides a solution for patients with underdeveloped arms to play, feed themselves and hug. And the moment Megan Lavelle saw the device, she knew it would change her daughter’s life forever. Lavelle’s youngest daughter, Emma, was born with arthrogryposis multiplex congenita (AMC), a non-progressive condition that causes stiff joints and very underdeveloped muscles. Emma was born with her legs folded up by her ears and her shoulders turned in. “She could only move her thumb,” says Lavelle. Doctors immediately performed surgery and casted Emma’s legs. The baby girl went home her parents who were determined to provide the best care. But at two years old, she still couldn’t lift her arms to play with things like blocks. The WREX worked for kids as young as six. But Emma was two years old and small for her age. For Emma to wear the WREX outside the workshop, doctors needed to scale it down in size and weight. The doctors printed a 3D-prototype WREX in ABS plastic. The difference in weight allowed them to attach the Emmasized WREX to a little plastic vest. The 3Dprinted WREX turned out to be durable enough for everyday use. Emma wears it at home, at preschool, and during occupational therapy. And the design flexibility of 3D printing allows continual improvements upon the assistive device, working out ideas in CAD and building them the same day. Fifteen kids now use custom 3D-printed WREX devices. Emma calls them her “magic arms.” As 3D printing continues to make quantum leaps in creating body parts, scientists have gone even further, using 3D printing to make blood vessels, skin and even primitive organs out of cells. Reports show that researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University and the Harvard School of Engineering and Applied Sciences (SEAS) have created intricately patterned 3D tissue constructs with multiple types of cells and tiny blood vessels. The work represents a major step toward creating human tissue, with the ultimate goal of building fully functional replacements for injured or diseased tissue that can be designed from CT scan data using computer-aided design (CAD), printed in 3D at the push of a button, and used by surgeons to repair or replace damaged tissue. “This is the foundational step toward
creating 3D living tissue,” said Jennifer Lewis, Ph.D., senior author of the study, who is a Core Faculty Member of the Wyss Institute for Biologically Inspired Engineering at Harvard University, and the Hansjörg Wyss Professor of Biologically Inspired Engineering at Harvard SEAS. Her team reported the results on February 18 in the journal Advanced Materials. According to the report, in order to print 3D tissue constructed with a predefined pattern, the researchers needed functional inks with useful biological properties, so they developed several “bio-inks” — tissue-friendly inks containing key ingredients of living tissues. One ink contained extracellular matrix, the biological material that knits cells into tissues. A second ink contained both extracellular matrix and living cells. To create blood vessels, they developed a third ink with an unusual property: it melts as it is cools, rather than as it warms. This allowed the scientists to first print an interconnected network of filaments, and then melt them by chilling the material and suctioning the liquid out to create a network of hollow tubes, or vessels. The Harvard team then printed 3D tissue with a variety of architectures, culminating in an intricately patterned construct containing blood vessels and three different types of cells — a structure approaching the complexity of solid tissues. Lewis and her team are now focused on creating functional 3D tissues that are realistic enough to screen drugs for safety and
effectiveness. “That’s where the immediate potential for impact is,” Lewis said. But in reality the impact 3D printing will play on the medical profession could go way beyond even Dr. Lewis’ wildest dreams, where creating life-saving organs— lungs, livers, hearts, maybe even the human brain—in just a matter of hours, isn’t simply a page in an H. G. Wells or Jules Verne novel, but an actual achievable goal. It’s not unrealistic to think that in the near future every hospital will be equipped with a 3D printer ready to create a customized part that will save a life by eliminating the need to ship plans to a factory. Now the device can be made in-house, often in a matter of hours. This is extremely important. Because when it comes to life and death situations, time is never a friend. “In my opinion, 3D printing is the most exciting thing I have seen since medical school,” said Dr. Glenn Greene, who created the solution to Garrett Peterson’s breathing problem. “We’re talking about taking something like dust and converting it into body parts. And in doing so we’re able to do things that were never possible before.” Justin Coutu is President of R&D Technologies, North Kingstown, RI. R&D Technologies is a reseller of the Stratasys line of 3D printing and rapid prototyping systems throughout New England, while also serving as a service bureau for companies throughout the U.S. who outsource their prototype printing. He can be reached at Justincoutu@rnd-tech.com. For more information visit www.rnd-tech.com
25 Years | Creating Facility Solutions
Architecture | Planning | Interior Design Shreveport | Jeffersonville | Louisville www.teg123.com | 318.424.3700
Louisiana Medical News
OCTOBER 2014 • 11
The changing role of SNFs By CINDy SaNDERS
Just as the notion of what’s considered ‘old’ has changed in today’s society … think ‘70 is the new 50’ … so too has the role and function of skilled nursing facilities. Gerald Coggin, senior vice president of Corporate Relations for National HealthCare Corporation, has witnessed transformative change in the long-term care industry during his more than four decades with NHC. With operations in 10 states, the publicly traded company based in Murfreesboro, Tenn. owns and/or operates 73 skilled nursing centers with 9,410 beds. NHC affiliates also Gerald operate 37 homecare Coggin programs, five residential living centers, 18 assisted living communities, plus offer additional services including long-term care pharmacies, memory care units, hospice care, and rehabilitative therapy. Coggin said the notion of a ‘nursing home’ as the last stop for seniors before they die is simply outdated. A little ironically, the industry has moved from being a residential model that looked like an oldfashioned, antiseptic medical facility …
Although NHC has adopted a medical model, the surroundings have an upscale residential feel.
to a medical model that often looks like a well-appointed residence. As the model has changed, one of the most striking differences is in length of stay. Coggin noted that less than a decade ago, NHC’s average length of stay was 210 days. Today, the median length of stay is 26 days. In a number of facilities, such as NHC Farragut in Knoxville, Tenn., that time frame is even shorter. “We’re serving more patients than
Primary Care - New Iberville Medical Complex OCHSNER HEALTH SYSTEM is seeking BC/BE Family Medicine and Internal Medicine Physicians to practice in our new 40,000 square foot Ochsner Iberville Medical Complex in Plaquemine, LA, scheduled to open for patients Dec. 1, 2014.
Primary Care Lead Physician
To lead a total of three healthcare providers including two primary care physicians, and one nurse practitioner or physicians’ assistant. Clinical leadership skills are required.
Primary Care Staff Physician
Physicians directly from residency training or with experience are welcomed to apply.
The medical complex will feature a free-standing 24/7 emergency department with an anticipated yearly patient volume of 10,000 – 12,000, an adjoining full service health center providing primary care, and have capacity for one OB/GYN or certified nurse midwife and two rotating specialists. Other features include: 22 patient exam rooms, lab services, and radiology services including X-Ray, CAT scan, MRI, Ultrasound and Mammography. Ochsner is perfectly positioned to provide value and efficiencies in the healthcare reform environment of accountable care, medical homes, budget cuts, declining reimbursement, and increased regulation. Ochsner Health System is a physician-led, non-profit, academic, multi-specialty, healthcare delivery system dedi-
cated to patient care, research, and education. Our mission is to Serve, Heal, Lead, Educate, and Innovate. The system includes 10 hospitals and more than 40 health centers throughout Southeast Louisiana. Ochsner employs over 900 physicians representing all major medical specialties and subspecialties. We conduct over 575 ongoing clinical research trials annually. We offer a generous and comprehensive benefits package and enjoy the advantage of practicing in a favorable malpractice environment in Louisiana. Please visit our website at www.ochsner.org. Ochsner is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, disability status, protected veteran status, or any other characteristic protected by law.
Please e-mail CV: profrecruiting@ochsner.org or call 800-488-2240. Ref. #APCNI01 Sorry, no opportunities for J-1 applications exist at present.
12 • OCTOBER 2014
PHOTOS COURTESY OF NHC
No Longer Last in Line
Louisiana Medical News
we’ve ever served, but the length of stay is much shorter than it’s ever been,” said Coggin. “Farragut is one of those facilities that is on the cusp of a new generation of long-term care. It’s all because of the emphasis on rehabilitation.” There are a number of reasons behind this change, but Coggin said cost and reimbursement … along with a culture shift … are among the primary drivers. The Omnibus Budget Reconciliation Act of 1987 signed into law by President Ronald Reagan fundamentally changed the way nursing homes operated … and simultaneously transformed society’s expectations of them. For long-term care facilities to receive Medicare and Medicaid funding in the post-OBRA world, they must provide services so that each resident might “attain and maintain her highest practicable physical, mental and psycho-social well-being.” “The emphasis was on making sure the right patient was at the right place. As a result, a new housing phenomena … assisted living … grew out of that,” Coggin explained. That ‘right patient, right place’ idea endured and changed the concept of how a skilled nursing facility could align with hospitals in an evolving post-acute care role. “So much has been driven by reimbursement,” Coggin noted. He added hospitals could only keep patients, who were progressing as expected, for so long before Medicare would stop paying the inpatient rates associated with the higher acuity level of care. Yet, Coggin continued, these patients weren’t ready to go home, either. “That’s when we saw a shift in our patients … from a few Medicare patients
Read Louisiana Medical News Online: LOUISIANA MEDICAL NEWS.COM
who needed rehab to a lot of patients needing rehab,” he said. A tiered-down system was born from these hospital reimbursement constraints. At the same time, a cultural shift was happening. Longer lifespans and medical technology improvements meant more seniors could expect to live active lifestyles far beyond retirement age … and the senior segment of the population also began to increase dramatically. According to the Social Security Administration, there were approximately 9 million Americans age 65 and over in the year 1940. By 2000, that number had jumped to almost 35 million. By 2010, that number had grown yet again to just over 40 million. Increasingly, Coggin said, skilled nursing facilities “are the recovery centers where you go to rehab.” He added with a chuckle, “It’s not unusual at all to have patients come to us for services and then get a note a month later saying, ‘Thanks for the rehab. I just finished a round of golf.” He continued, “I’ve been in this business for 41 years, and we have clearly switched over in the last 15-20 years from a residential model to a patient care model … and it’s ramped up even greater over the last 3-5 years.” Once again, he pointed to cost and reimbursement as drivers of the most recent jump in the rehab population. Not only do many SNFs like NHC provide a full range of occupational, speech and physical therapy services at a lower daily rate than hospitals, these post-acute facilities can also help hospitals avoid the monetary penalties associated with avoidable readmissions. Similarly, just as NHC accepts patients downstream from hospitals, the rehab facilities also look to move patients to a more appropriate care setting once therapists have maximized their time with a patient … whether that is to assisted living or hospice or a return home. In fact, Coggin said, about 80 percent of NHC’s patients ultimately are discharged home. “It’s clearly a focus on transitions of care to make sure the patient receives the appropriate level of care for the appropriate amount of time and avoids unnecessary readmissions,” Coggin concluded of the new role SNFs play in the care continuum.
ACA Grace Period Rule Could Pose Financial Risks for Providers By Ann B. DeBellis
A provision of the Affordable Care Act (ACA) has created a 90-day grace period that goes into effect before insurance policies can be cancelled for non-payment. This new rule has physicians concerned that the law could leave them unable to collect payment for treatments rendered, which could create a significant financial risk for medical practices and hospitals. The law provides patients who obtain subsidized coverage through state insurance exchanges a 90-day grace period before their policies can be cancelled for non-payment. Insurers are responsible for the first 30 days of care, but doctors will be stuck without payment for any services during the second and third months. Insurers may hold off paying the claims and ultimately can deny them if the patient doesn’t catch up on premium payments. Doctors can bill patients directly but may have difficulty collecting. The original version of the bill required that the insurance company cover medical bills for all three months of the grace period, but lawmakers changed the language after strong opposition by the insurance companies. The American Medical Association (AMA), which strongly
supported the ACA, is not happy. “The grace period rule imposes a risk for uncompensated care on physicians,” says AMA President Ardis Dee Hoven. “Managing risk is typically a role for insurers, but the grace period rule transfers twothirds of that risk from insurers to health care providers.” James A. Stroud, CPA, a healthcare consultant with Warren Averett in Birmingham, says the grace period is a major issue for physicians. “When corporations paid premiums for health coverage, we didn’t have this problem,” he says. “But when individuals purchase insurance, physician practices lose the certainty that premiums will be paid each month. That shifts the exposure from the insurance company to the provider. If the patient doesn’t pay, it’s the doctor or hospital that takes the hit.” Currently, a smaller than expected percentage of people in the Southeast have signed up for health care through an exchange. But by 2020, that percentage is expected to increase significantly, and If it does, it could become a big problem. To further complicate the situation, there is currently no system in place to notify physicians and hospitals when a patient falls into the grace period. With-
out that information, physicians will continue to treat patients, assuming premiums have been paid. “If a patient hasn’t paid premiums for the first 30 days, the provider doesn’t know about it,” says Mary F. Elliott, CPA, Chief Operating Officer for Warren Averett. “It does indicate payments pending for the next 60 days, but if coverage lapses after the 89th day, the provider will not get paid unless they go to the patient directly.” Stroud says another potential scenario can occur if a patient makes the first premium payment and goes to the doctor and receives a plan of treatment. “It can be costly to the medical practice to purchase drugs, especially for cancer treatment,” Stroud says. “If, during treatment, the patient stops paying premiums and the insurance company drops the coverage, the physician will be liable for the costs incurred. Because of their commitment to care for the patient and medical liability issues, the physician can’t drop the patient.” Maddox Casey, Warren Averett’s Service Area Leader for Healthcare in North Alabama, sees potential abuse by patients as a result of the grace period rule. “There may be a lot of unhealthy people on the exchange plans, and they
could pay premiums for one month and then drop the insurance,” he says. “One way to help collect from these patients is to get a credit card on file for each of them.” Elliott says they are advising their health care clients on the importance of having good practice management systems. “Just because a patient has an insurance card doesn’t mean he has coverage,” she says. “They must look up each patient, one at a time, to determine if they are covered. Most practices don’t have enough personnel to verify each patient, but they need to know in real time if they have insurance coverage.” Technology will eventually catch up with the law, but for now each practice will have to work out details for their individual situations. Stroud recommends that medical practices have financial counselors available to speak with patients prior to any procedures being performed. “The counselor can explain the cost to the patient and discuss the options for payment,” he says. “The art of collection is what we are working on with our clients. This is revenue cycle management and it’s a big deal. It will be an even bigger deal in the future.”
Louisiana Medical News
OCTOBER 2014 • 13
OUtline copy and paste select both sets of words hold shift key and select gradient choose reverse front to back text: 100 Helv. Ultra comp -20 AV(one on right) -100 (between words) stroke .25 pt.
In the News
LSU Health New Orleans Awarded Grant To Provide Early Data On Cancer In Kids
Time to Make Reservations
Louisiana Medical News is now accepting reservations for 2015!
Share your message with Louisiana’s professional healthcare community by reserving your advertising space now. No other publication has the targeted reach, the engaged readership, and the industryspecific editorial coverage offered by Louisiana Medical News. 2015 Editorial Calendar January – Public Health/ Infectious Disease – Health Law February – Cardiology – Mergers & Acquisitions
May – Women’s Health – Health Information Technology June – Men’s Health – Patient Care Models
March – Oncology – Healthcare Marketing April – Behavioral Health & Addiction – ICD-10/Practice Management
July – Personalized Medicine – Medical Schools/ CME August – Ortho/Sports Medicine – Compliance Mandates
September – Pediatrics – Reimbursement October – Neurology – Health Education November – Environmental Health/Medicine – Audits/ Compliance December – Pharmaceuticals – Financial/Tax Planning
Contact our sales staff to make your space reservation today. Baton Rouge, New Orleans, and Houma/Thibodaux Scott Cavitt • scott@louisianamedicalnews.com • (337) 255-4600 Lafayette, Lake Charles, & CENLA Brandy Cavitt • brandycav@gmail.com • (337) 235-5455
14 • OCTOBER 2014
Louisiana Medical News
NEW ORLEANS – The Centers for Disease Control and Prevention awarded LSU Health New Orleans School of Public Health’s Louisiana Tumor Registry a $1.3 million grant over five years to more rapidly find and report cases of cancer in children and young adults. One of only seven state registries to successfully compete for this funding, the award will support efforts to increase the availability of this data for surveillance and research activities at the local, state and national level. This continuation funding will enhance and build the existing infrastructure of the LSU Health New Orleans Louisiana Tumor Registry to capture this data more quickly and promote its use for research and cancer control programs. LSU Health New Orleans will enhance its cancer data on children and young adults by linkages with secondary data sets, providing a more robust research resource. Key partners include the LSU Health New Orleans Pediatric Cancer Program at Children’s Hospital where about 50% of new pediatric cancer cases are diagnosed and/or treated, major medical centers that treat pediatric cancers, St. Jude-affiliated clinics throughout Louisiana and out-of-state children’s hospitals. This data can serve as a valuable tool to better outcomes for young people who have cancer. “The data obtained from this award provides a unique opportunity for research to better understand why survival of a particularly vulnerable subgroup of adolescents and young adults has not improved over the last two decades and to change that,” concludes grant principal investigator Dr. Vivien Chen, LSU Health New Orleans Professor of Epidemiology. Dr. Chen led the Registry for many years and secured its designation as one of only 18 registries in the National Cancer Institute’s SEER Program.
Leonard Lacayo, MD, Joins Baton Rouge General Physicians
BATON ROUGE- Dr. Leonard Lacayo has joined Baton Rouge General Physicians. Dr. Lacayo is board certified in gastroenterology and has more than 20 years of experience. He is a graduate of Louisiana State University and earned his medical Dr. Leonard degree from Tulane UniLacayo versity School of Medicine in New Orleans, Louisiana. He completed his residency training at Mount Sinai Medical Center in Miami, Florida, and completed his fellowship in gastroenterology and liver diseases at Emory University Hospital in Atlanta, Georgia. Dr. Lacayo is a member of the American College of Gastroenterology. His office is located at Baton Rouge General Gastroenterology Center, 6615 Perkins Road in Baton Rouge.
EDITOR & PUBLISHER Scott Cavitt scott@louisianamedicalnews.com 337.235.5455 ADVERTISING SALES Brandy Cavitt brandycav@gmail.com 337.235.5455 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Ted Griggs, Lisa Hanchey, Lynne Jeter, Cindy Sanders
All editorial submissions, press releases, and comments should be mailed to: Attn: Editor Louisiana Medical News P.O. Box 60010 Lafayette, LA 70596-0010 or emailed to:
editor@louisianamedicalnews.com
Subscription requests or address changes should be mailed to: Louisiana Medical News P.O. Box 60010 Lafayette, LA 70596-0010 or e-mailed to:
scott@louisianamedicalnews.com Subscriptions: One year $48 • Two years $78
Louisiana Medical News is published monthly by Louisiana Medical News, LLC in affiliation with Medical News, Inc. All content ©Louisiana Medical News, LLC and Medical News Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes. Louisiana Medical News and the Helvetica font logo are registered trademarks of the publisher and may not be used without the prior written consent of the publisher.
PRINTED ON RECYCLED PAPER
www.louisianamedicalnews.com
In the News Scott Clinic Welcomes Family Medicine Physician
Radiology Associates Hires Beau S. Black, M.D.
LAFAYETTE – Family Medicine practitioner Jean C. Ancelet, M.D., has joined the practice of Darrin Menard, M.D., and Geoffrey Mire, M.D., at Scott Family Physicians in Scott. Dr. Ancelet has experience treating ailments such as allergies, asthma, arthritis, Dr. Jean C. heart and blood pressure Ancelet problems, diabetes and many other conditions. Dr. Ancelet earned his Bachelor of Arts degree from Centenary College in Shreveport and his Doctor of Doctor of Medicine degree from the LSU School of Medicine in New Orleans. He completed his residency at Lake Charles Memorial Hospital in Lake Charles. He is board certified by the American Board of Family Medicine. Lafayette General Health welcomes Dr. Ancelet to Acadiana. Scott Family Physicians is located at 202 Westgate Rd., in Scott.
BATON ROUGE- Radiology Associates announces the hiring of Beau S. Black, M.D. He is a board certified, fellowship trained radiologist who brings interventional expertise to the group. “We are excited to add Dr. Black to our Dr. Beau S. team,” says Dr. Robert F. Black Hayden, M.D., Radiology Associates’ Managing Member. “In ad-
Dr. Clement Wade Fox Appointed Chief Medical Officer at Gulf South Quality Network METAIRIE- Dr. Clement Wade Fox has been appointed as Gulf South Quality Network’s Regional Chief Medical Officer (RCMO). “Dr. Fox brings our organization the leadership and experience to move from our current healthcare delivery system to a model focused on population management, clinical best practice, and physician efficiency as it relates to patient care,” says Bill Bopp, President of GSQN. Dr. Fox has remained a long-time advocate of improving quality health care. As a result, he has acquired an extensive executive and clinical career history. Previous job titles include: Medical Director of National Accounts for Blue Advantage Administrators of Arkansas, Medical Director for Health Advantage and Clinic Arcadia SHS, Clinical Di- rector of Rural Health Affairs for Schumpert Health System. Dr. Fox also carries a strong background in working at a Private Clinical Practice, specializing in Pulmonary Diseases and Critical Care Medicine. Dr. Clement Fox completed his residency and received his Doctor of Medicine at Louisiana State University Medical Center. He holds a Master of Business Administration from Centenary College of Louisiana and has a Bachelor of Fine Arts in Broadcasting/ Film from Southern Methodist University. He also maintains involvement as a Fellow of the American College of Chest Physicians in Northbrook, Illinois, American College of Physicians in Philadelphia, and is an associate of the American College of Physician Executives in Tampa, Florida. Fox also is a community member on the Institutional Review Board Central for Arkansas Veterans Health System.
at Louisiana State University Health Sciences Center School of Medicine- New Orleans. He completed his Internal Medicine Internship at Louisiana State University Health Sciences Center School of Medicine- New Orleans. He completed his Radiology Residency at University of Texas Medical School in Houston, Texas. Dr. Black is a member of Alpha Omega Alpha, American College of Radiology, Radiological Society of North America and Society of Interventional Radiology.
dition to being a board certified diagnostic radiologist, Dr. Black has recently completed a year-long angio-interventional fellowship at MD Anderson. His skills will bolster an already strong and dynamic interventional service at Our Lady of the Lake Regional Medical Center.” Most recently Dr. Black completed his Interventional Radiology Fellowship at MD Anderson Cancer Center in Houston, Texas. He graduated with a Bachelor of Science in Biological Sciences from Louisiana State University. He earned his M.D.
Introducing A New Primary Care Program That Rewards Doctors and Patients for Better Health.
We invite our network primary care doctors in Family Medicine, Internal Medicine or General Practice to learn more about Quality Blue Primary Care.
We all know chronic illness is destroying lives. And crippling the healthcare system. That’s why Blue Cross has created Quality Blue Primary Care, a program that rewards doctors for getting better health results for our Blue Cross members. Especially those with chronic health issues. Our Quality Blue Primary Care program offers primary care practices in our network access to technology, tools and services to help them focus on what they do best: treating patients. Plus, providers and clinics enrolled in the program are paid a monthly care management fee—on top of their usual fee-for-service amount. Patients benefit. Providers benefit. And together, we create a healthier, more affordable healthcare system for all of us.
Dr. David Carmouche Executive Vice President of External Operations & Chief Medical Officer Blue Cross and Blue Shield of Louisiana
01MK5620 06/14
For more information on Quality Blue Primary Care: Call 800.376.7765 Email ClinicalPartnerships@bcbsla.com Visit www.bcbsla.com/qbpc
Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.
Louisiana Medical News
OCTOBER 2014 • 15