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Philip J. Blount, MD ON ROUNDS

Improving Continuity of Care for Babies NMMC and Baptist Union County partner on the first placement of an acute care telemedicine system in Mississippi NEW ALBANY–Baptist Memorial Hospital-Union County and the North Mississippi Medical Center’s (NMMC) Women’s Hospital in Tupelo are partnering for the first neonatal telemedicine initiative between two non-affiliated hospitals in Mississippi ... 3

A New View on Clinical Stroke Research Everyone wants to build a better mousetrap … but building it over and over again isn’t very efficient. Finding a way to keep the ‘mousetrap’ infrastructure in place while adding new features based on a collective body ... 9


Taking Action

Gov. Phil Bryant unveils new telehealth program to address state’s growing diabetes crisis Gov. Phil Bryant recently unveiled a program – a first of its kind nationwide – designed to address the state’s growing diabetes crisis while also reducing the total cost of care. To create the Diabetes Telehealth Network, Bryant partnered with the University of Mississippi Medical Center (UMMC), North Sunflower Medical Center (NSMC), GE Healthcare, Intel-GE Care Innovations and C Spire to offer diabetic patients more consistent and timely access to clinicians through the use of telehealth technology in their homes. “This revolutionary telehealth effort will deliver top-notch medical care to patients in one of Mississippi’s most medically underserved areas, providing a new lifeline for health and disease management,” said Bryant. “Innovations like this also spur further growth and economic benefit in the medical industry.” Mississippi ranks second among states nationwide in disease prevalence. Nearly 400,000 adults

Governor Phil Bryant at press conference unveiling Diabetes Telehealth Network.


Preparing for ICD-10 Conversion

Practice management consultant shares 8 steps for physicians to take now

Editor’s note: The Medical News It’s not too late to bring those Medicare has announced series, “Preparing for ICD-10 Conpractices up to speed, said that testing will occur the week of version,” began last month with Jennifer O’Brien, MSOD, March 3-7. A couple of fiscal intermediaries are requiring “8 Steps” for physicians to take a practice management providers to register to participate in the testing. At this now. This month, implementconsultant with Karenpoint, there’s no indication of another testing period, so if ing the “4 Ts” is the focus Zupko & Associates Inc. practices or clearinghouses miss that testing, there may not recommendation to facilitate a “Time is of the esbe another opportunity before October 1. sence, however,” she smooth transition. said. “Physician practices – Jennifer O’Brien, MSOD, Practice Management Even though ICD-10 conneed to understand the enorConsultant, KarenZupko & Associates Inc. version has been anticipated for mity of this mandated transition many years industry-wide, most physician that will affect their bottom line.” practices haven’t had the resources or the inclination to start O’Brien recommends applying the “4 Ts.” (CONTINUED ON PAGE 8) preparing before now.

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Philip J. Blount, MD By LUCY SCHULTZE

For physical medicine and rehabilitation physician Philip J. Blount, MD, success in patient relationships often hinges on a case-by-case definition. “This patient population, to a lot of medical professionals, can be very frustrating and difficult to manage,” said Blount, who treats those with nonsurgical orthopedic problems as well as those recovering from serious injuries, chronic conditions, or disabilities like stroke, amputations and spinal-cord injuries. “I think what some physicians might see as frustrating and futile, others can see as very rewarding when you’re able to come together with a patient, caregiver or family member and identify realistic, attainable goals that can give them a better quality of life,” Blount said. “When you approach it like that, it’s very rewarding.” The chance to interact with such patients in an outpatient environment drew Blount to a new position in January at the Methodist Spine and Joint Center on the Flowood campus of Methodist Rehabilitation Center. He previously served on the faculty of the University of Mississippi Medical Center, where he was an associate professor of physical medicine and orthopedic rehabilitation. “I’ve been very grateful for my experience at UMC, where I had the opportunity to work on the inpatient rehabilitation unit and was able to follow patients during their hospitalization and post-discharge,” Blount said. “I was also able to work in a team environment with our therapists, nurses, discharge planners and social workers to see firsthand how an integrated team approach can assist in patients’ success with their new medical condition.”

Continuing to apply that team approach, as well as the general rehabilitation principles in which he trained, were among aspects Blount was looking forward to as he began his tenure with Methodist. “A unique aspect of our practice is that we will develop specific individualized goals for each patient as part of our medical management – whether it’s getting people back to their sport or activity, back to work, or even success in being back at home,” he said. “Working from a team approach, I also appreciate being able to learn and see what other medical professionals like our therapists, our prosthetic doctors and our wheelchair-seating specialists can do and bring to the table when it comes to patient care.” A native of Jackson, Blount holds a bachelor’s degree from Baylor University

in Waco, Texas, and a medical degree from UMC. He completed an internship in general surgery at Wake Forest University Baptist Medical Center, followed by a residency in physical medicine and rehabilitation at the Carolinas Medical Center/Charlotte Institute of Rehabilitation. Blount received fellowship training in Rochester, Minn., at the Mayo Clinic’s Department of Physical Medicine and Rehabilitation. He is board certified in Physical Medicine and Rehabilitation, Electrodiagnostic Medicine and Sports Medicine. Even after training out of state, practicing in Jackson was a natural choice. “Home is home, and all of my family is here,” he said. “I have lots of strong family ties, friendships and relationships here.” “It’s always very rewarding to come back to a familiar area where people know and serve each other. I’ve also had the chance to be involved in the care of family friends.” For Blount, the personal connection extends even deeper, because his practice gives him the chance to apply lessons learned on the other side of the doctor-patient relationship. He experienced the rehabilitation journey himself as a first-year medical student, after sustaining major multiple trauma in a serious car accident. “I got firsthand knowledge of the process of suffering from an injury, recovering and getting back to a normal life,” he said. “With that personal history, I used my academic aptitudes with the musculoskeletal system and neurological system to choose a specialty in physical medicine and rehabilitation.” The experience of going through rehabilitation and recovery himself also allowed Blount to tune-in to the particular type of patients he’d be working with in his

St. Dominic’S carDiovaScular Surgery aSSociateS iS pleaSeD to welcome

Antoine Keller, MD, FACS Antoine Keller, a native of Louisiana, attended undergraduate school at the University of California, Los Angeles and then went on to Duke University School of Medicine where he graduated with honors. Dr. Keller completed his general surgery internship, residency and fellowship at Tulane School of Medicine, where he was active in various experimental and clinical research projects. He completed his thoracic and cardiovascular surgery residency at the Carolinas Heart Institute (Sanger Clinic) in Charlotte, North Carolina. He is board certified in General, Cardiovascular and Thoracic Surgery. St. Dominic’s Cardiovascular Surgery Associates 971 Lakeland Drive, Suite 657 Jackson, MS 39216 | 601-200-2780

S k i l l e d H a n d s . C o m p a s s i o n at e H e a r t s .


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MARCH 2014

specialty area. “While there are a lot of medical problems that happen as people get older, trauma is more common in a younger demographic,” he said. “Trauma, such as spinal cord injury, traumatic brain injury or multiple fractures, often occurs in the age when people are working, starting careers and starting families. “These injuries can result in functional deficits that limit normal activities of daily living or mobility. Rehab medicine plays such an important role in a patient’s full and maximum recovery.” In addition to those recovering from trauma, Blount’s patients at Methodist include those with serious neurological conditions as well as those with common and frustrating musculoskeletal issues like neck, joint and back pain. Beyond the clinic, Blount enjoys blending his professional and hobby interests by maintaining a Wilderness First Responder qualification in addition to his sports medicine credentials. “Using those two skill sets and backgrounds enables me to apply good, practical medical advice and treatment in a variety of environments — maybe in the clinic, maybe on the athletic field, maybe at the ballet studio or maybe in rural Mississippi in a mobile home,” he said. Blount, who worked as a park ranger at Olympic National Park in Washington during college and has also participated in the Outward Bound program, continues to nurture a lifelong love of the outdoors. It’s an interest he shares today with wife Carrie and daughters Kimberly, 11, and Bailey, 7. He enjoys cycling, geocaching and hiking with his family. They are also active members of Northminster Baptist Church.

Online Event Calendar To submit or view local events visit the Mississippi Medical News website. A user name and password are required to submit an event. Under Member Options, go to “free sign up” to register.

1/14/14 3:28 PM mississippimedicalnews


Improving Continuity of Care for Babies NMMC and Baptist Union County partner on the first placement of an acute care telemedicine system in Mississippi NEW ALBANY–Baptist Memorial Hospital-Union County and the North Mississippi Medical Center’s (NMMC) Women’s Hospital in Tupelo are partnering for the first neonatal telemedicine initiative between two non-affiliated hospitals in Mississippi. Using innovative two-way audiovisual communications, clinical data access and medical imaging, neonatologists may now provide immediate consultative care to physicians in New Albany. “With the flip of a switch, I can examine a baby in New Albany without ever leaving the NICU in Tupelo,” said Bryan Darling, MD, a neonatologist on staff at NMMC Women’s Hospital. In fact, Darling, who has been using telemedicine technology with Le Bonheur Children’s Hospital in Memphis since the mid-1990s, may access the technology anywhere that wireless Internet is available. “This technology has so far surpassed what we could do then by allowing us to

take such a close look at the baby,” he said. “If a pediatrician in New Albany calls me about a baby, I just log in to the system, and it’s like I’m there.” Darling said he could actually hear better through the stethoscope attachment and Bose earphones than with his own stethoscope. “I can even zoom in on an image and take photos or draw on the X-ray to show the parents,” he said. Keeping babies as close to their par-

ents as possible is the ultimate goal, said Darling. “This technology allows me face-toface communication with the parents,” he said. “It’s nice for them to see who their baby is being shipped to before the transfer.” Walter Grace, administrator and

CEO of Baptist Union County, said the partnership would enhance the services offered to newborns, particularly those who need intensive care. “Patients can now receive this service without leaving New Albany,” he said. “The evaluation will come from physicians trained specifically to handle the most complex and high-risk situations in newborns.” Ellen Friloux, administrator for women and children’s services at North Mississippi Medical Center, said the neonatology service at Baptist Union County will improve the continuity of care for the patient and family. “This telemedicine project will improve communication with referring physicians and with new parents when the neonatologists are consulted or when a baby is referred to NMMC’s neonatal intensive care unit,” Friloux said. “The neonatologists will be able to not only hear from the physician how the baby is doing, but will also be able (CONTINUED ON PAGE 10)

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Advancing Alzheimer’s Research Mississippi chapter prepares for April 5 fundraiser Next month, the Mississippi chapter of the Alzheimer’s Association will host what’s quickly become the state’s largest annual wine and culinary extravaganza. Santé South 2014, which features boutique vintners worldwide presenting their annual new release wines, will take place during the Ridgeland Fine Arts Festival at Renaissance at Colony Park on April 5. Santé South affords a rare opJNLMSMed-2 portunityJNLMSMed-2 for the wine enthusiast to speak

directly with the winemaker and features more than 120 exceptional wines and fine food samplings from more than 20 top Mississippi restaurants. Only small production and boutique wineries are invited to Santé South. Since 2006, the signature event for the Metro Jackson area has generated more than $350,000 for the Mississippi chapter for Alzheimer’s care, support and research.

Last month, the national organization received a boost with an unprecedented $122 million increase in federal funding for fiscal year 2014 to help meet the goal of the National Alzheimer’s Plan of preventing and effectively treating Alzheimer’s by 2025. The increase adds $100 million for National Institute on Aging for Alzheimer’s research, and includes extra money for caregivers, training for healthcare providers on Alzheimer’s issues, ex-

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panding the home- and community-based caregiver services. Legislatively, the Mississippi chapter is lobbying for passage of a bill that would provide a more uniform and efficient adult guardianship system. House Bill 218 and Senate Bill 2240 follow the 2007 national model, Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act, to allow guardians to easier assist dementia patients in crisis without intrastate wrinkles. The Council of State Governments (CSG) recommended it as “suggested state legislation” in 2007. Since then, 39 states have passed it. This year, it was introduced in Mississippi, Massachusetts and Maine.

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Prepping for Walking Season The Mississippi chapter of Alzheimer’s Association has eight Walk to End Alzheimer’s fundraisers slated for 2014. All have been moved to the cooler, more predictable (weatherwise) days of autumn: Metro Jackson: Sept. 13 at the Mississippi Museum of Art in Jackson. Tupelo: Sept. 20 at Ballard Park in Tupelo.

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Predicting the ICD-10 Conversion Outcome Some pundits liken it to Y2K issue; others call underestimating change ‘dangerous’ Controversy has swirled about a recent New York Times article stating that “some healthcare executives say predictions of a fiasco next Oct. 1 will prove as erroneous as those that said civilization would collapse on Jan. 1, 2000 ... the socalled Y2K issue.” “It’s not going to be a shock to the industry to confront this,” Christopher G. Chute, professor of biomedical informatics at the Mayo Clinic, told the NYT. “We’ve literally had seven or eight years to anticipate it.” Underestimating the conversion to ICD-10 is dangerous, say practice management experts. “When you’re in a roomful of payors hearing them talk about how they’re worried, it scares me,” said Shelly Bangert, director of revenue cycle management for Hawthorn Physician Services Corporation, one of the nation’s leading healthcare revenue cycle management companies. “Bigger payers are still expecting hiccups, and they’ve been working on this conversion for several years. We want to make sure practices are prepared.” The cost of preparing the new system by the original implementation date of Oct. 1, 2013, has already been financially draining for some providers, who had sunk hundreds of thousands of dollars



MGMA of Mississippi’s ICD-10 Boot Camp will be held March 20-21 at Hinds Community College Muse Center in Raymond. At press time, the workshop was quickly filling up, with less than a dozen spots remaining. The workshop cost for MGMA and MGMA of Mississippi members is $795. For non-members, the fee is $995. (Annual membership to MGMA costs $125.) In addition to the 2-day code set training, each attendee will receive an ICD-10 CM code manual, online general code set training access for use after the boot camp, an ICD-10 practice proficiency assessment voucher and 16 CEUs.

into meeting that deadline. “Some hospitals had teams ready to go, consultants in place,” said Bangert. “Then when the start date was postponed a year, everything was put on hold and money was lost. The payors were saying the same thing, but they were losing millions trying to convert dozens of systems – antiquated, those inherited from buyouts, and new and upcoming systems – into one that would work with ICD-10 codes.”

Practice management consultants also expressed concern about the American Medical Association’s recent ICD-10 readiness survey that ended Jan. 31, saying it’s irresponsible of the national group to take such a step nine months out, and will only put physicians in a greater state of denial and therefore less prepared for the new conversion date. “Some will run smoothly,” said Bangert. “Others will be total catastrophes. When you have a payor who’s just as worried about underpaying as overpaying, and reconciling and going through millions of provider contracts manually to make sure they’re all updated is overwhelming. That worries me. It won’t be a piece of cake. Some practices may go out of business as a result.”

Risk Assessment

Hospital informatics folks and administrators may have done a thorough job of preparing on behalf of the hospital but the situation physician practices face is different, said Jennifer O’Brien, MSOD, a consultant with KarenZupko & Associates Inc., a Chicago-based firm that has been specializing in physician practice management for 29 years. “If everything isn’t perfectly in place for the conversion to ICD-10, it’s not re-

duced reimbursement rates (that) practices are facing; it’s zero reimbursement,” said O’Brien. “Reimbursement rates for physician services aren’t directly attached to diagnosis codes, but rather to CPT codes. Diagnosis codes provide the justification for those CPT codes. It’s an all-or-nothing thing. We’re not talking about a risk of reduced reimbursement on a claim-by-claim basis; the risk is zero reimbursement because the ICD-10 code isn’t accurate and specific to justify the CPT code.” Decidedly, overall reimbursement flow will be slower, said O’Brien. “Hospitals and larger healthcare organizations have larger IT and administrative support structures, profit margins, cash flow, established credit lines and longer revenue cycles than physician practices,” she said. “If a physician practice averages 45 days (from the date of service) in accounts receivable (before payment) and a hospital averages 105, the practice is going to feel it in the reimbursement by November 15, 2014, whereas the hospital payment cycle doesn’t have it receiving payments for early October services until later.” Unfortunately, most practices haven’t been preparing well enough for the conversion date. (CONTINUED ON PAGE 10)

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Taking Action, continued from page 1 statewide have some form of diabetes. In 2010, 12 percent of adults in the Mississippi Delta, which remains one of the nation’s more underserved and impoverished regions, reported being diagnosed with type 2 diabetes; 293 died from complications related to the disease. In 2012, diabetic medical expenses in Mississippi totaled $2.74 billion, according to the American Diabetes Association. The network will begin recruiting patients this spring in the Mississippi Delta to participate in an 18-month remote care management program, a concept that fuses technology with UMMC specialists to improve patient outcomes in a historically underserved area of the state. “We know that diabetes is one of the foremost chronic diseases in Mississippi,” said Kristi Henderson, DNP, CFNP, director of telehealth at UMMC. “This program can help improve care coordination and strengthen connections between clinicians and patients, and will serve as a proof of concept as we look to expand this model geographically and to other diseases. Sunflower County has been a pioneer with us for telehealth and often is one of our primary sites in starting up new specialties.” UMMC’s Center for Telehealth offers a growing list of specialty services, including cardiology, dermatology, pediatrics, emergency medicine and stroke, through audio/visual link-ups at clinics and hospitals across the state. The Diabetes Telehealth Network will take that concept one step further by putting that technology in the hands of the patients themselves in the form of Internet-capable tablets equipped with the Care Innovations™ Guide platform. The Care Innovations™ Guide platform enables healthcare providers to offer a clinically driven, fully integrated remote care management solution for populations with chronic conditions. The project will recruit up to 200 patients in Sunflower County, who will use Care Innovations technology to share health data – weight, blood pressure, and glucose levels – daily with clinicians. The routine updates provided by patients will give clinicians a much more complete view of a patient’s health status. With this information, clinicians may easily adjust medical care, and also schedule phone calls or video chats with patients as needed. This type of “just-in-time” education can help avoid serious complications and also develop long-lasting behavioral change. Clinicians also can see a snapshot CLARIFICATION The Family Medicine Residency Program in Tupelo is an ACGME program with eight residents per year for Family Medicine, with a mix of MDs and DOs without being dually accredited. The only program linked to Tupelo was a cardiology fellowship that closed approximately 2 years ago.

of all patients under their care to help them better understand which patients need immediate support, making them more efficient and proactive. By using specialized tablet computers with mobile broadband access and cutting edge telehealth, the program is able to bring the resources and expertise of the state’s only academic medical center, UMMC, to rural Mississippians, rather than requiring them to travel to UMMC in Jackson, said Henderson. “We’ll bring UMMC’s specialists, including the pharmacist, the diabetic educator, the nurse, the endocrinologist and the ophthalmologist, to the Mississippi Delta through this technology,” she said. “We’ll be able to provide interactive video consults, deliver patient education, and engage with the patient daily to meet their needs. Until now, this type of coordinated care that engages the patient in their home setting was simply not an option.” With a telehealth relationship already in place at North Sunflower Medical Center, Henderson said the project came together with the technological and telecommunications resource support of Bryant, GE Healthcare, Care Innovations and C Spire. “North Sunflower Medical Center is excited and pleased to have been chosen for the opportunity to partner with the Governor’s Office, C Spire, GE, Care Innovations and UMMC on the Mississippi Diabetes Telehealth pilot project,” said NSMC Executive Director Billy Marlow. “We wholeheartedly support the use of the latest technology in aiding our patientcentered, team approach to controlling diabetes in the Mississippi Delta.” Care Innovations CEO Sean Slovenski said the new model of clinical care has delivered positive results and shown value in supporting management of chronic conditions. “Care Innovations is honored to have been chosen for this initiative, which we believe has the potential to transform care delivery in a way that solves real problems,” he said. Marcelo Mosci, president and CEO of GE Healthcare, U.S. and Canada, said the goal of extending world-class care into the homes of rural Mississippians who deal daily with the challenges of diabetes and other chronic conditions “is a goal that clinicians, policy-makers, industry and patients can all rally behind.” “We’re excited to help launch this innovative program alongside Gov. Bryant, and we’re confident that efforts like this will be vital in expanding access to quality healthcare for more people,” he added. C Spire CEO Hu Meena said the innovative pilot program “promises to make a real difference in the lives of Mississippians who are dealing with the reality of this chronic disease every day.” “Combining the power of our highspeed mobile broadband communications network with technology solutions from Care Innovations to link specialists at UMMC and patients in new ways will help us deliver more connected, collaborative and cost-effective care,” he said. mississippimedicalnews


UMMC Expanding Aircare Service to Grenada This spring, the University of Mississippi Medical Center (UMMC) will add a third AirCare helicopter to be based at UMMC Grenada, joining emergency flight service bases at the primary UMMC campus in Jackson and at Key Field in Meridian. “This expansion would improve emergency care in Mississippi, reduce response times, and help patients survive traumatic events,” said James E. Keeton, MD, UMMC vice chancellor for health affairs. “The timing and market are right for this expansion and certainly the need is present. We’ve been looking at this addition since bringing Grenada’s medical center into the UMMC family.” Last August, UMMC signed an agreement with the Grenada facility. A longterm lease went into effect last month. AirCare, which completed its first flight in February 1996, transports patients from accident sites to medical facilities and between hospitals. Administrators added the Meridian-based helicopter in 2009 and a dedicated hangar and other permanent facilities there late last year. The newest expansion would require approval from the Mississippi Institutions of Higher Learning Board of Trustees. UMMC would lease the third helicopter and source pilots and mechanics from its current partner, Lafayette, La.based PHI Air Medical. With all agreements and approvals in place, the new helicopter and four flight crews of a nurse, paramedic and pilot each, could be operational by April, said Jonathan Wilson, UMMC director of emergency services. “Our flight radius with this new aircraft, as with our current ones, would allow us to meet our mission of serving the entire state,” Wilson said. Even though the aircraft would primississippimedicalnews


marily serve north Mississippi and help reduce the amount of time it takes to get patients to definitive care, UMMC plans to build on relationships with the other hospital-based flight services, like North Mississippi Medical Center’s CareFlight and the Hospital Wing in Memphis, said Wilson. “By working together, we can provide the best patient care possible in support of local emergency-responders and hospital providers,” he said. AirCare’s helicopters are coordinated through Mississippi MED-COM, the statewide emergency medical communications and coordination hub at UMMC. Wilson said in addition to improving emergency medical care in Mississippi, the expansion would positively impact the state’s economy. “We would add over 15 jobs, leasing an aircraft and providing a valuable service to our state’s communities for years to come,” he said. AirCare Program Director Donna Norris said the service transports more than 1,000 patients annually using the two helicopters. She estimates the third would add 300 transports annually. “These are essentially flying intensivecare units capable of treating all ages, from newborn through adulthood,” Norris said. “For example, we can administer blood or specialty medications to treat clogged vessels causing heart attacks and strokes to our patients. We utilize an isolette to transport premature infants. And our pilots can fly in some marginal weather conditions using instruments-only. All those capabilities are important because they increase each patient’s chances for survival.” Norris said the new helicopter would be an American Eurocopter 135, the same model based in Meridian.

CONGRESSMAN STEVEN PALAZZO VISITS SOUTHERN EYE CENTER Deemed a “Center of Excellence” by local Congressman HATTIESBURG, MS, JANUARY 17, 2014 – Southern Eye Center has been a pillar in the Pine Belt community for over 35 years. A regional eye care and surgery center, Southern Eye Center has transformed the lives of thousands of patients. On Monday, December 16th, local Congressman Steve Palazzo visited Southern Eye Center to tour the facilities and observe the workings of the clinic. “The one thing I noticed immediately was this is a center of excellence. Not just here in South Mississippi but probably across the United States, if not the world. Where the doctors are first rate, the nurses, the staff … and you can pick all that up with the sense that the patients, they really seem to be happy to be here. There are not too many profesions or businesses where you see that kind of relaxation and them knowing that they are probably going to get the best care anywhere right here at Southern Eye Center.”

Southern Eye Center has stood as a landmark for exceptional eye care in South Mississippi, specializing in a wide range of eye care procedures from cataract removal to corneal transplants. Deemed as a “center of excellence” by Congressman Palazzo, Southern Eye Center continues to not only treat and serve the great people of South Mississippi, but also inspires others to give back in the community, by offering no cost procedures to selected individuals. The Pine belt community can rest-assured that the care they receive at Southern Eye Center, is a world class eye care right here in Hattiesburg, MS. With fellowship trained eye surgeons in Cataract, Cornea, Glaucoma, Retina, and ocular plastics Southern Eye Center is a regional eye care and surgery center serving the Pine Belt since 1976.  For more information, visit

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Preparing for ICD-10, continued from page 1

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Team: Establish a work group for ICD-10 conversion.

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“The group should be a cross section of the practice, including at least one physician, biller, and clinical assistant, and representatives from other functions in the practice that have diagnosis coding as part of their work, such as a surgery scheduler or ancillary service provider,” said O’Brien. “The practice manager Jennifer or administrator, O’Brien someone who has an understanding of the whole practice, should also be included. This will require true teamwork. No one person should be shouldering the bulk of the conversion for two reasons: it’s too much and it’s too risky. If one person is doing almost everything and wins the lottery in July, the conversion will fall apart.” Place a year-at-a-glance calendar in a common staff area so all employees may see the deadlines and target dates, suggested O’Brien. “The group will need to meet regularly,” she said. “Someone should create and be the keeper of a work plan that lists tasks, dates and who’s responsible. We recommend keeping a single work plan so that everyone can see the progress, looming dates, and the specifics of the shared responsibility.”

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vendor, clearinghouse and biggest payors concerning if, when and how testing of claims with ICD-10 will be done.

“Medicare has announced that testing will occur the week of March 3-7. A couple of fiscal intermediaries are requiring providers to register to participate in the testing. At this point, there’s no indication of another testing period, so if practices or clearinghouses miss that testing, there may not be another opportunity before October 1. That’s just Medicare; communicate with other big payors to find out about their testing.”

Training: Make time for training sessions, both selfand instructor-led.

Self-training exercises are available to all physicians, such as running a report of the 25 to 75 most frequently used ICD-9 codes and then crosswalking those to ICD-10. “I have a client who’s pregnant with her first, and due in April,” said O’Brien. “She’s already started on this process to teach herself how she’ll need to code and document differently and is planning on implementing necessary changes before she goes on maternity leave, so that when she returns in the summer, she’s not having to learn and prepare for ICD-10, in addition to adjusting to her new work-life balance.” Specialty societies, state medical societies, hospitals, software vendors and consulting firms also provide ICD-10 training sessions for physicians and staff. “Sign up for those sessions, go to them, listen and learn,” he said. “For most physicians, the dread associated with attending coding training is akin to that of having a root canal. It’s not going to be fun; it may be barely tolerable. Thing is, it’s not optional. In the past, when physicians considered coding training, it’s been for the opportunity to improve their existing CPT and ICD-9 coding, which they’ve been doing for decades. They already have a base fund of knowledge and experience with those two coding systems. This is completely new to everyone. Basic training on how to use the system – look up, differentiate, assign and document codes – is essential for every physician. Everyone is starting at a base of zero.”

Tools: Identify all practice tools, processes and systems that use diagnosis codes.

“They’ll all need to be converted to ICD-10, and folks will need to be introduced to and trained in their use,” said O’Brien. “At one of the early meetings, have your work team brainstorm to create a list of all affected tools, processes and systems. For example, if the practice contracts with an outside lab, which includes diagnosis codes in its orders form, the lab will likely issue a new form. Creating the list is just to understand the scope and delegate specific assignments so that everything can get done by October 1.”



A New View on Clinical Stroke Research By CINDY SANDERS

Everyone wants to build a better mousetrap … but building it over and over again isn’t very efficient. Finding a way to keep the ‘mousetrap’ infrastructure in place while adding new features based on a collective body of knowledge is fundamentally the basis of the new National Institutes of Health Stroke Trials Network. Funded and managed by the National Institute of Neurological Disorders and Stroke (NINDS), NIH StrokeNet is focused on the three prongs of stroke research — prevention, treatment and recovery. The new structure utilizes a network of academic medical centers across the country working with nearby satellite facilities to coordinate and streamline stroke research by centralizing approval and review, while creating a comprehensive data-sharing system. The network also is expected to lessen the time required to set up clinical trials since the infrastructure will already be in place, thereby making research more efficient and less costly. Scott Janis, PhD, program director in the Office of Clinical Research at NINDS and the scientific director for NIH StrokeNet, explained, “We identified 25 geographically distributed regional centers and identified over 200 hospitals that will be part of the network. Many are primary stroke centers, but many are community hospitals aligned with the regional stroke participant.” The 25 lead sites were chosen based on a demonstration of past experience in stroke research and recruitment, including the ability to enroll underrepresented populations. Each center has been granted five-year funding with $200,000 in research costs and $50,000 for training stroke clinical researchers per year over the first three years. The completion of milestones will drive additional funding. The University of Cincinnati has been named the national clinical coordinating center. With the new structure in place, Janis said it should be possible to more rapidly add studies to the pipeline. NIH StrokeNet also creates a central institutional review board and has a built-in master trial agreement to further expedite launching new trials. Janis also noted the network calls on a truly intraprofessional team of providers and researchers — from first responders and emergency room physicians to the specialists caring for patients acutely all the way through to ambulatory rehabilitative therapists. By having a coordinated team across the continuum of care, including pediatric specialists in the 25 regional centers, the hope is that stroke patients will be rapidly identified and more easily followed throughout their journey. “This network fosters communication in a collaborative way,” he said. “We can’t control when someone has a stroke, but we can control our ability to identify them for a mississippimedicalnews


potential study.” Previously, the model for stroke clinical trials happened in a stand-alone manner. A large team, often over multiple centers across the country, had to be assembled, and the infrastructure set up for each trial. Then, once completed, the entire team had to be disassembled only to start the process all over again for the next study. The cumbersome method led to delays in patient recruitment and repeated costs to initialize new projects. Sometimes those delays caused a stroke trial to go much longer than initially anticipated, costing millions of dollars more than the original estimate. “That effort in building and tearing down, building and tearing down, doesn’t efficiently allow us to ask the questions to move the science forward,” Janis said. Drug research to control stroke risk factors has improved to the point that Janis said sometimes the medicine had moved on by the time a stroke trial that had undergone delays managed to wind down. “You really want to get to answers more rapidly,” he noted. Janis said the tipping point to change the way stroke research occurred across the country came about in a couple of different ways. First, stroke experts identified key research priorities during a NINDS strategic planning meeting two years ago and stressed the need for an orchestrated effort. Second, Janis said NINDS already had honed their ability to manage a coordinated effort through SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke). “The idea behind the network is to take what we already know how to do and do it in a more efficient way,” Janis said. NINDS has a long history of overseeing successful stroke clinical trials, including the first treatment for acute stroke, announced in 1995. Although sometimes slow, research translated from bench to bedside still has been so successful that mortality rates from stroke have declined significantly over the past decade. While still a leading cause of disability, stroke recently moved from the third leading cause of death in the United States to the fourth. Janis noted funding still would be available to researchers outside the network when appropriate. However, he added, the goal would be to collaborate with the network and to coordinate trials through the new mechanisms now in place. “We want to be able to use this infrastructure we’re investing in to be our frontline sites for stroke trials,” he stated. In the Southeast, lead research sites include Emory University School of Medicine in Atlanta, Medical University of South Carolina in Charleston, Miller School of Medicine at the University of Miami, and Vanderbilt University Medical Center in Nashville. Providers and researchers can learn more about the network and clinical trials through the new website at

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to see and examine the baby. In addition, the neonatologists will be able to interact face to face with parents about what is going on with their baby and what the plans are for the baby’s care and possible transfer.”  Last year, more than 1,200 babies were born at Baptist Union County. “Based on the average percentage, we expect to be consulted on about 100 of these babies each year,” said Darling. “We’ll consult on babies who need NICU care or anytime a physician wants another set of eyes or recommendation.” The telemedicine technology solution is provided by InTouch Health, the leader in providing FDA-cleared solutions for high-acuity applications where doctors are required to take immediate clinical action. Even though this is the first placement of an acute care telemedicine system in Mississippi, InTouch solutions are deployed at nearly 1,000 hospital locations on six continents and are now in use by 15 percent of all U.S. hospitals. NMMC’s 34-bed intensive care nursery treats patients born at the Women’s Hospital and those transferred from area hospitals by CareExpress neonatal transport ambulance. More than 300 infants are admitted to the NICU annually, and more than one-fourth of them are transported to Tupelo from area hospitals.

“One large, Midwestern specialty practice client of ours has been preparing for the transition since 2011,” said O’Brien. “They’ve been doing bilingual coding (both ICD-9 and ICD-10 for some time) and still, they’ve bolstered their line of credit to cover six months of operating expenses and minimal physician salaries in anticipation of October 1, 2014.” Regardless of physicians’ preparation for ICD-10 conversion, or lack of, the looming Oct. 1 coding change date will signal one of the most significant challenges the medical industry has faced, said Bangert. “Likening it to Y2K is a risky over simplification” said O’Brien. “Y2K applied to two digits in the year fields of four digits, and while it had global implications in every industry and system, it was that contained. In other words, there was some analysis, hypothesis and possibly software changes to prepare, but that along with crossed fingers could be, and in fact was, enough. Not the case with ICD-10.”

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Woman’s Hospital Designated AIMIS Surgical Center of Excellence. Woman’s Hospital has reached a milestone event by being designated as an American Institute of Minimally Invasive Surgery Gynecological Surgery Center of Excellence for the second time. This accomplishment was achieved after passing a series of rigorous criteria established by the accrediting body AIMIS. The Gynecological Center of Excellence designation is important to the state because it gives patients added assurance that Woman’s Hospital has not only passed and exceeded existing norms for minimally invasive surgery quality and delivery, but also has physicians on staff who have achieved the AIMIS designation as an accredited AIMIS physician as well. According to Steven McCarus, MD Chief Executive Officer of AIMIS, Woman’s has now joined only a handful of leading hospitals around the nation and the only one in Mississippi to enjoy the AIMIS accreditation.

UMMC Nurse Educator Earns Coveted Leadership Training Slot Kimberly Rowzee, a nurse educator at the University of Mississippi Medical Center, has won acceptance to an exclusive, year-long development program that cultivates the nursing profession and advances the care of women and newborns. Rowzee, who works at Kimberly UMMC’s Wiser Hospital for Rowzee Women and Infants, was one of 42 candidates considered for the Emerging Leaders Program run by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). From that nationwide pool, she was one of only 10 chosen. A UMMC employee for almost 11 years, Rowzee coordinates programs for pregnant women and their families and supervises the breast-feeding program at Wiser. An obstetrics and gynecological nurse for 18 years, she was also a part-time UMMC faculty member in the School of Nursing in the fall. Designed to recruit future AWHONN leaders and enhance leadership and business skills among a diverse group of nurses, the training program begins for Rowzee with a two-day trip to Washington, D.C., that features legislative visits on Capitol Hill. Overseen by a personal mentor, Rowzee will participate throughout the year in webinars, develop a leadership project, serve on an AWHONN committee or task force, and attend the 2014 AWHONN Leadership Conference in Washington, D.C., as well as the 2014 Annual AWHONN Convention in Orlando, Fla. A Meridian native, Rowzee earned her undergraduate degree at Mississippi University for Women in Columbus and her master’s at UMMC’s School of Nursing.

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GrandRounds CMMC Names ED and Trauma Program Manager Shea Bishop, RN, BSN, has been promoted to director of the Emergency Department and Ben Richards, NREMT-P, RN, BSN, has been named trauma program manager at Central Mississippi Medical Center (CMMC). Bishop is a registered nurse and has been working at CMMC for three years, Shea Bishop first as an Emergency Department charge nurse before being named interim director. She previously served as chief nursing officer for Pioneer Community Hospital of Newton. She earned a bachelor of science degree in nursing from the University of Southern Mississippi and an associate of science degree in nursing from Meridian Community College. Bishop is appointment to the position that oversees staffing and operations in an emergency department in excess of 48,000 visits annually. Richards is a registered nurse and paramedic with numerous years of experience in the fields of emergency medicine, trauma and post-operative care. He previously served as trauma program coordinator at a Colorado hospital and worked as a flight nurse on an Arkansas AirEvac LifeTeam, responsibilities that included working with critically-ill and injured patients both at the scene and during inter-facility transports. He earned a bachelor of science degree in nursing from Union University, a bachelor of arts degree in management and human resources from Trevecca Nazarene University and an associate in applied science degree in emergency medical technology-paramedic from Hinds Community College.

Anderson Regional Cancer Center Earns National Accreditation The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) has granted Three-Year Accreditation with Commendation to Anderson Regional Cancer Center. To earn CoC accreditation, a cancer program must meet or exceed 34 CoC quality care standards, be evaluated every three years through a survey process, and maintain high levels of excellence in the delivery of comprehensive patient-centered care. Three-Year Accreditation with Commendation is only awarded to a facility that exceeds standard requirements at the time of its triennial survey. When cancer patients choose to seek care locally at a CoC-accredited cancer center, they are gaining access to comprehensive, state-of-the-art cancer care close to home. The CoC Accreditation Program provides a framework which enables Anderson to improve its quality of patient care through various cancer-related programs that focus on the full spectrum of cancer care including prevention, early diagnosis, cancer staging, optimal treatment, rehabilitation, life-long follow up for recurrent disease, and end-of-life care. When patients mississippimedicalnews


receive care at a CoC facility, they also have access to information on clinical trials and new treatments, genetic counseling, and patient centered services including psychosocial support, a patient navigation process, and a survivorship care plan that documents the care each patient receives and seeks to improve cancer survivors’ quality of life. Like all CoC-accredited facilities, Anderson Regional Cancer Center maintains a cancer registry and contributes data to the National Cancer Data Base (NCDB), a joint program of the CoC and American Cancer Society (ACS). This nationwide oncology outcomes database is the largest clinical disease registry in the world. Data on all types of cancer are tracked and analyzed through the NCDB and used to explore trends in cancer care. CoC-accredited cancer centers, in turn, have access to information derived from this type of data analysis, which is used to create national, regional, and state benchmark reports. These reports help CoC facilities with their quality improvement efforts.

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Memorial President/CEO Appointed by Governor to Health Care Solutions Board Mississippi Gov. Phil Bryant recently appointed Memorial Hospital President and Chief Executive Officer Gary G. Marchand, MPH, to Mississippi Health Care Solutions Institute’s Board of Directors. The Health Care Solutions Institute is a public-private partnership foGary G. cused on strengthening MisMarchand sissippi’s economy through developing the state’s health care industry. New board appointees were honored at a luncheon recently. Marchand has more than 25 years of health care experience in a variety of related fields, including hospital administration and finance, managed care operations and joint venture development. He received his Bachelor of Science degree from The University of New Orleans and his Master of Public Health degree from The University of Southern Mississippi.


Online Bill Pay Available To Hattiesburg Clinic Patients Hattiesburg Clinic patients now have the option to pay their medical bills online through Iris, the secure portal that connects patients to their Hattiesburg Clinic health care providers and records. Through Iris, patients can also use online bill pay to view up to 10 previous statements, view their current balance, opt in or out of paper statements and view their recent payments. Using Iris, patients can message their providers, request prescription refills onmost medications, schedule appointments, receive certain test results, review medical history and link family records through any Internet connecting device. Iris is available to all Hattiesburg Clinic patients, but a username and password are required. For more information about Iris, visit

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Mississippi Medical News March 2014  
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Mississippi Medical News March 2014