M A RY L A N D
Physician YOUR PRACTICE. YOUR LIFE.
NOVEMBER/DECEMBER 2011 VOLUME 1: ISSUE 4
Neurological Disorders New Approaches and New Treatments Pain Management Diminishing Pain and Restoring Function Healthcare IT Client Server or Cloud?
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Contents 12
November/December 2011 Volume1: Issue 4
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F E AT U R E S
12 New Approaches Aid the Understanding & Treatment of Neurological Disorders
16 Diminishing Pain, Restoring Function Treat it quickly and effectively for better results D E PA R T M E N T S
Cases
| 7 | Pain and Symptom Management through Hospice Palliative Care
Solutions
| 8 | Four Key Factors that Could Make or Break a Medical Office Lease
Healthcare IT Policy
| 20 | ShouldYou Store EHR Data Onsite or Offsite?
| 25 | Coming Soon: Maryland’s Prescription Drug Monitoring Program (PDMP)
Compliance Heritage
| 27 | The Anti-Kickback Statute:WhatYou Don't Know Could HurtYou
| 29 | MHA: Leadership and Advocacy for State Healthcare Providers
Good Deeds
| 30 | Gilchrist Hospice Care Making A World of Difference
On the Cover: Dr. Rami, co-director of the Minimally Invasive Pituitary and Skull Base Center at GBMC NOVEMBER/DECEMBER 2011
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JACQUIE ROTH, PUBLISHER/EXECUTIVE EDITOR jroth@mdphysicianmag.com LINDA HARDER, MANAGING EDITOR lharder@mdphysicianmag.com
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HIS ISSUE CLOSES OUT the inaugural year of Maryland Physician. It was just over a year ago when I first introduced to a growing advisory board, the concept of building a Marylandbased physician network with a commitment to achieve the highest standards of quality patient care built upon a foundation of a print magazine – Maryland Physician Magazine. I’m very proud of the relevant, engaging and well-written content delivered with clean and inviting graphic design the Maryland Physician team has delivered in “Volume 1”, showcasing Maryland physicians spearheading cutting-edge treatments and delivering practical advice on how to run a Maryland-based practice most efficiently. We’re well on our way to growing that network – a network inclusive of leading healthcare subject matter experts who have contributed both clinical and practice management focused content in each issue. Over the first year of publication, we’ve celebrated women in medicine; went beyond the hype of some orthopedic treatments; spotlighted new cancer treatments and imaging advances while quite proudly, showcasing your Maryland healthcare peers. Online, Maryland Physician offers you a searchable archive of treatments; physicians and practice management solutions. Newest to our online content is digital video with Maryland Physician’s Physician Spotlight. The very first reader message I received after the launch of Maryland Physician was a request for content focused on pain management. Acute, chronic or imagined, pain brings many of your patients into your practice. A cover story exploration of advances in three very diverse areas in the field of treating neurologic disorders leads into the requested pain management feature, focused on new and ancient treatment options. November is celebrated as National Hospice/Palliative Care Month. As an advocate for hospice care, I’m raising awareness of the incredible work hospice and palliative care professionals provide throughout Maryland. A few of these very special people are recognized in these following pages and at Maryland Physician Magazine online. Along with input from the variety of specialists on the Maryland Physician advisory board, we look to you for editorial counsel. How can Maryland Physician help you achieve the highest standards of quality patient care? Wishing you a very happy and healthy New Year,
Jacquie Roth Publisher/Executive Editor jroth@mdphysicianmag.com
CONTRIBUTING WRITERS Allison Eatough Tracy Fitzgerald CONTRIBUTING PHOTOGRAPHY Tracey Brown, Papercamera Photography www.papercamera.com Mark Molesky, Moleskey Photography www.moleskyphotography.com DIGITAL Andrei Palmer, Digital General Manager Aertight Systems andreip@aertight.com ADMINISTRATION Ginger Jenkins Maryland Physician Magazine™ is published bimonthly by Mojo Media, LLC. a certified Minority Business Enterprise (MBE). Mojo Media, LLC PO Box 1663 Millersville, MD 21108 443-837-6948 www.mojomedia.biz Subscription information: Maryland Physician Magazine is mailed free to Maryland licensed and practicing physicians and a select audience of Maryland healthcare executives and stakeholders. Subscriptions are available for the annual cost of $42.00. To be added to the circulation list, call 443-837-6948. Reprints: Reproduction of any contact is strictly prohibited and protected by copy right laws. To order reprints of articles or back issues, please call 443-837-6948 or email jroth@ mdphysicianmag.com. Maryland Physician Magazine Advisory Board: An advisory board comprised of medical practitioners and business leaders in diverse practice, business and geographic scopes provides editorial counsel to Maryland Physician. Advisory board members include: JOHN BARRY, M.D. Chesapeake Orthopaedic & Sports Medicine Center KAREN COUSINS-BROWN, D.O. Maryland General Hospital HOLLY DAHLMAN, M.D. Greenspring Valley Internal Medicine, LLC PAUL W. DAVIES, M.D., FACS Advanced Pain Management GAUROV DAYAL, M.D. Adventist HealthCare MICHAEL EPSTEIN, M.D. Digestive Disorders Associates STACY D. FISHER, M.D. University of Maryland Medical Center REGINA HAMPTON, M.D. FACS Signature Breast Care DANILO ESPINOLA, M.D. Advanced Radiology GENE RANSOM, J.D., CEO MedChi Although every precaution is taken to ensure accuracy of published materials, Maryland Physician and Mojo Media, LLC cannot be held responsible for opinions expressed or facts supplied by authors and resources.
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YES, WE’VE REDESIGNED OUR BREAST CARE CENTER TO FEEL MORE LIKE A FOUR-STAR HOTEL. NO, YOUR IN-LAWS CAN’T STAY HERE WHEN THEY’RE IN TOWN. Call it transformation. A renovation. Or an extreme hospital makeover. But for those who haven’t experienced the hotel-like comfort of the newly redesigned Herman & Walter Samuelson Breast Care Center at Northwest Hospital, you will be pleasantly surprised. Led by Dr. Dawn Leonard, fellowship-trained breast surgeon, you’ll find a relaxing spa-like atmosphere, the latest in digital mammography and a staff of leading oncologists and surgeons. There is no finer setting in Baltimore for comprehensive breast care. To learn more, go to lifebridgehealth.org.
Northwest Hospital is located at the corner of Old Court and Liberty Roads.
Cases
Pain and Symptom Management through Hospice Palliative Care Karen Cousins-Brown, D.O., CMD
CASE: A 61-year-old male – homeless, but social and productive in his community – has a diagnosis of advanced non-small cell lung cancer, failure to thrive, near obstruction due to superior vena cava syndrome, debility, and a right-sided non-malignant pleural effusion. Despite receiving chemotherapy with Cisplatin and radiation, he continued to decline. He decided to discontinue treatments and signed onto hospice. Upon hospice admission from a local hospital, he was taking MS Contin 30 mg every eight hours and Oxycodone 10 mg every four hours PRN for pain. He became progressively bedbound, ate a minimal amount, exhibited depression and presented with significant, variable pain management issues. What treatment options are available for this patient? DISCUSSION Hospice and palliative care medicine focus on improving the quality of one’s life rather than on curative medical options, and expert pain and symptom management are a large part of achieving quality of life objectives. Statistics show that, while cancer pain can be managed well in 90% of patients, it
often is not. Pain management can be challenging, yet can be tackled successfully with a thorough assessment of cancer pain, non-cancer pain and nonphysical types of pain. First, the hospice team assessed the cancer pain. Cancer pain can be bony, neuropathic, visceral or intramuscular. The patient had a dull ache in his shoulders, legs and back that increased with ambulation and weight-bearing. For the bony pain, the patient was already on an opioid that, while progressively increased to Morphine 75 mg twice daily, was still ineffective. In this case, an NSAID, steroid or both can be used. We started him on Decadron 4 mg twice daily. Within a few days of starting the steroid, the patient was able to ambulate again, increase his food intake, and generally function better. His non-cancer pain (arthritis, headaches and constipation) also was assessed. The patient did have occasional headaches that resolved with the steroid. An NSAID could have been used in lieu of the steroid. For many hospice patients, nonphysical pain, including feelings of anxiety, denial, fear, and hopelessness, can be even more important to treat than their physical pain. The hospice team – including the physician, nurse, social worker, clergy, volunteer coordinator and multiple volunteers – saw the patient and addressed his fear of aloneness, loss of independence and denial of his medical condition. Other patients in the hospice facility befriended him, sharing time and conversation outside on a wooden deck adorned with beds of planted flowers. These types of emotional and spiritual support, tailored to the patient’s needs, are important components of hospice care that are specifically mandated by federal regulations. The patient is now ambulatory, eats regularly, goes out independently at times
with friends and still performs odd jobs, all of which bring him pride, self worth, and a feeling of purposeful living. This patient’s case exemplifies how a hospice team approach can effectively address myriad types of pain and dramatically improve the physical and emotional lives of terminally ill patients. He is also a testament to one of the core precepts of hospice, namely giving patients the right to die without pain and with dignity. As long as this patient lives, he will receive compassionate care directed at expert management of his pain, symptoms and a high quality end-of-life. Hospice is now a significant player in end-of-life care options and statistics demonstrate its appeal. The latest usage data, compiled for 2009 by the National Hospice and Palliative Care Organization (NHPCO), shows hospice as a steadily growing resource for the terminally ill, with an estimated 41.6% of all U.S. deaths occurring under hospice home care or inpatient services. More than 5,000 hospice providers in the country now meet this steadily growing demand, providing an average 69-day service per patient. According to the NHPCO, cancer diagnoses account for 40.1% of all hospice admissions, followed by debility unspecified (13.1%), heart disease (11.5%), dementia (11.2%), and lung disease (8.2%). Karen Cousins-Brown, D.O., CMD, earned her Doctor of Osteopathy from the Philadelphia College of Osteopathic Medicine. She is the Medical Director at Maryland General Hospital in Baltimore, Maryland of the Acute Care Unit for the Elderly and is the Clinical Preceptor for the Johns Hopkins Geriatric Fellows for the Unit. In addition, Dr. Cousins-Brown is the Medical Director for Joseph Richey Hospice in Baltimore and serves as Long Care Attending for several nursing facilities in the greater Baltimore Metropolitan Area. She can be reached at kacbrown@marylandgeneral.org.
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Solutions
Four Key Factors that Could Make or Break a Medical Office Lease
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BY REED P. SEXTER
NE OF THE LARGEST annual expenses of any medical practice is the cost associated with the space in which it operates. In today’s recovering economy, the medical office building sector has rebounded, too, making leasing costs for medical practices an even more important consideration, particularly in Maryland where real estate costs and cost of living are higher than in neighboring states. Medical office building sales have increased and vacancy rates have begun leveling out from their high in 2009 – making it crucial for physicians and medical office administrators to understand all of the options available to them when negotiating a new lease. Medical practices should view their leases as they would a personal investment. The total lease obligation for a medical practice can range from hundreds of thousands of dollars to millions of dollars depending on the size of the space, the rent per square foot and the length of the term. A medical practice will have only one opportunity to get it right – at the time the letter of intent and lease are negotiated. It is, therefore, critical to retain experienced attorneys and accountants who have substantial leasing and related experience. Perhaps more importantly, the medical practice will need a leasing broker that specializes in leasing medical office space and that knows the market in order to negotiate the best deal possible. Having the right team could save the practice a substantial amount of money over the lease term. The four most important factors of a new lease (or lease renewal) to consider are:
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Lease Term Rent Tenant Improvement Allowance Security Deposit/Limitations on Risk
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1. Lease Term
A new medical practice that is establishing itself can reduce its financial exposure by considering a shorter-term lease (5 years or less) with one or more renewal options thereafter. A more established medical practice might consider a longer-term lease (10 years or more) with one or more renewal options thereafter. Remember, however, the longer the lease term, the more concessions (for example, rent abatement, tenant improvement allowance and free rent) the landlord is generally willing to consider. 2. Rent
Base rent is generally dictated by the market value of the space, which is determined by factors such as location, type of building and location of the space within the building. New buildings with more amenities cost more. The length of the lease term and rent concessions granted to the tenant can also affect the base rent. In today’s market, landlords often will consider some component of free rent or abated rent for a period of time. 3. Tenant Improvement Allowance
An important component of any new lease is the monetary contribution by the landlord to the build out of a practice’s space (sometimes known as a tenant improvement allowance). The greater the contribution by the landlord, the less money a medical practice will be required to pay out of pocket for construction expenses. A carefully drafted letter of intent and lease should provide that the tenant be permitted to use the tenant improvement allowance for hard costs of performing improvements and soft costs (e.g., architectural and engineering fees) of construction.
The lease should also be clear that the landlord will pay the contractor directly (or jointly with the practice) so that the practice is not required to pay construction costs prior to being reimbursed by the landlord. 4. Security Deposit/Limitations on Risk
The amount of the security deposit will most likely be dictated by the practice’s financial strength. If the practice is new or does not have strong financial statements, the landlord likely will require some combination of cash and personal guarantee(s). If a personal guaranty is required, try to limit the amount of personal liability under the guaranty (in the form of a fixed dollar amount) instead of merely guaranteeing all obligations under the lease. The landlord might agree to reduce the cash security deposit over time as long as the medical practice is not in default, sometimes referred to as a “burn off” or a “phased reduction.” An alternative to providing cash for the security deposit is a letter of credit issued by a bank, with the landlord as the beneficiary. While this frees up the practice’s cash, letters of credit often entail fees. Other leasing considerations include assignment and subleasing rights, default and remedy provisions and holdover. Decisions regarding a medical practice’s lease (or lease renewal) could have farreaching implications. Careful consideration must be given to every aspect of the lease transaction prior to execution. Reed P. Sexter is Vice President and Senior Counsel at Shapiro, Lifschitz & Schram, P.C. where he advises numerous local medical and dental practices on entity formation, leases, property acquisitions, partnership agreements and employment agreements. He can be reached at reeds@slslaw.com
Amiel Bethel, M.D. & Clifford Solomon, M.D. Neurosurgeons
You’ve Y ou’ve never ever seen neurosurgery rosurgery like this. And you’ve never ever met d doctors like k ours. ke Welcome to the Balt Welcome Baltimore imore W Washington ashington Spine and d Neurosciences Center where our foc focus cus is getting you back to the e life you love. Where procedures ar are re less invasive, due to advan advances nces like stereotactic mapping and 3D tec technology. chnology. Our experienced ne neurosurgeons eurosurgeons treat the full range of brain an and nd spinal conditions using th the he most sophisticated tools to deliver the most m consistent results. Drs. Bethel and Solomon work in partnership with the Department of Neurosurgery at the University of Marylan Maryland nd School of Medicine and th the he University of Maryland Medical Ce enter. Go to mybwmc.org to ge et to know our surgeons. Center. get
Baltimore Wa Baltimore W Washington shington Medical Medi cal Center Cen nter Un i v e r Uni rsi si t y of M a ry r la and nd M e d iic cal System
WWW.MYBWMC.ORG WWW .MYBWMC.ORG s 4 410-553-BWMC 10-553-BWMC (2962)
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Profiles
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PAPERCAMERA PHOTOGRAPHY
Dr. Rami, co-director of the Minimally Invasive Pituitary and Skull Base Center at GBMC
New Approaches Aid the Understanding & Treatment of Neurological Disorders BY LINDA HARDER
Endonasal Pituitary Surgery
Neurological and neurosurgical specialties cover a vast range of disorders. In this issue, Maryland Physician explores advances in three very diverse areas of this field in its interviews with three Maryland medical experts: Amiel W. Bethel, M.D, about the re-emergence of total disc replacement in the spine; Bimal G. Rami, M.D., about endonasal pituitary surgery; and Stewart H. Mostofsky, M.D., about new understanding of the motor control issues faced by children with ADHD.
Dr. Rami, co-director (with Marc G. Dubin, M.D., FACS) of the Minimally Invasive Pituitary and Skull Base Center at GBMC, is unapologetically enthusiastic about the advantages of endonasal pituitary surgery to treat micro- and macropituitary adenomas. While tumors in this region of the brain are not common, and most are benign, the symptoms they create can greatly impact a patient’s function. The macro adenomas often cause severe double vision and other visual impairments, while the micro adenomas secrete excess hormones, leading to prolactinemia and other endocrine issues. Until about five years ago, the only approach to tackle tumors in the pituitary fossa was a transnasal or sublabial approach, in which the ENT made an incision in the nose or gum area followed by a destructive approach to the sphenoid sinus. The endonasal procedure, by contrast, uses an exclusively endoscopic approach that, surprisingly, provides superior visualization of the tumor
and surrounding anatomy. “With the endoscope, we can look at the area as if we were right in front of the tumor,” exclaims Dr. Rami. “We employ stereotactic navigation so we know real time where we are in relation to the preop CT or MRI. We can perform a more delicate dissection and better preserve the normal surrounding anatomy. Patients benefit by having a shorter hospital stay, far less pain, and often a more complete resection of the tumor than was ever possible using traditional techniques.” The University of Pittsburgh, where Dr. Rami was trained in the use of the endoscope, pioneered the procedure, which has since been extensively reviewed and validated in the literature over the last five years. “To the best of my knowledge,” he says, “we’re fairly unique in the Baltimore area for employing a purely endoscopic approach, though some surgeons are using a hybrid approach. “There is a learning curve associated with having to look at the video screen while moving your
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“With the endoscope, we can look at the area as if we were right in front of the tumor… We can perform a more delicate dissection and better preserve the normal surrounding anatomy.”
COURTESY BWMC
– Bimal Rami, M.D.
“Total Disc Replacement avoids adjacent disc problems, which affect up to 25% of patients within 10 years.” –Amiel Bethel, M.D.
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hands; it’s comparable to playing a video game,“ notes Dr. Rami. “But the instruments are largely the same, and the ability to visualize the important structures, such as the carotid arteries and the optic nerves, is extremely advantageous.” Both the endoscopic and the traditional approach involve collapsing the capsule of the tumor to remove it. However, in the older technique, physicians would sweep out as much of the tissue as possible but depend on post-operative imaging to determine how much of the tumor was removed. Thanks to the surgeon’s ability to visualize and resect the entire tumor with the endonasal approach, patients typically avoid the serial MRIs that are necessary with partial resections. They also experience fewer symptoms, such as hyper secretions, and are far less likely to need a future craniotomy as a result of a large tumor that wasn’t fully resected. “We’re performing the procedure on lots of patients who originally underwent the traditional procedure years ago but did not have the entire tumor removed,” Dr. Rami concludes. Total Disc Replacement (TDR)
The early research on TDRs began in the 60s and 70s, but languished for many decades due to research investigation in the United States. The approach has regained popularity in the last 10 to 15 years, chiefly for cervical degenerative diseases. Amiel Bethel, M.D., neurosurgeon at the Baltimore Washington Spine and Neuroscience Center, explains, “Unlike fusion, TDR offers you maintenance of motion at the disc level, while still relieving pain. When you fuse one disc, it negatively affects adjacent discs. TDR is at least as good as spinal fusion for pain relief and function, especially in the cervical area.’ Dr. Bethel comments, “The first FDA-approved devices emerged three to four years ago, with three in current practice and several more in the wings.
My group has performed many cervical TDR procedures with excellent outcomes. In our experience, C2-C3 disc replacements do very well. “When TDR is used on one level, the return to activity is quicker,” he continues. ‘The ideal patient for this procedure is younger and has mild degenerative arthritic changes. It gives us another option and prevents disc degeneration in the future. TDR avoids adjacent disc problems, which affect up to 25% of patients within 10 years.” Fusion remains the gold standard, especially for patients with more severe spondylosis. New inter-body devices have a lower profile that decreases dysphagia and other common side effects of this procedure. “Of course, the majority of patients can have their degenerative disc disease treated without surgical intervention,” Dr. Bethel notes. “Patients should be referred to doctors who believe in these alternatives. Care conditioning is very important. I start with treatments such as medication, exercise, PT, chiropractics, yoga, Pilates, acupuncture, physiatry and pain management. About 30% to 40% of patients do well with those treatments. If they fail conservative therapy, we discuss their options. Of course, some patients have severe neurologic symptoms that have progressed to the point where you can almost tell when they come in the door that they’ll need surgery.” Motor Clues Help Doctors Understand & Predict ADHD Severity
Attention Deficit Hyperactivity Disorder (ADHD), currently the most common child behavioral condition, did not become an official diagnosis until 1980. Practitioners have since primarily focused on the behavioral features of the disorder. In the late 1970s, early studies identified excessive overflow movements and distractible behavior in children with excessive hyperactive behavior. However, little attention was paid to the motor function effects of ADHD until 2003, when a study
PAPERCAMERA PHOTOGRAPHY
Stewart H. Mostofsky, M.D.
observed the presence or absence of overflow movements during walking and other activities, but did not quantify them. “Despite its prevalence, there is a lack of understanding about the neurobiological basis of ADHD,” says Dr. Mostofsky, M.D, director of the Laboratory for Neurocognitive and Imaging Research at the Kennedy Krieger Institute. “A critical obstacle is the lack of quantitative measures of brain function that would provide a basis for more accurate diagnosis and effective treatment.” To rectify that situation, Dr. Mostofsky and his colleagues recently published two studies on ADHD that measured the motor control failures associated with excessive impulsivity. “We and other labs are revisiting motor issues,” says Dr. Mostofsky. “Earlier studies have used blunt measurement approaches to overflow.’ In the first study, children with ADHD performed a finger-tapping task. Any unintentional, overflow movements occurring on the opposite hand were noted. Researchers developed two measurements to quantify the amount of overflow – video recording and electronic goniometers that precisely measure the change in angular displacement across a joint. Children
with ADHD showed more than twice the amount of overflow as did typically developing children, with a high degree of correspondence between the results using video and goniometer measurement methods. This was the first time that scientists have been able to quantify the degree to which ADHD is associated with a failure in motor control. “While we expected to find a strong correlation between ADHD and overflow movements,” notes Dr. Mostofsky, “we were a bit surprised to find that school age boys exhibited far more overflow than girls their age. We think this is age related, since girls mature more quickly.” In the second study, the researchers investigated inhibitory control in the
motor cortex using Transcranial Magnetic Stimulation (TMS) to trigger muscle activity in the hand. Researchers measured the level of muscle activity and monitored the resulting brain activity, and also used a paired-pulse stimulation to measure short interval cortical inhibition (SICI). The degree of cortical inhibition in children with ADHD, measured by SICI, was 40% less than typically developing children. Furthermore, within the ADHD group, less motor inhibition correlated with more severe behavioral symptom ratings, as reported by parents. Dr. Mostofsky explains, “These findings provide a window into identifying relevant biomarkers of ADHD that can be used to improve how we diagnose and treat children with the disorder. Currently, the diagnosis is based chiefly on behavior reports, which is limiting. Further, from a clinical standpoint, it’s helpful to recognize that children with ADHD have difficulty with motor control, which leads to difficulty performing handwriting and other fine motor tasks. Study results such as these may help guide intervention recommendations and accommodations in the school setting. It adds to the growing body of evidence that these are involuntary behaviors, not willful. “We’ve learned in recent years that the long-term outcomes for children with ADHD are not as good as the general population,” Dr. Mostofsky concludes. “ADHD is associated with higher rates of incarceration, motor vehicle accidents, and other problematic behaviors into adulthood. By identifying physiologic biomarkers, we can improve our ability to more effectively guide specific and targeted interventions, and thereby help improve these long-term outcomes. ”
Bimal G. Rami, M.D., a fellowship-trained neurosurgeon, is co-director of the Minimally Invasive Pituitary and Skull Base Center at GBMC. Dr. Rami also specializes in spinal cord stimulation, disc replacement and neuro-oncology. Amiel W. Bethel, M.D., a fellowship-trained neurosurgeon with the Baltimore Washington Spine and Neuroscience Center and formerly served as chief of surgery at GBMC. He is also an Assistant Professor in the Department of Neurosurgery at the University of Maryland School of Medicine. Stewart H. Mostofsky, M.D., is a research scientist and director of the Laboratory for Neurocognitive and Imaging Research at the Kennedy Krieger Institute. He is also an associate professor of neurology at the Johns Hopkins University School of Medicine.
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DIMINISHING PAIN, RESTORING FUNCTION Treat it quickly and effectively for better results
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BY LINDA HARDER PHOTOGRAPHY BY TRACEY BROWN
Managing patients with persistent pain can be one of the more frustrating aspects of primary care. Maryland Physician explores new treatments and when to refer to a pain specialist by speaking with three Maryland experts: Paul W. Davies, M.D., board-certified in Pain Management and Anesthesiology; Ira D. Kornbluth, M.D., board certified in Pain Management and Physical Medicine and Rehabilitation; and Lauren P. McNeal, L. Ac., Dipl. Ac., a licensed and board-certified Acupuncturist and Herbalist.
PAIN
specialists have come a long way in their understanding of how pain signals are transmitted and processed, and they have a growing arsenal of interventions to keep patients from becoming chronically impaired. New medications, improvements in existing procedures like Spinal Cord Stimulation (SCS) and complementary medicine (including acupuncture, Reiki and therapeutic massage) join existing methods of combatting pain. NEW PHARMACEUTICALS, FORMS AND COMBINATIONS
A dizzying array of new pharmaceutical options is providing greater relief for patients suffering with pain. Newer medications include opiates that attempt to thwart or diminish misuse. Oxecta, just approved by the FDA this summer, is the first immediate-release Oxycodone HCl medicine designed to discourage tampering by making it difficult to crush or dissolve it. Pain management physicians also are using antidepressants, anticonvulsants and seratonin and norepinephrine reuptake inhibitors (SNRIs) to treat select types of pain. “Cymbalta and Savella have revolutionized the treatment of fibromyalgia and, when used off label, other pain conditions,” says Dr. Davies. “Pain and depression typically go hand in hand, and these medications work on both conditions at the same time.”
Paul W. Davies, M.D.
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Dr. Davies adds, “Lyrica, is another relatively new medication, not dissimilar to Neurontin. It has had a profound impact on our management of fibromyalgia and many painful conditions, eliminating or reducing the need for narcotics.” Lyrica is also FDA approved for the treatment of diabetic peripheral neuropathy and post herpetic neuralgia. Many doctors use it off label to treat different forms of neuropathic pain with excellent results. Newer ways of ingesting or applying existing medications, such as Fentanyl, include “lollipops” and submucosal tabs – highly potent forms of this opiate indicated for patients with breakthrough cancer pain. “We’re also now able to provide more localized treatment for many types of pain, which helps to minimize side effects,” comments Dr. Davies. “A good example is Qutenza, which has been shown effective in treating neuralgias such as shingles with a patch that lasts up to three months.” SYSTEMS MINIMIZE ABUSE, ADDICTION
Abuse and addiction are major societal problems that often are used interchangeably, but are very different. Whereas abuse refers to those who use medications for something other than their intended medical purpose, addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use. Dr. Davies describes the multi-step process pain specialists use to minimize abuse and deter addicts. ‘First, we do an initial urine drug screen to rule out
database has allowed us to take an incredible leap forward in evaluating a patient’s medication use history. Third, we conduct frequent ongoing drug screens. When appropriate, we conduct a criminal record check. The benefit of sending patients to a pain management office is that our staff are trained to do these things.” Dr. Kornbluth notes, “Pain management physicians have a renewed focus on recognizing and monitoring patients to prevent abuse. We require patients receiving opiates to sign an agreement, then we perform drug testing to monitor and prevent abuse. If the test is concerning, the patient probably won’t be allowed into the practice, and if they become noncompliant, they’re discharged.” The patient may not be the one abusing medications. Cancer or elderly patients may have relatives that sell their medications on the street. “The problem is really society at large,” Dr. Kornbluth adds. “It’s a shame that some referring physicians still have the misperception that pain physicians contribute to the addiction problems in society.” Dr. Davies concludes, “Doctors have to consider the health of their community, not just the health of their patient, when treating pain.” ADVANCES IN SPINAL CORD STIMULATION
Both physicians believe that spinal cord stimulation is being underutilized by referring doctors. “When a patient fails to respond to medications and other more conservative measures, spinal cord
“…pain management physicians are very responsible. We have a renewed focus on recognizing and monitoring patients to prevent abuse.” –Ira Kornbluth, M.D. street or other drugs for which they don’t have a prescription. We also review the patient’s medical records, checking for evidence of a medical problem in an MRI or other procedure. Second, we check pharmacy records to determine if other doctors have prescribed narcotics or other medications with abuse potential. In the last year, the new electronic pharmacy 18 |
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stimulation (SCS) can be very helpful,” says Dr. Davies. “Primary care physicians should be aware of its potential to treat peripheral neuropathies and back pain.” SCS is commonly used for:
Neuropathic pain in upper and lower extremities, i.e., diabetic peripheral neuropathy
Ira D. Kornbluth, M.D.
Complex regional pain syndrome (CRPS) Back and neck pain “The battery life of these devices is much longer than it used to be and we can now cover broader areas,” says Dr. Kornbluth. “There are new arrays of electrodes that address all of the conditions listed above. Patients can recharge the SCS at home and use it for many years. An advantage of this procedure is that we can conduct a trial prior to implementation of the device. The device can then be implanted in patients that get good results. Studies have shown that these procedures improve return to work, increase sleep and decrease opioids.” WHEN TO REFER TO A PAIN MANAGEMENT PHYSICIAN
Studies demonstrate that patients whose pain is managed early do better. “The medical community now recognizes that if pain is not treated aggressively early on, it has a poorer long-term outcome. Many patients benefit from referral to
a pain specialist, as we offer more comprehensive therapies,” Dr. Davies observes. Patients should be referred when:
They require anything more than a short course of narcotic medications An acute or sub-acute problem could be remedied with interventions (i.e., sciatica) They have ongoing chronic pain
“If a patient has back pain, for instance, there’s a lot we can do instead of just continuing their medications. That often allows them to avoid surgery,” notes Dr. Kornbluth. DOES ACUPUNCTURE WORK?
Both Dr. Davies and Dr. Kornbluth believe strongly that adjunct therapies, such as physical therapy, Reiki, therapeutic massage, and acupuncture, play an important role in pain management. This article limits discussion to the role of acupuncture. After suffering for decades from Western skepticism, acupuncture has become a validated approach to treat pain. NIH studies have demonstrated its value for back and knee pain. As a result, more major insurers are covering acupuncture for a number of pain conditions. “I’m a proponent of acupuncture, especially when you have a localized myofascial problem or persistent, intractable pain after a procedure,” says Dr. Kornbluth. Lauren McNeal knows first hand the pain relief that can be provided. She became an acupuncturist about 10 years ago after she found that it was effective in treating problems she suffered in an auto accident. She states, “It helped my back and neck pain tremendously, so I became a convert.”
rate if the pain is treated within three months, but we often see people years after the initial pain.” Ideally, McNeal says, refer for acupuncture prior to injecting a steroid or any numbing agent, as they slow the body's ability to respond to treatment. “Acupuncture also can manage chronic pain, reducing the ongoing need for medications,” states McNeal. “It may be considered prior to surgery, and can speed post-op recovery by reducing inflammation and resolving the trauma it causes. Combining acupuncture with physical therapy and/or nutritional supplements is an ideal way to treat back pain, increasing patients’ mobility and function.” Acupuncture takes time to demonstrate results and the frequency and duration of treatment vary with the type of problem. McNeal explains, “Someone with chronic headaches may be seen once a week for a longer period, while a patient with acute back pain may be seen twice a week for two to three weeks. The longer the condition has been present, the longer it takes to reverse it. But generally, we see a significant difference in four to six sessions.” PROPER CREDENTIALS ARE IMPORTANT
“It’s important to get a practitioner with good credentials and a proven track
record,” says Dr. Davies. McNeal concurs. “Most acupuncture schools provide a masters level of education. The practitioner should have both a state license and board certification in acupuncture and have passed the National Acupuncture Boards. Maryland does not require that you pass the national boards to practice acupuncture, which most patients and doctors don't realize. The MD state credential is displayed as “L. Ac.” and the national credential is displayed as “Dipl. Ac.” “My advice is to have an open mind, she concludes. Try it before you decide it doesn’t work. Western and alternative medicine work nicely together.”
Paul W. Davies, M.D., pain management physician, is the founder and CEO of Advanced Pain Management. Ira D. Kornbluth, M.D., MA, FAAPMR, CIME, pain management physician and physiatrist, is the founder of SMART Pain Management. Lauren P. McNeal, L. Ac., Dipl. Ac., is a board-certified Acupuncturist, Herbalist and founder of Chesapeake Acupuncture & Healing Arts, LLC..
WHEN TO REFER FOR ACUPUNCTURE
McNeal believes doctors should consider a referral to acupuncture for virtually any type of pain. “They may want to consider acupuncture as a baseline referral before or with physical therapy to address any mobility, function or pain issues.” Acupuncture is more effective when started early, though McNeal acknowledges that many patients are referred only after months of suffering. “We can achieve an excellent success
Lauren P. McNeal, L. Ac., Dipl. Ac.
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Healthcare IT
Should you store EHRdata Onsite or Offsite? The pros and cons of a client server vs. cloud approach
BY LINDA HA RDER PHOTOGRAP HY BY TRACE Y BROWN
Lisa Ackerson is business development manager, Sidus BioData
I
MPLEMENTING ELECTRONIC Health Records (EHRs) forces physicians to make myriad decisions, not the least of which is whether to store your electronic patient data onsite or off. While there’s not one right answer for every practice, Maryland Physician spoke with several Maryland IT experts and a physician that is managing data onsite, to help you decide what’s best for your practice. Our interviewees were: Theodore C. Houk, M.D., a board-certified Towson internist in solo practice; George Cuthbert, VP, MEDENT® EMR/EHR; Mylon Staton, President/ CEO, DataLink Interactive, Inc.; and Lisa Ackerson, business development manager, Sidus BioData. Client Server Model
Choosing to keep your EHR data onsite, on a server in your practice, is called a Client Server approach. This approach can be a cost effective solution, especially for smaller practices. Theodore Houk, M.D. is making this approach work for his practice. “We use MacPractice CCHIT EHR and were able to quickly ramp up to begin e-prescribing. Within a month, we found electronic prescribing to be very fluid and we’re on schedule to attest to Medicare this fall,” Dr. Houk remarks. “I learned my first day of medical school that I can see things as a threat, a challenge or an opportunity,” muses Dr. Houk. “Electronic data is the future. Providers who don’t adopt it not only will lose Medicare funds, but Carefirst will eventually take a physician's use of EHR into account when computing reimbursement levels in the PCMH (Patient Centered Medical Home) program.” He continues, “We already had the hardware, including a server, two terminals, two laptops and an iPhone, plus a VPN peripheral drive through which we can call in. We spent less than $5000 on system updates to a version that would support EHR, then we spend about $100/month for e-prescribing and
Theodore C. Houk, M.D.
EHR software, which is far less than what a cloud-based approach would cost us.” Dr. Houk touts the remote access of his client server approach. “I can access the data through my iPhone, too, from virtually anywhere, and the system also works with an iPad. We started with remote access to visit and allergy information; now, we can see our progress notes and more. The 3G access through cellular towers means that even in the midst of a hurricane or other weather issues, I can still capture my claims data. We do keep print-outs of the last year of progress notes, including labs, so that we can access the most critical data in the event of electronic device failure,” he continues. “I back up data to a DVD that I take off site. If the power goes out, we can run the server for half an hour with battery back-up, then finish the day on paper.” George Cuthbert, VP, MEDENT® EMR/EHR, which recently expanded to Maryland, concurs with Dr. Houk. “We provide exclusively a client server approach, which is less expensive, more reliable and provides faster data retrieval. Servers typically last for eight years and can cost less than $2000. Practices can
back up onto tape and not have to worry about their data being hacked into, or lost if a data center goes out of business. During storms such as Hurricane Irene, practices don’t have to worry about losing internet access or getting slow, unreliable internet transmission.” The client server approach is best for physicians that desire to have hands-on management of their data and are able to address security, access, disaster recovery, encryption and storage of backup media, and that can keep up to date with regulatory requirements. Virtual or Cloud Hosting
Mylon Staton, president/CEO of DataLink Interactive, Inc., an IT consulting and management firm based in Maryland, helps physician practices and other businesses deploy and manage their electronic data. He is a proponent of cloud-based hosting of EHRs for most physician practices, even ones with a single location and a few physicians. “We advise our clients to consider virtualization technologies in lieu of the old school client server model,” he says. “They can leverage virtualization NOVEMBER/DECEMBER 2011
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Mylon Staton, President/ CEO, DataLink Interactive, Inc.
software to take advantage of these new technologies and leverage remote connectivity from any device such as an iPad. Implementing virtual technologies (Cloud) then makes it easier to move the
growing rapidly. Experts advise physicians to choose a certified data center that can provide secure, HIPAAcompliant data storage. IT firms such as DataLink Interactive typically purchase
“We provide exclusively a client server approach, which is less expensive, more reliable and provides faster data retrieval.” –George Cuthbert system to a data center later on. The practice doesn’t have to buy, house and securely manage a practice management server and terminal server, which require an air-conditioned environment and take up space.” Staton continues, ‘If you have a traditional PC that runs the server and shares data, and that equipment goes down due to air conditioning failure, weather, or sabotage, you can’t schedule patients or do your billing. Cloud technology is now affordable for small businesses. It introduces redundancy and other safety features to protect access to your data and to ensure compliance with HIPAA.” “The cloud is a more efficient way to store data,” concurs Lisa Ackerson of Sidus BioData, a Maryland owned and operated Validated Cloud Hosting/Managed Hosting Services provider since 1999. “You can start by buying only what you need, and expand in the future as your needs change.” With Meaningful Use, the number of healthcare-oriented data centers is 22 |
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large amounts of data “racks” at the data center and then charge clients for using a portion of those racks. Staton states, “Single site practices with five or fewer physicians may not need a data center – it’s likely not cost effective. But if you’re looking to upgrade your technology today, you should move away from the client server model and at least use virtual (Cloud) technology. As your practice grows and you need more IT infrastructure to serve multiple sites, you are then in a position to move to a data center.” While the cost of cloud hosting is not insignificant, it can save on capital costs by outsourcing IT infrastructure. Staton estimates that it can cost as little as $500 per month for a rented virtual server. If you house your own equipment at a data center it can average between $1500 to $2000 per month for data center rack and internet access. Ackerson discusses the advantages of using a data center. “Datacenters provide an economy-of-scale model benefiting small to medium size
practices that may not be able to afford their own datacenter with critical attributes such as backup power, off-site disaster recovery capability, security monitoring and HIPAA compliance,” says Ackerson. “By using this approach, physicians are freed from the inevitable IT distractions, which results in an increased focus on patient care.” Another advantage of using a HIPAA compliant datacenters is that practice staff members may not have the time to stay ahead of the curve with some of the IT-specific regulations found in HIPAA HITECH. In some cases, datacenters have developed mature approaches to compliance by implementing regulatory requirements such as risk analysis/management, security policies and contingency planning. Capturing the data with software isn’t the end of the line – physicians then have to figure out how to manage it without breaching confidentiality. In the event of server failure, practices that don’t have cloud-based data may be unable to access it. If the data is stored on a laptop or other device that is stolen, a thief could hack into the confidential patient information. Practices that participate in an MSO automatically use a common data center. In Maryland, MSOs need to be EHNAC (Electronic Healthcare Network Accreditation Commission) compliant going forward. Considerations for Selecting a Data Center
Ask the following questions when selecting a center to host your data: Is the center able to run all types of software? Is the center accredited? EHNAC has introduced a new program for accrediting vendors of health information exchange services. Is the center truly HIPAA compliant? Make sure they can prove it, not just claim compliance.
Theodore C. Houk, M.D. is a board certified Towson internist in solo practice. Mylon Staton is President/CEO of DataLink Interactive, Inc. Lisa Ackerson is business development manager of Sidus BioData. George Cuthbert is VP of MEDENT®.
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Policy
Coming Soon: Maryland’s Prescription Drug Monitoring Program (PDMP)
Y
Peter R. Cohen M.D.; Laura Herrera M.D., MPH; and Michael Baier
OU ARE CURRENTLY treating a patient with documented chronic pain, a severe anxiety disorder, and a history of chemical dependence. Your worries have now increased exponentially. What is your liability risk? Could you be charged unfairly even if you are treating the patient by accepted guidelines? Is your patient being seen by several other physicians without your knowledge? Is the patient diverting medications you are prescribing? These issues frequently present a dilemma for clinicians, who want to help stem the public health crisis of increased prescription abuse and potentially lethal overdoses, especially of opiates and benzodiazepines. This dilemma is going to change for the better, for the patient and for the practitioner. On May 10, 2011, Governor Martin O’Malley signed into law Senate Bill 883, legislation to create a Prescription Drug Monitoring Program (PDMP) in Maryland, joining 47 other states. For the first time, comprehensive information on prescribed and dispensed Controlled Dangerous Substances (CDS) on Schedules II-V will be made available to doctors, pharmacists and other healthcare providers. What are the goals of the PDMP?
PDMP will provide a powerful clinical tool for the prevention, early identification, intervention and referral to treatment of persons who are addicted to or who abuse prescription drugs. The most effective PDMPs have reduced the non-medical use, abuse and diversion of prescription drugs while preserving legitimate patient access to optimal pharmaceutical-assisted care. This program will also assist bona fide investigations by law enforcement, licensing and regulatory agencies to reduce the diversion of CDS to the illegal market. Finally, in partnership with government agencies, universities, non-profits,
professional societies and other stakeholders, the PDMP will provide healthcare practitioners, policymakers, researchers and the general public with training and educational resources about the appropriate clinical use of CDS and prescription drugrelated abuse and addiction. How will the PDMP work?
When a patient appears in your office, you can sign into this secure database and discover if he or she is being prescribed CDS by other physicians, including how much and how often. This data can help you to analyze the patient’s use and determine if an intervention is needed. Here are the details: What data is reported: For each Schedule II-V CDS prescription, dispensers must report data sufficient to identify the patient for whom the prescription is dispensed, the prescriber, the dispenser and the drug type, dosage and quantity. Who must report: Dispensers of CDS, including in-state and non-resident pharmacies. Prescribers are not required to report unless they are also dispensing. Who is exempt from reporting: 1) Licensed hospital pharmacies dispensing CDS directly to hospital inpatients, 2) Opioid maintenance treatment programs, 3) Veterinarian dispensers, 4) Pharmacies licensed to dispense CDS exclusively to residents of assisted living, comprehensive care and developmental disabilities facilities, 5) Dispensers granted a waiver for inpatient hospice care. Who has access to the data: With formal approval and registration, controlled substance prescribers and dispensers will have electronic access to data close to “real-time.” Health professional licensing boards and law enforcement, regulatory and investigative agencies will
need either a subpoena or have an existing investigation to request PDMP data. Patients and researchers are permitted to request data, with restrictions. Where the data is housed and controlled: The Alcohol and Drug Abuse Administration (ADAA), located in the Department of Health and Mental Hygiene. The technical infrastructure to support the PDMP: Now under development to ensure reliability, validity, security and confidentiality. How will this data be legally protected?
Prescription data are confidential and privileged, not subject to discovery, subpoena, or other means of legal compulsion in civil litigation, and not a public record. Unlawful disclosure is a misdemeanor punishable by up to 1 year imprisonment and a $10,000 fine. Who oversees this program?
ADAA will work closely with the multidisciplinary Advisory Board on Prescription Drug Monitoring, created by statute, to advise on program design and implementation. The Advisory Board will also evaluate the impact of the PDMP on CDS drug abuse, diversion, and legitimate patient access. When will the PDMP be ready?
We anticipate that the database will be open for submitting data and obtaining reports by the summer of 2012. Peter R. Cohen M.D., Medical Director, Maryland Alcohol and Drug Abuse Administration. Laura Herrera M.D., MPH, Chief Medical Officer and Chair of the PDMP Advisory Board, Maryland Department of Health and Mental Hygiene. Michael Baier, PDMP Coordinator, Maryland Alcohol and Drug Abuse Administration. NOVEMBER/DECEMBER 2011
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National power. Local clout. No compromises. The Doctors Company protects Maryland members with both. What does uncompromising protection look like? With nearly 55,000 member physicians nationwide, we constantly monitor emerging trends and quickly respond with innovative solutions, like incorporating coverage for privacy breach and Medicare reviews into our core medical liability coverage. In addition, our over 1,000 Maryland members benefit from the significant local clout provided by our longstanding relationships with the state’s leading attorneys and expert witnesses, plus litigation training tailored to Maryland’s legal environment. When it comes to your defense, don’t take half measures. Get protection on every front with The Doctors Company. This uncompromising approach, combined with our Tribute® Plan that has already earmarked over $11 million to Maryland physicians, has made us the nation’s largest insurer of physician and surgeon medical liability. To learn more, call (866) 990-3001 or visit us at www.thedoctors.com.
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Compliance
The Anti-Kickback Statute: What You Don’t Know Could Hurt You By Laura L. Katz
W
ITH THE SWEEPING changes made by the health care reform law, enacted on March 23, 2010, the provisions in the law which amend the federal Medicare/Medicaid Anti-Fraud and Abuse Statute (commonly referred to as the Anti-Kickback Statute) have not received widespread attention. However, these provisions contained in Section 6402(f) of the health reform law, which lower the criminal intent standard for violation of the Anti-Kickback Statute and clarify that a violation of the AntiKickback Statute constitutes a false or fraudulent claim, could have far reaching effects for physicians. By making it easier for the government to prove a violation of the Anti-Kickback Statute and adding new tools to the government’s arsenal of weapons used for enforcement purposes, physicians will have significantly greater exposure to liability. More specifically, Statute 6402(f) lowers the criminal intent standard under the statute so that the government no longer has to prove that the physician had actual knowledge of the Anti-Kickback Statute and or a specific intent to violate the law. Section 6402(f) also makes it clear that violation of the statute constitutes a false or fraudulent claim under the False Claims Act. No one can escape the recent headlines of how federal agents have recovered billions of dollars from health care fraud judgments. By converting violation of the Anti-Kickback Statute into a false claim, physicians will now be exposed to liability under the federal False Claims Act. Civil penalties imposed for violation of the False Claims Act include treble damages plus a fine from $5,000 to $10,000 per claim. These penalties combined with the administrative sanctions available for violation of the Anti-Kickback Statute can be crippling to any practice.
The Anti-Kickback Statute is not a new phenomenon. It essentially prohibits the knowing and willful offer and acceptance of remuneration in cash or in kind to induce the referral of patients for the furnishing of items or services reimbursed by Medicare or Medicaid. While it is a generally acceptable practice in other industries to reward a person for his//her business or the referral of business, such practices are not permitted in the health care industry. The AntiKickback Statute makes it a crime to give and accept rewards for the referral of business reimbursed by the federal health care programs. Upon conviction for violation of the statute, an individual can be imprisoned for up to five (5) years, and fined up to $25,000 per violation or both. In addition, physicians who violate the statute may be subject to civil monetary penalties up to $50,000 and suspension or exclusion from participation in federal health care programs. Prior to the amendments made to the Anti-Kickback Statute, some courts adopted a criminal intent standard established by case law that requires the government to prove that the defendant’s had knowledge of the Anti-Kickback Statute and had a specific intent to violate the statute. Other courts declined to follow that standard and found that the defendant violated the Anti-Kickback Statute if one purpose of the remuneration at issue was to induce or reward referrals of items or services reimbursed by Medicare or Medicaid, regardless of the defendant’s knowledge. Passage of the amendments to the Anti-Kickback Statute now eliminates these differences. The breadth of the Anti-Kickback Statute is staggering. It is commonplace for physicians in their everyday practice to be presented with situations that may be deemed a violation of the statute including, but not limited to, proposed
lease or management services arrangements tied to the volume or value of referrals, the routine waiver of coinsurance and deductibles, or the offer or acceptance of free gifts, such as free tickets to sporting events, to induce referrals. Because of the breadth of the statute, the Department of Health and Human Services, Office of Inspector General (OIG) issued safe harbor regulations which immunize certain business arrangements from prosecution, as long as all of the criteria of the pertinent safe harbors are met. The OIG has also issued continuing guidance in other forms, such as Special Fraud Alerts, Advisory Opinions and Bulletins. Some of the lessons learned from these materials are that arrangements should be reduced to writing, the compensation under the arrangement should not be tied to the volume or value of referrals and the compensation arrangement should be equal to the fair market value of the space, equipment, services or items being provided. Particularly in this new environment, to the extent possible, a good defense against the possibility of government action will be to structure transactions to comply with the criteria of all applicable safe harbors. Laura Katz is a partner in the Baltimore office of Saul Ewing LLP and is a member of the firm’s Health Law Practice Group and Insurance Practice Group. She can be reached at lkatz@saul.com.
NOVEMBER/DECEMBER 2011
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Heritage
Maryland Hospital Association: Leadership and Advocacy for State Healthcare Providers By Tracy M. Fitzgerald
I
n the 1940’s, a small and influential group of healthcare leaders began meeting to discuss mutual interests and best practices, as a means of supporting one another and ultimately improving the delivery of healthcare in Maryland. In 1970, that group formalized to become the Maryland Hospital Association (MHA). And today, the organization serves as a resource and leader for the 66 acute and specialty care hospitals, as well as large health systems, across the state. President and Chief Executive Office Carmela Coyle provided Maryland Physician with some insights on key priorities of MHA, including how her staff of 40 are helping Maryland hospitals be the very best they can be.
Q: A:
What is the mission and vision of MHA?
MHA’s mission is to help Maryland hospitals and health systems serve their communities by providing leadership, advocacy, education and innovative programs and services. Ultimately, we are here to help Maryland hospitals help people. Our vision is to be the lead association shaping health policy, healthcare and health in Maryland.
Q:
What core services does MHA provide to hospitals and health systems in the state?
A:
We have a number of key priorities, the first of which is to provide advocacy for Maryland hospitals in both Annapolis and Washington D.C. We are also very involved with financial policy, negotiating for Maryland hospitals as prices are set through the Health Services Cost Review Commission. This is a critically important role, as Maryland is the only state in the U.S. not paid under federal Medicare rules. We are working to modernize Maryland’s payment system with the advent of federal healthcare reform. Quality and patient safety initiatives are significant areas of focus for us, as well as the general services we provide to our members, such as group purchasing and educational opportunities.
Q:
What challenges are most apparent in the landscape of healthcare today?
A:
Healthcare has become so complex in terms of what it actually takes to care for a patient. Literally, hundreds if not thousands of people must come together to provide specialized care for each patient. And of course there is a lot of concern about rising healthcare costs. More than ever before, hospitals are being asked to do more with less. Financial constraints in today’s world of budget deficits is definitely the number one challenge.
MHA President and Chief Executive Officer Carmela Coyle is joined by Richard “Dick” Davidson, Maryland Hospital Association’s first appointed President, who served from 1970 – 1991.
Q: A:
What are MHA’s goals for the future?
We are working hard to help Maryland hospitals and health systems stay at the forefront of innovation. Our goal is to help move Maryland hospitals to the leading edge of quality, safety and population health performance, so that every patient receives care of the very highest quality. We don’t want to just improve; we want to LEAD and be known as the best of the best.
Q:
What is the most important thing for healthcare leaders to know about MHA?
A:
MHA is an organization that is for, and led by, its members. Second, we are driven not just by what is important to hospitals, but by the process of actually shaping health policy, healthcare and the general health of our community. We are here to serve our members as they straddle the healthcare system of today while building the healthcare system of tomorrow. NOVEMBER/DECEMBER 2011
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Good Deeds
Gilchrist Hospice Care Making A World of Difference By Tracy M. Fitzgerald
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N SEPTEMBER 2010, A TEAM of four professionals from Baltimore based Gilchrist Hospice Care boarded a plane and headed to the Arusha Region of Tanzania, Africa. There, they spent two weeks working with their partners at the Nkoaranga Lutheran Hospital, with a goal to better understand how hospice and palliative care services are administered, and ways that their support could help improve quality care for patients in this under-privileged part of the world.
Maryland, have established similar partnerships, through the Foundation for Hospices in Sub-Saharan Africa (FHSSA), whose mission is to enhance patient care offerings in Africa through the facilitation of mutually beneficial relationships. While those with limited resources in Africa benefit from financial support and educational platforms, participants from the U.S. are gaining a deeper understanding of cultural diversity as well as a greater appreciation for the psychosocial and spiritual aspects of hospice and palliative
“The better we are about getting word out about what we are doing, the more we can do to make a positive difference for the people in Tanzania.” –Cathy Hamel
The need for improved facilities and medication systems were obvious immediately. But the Nkoaranga Lutheran Hospital was lacking many of the “basics” too, including resources needed to effectively provide hospice and palliative care. In some cases, a physician was walking eight to ten miles to see and treat a patient at their home, then turning around and making the long hike back. Committed to providing financial, technical and educational support to their partner in need, among other things, Gilchrist Hospice Care is now funding the transportation needs of the African hospital, leading to not only more efficient operations, but also an expansion in the geographical territory served. “It was reinvigorating to see how much they are doing there, with so little,” said Aaron Charles, M.D., Assistant Medical Director for Gilchrist Hospice Care, an affiliate of GBMC Healthcare. “You quickly realize how fortunate we are; we have much more than people in other parts of the world.” More than 90 hospice organizations in the U.S., including two others in 30 |
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care, and of course, some valuable lessons in how to do more, with less. “We can’t help but to be better as a result of what we are learning through this partnership,” said Cathy Hamel, Executive Director of Gilchrist Hospice Care. “We are helping others and at the same time, opening new doors for ourselves. We are making connections with other organizations doing work internationally, and we are all learning from and supporting one another.” Gilchrist Hospice Care has pledged to fund $37,000 annually, to keep the core services offered by Nkoaranga Lutheran Hospital intact. As they prepare for their second trip to Tanzania, planned for February 2012, the organization has implemented a number of fundraising programs to support their commitment, including the making and selling of African jewelry at community events, health fairs and conferences. To date, Gilchrist Hospice Care’s volunteer team has made and sold thousands of beaded pieces, with all profits benefiting this partnership program. “This is a big commitment and we are interested in engaging more physicians,
While in Tanzania, Aaron Charles, M.D., spent some time observing how hospice and palliative care is administered to patients, including children, at the Nkoaranga Lutheran Hospital.
healthcare leaders and members of the community in our efforts,” said Hamel. “The better we are about getting word out about what we are doing, the more we can do to make a positive difference for the people in Tanzania.” To learn about opportunities for involvement with Gilchrist Hospice Care’s partnership with the Nkoaranga Lutheran Hospital, including volunteer, fundraising and advisory board efforts, please call 443-849-8283. Maryland Physician would like to hear about your “Good Deeds.” Please share your ideas with us by contacting us via email at gooddeeds@mdphysicianmag.com.
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