Louisiana Medical News April 2015

YOUR PRIMARY SOURCE FOR PROFESSIONAL HEALTHCARE NEWS APRIL 2015 / $5

SOU TH LOU ISIANA ED ITION PRACTICE MANAGEMENT

On Rounds Physician Spotlight

Cuts to Medicaid Payments Hurt Physicians, Patients

Dr. Stewart Greathouse

middle of 2014 because no one could pinpoint the size of the pending reimbursement cuts.

Independence is a small, poor area with a For two years, family doctors in Louisiana fair number of Medicaid patients. Genovese said got the same amount for treating Medicaid pahe’s not sure now where those new Medicaid patients as Medicare enrollees, thanks to the Affordtients will go for care. He can’t afford to take on able Care Act. But the Medicaid fee hike ended more patients, and a lot of family doctors nearby when 2014 did, and primary care physicians and are in the same boat. their patients are dealing with fee cuts that avThe only place left is a hospital Emergency erage around 32 percent statewide, according to Room, which as everyone knows is “the most the nonpartisan Urban Institute. cost-effective” care there is, Genovese said. It’s Dr. Charles Genovese of Independence said so cost-effective that Baton Rouge General – he went from making $50 a visit for a Level 4 Mid City is closing its ER. patient to $10. Most of his practice consists of Hospital officials have said the Mid City ER treating these sorts of patients, people with sevDr. Charles Genovese is losing $2 million a month. The losses have eseral chronic health issues and taking multiple precalated in the two years since the state closed Earl K. Long Mediscription medications. cal Center, a state-run charity hospital. Many of the uninsured “Close to 50 percent of my practice is Medicaid. So if it was patients treated at Earl K. Long began seeking care at the Mid any more than that I would have just closed up and got a job City ER and the financial burden mounted. somewhere else,” Genovese said.

He stopped accepting new Medicaid patients around the (CONTINUED ON PAGE 6)

BY TED GRIGGS

What’s the buzz?

Growing up between Lake Charles and Grand Lake, Stewart Greathouse enjoyed living the rural life. But, it wasn’t until attending Pensacola Christian College that he received his calling to be a doctor ... page 3

PRACTICE MANAGEMENT

Providers Fight Medicaid Billing Period Cut Protests by Lafayette-area hospitals and the state’s largest ambulance service have apparently convinced the state to reverse an abrupt decision that would have cut the Medicaid timely filing limit in half ... page 5

Gearing up for ICD-10

CMS confirms Oct. 1 switch; healthcare consultant offers cautionary notes

BY JULIE PARKER Successful completion of a full week of end-to-end testing of the new ICD-10 coding shows the healthcare industry is ready for the next step toward total conversion from ICD-9 coding, Marilyn Tavenner, former administrator of the Centers for Medicare

and Medicaid Services (CMS) said before her departure from the federal agency earlier this year.

To promote the healthcare industry’s smooth transition from ICD-9 to ICD-10, CMS is conducting a comprehensive program of testing. In the first full week of testing -- from Jan. 26 to Feb. 3 – CMS received nearly 15,000 test claims from 660 providers.

“Testing allows us to identify areas of improvement, and we’ll work with outside

October

(CONTINUED ON PAGE 6)

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Physician Spotlight

Dr. Stewart Greathouse What’s the buzz?

BY LISA HANCHEY

Growing up between Lake Charles and Grand Lake, Stewart Greathouse enjoyed living the rural life. But, it wasn’t until attending Pensacola Christian College that he received his calling to be a doctor. “I was in a chapel service and heard a message about being faithful and a good steward with the talents that God has blessed me with, and I felt convicted,” he revealed. “I had really never thought of doing anything medical before.”

This included a knack for science. So, the biology major decided to put his talent to work by becoming a physician.

Greathouse returned to Louisiana for medical school at LSUHSC in New Orleans. During his first and second years of med school, he met another Lake Charlesbased physician, Dr. Carl Nabours. The Calcasieu Parish natives discovered that they shared many common interests. It was Nabours who introduced Greathouse to beekeeping. “We talked a lot about gardening, farming, working cattle – and beekeeping,” he said. “I found beekeeping very interesting.”

Intrigued, Greathouse read a couple of books on the subject in between semesters, then discussed it with his father, James. At first, his Dad brushed it off. “He hates anything that stings or flies,” Greathouse explained with a laugh.

But, about six months later, James called his son and said that he had changed his mind. The two decided to do beekeeping together on James’ property. James provided the start-up funds and equipment; Stewart provided the research, and both did the grunt work. Through a little digging, they discovered family members on both sides who had been beekeepers in North Dakota and Wisconsin.

Stewart went on to complete medical school at LSU in New Orleans, then returned to Lake Charles for his internship and residency at the Memorial/LSUHSC Family Medicine Center at Lake Charles Memorial Hospital. “I enjoyed working with people who lived in a more rural, agricultural area outside of the city limits,” he explained. “When looking at the different medical specialties, family practice was the one that seemed to fit most with being able to do the most for that group of people. I wanted to be able to develop relationships with people and take care of them long-term.”

After completing his studies, Greathouse started practicing at Moss Bluff Family Medicine, part of the Memorial Hospital Group, in the fall of 2014. This allowed him to be close to his father’s property, where the family continued to expand their beekeeping business.

Depending on the season, the Greathouse men regularly check on the bee

hives about every three to six weeks. Starting in late February or early March, the beekeepers make sure that the queen and worker bees are healthy and the hives are roomy enough. In early Spring, the bees begin ramping up their nectar storage and egg laying. Late spring, the eggs hatch and produce a new population of bees. Then, the colony leaves the nest to forage nectar from blooming flowers, which they use to make honey.

When it comes to making honey, the Greathouses obviously have the Midas touch. They now have 25 to 30 hives, which

produce enough honey to supply Greathouse’s entire family and beyond. The Greathouses sell the honey, appropriately dubbed “Greathouse Honey,” out of their house as well as at the Charlestown Farmers’ Market in downtown Lake Charles.

Beekeeping has become a great way to bind the Greathouse family. James and Stewart still work the bees together, with occasional help from Dr. Greathouse’s sixyear-old son, Brock, and his wife, Erica.

“She loves it,” Greathouse said of Erica.

“When she has free time, she’ll come out and help me every once in a while.”

The Greathouses also have three other children: Tara, age 4, Alyssa, 3, and Cade, 1. At harvest time, the whole family pitches in to extract the honey using a hand-driven extractor and hand-held uncapping knife before spinning the golden fluid. “We get to do that all together, so it’s a lot of fun,” Greathouse said.

Based on the buzz, the Greathouse honey empire will continue to grow. “We never thought we’d have 25 to 30 hives,” Greathouse said. “It could go up to 50.

My Dad is not showing any signs of slowing down.”

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Louisiana Medical News

APRIL 2015 • 3

Hogs for the Cause Going hog wild for kids with brain tumors

BY LISA HANCHEY

Growing up on the same street in New Orleans, childhood friends Becker Hall and Rene Louapre knew about good food and good times. When Hall went away to college in South Carolina, he discovered a cuisine that was new to him – low country barbeque. “We used to have whole hog roasts before football games,” he recalled.

After returning to New Orleans, he found himself missing the whole hog experience. So, he and Louapre decided to host a Carolina-style whole pig roast for a few friends. Along the way, they had an opportunity to meet a child with an inoperable brain tumor, DIPG (Diffuse Intrinsic Pontine Glioma). The young patient’s predicament made such an impact that they decided to convert the BBQ into a fundraiser.

Seven years ago, Hall and Louapre launched the inaugural Hogs for the Cause Fundraiser and Cookoff benefitting families of children with brain cancer and facilities treating the disease, including Children’s Hospital New Orleans, Ochsner, Duke and Medical University of South Carolina in Charleston.

In its first year, over 200 people attended the event, which raised $7,000. For the second year, the co-founders added a BBQ contest. Bands followed in the fundraiser’s third year. “By year three, we were a full festival,” Hall said.

Since then, Hogs for the Cause has grown exponentially, with 20,000 attending last year despite seven inches of rain.

As of press time, Hogs had distributed over $350,000 since March 2014. About 300 people volunteer to help with the event annually. “New Orleans is a festival-rich city, so it’s easy to get people out to enjoy good food and good music,” Hall said. “But, there’s a good cause involved, too. We’re all about the giving.”

Two years ago, Children’s Hospital in New Orleans became a beneficiary of Hogs for the Cause. The hospital uses its Hogs for the Cause fund to assist pediatric brain cancer patients’ families with nonmedical bills. “What we’ve found is that while a child is being treated here, parents frequently have to take off of work to be with their child, and that might be for several weeks,” explained Roger Gorman, Director of Development for CHNOLA. “They get behind with paying their bills, and they really find themselves in a difficult spot. So, the Hogs for the Cause fund is designed to help those families with those sorts of problems.”

CHNOLA does not use the fund to pay for patient care, but to help families with personal expenses including major car repairs, car payments and home HEPA fil4 • APRIL 2015

Louisiana Medical News

ters. At press time, the facility had just provided a family with funds to pay its phone bill. “This is really a godsend for a lot of our families,” Gorman said of the fund.

In 2014, CHNOLA received $25,000, used to issue 39 check requests totaling $14,668.34. So far this year, the hospital has received $5,848.92 to provide aid to 19 families.

The seventh annual Hogs for the Cause is slated for March 27-28 in New Orleans City Park, which becomes City “Pork” for the weekend. This year’s theme is “Morroc-and-Roll, a Mediterranean Street Fair.” Thursday night features a gala at 6 p.m. with food prepared by James Beard Award winning Chef Donald Link

and his team of chefs from Cochon and Pêche. On Friday, the gates open at 3 p.m. with bands including Drive-By Truckers, Earphunk, Strand of Oaks, Moon Hooch, Uncle Lucius and The Wooden Wings.

Saturday’s live band line-up includes The Wood Brothers, J. Roddy Watson & the Business, Tab Benoit, Hiss Golden Messenger, Toubab Krewe, The Soul Rebels, George Porter & Runnin’ Pardners, Little Freddie King and King James & The Special Men. Beginning on Saturday at 11 a.m., teams compete in the High on the Hog pork cookoff. This year, 85 teams from

For more information, visit the website at www.hogsforthecause.org., or email at info@hogsforthecause.org.

across the country, including California, South Dakota, South Carolina, Florida – and, of course, New Orleans – for the grand prize. “It’s gotten to the point where it’s become a pretty respected barbeque competition, and people want to win it,” Hall said.

The teams are the primary fundraiser for the event. One team alone raised $65,000.

“There are a lot of teams shooting for six figures this year,” Hall revealed.

This year’s goal is to raise even more money and have more people attend the event. “We hope to have people go away happy and say, ‘That was one of my favorite events of the year,’” Hall said.

But for the co-founders, the most rewarding aspect of Hogs for the Cause is the impact it makes on patients’ families.

“Meeting with these families is an incredible experience,” Hall said. “Being able to alleviate a lot of their financial pressures is a great feeling. We get mails and emails from our families almost weekly telling us how much it helped them and what it meant to them. That’s when you know you’re making a difference.”

Tickets are $20 online and $30 at the gate. Admission is free for children under 12.

PRACTICE MANAGEMENT

Providers Fight Medicaid Billing Period Cut

By TED GRIGGS

Protests by Lafayette-area hospitals and the state’s largest ambulance service have apparently convinced the state to reverse an abrupt decision that would have cut the Medicaid timely filing limit in half.

The state Department of Health and Hospitals issued a provider memo on Jan. 30. In it the department said as of Feb. 1, timely filing requirements for Louisiana traditional Medicaid claims must be filed within 180 days with few exceptions. The timely filing period had been 365 days.

Attorney Theodore M. “Ted” Haik Jr., whose law firm represents four hospitals, said DHH’s decision would have cost his clients an estimated $750,000 a year. Acadian Ambulance Services officials told him shortening the filing period could cost the company as much as $1 million a year.

Ted Haik, Jr. Asked if that loss of revenue could make the difference between a smaller hospital remaining in operation or closing its doors, Haik replied “No question. No question.”

The major issue for hospitals and other providers involves third-party claims, Haik said. These sorts of Medicaid claims

can take several months to file. Typically they’re made after all other payers and avenues have been exhausted.

For example, suppose an uninsured person gets rear-ended through no fault of his own. He suffers multiple injuries and an ambulance has to take him to a hospital Emergency Room. Eventually a lawsuit is filed, but it takes months to litigate. Meanwhile, the patient can only pay part of the hospital bill. The hospital then bills Medicaid for the balance. But the entire process can easily take more than 180 days.

“I requested from four of the hospitals I represent to help us determine how much money each one would lose, if in fact, they did not pursue a third-party claim and had to file it directly with Medicaid,” Haik said.

“It was in the neighborhood of $750,000 or so, just from those four hospitals.”

For Iberia Medical Center, that amount of money represented somewhere between 20 percent and 25 percent of its bottom line, Haik said.

Roughly two weeks after the memo came out, a large group of hospital representatives, and the ambulance service, met with DHH to ask the agency to drop the new rule. Haik said agency officials appeared open to that request.

Sen. Fred Mills, R-Parks, who has worked on the issue, said DHH has been very willing to discuss the change.

“From my preliminary talks I think a final verdict will prevent legislation this session,” Mills said.

An official decision had not been made as of press time.

The providers’ urgency is understandable.

In order to overcome a Jennifer DHH-promulgated rule, Marusak legislation is required.

And there is a limited time available to file bills for the regular session of the Legislature.

Jennifer Marusak, vice president of governmental affairs at the Louisiana State Medical Society, said there’s no way now to estimate the shortened billing period’s financial impact on physicians.

So far, none of the Medical Society members have complained, Marusak said.

But that’s probably because most aren’t aware of the new rule.

Physicians are busy taking care of patients. Oftentimes they’re not running the business end of the practice, Marusak said.

Their billing agencies or office managers are dealing with that, and the physicians may not hear about the problem for a while.

While the shortened period would affect physicians less than the hospitals or ambulance services, it will have some im-

pact, Marusak said.

“It’s just going to add to the hassle factor until it ends up being an administrative nightmare,” Marusak said.

DHH officials were unavailable for comment.

Haik said he didn’t want to speculate on the thinking behind DHH’s decision to shorten the timely filing limit.

For some unknown reason or reasons, while changing some aspects of Medicaid funding, the agency didn’t really think through this particular portion of the billing process, Haik said.

“They didn’t realize that by shortening this time period to file, they would actually be penalizing the hospitals,” Haik said.

“They would actually be causing much more administrative work for DHH to process Medicaid filings. They did not really realize the significant financial drag that would be on the Medicaid fund.”

That “drag” would basically total the same amount that providers are now collecting from third-party payers, Haik said. For the hospitals he represents, that’s $750,000 a year.

With the state strapped for cash, those third-party payments represent a significant contribution, Haik said. There’s no good reason the state would want the Medicaid fund to pay instead of whoever is actually liable for the bill.

Louisiana Medical News

APRIL 2015 • 5

PRACTICE MANAGEMENT

Cuts to Medicaid Payments Hurt Physicians, Patients, continued from page 1 Genovese’s father opened the practice in 1945 and worked there for more than 50 years. Genovese himself has been at the family practice for 31 years. But he’s not sure how much longer he will stay.

“I’m not sleeping at night. I’m up at 2 o’clock in the morning … thinking about selling my house, because I can’t afford it now. Things like that,” Genovese said.

The payment bump was designed to improve the support for primary care physicians and access to primary care as Medicaid coverage expanded. The program pumped $5.6 billion into primary care over two years.

It’s difficult to estimate how many primary care physicians are struggling with the Medicaid cuts. But one thing is certain. Genovese is not alone in coping with the cuts.

Only 15 states have said they plan to continue the fee increase, in full or in part, for 2015, according to the Urban Institute. Without the Medicaid primary care bump, providers are looking at an average cut of 42.8 percent nationwide.

The public policy think tank found that reimbursement cuts vary widely.

Seven states will see fee cuts of 50 percent or more. Four states will experience no change.

Research shows a correlation between lower payment rates and fewer physicians accepting new Medicaid patients “Although payment is not the only

factor in physician acceptance of Medicaid, research has demonstrated a correlation between lower payment rates and fewer physicians accepting new Medicaid patients,” the report says.

Jennifer Marusak, vice president of governmental affairs at the Louisiana State Medical Society, said the boost was always going to fade away on Jan. 1.

Physicians knew the higher payments were going away, she said. The question is how much did the doctors rely on them?

Nothing can be done at the state level because the Affordable Care Act, also known as Obamacare, is a federal law, she said.

Greg Waddell, former vice president of legal affairs at the Louisiana State Medical Society, said the state wasn’t in a financial position to extend the payments.

“Our hope was that Congress would extend the payment hike,” said Waddell, current vice Greg Waddell president of legal, governmental and regulatory affairs for the Louisiana Hospital Association.

But efforts to extend or expand the Medicaid payment hike proved unsuccessful. A lot of people had asked Congress to include obstetricians, who were excluded from the pay bump.

Physicians’ health Foundation oF louisiana

Waddell said the end of the payment increase will be difficult for everyone, patients, physicians and hospitals.

Hospitals will see the effects as more people try unsuccessfully to find a primary care physician, Waddell said. Those patients will resort to other avenues of care,

Gearing up for ICD-10, continued from page 1 entities and stakeholders to improve those very small deficiencies identified,” she said at the time. “And we’ll continue to do testing, especially in those areas we identify as needing improvement.” Tavenner added, “Because ICD codes are required on medical bills, we want healthcare providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.”

CMS also identified a point that’s prompted some confusion among the healthcare community. Acting Administrator Andy Slavic has reiterated ICD-9 coding is to be used for services provided before the Oct. 1 deadline; ICD-10 coding will be used for services provided on or after Oct. 1. Prior to Oct. 1, ICD-10 can be used only for test purposes. However, once we hit Oct. 1, 2015 only ICD-10 can be used for services rendered on or after that date. But claims submitted after Oct. 1, 2015, for services provided before that date, must still use ICD-9 codes.

Margie Maley, BSN, MS, coding educator and consultant with KarenZupko & Associates Inc., a national consulting firm based in Chicago, said she’s strongly advising clients that bill directly to Medicare to apply for end-to-end testing.

“If you don’t get accepted for end-to-

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and those avenues will likely lead to hospital Emergency Departments.

It’s also possible that the state will see an exodus of primary care physicians, Waddell said. But it’s impossible to say now whether that is happening or how long that will take to develop.

louisianamedical news.com

end testing, at the very least conduct acknowledgement testing,” she said, noting that applications for the next available end-to-end testing (mid-July) became available on all carrier websites (MACs) on March Margie Maley 13.

“Medicare is only accepting up to 850 providers per testing week, so act fast,” urged Maley. “Even our orthopedic clients who must deal with the greatest increase in ICD-10 codes and reorganization have jumped onto the testing bandwagon successfully.”

Maley pointed out that claims testing highlights more than ICD-10 issues.

“Medicare says that 6 percent of testing errors were due to ICD-10,” she emphasized. “Yet more than twice that – 13 percent – were due to provider-preventable errors, such as incorrect NPI or submitter ID, or invalid place of service or HCPCS codes.”

Carrier software bugs are also being caught in the testing phase.

“A lot of this is just the nature of software development … not necessarily a coding issue,” Maley said. “Everyone is creating new features to deal with ICD10 and they need to be tested so bugs are caught and fixed before the deadline. So make sure your practice is part of the testing process. You never know what you might learn about your own processes.”

CMS is clearly ready for ICD-10, emphasized federal officials.

“And thanks to our many partners — spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups — the healthcare community at large will be ready for ICD-10 on Oct. 1,” Tavenner promised before stepping down. “I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of healthcare for all Americans.”

For healthcare providers unable to complete the necessary systems changes to submit claims with ICD-10 codes by Oct. 1, CMS has provided free billing software via MAC websites.

This billing software has been updated to support ICD-10 codes to offer submitters an ICD-10 compliant claims submission form; coding assistance isn’t provided. Alternatively, all MACs websites provide internet portals; a subset of those portals offer claims submission.

PRACTICE MANAGEMENT

Survey Says … A Digital Disconnect Exists Between Patients, Practices

By CINDY SANDERS

Patients increasingly want to access online services to enhance convenience and communication with providers, according to a recent national survey conducted by TechnologyAdvice Research. Yet, the majority of respondents in the “2015 Trends in Patient Engagement” survey said a number of digital solutions that would be helpful are not offered by their primary care practices.

“Only 19 percent said their physician offered online appointment scheduling,” noted Cameron Graham, survey author and managing editor for TechnologyAdvice, a company that conducts research and analysis of IT products in a number of industries including Cameron healthcare. “Only 17 perGraham cent said their physician offered online bill pay.”

In addition to scheduling and payment functions, Graham said viewing test results or diagnoses online also ranked high among survey participants. However, only 27.8 percent said their physician provided that option. Graham pointed out all three of the most desired digital services are fundamental patient portal features.

With that in mind, he continued, “There’s a big discrepancy between what patients report having access to and the EHR adoption rate among physicians.”

Graham said electronic health record adoption rates are in the “high 70s, low 80s” by office-based physicians in the United States. “A lot of those systems should have online appointment and bill pay capabilities,” he said, adding some of the older systems might not have those options but virtually all newer products offer robust patient portal resources.

“I think one of the big takeaways is that the patients don’t seem to be aware of the tools their physicians probably have,” he said. The other option, Graham continued, is that offices have these capabilities but are not using them. Either answer could spell trouble for practices.

“When we asked how important these services were when people were choosing a physician, 60.8 percent said it was ‘important’ or ‘somewhat important,’’ Graham said. “If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”

Graham added he also believes physicians need to more fully embrace digital services. “Patients value them a lot. Physicians think of them as an extra or add-on.”

With meaningful use requirements staged to increase health information exchange and promote patient engagement, Gra-

ham noted the effective use of patient portals could help practices hit the necessary benchmarks to access incentives.

However, he noted, there probably won’t be a ‘one size fits all’ solution when it comes to patient engagement. “We did find age played a role in which services patients wanted their physicians to offer,” he said.

Not surprisingly, the demand was much higher by younger adults than in the senior population. “Among the 25- to 34-year-old demographic, almost 40 percent said they would like to have a smart phone app for scheduling appointments; but among the 65 and older demographic, only 3.8 percent said that would be something they’d

want.”

Similarly, 35.3 percent of patients ages 25-34 would like for their physician practice to offer secure messaging outside of office hours compared to just 11.5 percent of those ages 65 and older. Of the six digital services listed on the survey (online (CONTINUED ON PAGE 13)

Louisiana Medical News

APRIL 2015 • 7

PRACTICE MANAGEMENT

Compiling ‘The Notebook’

A free comprehensive standards ‘cleaning product’ directory is near completion for the healthcare industry

By JULIE PARKER

Time to Make Reservations

Louisiana Medical News is now accepting reservations for 2015!

Share your message with Louisiana’s professional healthcare community by reserving your advertising space now. No other publication has the targeted reach, the engaged readership, and the industryspecific editorial coverage offered by Louisiana Medical News.

2015 Editorial Calendar January – Public Health/ Infectious Disease – Health Law February – Cardiology – Mergers & Acquisitions March – Oncology – Healthcare Marketing April – Behavioral Health & Addiction – ICD-10/Practice Management

May – Women’s Health – Health Information Technology June – Men’s Health – Patient Care Models July – Personalized Medicine – Medical Schools/ CME August – Ortho/Sports Medicine – Compliance Mandates

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It’s not sexy, but it’s certainly important.

The Notebook, that is, a new standards “cleaning product” directory so completely new across the entire acute care spectrum that no one has touched it.

“If it was easy to do, it’d have been done,” said Stephen Sawyer, director of healthcare strategic sourcing for CBRE | Global Corporate Services in Charlotte, NC. Sawyer, who previStephen Sawyer ously worked in a group purchasing organization, has voluntarily undertaken the tedious task of assembling a compendium of cleaning product information for healthcare administrators, with information ranging from the listing of chemicals used in cleaning products to the infectious diseases germs killed by antibacterial lotions.

“The healthcare industry could learn a lot from the hospitality sector,” said Sawyer, noting that hotel chains like Marriott set the standard for homogenous janitorial supplies. “As hospitals merge and acquire physician practices, it would benefit them to follow this standardization trend. Like a hotel, hospitals can and should condense their manufacturer supply base to one brand. Standards by definition reducing waste and hard cost.”

Sawyer, who suffered from asthma and allergies as a child, was recently in a cough-riddled waiting room of an urgent care clinic when he asked the administrator which germs their antibacterial lotion killed.

“Administrators and clinicians are so busy, it’s one of the last things they might think about,” said Sawyer. “Knowing the particulars of varying manufactured products is a task that gets buried with higher priority patient care and administrative processing tasks. If they do have or know information, it’s typically piecemeal because that information isn’t commonly shared with its venue of use.

I consider this product directory a support mechanism – an important component of the educational toolbox – to hand out to patients and anyone in a medical office that needs or wants to know how these products will affect them.”

To complete this arduous task, Sawyer partnered with various manufacturers in

five janitorial industries. “I haven’t had one manufacturer tell me they already have this information handy,” he noted.

To facilitate manufacturer responses, Sawyer provided questionnaires that made it easy for them to fit their solutions into the mold or wireframe.

“For example, can liners more commonly known as trash bags, and other products are categorized in multiple ways, such as soaps and lotions, housekeeping and floor care chemicals and related products, and paper towels, tissues and dispensers,” he said. “The Notebook will eliminate inconsistencies of products, service cleaning and pricing.”

At press time, Sawyer was near completion of the soup-to-nuts “cleaning program” compendium that CRBE will gladly share with healthcare clientele at no charge. As products are added, deleted or changed to the skeleton directory, he’ll provide instantaneous updates.

“We’re not expecting accolades for compiling this information,” said Sawyer. “Packaging this important type of information was simply the right thing to do. When the next epidemic comes, with healthcare providers having instant access to this specific data, we’ll be better prepared to deal with it and therefore mitigate the damage.”

Sawyer, who specializes in healthcare brand identity, said the information will also boost the patient experience, which represents one of the top three priorities of healthcare leaders over the next three years, according to new research by The Beryl Institute, a global company focusing on patient experience improvement.

“Creating consistency while capitalizing on economies of scale should be a core proponent of a system’s strategy,” he said. “Identifying solutions that assist in delivering a uniform brand while challenging suppliers to create new visual and budgetary business models will produce a competitive advantage and best-in-class outcomes.”

Creating standards that can be replicated from location to location will deliver the outcomes that enhance the patient experience, Sawyer pointed out.

“Leveraging the expertise and knowledge available,” he said, “will eliminate waste and reduce cost while promoting the brand and allowing healthcare leaders to keep their eye on delivering superior patient care.”

PRACTICE MANAGEMENT

What Does UnitedHealth’s Latest Move on Hysterectomies Mean?

Nation’s largest health insurer stiffens rules on hysterectomy coverage

By JULIE PARKER

UnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterectomy coverage.

Even though the insurer’s plan to impose tighter restrictions on the use of the morcellator has garnered the most attention – many hospitals ceased using the laparoscopic surgical device after the FDA reported in April 2014 the fast-spinning blade can actually spread uterine sarcoma in some women undergoing hysterectomies – the squeeze is also being felt on the performance of hysterectomies in general.

UnitedHealth (NYSE: UNH), the insurer of 40 million patients based in Minneapolis, Minn., now requires specific authorization before most types of hysterectomies are performed. Only vaginal hysterectomies – the least invasive and inexpensive option – done on an outpatient basis are exempt. The policy doesn’t affect hysterectomies performed in cancer treatment. Approximately half a million hysterectomies are performed annually in the United States.

Before UnitedHealth announced its policy decision, Anthem was the only major commercial insurer requiring preauthorization for hysterectomies. Cigna and Aetna haven’t indicated they will follow suit. An Aetna spokesperson said the decision is “best left up to the physician and patient based on clinical circumstances,” a position also adopted by the American College of Obstetricians and Gynecologists (ACOG).

Days after UnitedHealth’s announcement, ACOG members buzzed about the issue at an ACOG national leadership conference.

“It’s been good fodder for discussion, though we’re taking it very seriously,” said Ravi Johar, MD, an OB/GYN from St. Louis, Mo., past president of the St. Louis Metropolitan Medical Society. “For UnitedHealth to reverse course, no one knows exactly what it means.”

Johar, council chair of the Missouri State Medical Association, said OB/GYNs are certainly accustomed to the pre-certification process.

“We’ll do what we’ve always done,” he said. “We’ll discuss with patients all of the options and go from there. The decision is between the patient and physician.

My job is to provide the best medical care possible. How that affects them financially is a big impact, but it’s not my area of expertise.”

UnitedHealth is a good weathervane in the post Affordable Care Act era, with its combination of market power, commu-

nity support, and access to exceptional data, said Jay Wolfson, DrPH, JD, Distinguished Professor of Public Health, Medicine and Pharmacy at the University of South Florida (USF) Morsani Dr. Jay Wolfson College of Medicine.

“In this case in particular, it’s important to recognize that UnitedHealth, over the past couple of years, has been the most aggressive of the health insurers in tightening up their markets,” he said. “They began eliminating a lot of physicians and hospitals from their panels in many communities.”

For example, said Wolfson, cancer and children’s hospitals were removed from UnitedHealth’s list of risk providers, based on the argument of cost being significantly higher at those healthcare facilities than others.

“Procedures in hospitals like MD Anderson, Sloan Kettering and Moffitt may cost 50 percent more than non-specialty, community facilities,” he said. “That’s to be expected because they’re teaching hospitals.”

Wolfson also pointed out that UnitedHealth acquired Optum, a healthcare technology firm established in 2010, which he considers one of the “best staffed analytic division of third parties.”

“Optum focuses on quality, outcome and cost-effective analyses of United’s (and other available) databases” said Wolfson. “Their research translates into what, to whom and how much United will pay.”

That influence has infiltrated the healthcare industry in many ways. In January 2013, while outsourcing work with Optum before bringing the firm in-house, UnitedHealth Group’s Center for Health Reform and Modernization proposed the use of predictive modeling software, particularly in Medicare and Medicaid programs, as tools for care management and information security as a possible solution to both healthcare fraud and preventable hospitalizations.

“As part of the ACA, they’ll continue to drill down and drive down costs and utilization and attempt to be as directive as they can to their patients, physicians, hospitals … to optimize cost, utilization and safety while also reducing liability,” said

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Wolfson.

Some hospital systems are adopting a tough stance against UnitedHealth’s culling process and policy changes they view as unfavorable.

“Three years ago, BayCare (Health System, Tampa Bay’s dominant non-profit hospital chain), went up against UnitedHealth over reimbursement issues,” noted Wolfson. “Unlike most standoffs, there was no last minute negotiation and 450,000 members in Tampa Bay had to change hospitals and physicians because BayCare stood its ground against this healthcare delivery powerhouse.”

Wolfson also sees a trend of separate policy issues, in part led by UnitedHealth, that are shaking up the medical device manufacturing industry and the pharmaceutical sector.

“Until recently, pharmaceutical companies have had a tremendous influence in medical schools and communities concerning what medications physicians prescribe,” he said. “Now some medical schools across the country like ours have gone ‘drug-free’ and no longer allow phar-

maceutical reps to teach in our classrooms or offer ‘educational’ program lunches.”

The same cycle holds true for manufacturers of medical devices, Wolfson said.

“The device manufacturing industry has also heavily affected medical practice,” he said. “Their significant influence is waning.”

In response to UnitedHealth’s policy change on hysterectomies, medical schools will place a stronger emphasis on technical skills to perform vaginal hysterectomies.

“We’ve developed a generation of surgeons who don’t know how to do vaginal surgery, quite frankly,” said Neil Finkler, MD, an OB/GYN in Orlando and CMO at Florida Hospital Orlando.

“So many physicians stopped using vaginal hysterectomies and it’s not being taught very much,” Wolfson added. “Our younger medical students don’t have the skills. It’s easier to use a device, which generates more revenue and becomes a standard. Most clinicians interviewed say it’s safer, less complications, but it’s not done because it’s just not being done. That’ll change.”

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APRIL 2015 • 9

3-D Digital Mammography Comes to Acadiana Lourdes’ St. Agnes Breast Center is the first

BY BARBARA MCCONNELL

The newest technology out there in breast imaging is in the Selenia® Dimensions ®3D breast tomosynthesis system

by Hologic® at Our Lady of Lourdes RMC Imaging Network at St. Agnes Breast Center installed in January.

This machine produces digital, 3-dimensional x-ray views of the breast taken from many angles and re-created in multiple small layers by computer software, with the images viewed on large flat screen monitors either individually, or in a scrolling, ciné mode.

This is an improvement over the 2-D, single digital images that were state of the art until the FDA approved 3-D mammography in the United States in February 2011.

Dr. Jamie Joseph, a radiologist who came to Lourdes in Selenia Dimensions 3D mammography machine with Dawn Richard August 2014 with a residency uct and she trained with it, used it and was in radiology and a fellowship in breast happy with it, so there was no reason to imaging from UT Southwestern Medical change when Lourdes acquired their new Center at Dallas, said they had 3-D there equipment. so she had already been using it.

Tomosynthesis, tomo or 3D, whatever “With 3-D mammograms you see it is called, is something that is going to x-ray ‘slices’ from many angles thru the help not only in detecting more cancers, breast so you can detect lesions that reprebut also at screening it is going to help resent cancer more easily, and also see if it is duce the number of patient call-backs due just overlapping tissue instead of an actual to image clarity and the ability to detect lemass, something that is hard to visualize sions more readily. with a 2-D mammogram,” she stated.

And call-backs for the patient are The size of the breast determines the nerve racking, represent more expense, thickness of the individual slices and nummore radiation, lost work time and are genber of slices obtained, though generally erally worrisome for everyone. they are one mm thick.

Everyone also worries about radiation, Joseph feels Hologic has a good prod-

10 • APRIL 2015

Louisiana Medical News

and the dose with a 3-D mammogram is about the same as a 2-D mammogram, but that’s still considered low dose radiation. If the patient decides on 3-D at screening or their physician has ordered it, both studies together are still less than the recommended MSQA (Mammography Quality Standards Act) allowable maximum dose.

“We are still having to do 2-D and 3-D together and that’s for several reasons: you have to be able to compare the prior year’s mammogram to this year’s study and most patients will have had a prior 2-D mammogram.

The best thing that a radiologist has to go by is looking for a change from last year’s mammogram,” said Joseph.

And the ImageChecker ®CAD (computer aided detection) from Hologic, a software algorithm that highlights potential areas of concern for the radiologist to double-check, is only available at this time on the 2-D. “So if you want to use the CAD, you must do both studies, and the radiologist is going to want to use the CAD,”Joseph added.

The process of taking a 3-D image is almost imperceptible to the patient. Obtaining a 3-D image is in the same (breast) compression as the 2-D, so the patient is in the same standing position for both, and doesn’t have to move or be repositioned as the tube of the machine makes two separate passes in an arc over the breast for both, with the tomo portion coming first.

It doesn’t take very long-10-12 secondswhich is essential to limit patient movement.

For patients that are sensitive, they offer the MammoPad® for comfort because everyone is different in their degree of sensitivity.

Though Hologic has said that it takes less compression to perform the 3-D, it has been Dr. Joseph’s experience, and she has gone back and forth about it and discussed it with the technologists, that the same pressure in the breast as with 2-D might be the best, otherwise there may be a loss of important fine detail.

“A few moments of discomfort is better than having to come back and do it all over again” said Joseph.

Peggy Grace, a patient who just had her mammograms done in February at St. Agnes said, “I felt it was easier, shorter in time, it didn’t Dr. Jamie seem to hurt as much; Joseph they didn’t have to reposition me repeatedly and honestly the only difficulty I had with the whole process was getting my records transferred from the other hospital in New Orleans so they could compare.”

And as far as the expense of 3-D, Joseph continued, “We are not doing the 3D on all screening mammograms, but if someone asks for it we would be more than happy to do it and the great thing is some insurance is now covering it instead of the patient having to pay for it out of their own pocket.”

And she feels strongly about the 3-D, “It is a great technology and it is probably the future of mammography. If you get 3-D at screening you don’t necessarily have to come back again for additional views, but if you do get called back you may sometimes just go straight to ultrasound. If you have calcifications or if it is something that catches the radiologist’s eye, you are still going to need additional views but, it’s better to be safe than sorry.”

Studies point to the efficacy of tomosynthesis: the most recent published in June 2014 in JAMA by Dr. Friedewald, et al, involved almost 500,000 patient mammograms, taken at 13 locations, and readings by 139 radiologists which compared the use of 2-D to 3-D and showed that with 3-D: there was a 41 percent increase in the detection of invasive carcinoma; 29 percent increase in the detection of all breast cancers and 15 percent decrease in call backs. What is also significant is that it was not Hologic doing the study.

Though 2-D digital mammography can be performed at both the St. Agnes location, as well as at the medical office building next to Lourdes RMC on Ambassador Cafferty, all the studies can be sent back and forth for radiologist reading through the PACS system.

Lafayette General Medical Center Breast Center, will be installing their own Hologic 3-D mammography system.

Legislative Affairs

BY CINDY BISHOP, AND EARL MICHAEL WILLIS

Back to the Capitol: A Look at the Upcoming Session The 2015 Regular Session of the Louisiana Legislature will commence on Monday, April 13, 2015 at 12:00 noon.

It is safe to say that no one, or no program is completely safe. State lawmakers will remain in session until 6 p.m. on June 11, 2015. They face the daunting task of addressing a $1.6 billion budget shortfall for the state fiscal year that begins on July l.

On Friday, February 27, Commissioner of Administration Kristy Nichols presented the Governor’s proposed executive budget. The lawmakers sat through a lively four hour presentation as Commissioner Nichols outlined the administration’s proposal to balance the state’s budget for fiscal year 2015-2016.

With a $1.6 billion deficit looming to solve this budgetary shortfall, the first place the state is looking to reform is refundable tax credits. According to the Governor’s office this would allow the state to reduce expenses by $526 million without touching tax increases.

Additionally, the administration proposes the elimination of 727 positions which will leave the lowest number of state government employees in 25 years.

With no surprise, healthcare is also one of the hottest areas for cuts, and will be under much scrutiny during the 2015 regu-

lar session.

In the proposed budget, the Department of Health & Hospitals budget has been reduced by a net of $15 million.

Outlined in the executive budget have been promises to many things that will be cut, and things that will be protected. Here are some of the following budgetary items that have been highlighted so far: • No Medicaid provider rate reductions • No cuts to medical schools • No cuts to Bayou Health plans • Protects current funding levels for LSU public-private partnership hospitals and clinics • Protects individuals receiving home and community based waiver services, ensuring no cuts to those currently receiving services While it is great to see the executive branch protecting some of the most essential aspects of the vital healthcare services, several cuts have been proposed to important and necessary healthcare services.

Being that healthcare sending is not protected by the state’s constitution, this is an easy place for state government to look for extra money.

Here are the list of healthcare expenditures that are being cut or eliminated in the

Governor’s proposed budget: • Eliminate hospital outlier pool – $2.7 million • Reduction of $7.7 million through the elimination Greater New Orleans Community Health Connection Program.

• Elimination of Developmental Neuropsychiatric Program - $338,107 • Eliminate the state general fund in the LSU + UPL Program - $9.6 million • Eliminate inpatient teaching hospital program - $100,000 • Eliminate the LAHIPP program $2.3 million Here are some other healthcare related items in the proposed budget for FY 20152016: • Increase in FMAP for $43.3 million, mostly due to increased federal match for LACHIP • Human service districts, including mid-year –$6.8 million • Program offices, including mid-year –$12 million They call it a budget process because it is just that – a process. The Constitution mandates that the executive branch propose an executive budget to the state lawmakers in advance of the legislative session. The House Appropriations Committee will soon

begin holding hearings and briefings on the Governor’s proposed executive budget. Once the legislature convenes in April 2015, the House Appropriations Committee and the Senate Finance Committee will begin making changes to the Governor’s Executive Budget. Once the session ends on June 11th at 6 p.m., we should have a balanced budget in place. If lawmakers do not balance the budget by the date and time that the session ends, they may opt to call themselves into a special session.

Stay tuned to Louisiana Medical News for more updates on the upcoming legislative session and the state’s operating budget. Feel free to email me at my new email address: cindy.bishop@checkmate-strategies.com if you have any questions or concerns about any healthcare related topic or the state’s budget in regard to healthcare. If you would like a copy of the PowerPoint, let me know by emailing me at cindy.bishop@ checkmate-strategies.com Legislative Affairs content is provided by Checkmate Strategies, publisher of Health Care Information Services. All content © Checkmate Strategies and Louisiana Medical News, LLC. For more information, readers may contact Cindy Bishop at 225.923.1599 or P.O. Box 80053, BR, LA 70598, or send email to destiny362@aol.com.

Our website is www.checkmate-strategies.com

Dr. Ann Marie Flannery

PEDIATRIC NEUROSURGEON Ann Marie Flannery, M.D. is board certified in pediatric and adult neurosurgery. She specializes in the diagnosis, management and treatment of children’s surgical and traumatic nervous system conditions, including: traumatic injuries of the brain, spine and nerves; gait abnormalities (spasticity); craniosynostosis (skull abnormalities); excess water on the brain (hydrocephalus); brain and spine tumors; and other surgically-treatable abnormalities of the nervous system.

Dr. Flannery has almost 30 years of experience in the field of neurosurgery, specializing in pediatric and general neurosurgery. Most recently, she has been leading a group of pediatric neurosurgeons in developing evidence-based guidelines for the treatment of common pediatric neurosurgical disorders.

Dr. Flannery’s office is located in the Kids Specialty Center 4704 Ambassador Caffery Parkway, Lafayette.

For appointments call 337-371-3101 or 1-877-302-2731.

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Louisiana Medical News

APRIL 2015 • 11

Marijuana, Medicine & Addiction A conversation with ASAM President Dr. Stuart Gitlow

By CINDY SANDERS

With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states either allowing for or considering decriminalization and/or medical use of the drug, the great marijuana debate has become a legislative hot topic over the last three years. For Stuart Gitlow, MD, MPH, DFAPA, however, talk of medical benefits associated with inhaling the plant is just smoke and mirrors.

Gitlow, who concludes his term as presiDr. Stuart dent of the American Gitlow Society of Addiction Medicine this month, said there are two major issues with the drug … addiction and toxicity. The double board-certified psychiatrist, who has a private practice in Rhode Island, is concerned by the possibility of adding marijuana to the mix of alcohol and tobacco as yet another substance with the potential to do more harm than good.

The Drug Marijuana refers to the dried leaves, flowers, stems and seeds from the hemp plant Cannabis sativa, which contains the

mind-altering chemical delta-9-tetrahydrocannabinol (THC), along with other compounds. The National Institute on Drug Abuse (NIDA) has found marijuana to be the most common illicit drug in America and one for which usage is on the rise. The national organization stated marijuana’s popularity, particularly since 2007, has coincided with a diminishing public perception of the drug’s risks.

However, at the same time risk perception has been declining, the drug’s potency has actually been on the rise. In looking at the amount of THC in marijuana samples confiscated by the police, the THC concentration averaged close to 15 percent in 2012 as compared to around 4 percent in the 1980s, according to the NIDA fact sheet on marijuana.

Gitlow agreed, saying, “The marijuana that is available today is much different, much more potent, than the marijuana that was available in the ‘60s.

More research needs to be done to see if there are even more long-term issues with this more potent form.”

Addiction Gitlow noted marijuana works like any other addictive drug. “There’s not debate at all within the medical community that it’s addictive … that’s a given,”

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Louisiana Medical News

he said. “It’s like any other psychoactive drug … it’s not addictive to the majority of those using it once or twice.” However, he continued, “There’s no way of knowing if a person is going to have a problem with the drug until they try it … and then they are playing Russian roulette.”

Gitlow explained, “Addictive disease is not about the drug, it’s about a brain abnormality. It exists before somebody picks up the drug.” The three factors required for addiction, he said, are a genetic abnormality, environmental trigger and the drug. “Addictive disease is in only, give or take, 15 percent of the population.”

He added popular consensus is that about 9 percent of adults and 17 percent of adolescents who use marijuana become addicted. In addition, NIDA’s marijuana fact sheet noted addiction rates jump in daily users, with as many as 25-50 percent becoming addicted.

Toxicity “There’s a second issue with marijuana, and it’s independent of addiction.

Marijuana has toxic ramifications,” Gitlow said. “Marijuana makes you stupid,” he stated bluntly. “It lowers IQ. It causes slowing of the processing speed. It causes abnormalities of attention and focus. It basically dumbs you down, and it does that more or less universally.”

When marijuana is smoked, the THC passes quickly from the lungs into the bloodstream and to the brain. THC targets cannabinoid receptors, which have a higher density in areas of the brain that influence pleasure, memory, concentration, coordination, thinking and time perception. Additionally, THC’s chemical makeup is similar to a naturally occurring brain chemical called anandamide. That similar structure lets THC be ‘recognized’ by the brain, allowing the outside compound to alter normal brain communication.

Of major concern is the affect marijuana has on brain development when used heavily among adolescents. A recent study showed marijuana users who began in adolescence had fewer connections in the areas of the brain that control memory and learning. A large, long-term New Zealand study found those who began heavily smoking marijuana in their teens lost an average of eight IQ points between ages 13 and 38. However, that impact on IQ wasn’t replicated in the study among those who didn’t begin smoking until adulthood.

NIDA also cited issues with cardiopulmonary and mental health. Gitlow said, “There’s a five-fold increase in psychotic disorders among those who use marijuana as compared to those who don’t.”

Alcohol vs. Tobacco, Marijuana Last month, results of a new study stating marijuana is 114 times less lethal than alcohol made the media rounds and became fodder for late night comics. Gitlow said comparing the two is like comparing

apples and oranges. “They affect different parts of the brain,” he said.

Gitlow also noted it is possible to ingest enough alcohol in one sitting to kill you, which isn’t really true of marijuana or tobacco. “So I could make the argument that cigarettes are safer than alcohol,” he said. However, there aren’t many physicians recommending a patient give up the occasional glass of wine and take up smoking tobacco instead.

“We’re not prohibitionists,” Gitlow continued. “No one at the American Society of Addiction Medicine says alcohol should be banned, but all these drugs collectively are an enormous burden on the American public from an economic and health-related standpoint.”

Considering the dangers of tobacco and alcohol, Gitlow said he couldn’t fathom why, as a country, we would want to add marijuana to the mix. “Why would we want to make our burden worse?” he questioned.

Possible Benefits Gitlow reiterated his frustration at claims of marijuana being a medical marvel. “There is no medical purpose. No one has ever proven through a double-blinded trial a medical benefit of marijuana.” He continued, “That’s not to say there aren’t components within the plant that might not have medical application.”

However, Gitlow said breaking down the more than 100 components in marijuana would require scientific investigation just like any other drug in this country seeking approval from the Food and Drug Administration. He added marijuana lobbyists bringing anecdotal evidence to legislators interested in the bottom line doesn’t constitute a thorough research endeavor.

NIDA’s viewpoint is similar, noting that so far clinical evidence does not show the therapeutic benefits of marijuana outweigh the health risk. In it’s assessment of the drug, the national organization stated, “To be considered a legitimate medicine by the FDA, a substance must have welldefined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, and because the plant is typically ingested via smoking, its use as a medicine is difficult to evaluate.

“However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant – such as cannabidiol, a non-psychoactive cannabinoid compound that is being studied for its effects at treating pain, pediatric epilepsy, and other disorders.”

With the increased attention being given to marijuana around the country, it’s a safe assumption that opponents and proponents will continue the debate.

In the News Our Lady of the Lake Announces Specialists at New Neurology Clinic BATON ROUGE – Our Lady of the Lake Physician Group is pleased to welcome Joseph A. Acosta, MD and Kevin J. Callerame, MD as specialists to its new Neurology Clinic at 5247 Didesse Drive in Baton Rouge.

The Neurology Clinic provides the highest quality care related to the diagnosis and treatment of Dr. Joseph A. Acosta disorders of the brain and

nervous system, including seizures, stroke, carpal tunnel syndrome, nerve disorders, Parkinson’s disease, dementia and nerve pain.

Dr. Acosta specialDr. Kevin J. Callerame izes in general neurology, clinical neurophysiology and is trained in neurovascular ultrasound with a special interest in the treatment of stroke.

He received his medical degree from the University of Texas Medical Branch in Galveston, Texas in 1989. Following

his internship in internal medicine, Dr. Acosta completed a residency in neurology at Hahnemann University Hospital in Philadelphia, Pennsylvania, where he also served as chief resident of the program from 1992 to 1993. After his residency, he was fellowship trained in neurovascular disease and stroke at the University of Maryland Medical Center in Baltimore, Maryland from 1993 to 1995.

Dr. Callerame is Board Certified in neurology, clinical neurophysiology and sleep medicine. He has a special interest in epilepsy, sleep disorders, EMG and the

use of botox in neurological indications.

He received his undergraduate degree in biomedical engineering, a master’s degree in public health, and medical degree from Tulane University in New Orleans, Louisiana. Dr. Callerame completed a residency in neurology at Wilford Hall United States Air Force Medical Center in San Antonio, Texas, followed by a Fellowship in epilepsy at the University of Miami in Florida. He completed his term with the United States Air Force at Wilford Hall Air Force Medical Center where he served as head of EEG and clinical neurophysiology.

Survey, continued from page 7 appointment scheduling, smartphone app for scheduling, online test results/diagnoses, online bill pay, secure messaging, and health resources/educational material), 23.5 percent of those ages 25-34 reported they didn’t want their physician to offer any of the services, while 44.2 percent of participants 65 and older had that same response.

Graham continued, “I think it’s important for physicians to be aware of what these different demographic groups want.”

He added such information could help providers tailor their message accordingly when discussing the different ways patients could access the practice and engage with providers.

Another disconnect highlighted by the survey was provider follow-up. While 68.6 percent of respondents said it was either ‘very important’ or ‘somewhat important’ that a physician follow up with them, only 30 percent reported receiving any followup from the practice that wasn’t tied to bill pay. “They’re very good about following up related to money,” Graham pointed out, but patients want more than that. In addition to building rapport with a patient, Graham said digital communication offers an easy way to make sure instructions were understood and are being followed, check on medication adherence, share prevention tips, and remind patients about the need to schedule routine screenings and services.

The “Trends in Patient Engagement” survey included responses from more than 400 adults across the United States regarding their digital experience at primary care practices. The survey was conducted Jan. 5-7, 2015. A download of the survey whitepaper is available at technologyadvice. com/research.

TechnologyAdvice, which is headquartered in Brentwood, Tenn., offers free, neutral research and analysis of IT products to connect businesses with technology options that best address each company’s specific needs. The company works with businesses and practices looking for the right software for just a few people up to large enterprises in need of solutions for thousands and has assisted Apple, Oracle and HP in selecting new technology. Last year, TechnologyAdvice was named to the top half of the Inc. 5000 list of America’s fastest-growing private companies.

Good Health Has Its

Rewards

Let’s face it: Louisiana has some of the highest healthcare costs and worst disease outcomes in the country. But working together, we can change for the better.

That’s why Blue Cross and Blue Shield of Louisiana has developed Quality Blue – our series of programs designed to improve the health of our members.

Blue Cross works with doctors, hospitals and clinics in our network to be part of the solution. Doctors can earn recognition and even extra payments for taking steps that help their patients get and stay healthy while keeping costs in line.

And together, we create a healthier, more affordable system for all of us.

For more information about how you can enroll in our Quality Blue programs: Call 1-800-716-2299 Email QualityBlue@bcbsla.com Visit www.bcbsla.com/QBprograms

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Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.

Louisiana Medical News

APRIL 2015 • 13

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In the News Louisiana Health Information Exchange Launches Patient Portal BATON ROUGE – The Louisiana Health Care Quality Forum has announced the launch of the Louisiana Health Information Exchange (LaHIE) Patient Portal.

The LaHIE Patient Portal is a secure, online website that provides patients with 24-hour access to their personal health information. In order to access the portal, their health care provider must be actively participating in LaHIE and subscribed to the service. LaHIE is the state’s electronic health system that allows authorized doctors to view and share patient data through a secure platform.

Patients must register with their doctors to gain access to the portal. Once registered, they will be able to review their personal health information using a secure username and password. Only information stored by participating LaHIE providers will be available through the portal.

Cindy Munn, Quality Forum CEO, says, “The LaHIE Patient Portal presents a unique opportunity for patients to become proactive in monitoring and managing their health. We hope the portal encourages patients to make their personal health a priority by knowing their numbers and making the necessary

changes toward healthier living.”

Brian Richmond, Chief Technology Officer for the Quality Forum, says, “The launch of the portal is the culmination of years of hard work by our team stemming from a commitment to improving health care through the use of advanced technology. We are confident that patients will view the implementation of this service as an asset to their health care experience.”

Schumacher Group Adds Five Additional Focused Roles to its Executive Leadership Team LAFAYETTE – Schumacher Group (SG) announces five additional roles to its Executive Leadership Team (ELT), the highest ranking management team for the company.

The new appointments include: Diane Broussard, Senior Vice President of Human Resources; Ryan Domengeaux, JD, General Counsel; Rick Kramer, Managing Partner, Subsidium; Stephen Nichols, MD, Chief of Clinical Operations Performance - Emergency Medicine & Hospital Medicine; and Byron Speights, Chief Executive Officer of SG WellnessWorks.

Broussard has served as SG’s Vice President of Human Resources since 2010. Prior to joining SG, she served in various capacities within the industry, including Director of HR for Lafayette General Hospital, Regional Director of HR for

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LifePoint Hospitals, and Employee Relations Coordinator for Louisiana Healthcare Group. As Senior VP of Human Resources, Broussard oversees all aspects of Human Capital Management, including talent acquisition and retention, performance management, learning & development and administration of benefits.

Domengeaux is a nationally recognized leader in risk management with 19 years of experience in both the public and private sectors. Since joining Schumacher Group in 2006, he architected the company’s industry-leading Enterprise Risk Management Program. Prior to SG, he served 9 years as the Risk and Insurance Supervisor for Lafayette Consolidated Government where he was responsible for the claims, safety and wellness programs for one of Louisiana’s largest municipalities.

Kramer is currently Managing Partner of Subsidium Healthcare, a healthcare consulting firm affiliated with Schumacher Group, and serves as an ex officio Executive Leadership Team member of SG. Kramer began his career at IBM, his initial introduction to the healthcare industry. He later served as a senior executive at KPMG, First Consulting Group, PinnacleCare and Tatum. He also serves as director of CareFirst (Blue Cross/Blue Shield Plan of Maryland). In his current role, Kramer is responsible for all of Subsidium’s operations and the strategic direction of the firm.

Nichols brings over 25 years of experience in emergency medicine. His expertise includes having served as SG’s Medical Director in the ED in Brownwood, Texas for the last decade. His work for Schumacher Group focuses on helping facilities and systems with various operational and service challenges by integrating services in effective and efficient ways.

Speights’ experience and success as a health care leader spans over 25 years in executive leadership roles. As CEO of SG WellnessWorks - our program that works hand-in-hand with employers to provide for their many health needs - he focuses on industry, public policy, physician and employer issues, all aimed at producing higher quality, better coordinated, and more efficient care in each of the communities we serve.

“These individuals bring remarkable leadership skills and superior service expertise to our Executive Leadership Team,” said Rich D’Amaro, SG Chief Executive Officer. “Their industry insight will continue to expand the potential of our company and further our strong commitment to providing unmatched care to patients and world-class EM & HM services to our partners.”

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From left: Mitchell D. Lirtzman, M.D.,

and Charles H. Wyatt, M.D.,

cardiovascular and thoracic surgeons

Care Chex® is a division of Comparion Medical Analytics®

They are Acadiana’s leading cardiovascular surgical team, nationally known for their expertise and decades of service. And they’re part of the reason our hospital has been recognized for excellence by an independent hospital rating service.

Doctors Lirtzman and Wyatt receive thousands of referrals each year. They’re the surgeons other physicians turn to when patients need heart surgery and vascular surgery.

Call them if you would like more information: 337.273.2863. It’s a smart decision.

2810 Ambassador Caffery Pkwy. • Lafayette, LA 70506 • Corner of Ambassador and W. Congress • 337-981-2949 • ournameisregional.com

Louisiana Medical News

APRIL 2015 • 15