Louisiana Medical News May 2013

YOUR PRIMARY SOURCE FOR PROFESSIONAL HEALTHCARE NEWS MAY 2013 / $5

SOU TH LOU ISIANA ED ITION

On Rounds Physician Spotlight Dr. Ralph Chesson While stationed in the U.S. Navy as an engineering officer, Ralph Chesson had a conversation with the ship’s doctor on a Polaris submarine that changed his life. “I’d always kind of wanted to be a doctor,” he revealed ... page 3

ObamaCare May Generate Medical Tourism The power of the Internet and greater price transparency have helped give patients more care options, with millions of U.S. residents traveling abroad each year to seek treatment. But more and more U.S. physicians are trying to tap into the multibillion-dollar business ... page 4

2013 Legislative Session to be Busy with Healthcare The 2013 Regular Session of the Louisiana Legislature convened on Monday April 8, 2013 ... page 9

Medical Society Says Pay Reform Group Misses Mark

By TED GRIGGS

A few of the National Commission on Physician Payment Reform’s recommendations, such as paying the same rates for the same services regardless of setting, merit consideration, according to the Louisiana State Medical Society’s president.

But the commission misses on a number of other proposed changes, Dr. Van Culotta said, including the group’s major premise: that fee-for-service payments to physicians are a chief driver of healthcare costs and uneven quality of care.

“Doctors are the least of the problem,” Culotta said. “Most doctors are working under a 20-year-old fee schedule.”

The never-ending increases in healthcare costs have far more to do with the amounts spent on new technologies and prescription drugs, Culotta said. If the United States focuses on cutting physician payments and doesn’t do something to control the spiraling price tags of prescription drugs and technology, the only reductions achieved will be in the number of doctors.

The Affordable Care Act, also known as ObamaCare, will bring 32 million newly insured people into the healthcare system in 2014, Culotta said. The problem is there aren’t enough doctors practicing today to handle those 32 million people.

And cutting physician payments isn’t going to help with the doctor shortage, he added. The (CONTINUED ON PAGE 12)

Heart to Heart

Ochsner implants first total artificial heart in Gulf South

By LISA HANCHEy

In December, a man in his 40s was admitted to Ochsner Medical Center in New Orleans with biventricular heart failure. He had been surviving on two IV medications and an intra-aortic balloon pump. “Because of his biventricular heart failure, there was not really much we could offer him, other than medical therapy, which he already was on and was not doing well,” recalled Dr. Aditya Bansal, a cardiothoracic surgeon at John Ochsner Heart & Vascular Institute. “Patients like this were basically relegated to go to hospice.”

That all changed in February when Ochsner became the first site in the Gulf South region to perform the Total Artificial Heart (TAH) implant. The SynCardia TAH, the world’s first and only FDA-approved device, is indicated for patients with Dr. Aditya end-stage biventricular heart failure. Consisting of two biocompatible pumping chambers Bansal with four valves, this mechanical heart is operated by an external power supply connected by two drivelines below the rib cage. This device provides blood flow of up to 9.5 liters per minute through each ventricle. “With the presence of total artificial heart, you actually remove the right and left ventricles, and (CONTINUED ON PAGE 12)

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2 • MAY 2013

Louisiana Medical News

Physician Spotlight

Dr. Ralph Chesson Sea Story

By LISA HANCHEy

While stationed in the U.S. Navy as an engineering officer, Ralph Chesson had a conversation with the ship’s doctor on a Polaris submarine that changed his life. “I’d always kind of wanted to be a doctor,” he revealed. “But when I talked to my ship’s doctor, I told him that I didn’t try to apply because I did so badly in foreign language. He said, ‘Oh, you don’t need that anymore.’ And, at that point, I knew that that was what I was going to do.”

A graduate of the Naval Academy, Chesson served on nuclear submarines from the time he entered the Navy in 1962. After that fateful conversation with the ship’s doc, he took a hiatus from military service in 1968 to attend Virginia Commonwealth University for pre-med.

Next, he earned his doctorate at the Medical College of Virginia. “While I was in medical school, I came back in the Navy on a scholarship program, which paid my way nicely,” he said.

After completing medical school a year early, Chesson performed an internship and residency in obstetrics and gynecology at Naval Regional Medical Center in Portsmouth, Va. Why OB/GYN? “It was just a natural thought process for me when I was first did it as a medical student,” he said matter-of-factly. “It became obvious to me that that was what I wanted to do.”

Following his residency, Chesson was sent to Camp LeJeune for three years.

Afterwards, he returned to Portsmouth to teach. In 1979, one of his mentors told him about urogynecology. “My mentor told me I needed to do this and, he was correct,” he said. “I’ve been working in urogynecology since before it had that name.”

After serving in the Navy for 20 years, Chesson retired from military service. He continued to teach in Portsmouth until two of his residency students recruited

him to LSU in New Orleans. In 1995, he left his home state for Louisiana. Since then, he has served as a clinical professor of gynecology for the LSU Health Sciences Center, section of Urologynecology and Pelvic Floor Reconstruction. “Urogynecology has actually become an official subspecialty this year,” he reported.

“Finally. It’s been a long time coming.

It’s hard to establish a new subspecialty. I didn’t think it was going to happen before I retired, but it has.”

From 1995 until today, Chesson has

practiced urogynecology with various groups in New Orleans and at Women’s & Children’s Hospital in Lafayette, La. as part of its Women’s Multi-Specialty Group. “I spend part of my time in Lafayette, part of my time in New Orleans,” he explained. The board certified OB/ GYN, urogynecologist and reconstructive surgeon specializes in diagnosis and treatment of pelvic conditions including stress and urge continence, uterine prolapse and other pelvic problems resulting from childbirth. He serves as a member

of the American College of Obstetrics and Gynecology, American Urogynecology Society and the Society of Gynecologic Surgeons.

On a personal note, Chesson just celebrated his 50th wedding anniversary with his wife, Dianne. Their daughter, Meredith, has a PhD in archeology and teaches at the University of Notre Dame.

Son Ralph, III works as a stockbroker in Norfolk, Va. In his free time, Chesson enjoys playing duplicate bridge with Dianne. “My wife plays a lot more bridge than I do; I work for a living still,” he said. “It keeps you going.”

Each year, Chesson participates in medical mission trips to third-world countries. At press time, he was planning a journey to Rwanda, Africa to perform obstetrical fistula surgeries and teach.

“Teaching is very important to me,” he revealed. He also travels annually with a group to Nicaragua to help with different procedures.

While Chesson enjoys exercising, particularly walking, he has a pastime that his colleagues might be surprised to know.

“I do ballroom dancing,” he said. “I’ve done that for a long time, since the early 1990s. Dianne and I like to dance. We did it competitively a long time ago. But that’s stupid. We enjoy it.”

Are You CONNECTED?

Louisiana Medical News

MAY 2013 • 3

MARKETING

ObamaCare May Generate Medical Tourism

By TED GRIGGS

The power of the Internet and greater price transparency have helped give patients more care options, with millions of U.S. residents traveling abroad each year to seek treatment. But more and more U.S. physicians are trying to tap into the multibillion-dollar business.

Dr. Arnold Feldman, a Baton Rougebased pain management specialist, is one of them.

Feldman has established a full-service concierge program, The Feldman Institute Travel Program, Dr. Arnold that offers patients, no Feldman

matter where they’re from, a sort of onestop shopping experience.

“Our goal is to develop a travel program where you can say, ‘Doctor, I want to come and see you.’ And we just basically say, ‘Would you like us to take care of the arrangements?’”

Feldman has three employees out of a 40-person staff who handle the travel services. The staff will do whatever the patient prefers, including making airline reservations, picking patients up at the airport, arranging hotels and rental cars, and recommending restaurants, attractions and events.

These tasks are not overly difficult, Feldman said.

Feldman’s practice has also made ar-

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4 • MAY 2013

Louisiana Medical News

rangements with hotels near his practice to make sure his patients can always get a room.

Marcy Rogers, CEO of SpineMark Corp., is building a global network of spine centers and working with Feldman to boost his medical tourism business.

In 1998, The Wall Marcy Rogers Street Journal published a story about Apollo Hospitals Group in India and how it was attracting patients from the United States and Europe for joint and cardiac stent replacements, Rogers said. At the time, people thought medical tourism might generate $200,000 in revenue a year.

Those estimates were obviously too low, Rogers said.

Medical tourism is now one of the fastest-growing segments of the healthcare industry, she said. There are now companies whose sole purpose is to manage medical benefits for patients and help them travel outside their home city, state or country.

A Google search of medical tourism and concierge generates more than 1.1 million results.

Medical tourism used to mean leaving the United States for the lower prices offered in less developed countries, Rogers said. But that is no longer the case.

Germany, Spain and other so-called Tier One countries, which are every bit as developed as the United States, are recruiting patients from abroad for surgery, she said.

An April story by Reuters says around 270,000 of the 37 million tourists who visited Turkey in 2012 came for surgical procedures, which generated $1 billion in

revenue. Turkish Airlines has standing discounts for medical tourists.

Those sorts of business opportunities aren’t limited to foreign countries, Rogers said.

Feldman said medical tourism now accounts for 1 percent to 2 percent of his practice’s revenue, but he hopes to boost that percentage into double digits within the next year or so.

The tremendous changes being brought about by the Affordable Care Act – the majority of requirements kick in next year – will mean even greater numbers of people traveling to seek care, Feldman said, and more personal service.

Over the past several years, insurance companies and employers began looking at physicians as interchangeable, Feldman said. They seemed to think that doctors were all the same, and it didn’t really matter who a patient saw.

Feldman said this opinion is totally wrong. But this attitude, along with a number of other contributing factors, helped create a more impersonal approach to medicine.

It also helped spawn the practice of concierge medicine, he said, and concierge travel service is just the next step.

The physician entrepreneurs involved in medical tourism, whether in the United States, China, Germany, etc., are like the pioneers who settled the West, Feldman said.

“I think you couple the pioneer spirit with the Internet, and you’re going to find a growing, burgeoning part of medicine.

And I think it’s going to be a great thing,” Feldman said. “Because I got news for you.

What we have in this country is about to implode. I don’t know what’s going to happen, but it ain’t going to be good.”

Feldman said that in 2014, the Affordable Care Act is going to scramble the healthcare industry’s eggs.

Within a year, everybody is going to be clamoring for some reasonable change, he said. And that may mean getting on an airplane to seek care in a different city or state.

Feldman doesn’t have a primary care physician. Like a lot of other people, Feldman said, he is too busy to sit in a doctor’s office for eight hours.

But the U.S. healthcare system in its current incarnation makes zero accommodations for people who cannot afford to spend time away from work, Feldman said.

Unless a person has some sort of inside connection, he or she must place their life on hold – even for a trivial matter – in order to seek treatment.

Feldman said his goal is to provide patients with “an oasis” from that sort of experience.

The idea behind the travel center is to give people the highest quality medical care without disrupting their lives too much, he said.

The heart surgeons and cardiologists at The Regional Medical Center of Acadiana’s new Heart Institute are operating with the latest life-saving, valve replacement technology in their hands. We are the first and only facility in Acadiana and third in Louisiana chosen by Edwards Lifesciences as a transcatheter aortic valve replacement (TAVR) hospital.

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High-risk Patient Criteria for TAVR Include: • • • • • • •

Patients who do not meet the criteria for conventional valve surgery Advanced age Previous sternotomy Previous radiation to the chest Calcified aorta Frailty or debility Cerebral and/or peripheral vascular disease, COPD, renal insufficiency or other significant co-morbidities

If you or a colleague have a high-risk or inoperable patient who may be a candidate for TAVR, contact Cindy Langley, RN, Heart Institute Director of Cardiovascular Services, at 337-406-4127.

We are the future of heart care, and we are keeping hearts beating.

TAVR Team: (L to R) Dr. Raghotham Patlola, Cardiovascular Institute of the South (CIS); Dr. Wade May, CIS; Dr. Charles Wyatt, Regional Medical Center of Acadiana; Dr. Mitchell Lirtzman, Regional Medical Center of Acadiana; Dr. John Patterson, CIS; Dr. Louis Salvaggio, CIS

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Louisiana Medical News

MAY 2013 • 5

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6 • MAY 2013

Louisiana Medical News

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The Move from Social Media Marketing to Social Business Strategies

By CINDY SANDERS

Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Andrew Dixon Healthcare Summit.

At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients.

“Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.”

One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.”

He continued, “The most popular tool being used today to do that is email, but email was never intended to be a collaborative tool.”

In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review.

Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years.

To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm.

Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community.

The concept of online communities, he continued, isn’t new to healthcare.

“Even back in the 1990s, people would have early dos-based discussion boards.

Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other.

“Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.

Creating Engaged Communities Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support.

That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions.

“It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models.

For physicians, the community setting (CONTINUED ON PAGE13)

IT Acceleration

MedEvolve finds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide

By LYNNE JETER

LITTLE ROCK – When Bill Hefley, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new information technology (IT) system to replace an antiquated one. After completing due diligence on various options, he played it safe and purchased a new system from the na- Dr. Bill Hefley tion’s largest vendor.

“It was a complete disaster,” recalled Hefley, noting the software was different than the demonstration version, the trainer was “preoccupied and disinterested,” and customer support was practically non-existent. “Our practice collections soon approached zero. I knew there had to be a better way.”

A hobbyist computer programmer, Hefley devoted his energies to filling the void in the marketplace. From it, he established MedEvolve as a truly collaborative industry partner to solidify the IT backbone of medical practices. The success of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing Board In searching for a better solution in the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Horsham, Pa., and a pioneer in the emerging field of electronic medical records (EMR).

“Intrigued, I became an early investor and a development partner focused on orthopedic clinical content,” he said, noting that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development partner with NextGen in 1994, working on the development of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing computerized billing and scheduling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering support and customer service. I frequently heard my physician friends and colleagues recount horror stories of flawed software systems with dismal support that were mak-

ing it impossible to run their practices successfully. I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.”

In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service.

“My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We integrated our PM product with several specialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.”

With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM. “Physicians were struggling with increasingly complex third-party payor systems, growing documentation requirements, mounting government regulations, and threats of audits, fines and imprisonment,” said Hefley. “Practices were searching for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of the ever-changing rules and regulations.

Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.”

MedEvolve developed an RCM division, acquired three small RCM companies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists.

“With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers immediately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”

Health Reform Impact The 2009 American Recovery and Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system.

“With the new criteria defined, MedEvolve saw a need for a modern EHR product designed from the ground up to meet Meaningful Use mandates and finally deliver on the industry’s promise of a cutting edge, customized solution that helps prac-

tices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.”

Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excellent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature. As a result, employees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.”

“In the software business, that means several operators are at the ready for periods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less support is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some detached, impersonal entity; we partner with the practice in achieving their goals.”

Today, MedEvolve offers PM and EMR software and RCM services to physician partners, and also electronic prescribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitioners to practices with more than 50 physicians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide.

By year’s end, MedEvolve will outgrow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion.

“We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”

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Louisiana Medical News

MAY 2013 • 7

Unconventional Wisdom Rethinking the approach to some autoimmune disorders

By CINDY SANDERS

What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research findings.

Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treating a range of inflammatory and autoimmune disorders. The rheumatologist, who is also a professor of Medicine and Rheumatic Dr. Stephen A. Paget Disease at the Weill Medical College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease.

Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is due to the body’s subsequent response. “What you

8 • MAY 2013

Louisiana Medical News

were left with was an inflammatory problem that was no longer tied to the previous organism,” Paget explained.

A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder.

In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological Association, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order to rein in the overactive

immune system we believe to be causing the disease, we employ immunosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.”

A small but intriguing study out of the Division of Rheumatology at the University of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combination antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospective, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in any variable.

At month six, the authors found significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The primary end point was achieved in 63 percent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into complete remission. No patient in the placebo group achieved remission.

Pointing to this study, Paget noted that one of the failures of antibiotic regimens in the past in treating autoimmune disorders

might be the duration of the therapy. “If you give long courses of antibodies, you may very well calm the problem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosuppressive drugs to ameliorate the ongoing inflammatory issue after treating the triggering microorganism with antibiotics or antivirals for a relatively short course, “It may very well be we have to improve the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system.

While much more research must be done, Paget said mounting evidence of the important connection between microorganisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ultimately portend a paradigm shift in the delivery of care.

“In some of these, the organism is slow, smoldering … but still there in a low-grade way that is triggering the inflammatory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded.

Legislative Affairs

2013 Legislative Session to be Busy with Healthcare

By CINDy BISHOP

HB 111, Hoffmann Prohibits outdoor smoking within 25 feet of certain exterior locations of state buildings

HB 120, Pugh Authorizes the La. State Board of Nursing and the La. State Board of Practical Nurse Examiners to accept certain accreditations for nurses

HB 116, Hoffmann Provides relative to textbooks and other instructional materials for elementary and secondary schools

HB 121, Montoucet Provides with respect to the membership of the Workers’ Compensation Advisory Council (CONTINUED ON PAGE 10)

AWESOME

HB 1, Fannin Provides for the ordinary operating expenses of state government for Fiscal Year 2013-2014

HB 110, Norton Requires that La. Medicaid eligibility standards conform to those established by the Affordable Care Act

HB 115, James Provides for parent petitions relative to the transfer of certain schools from the Recovery School District back to the local school system

UNIQUE

The 2013 Regular Session of the Louisiana Legislature convened on Monday April 8, 2013. State lawmakers will meet until June 6, 2013. Below is the list of pre-filed bills that are related to healthcare and/or social services. If you would like to view a particular bill, visit the Louisiana Legislature’s website at www.legis.la.gov Cindy Bishop Feel free to email me at destiny362@ aol.com if you have questions about any of these measures. For regular legislative updates, like Checkmate Strategies facebook page or sign up for tweets @capitolbabe

of marijuana or synthetic cannabinoid offenses

HB 6, Schroder Provides that the crime of carrying a firearm or dangerous weapon on school property shall not apply to off-duty law enforcement officers HB 10, Pearson Adds certain hallucinogenic substances to the list of Schedule I controlled dangerous substances HB 15, Mack Adds certain compounds to the Schedule I classification of controlled dangerous substances HB 35, Barrow Provides for retirement eligibility of employees of state hospitals under certain conditions HB 79, Hensgens Provides relative to school crisis management and response plans HB 82, Hill Limits the sale and purchase of products containing dextromethorphan HB 89, Hoffmann Provides relative to the use of seclusion and physical restraint to address the behavior of certain students HB 90, Mack Authorizes DPS&C to sell bulletproof vests to other law enforcement agencies HB 95, Dixon Provides relative to eligibility criteria for admission or readmission to a public school and prohibits the denial of admission or readmission based on certain student characteristics HB 103, Badon Provides relative to criminal penalties for possession of marijuana or synthetic cannabinoids and the applicability of the Habitual Offender Law relative to possession

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Louisiana Medical News

MAY 2013 • 9

2013 Legislative Session to be Busy with Healthcare, continued from page 9 HB 129, Pierre Prohibits giving a teacher or administrator a performance rating until completion of his full evaluation HB 150, Greene Requires recognition of assignment of health insurance benefits to health care providers HB 153, Foil Expands the income tax checkoff applicable to prostate cancer to include all types of cancer HB 155, Cox Provides relative to school safety, security, and crisis HB 160, Reynolds Delays implementation of certain teacher evaluation program requirements and requires legislative approval of the valueadded teacher assessment model prior to implementation of the requirements HB 173, Hazel Amends Louisiana’s safe haven law to provide that a child 12 months old or younger may be relinquished to a designated emergency care facility HB 206, Reynolds Removes geographic limitations on the legislature’s authority to create new school boards and on provisions relative to financing education HB 212, Brossett Provides relative to the creation of a statewide mapping and planning system for certain schools HB 214, Jefferson Provides relative to parental involvement in public schools HB 216, Shadoin Provides relative to the ability of the Patient’s Compensation Fund Oversight Board to invest certain funds HB 224, Hollis Provides for the removal of a school bus driver convicted for certain offenses relative to operating a vehicle while intoxicated HB 226, Richard Creates the crime of prohibited sexual contact between a psychotherapist and a client or patient

HB 228, Fannin Provides relative to balance billing by and reimbursement of noncontracted facilitybased physicians for covered health care services rendered in an in-network health care facility HB 230, Pope Provides relative to the definition of “eligible student” for participation in the Student Scholarships for Educational Excellence (voucher) Program HB 233, Smith Provides that eligibility standards for the La. Medicaid program shall conform to those established by the Affordable Care Act and requires reporting of program outcomes HB 234, Williams, P. Requires that owner identification information be marked on every removable dental prosthesis fabricated by a dentist or pursuant to a dentist’s order HB 251, Talbot Requires DHH to institute Medicaid cost containment measures to the extent allowed by federal regulations HB 273, Lorusso Provides relative to reports, records, and adjudicatory functions of the La. State Board of Medical Examiners HB 275, Willmott Authorizes podiatrists to obtain patient histories and perform physical examinations under certain conditions HB 281, Simon Creates a single license for behavioral health services providers HB 291, Price Changes composition and requirements relative to Advisory Committee on Equal Opportunity HB 294, Ritchie Provides relative to regulation of longterm care insurance policies HB 322, Thierry Requires birthing facilities to perform pulse oximetric screening for certain heart defects on each newborn in the care of those facilities HB 342, Huval Provides relative to balance billing by and reimbursement of noncontracted health

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care providers of emergency medical services HB 374, Stokes Provides relative to timing of payment of insurance premium taxes to the commissioner of insurance

SB 76, Buffington Provides for use of monies in the Louisiana Medical Assistance Trust Fund SB 86, Morrell Provides relative to the Louisiana Mental Health Counselor Licensing Act

HB 543, Pierre Provides relative to regulation of surplus lines insurance

SB 101, Johns Provides with respect to life insurance reserves

HB 592, Thibaut Provides for the adequacy, accessibility, and quality of health care services offered by a health insurance issuer in its health benefit plan networks

SB 125, Peterson Provides that eligibility standards for the La. Medicaid program shall conform to those established by the Affordable Care Act and requires reporting of program outcomes

HB 645, Cromer Provides relative to an internal claims and appeals process and external review procedures for health insurance issuers HCR 7, Barrow Suspends laws authorizing DHH to implement resource allocation models for Medicaid-covered home- and community-based long-term care services HCR 8, Edwards Amends administrative rules to provide that La. Medicaid eligibility standards conform to those established in the Affordable Care Act SB 18, Ward Provides for cake and cookie products and preparation of cakes and cookies in home for public consumption SB 21, Mills Limits liability for a nonprofit corporation entering into a cooperative endeavor agreement with the Department of Health and Hospitals to operate a supports and services center SB 26, Peterson Repeals the Louisiana Science Education Act SB 33, Brown Provides relative to a minority hiring survey by the division of minority affairs in the Department of Insurance SB 35, Heitmeier Provides for health action plans by the Department of Health and Hospitals SB 55, Johns Provides for Medicaid transparency SB 57, Dorsey-Colomb Creates the Louisiana Sickle Cell Commission SB 67, Peterson Creates the Louisiana Statewide Education Facilities Authority SB 73, White Constitutional amendment to grant the Southeast Baton Rouge community school system in East Baton Rouge Parish the same authority granted parishes relative to MFP funding and raising revenue for schools SB 75, Buffington Provides with respect to monies deposited into the Medicaid Trust Fund for the Elderly

SB 126, Smith, G. Provides relative to health insurance rate review and approval SB 134, Morrell Provides for licensure of behavior analysts SB 150, Adley Provides for authorized agents for purposes of criminal history checks on nonlicensed persons and licensed ambulance personnel SB 180, Erdey Provides relative to the division of insurance fraud in the Department of Insurance SB 185, Murray Provides relative to Medicaid and certain managed health care organizations providing health care services to Medicaid beneficiaries SB 199, White Creates and provides for the Southeast Baton Rouge Community School Board and school system in East Baton Rouge Parish SB 205, LaFleur Provides for the establishment of foreign language immersion programs in local public school districts SB 206, LaFleur Provides for empowered community schools SB 220, Walsworth Provides for the “Louisiana Has Faith in Families” Act SB 221, Ward Enacts the Louisiana Has Faith in Families Act SB 222, Walsworth Revises licensure procedures for child day care centers and facilities

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

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Louisiana Medical News

MAY 2013 • 11

Medical Society Says Pay Reform Group Misses Mark, continued from page 1 end result could be more patients in hospital Emergency Rooms, the most expensive form of care anywhere.

The National Commission on Physician Payment Reform was convened in 2012 by the Society of General Internal Medicine. Dr. Bill Frist, former Senate Majority leader, served as the honorary chair. Dr. Steven Schroeder, a health professor at the University of California, chaired the group.

The commission says that each year, U.S. spending on healthcare amounts to $8,000 per person.

Despite this enormous investment, Americans’ health “pales” in comparison to people in other countries, according to the commission. A large portion of Dr. Van the blame for this is the Culotta fee-for-service payment system, and the “skewed financial incentives” that encourage doctors to provide more care, and more costly care, regardless of whether patients benefit.

The long-term solution? Moving to a payment system based on value through bundled payments, capitation and increased financial risk sharing, according to the commission.

The commission’s recommendations include: • Increasing reimbursement for evaluation and management services. The payments for technical services are much higher than those for preventive care or for office visits to help patients manage their diabetes. The average radiologist earned $315,000 in 2011, roughly double the average for a family doctor.

• Pay equal rates for the same physician services, regardless of whether the services are done at an outpatient clinic or in a hospital.

• Abolish Medicare’s Sustainable Growth Rate. The Congressional Budget Office has estimated doing that will cost

$138 billion, but reducing the overutilization of medical services within Medicare would easily cover that amount.

• Where fee-for-service contracts exist, they should always include a component of quality or outcome-based performance reimbursement at a level sufficient to motivate substantial behavioral change.

Culotta agreed that evaluation and management are the most undervalued healthcare services and the reimbursements for both should be fixed.

The commission’s solution is annual updates for evaluation and management codes while freezing payments for procedures for three years.

Culotta said Louisiana’s Medicaid program has tried something along a similar line, cutting reimbursements for specialists in an attempt to control costs.

The problem with that approach is that it has become almost impossible for a primary care doctor to refer a Medicaid patient to a specialist, such as an orthopedic surgeon, Culotta said.

“What specialist is going to take a Medicaid patient if he is being paid less and less?” Culotta said.

Culotta also said the payments for outpatient services should be equalized.

One idea the commission didn’t address is tort reform, which Culotta said could reduce healthcare costs.

Physicians are still practicing defensive medicine because they fear being sued, Cultta said.

The commission report says major studies have shown malpractice is not a significant driver of healthcare costs, but the threat of lawsuits means physicians order unnecessary tests and providing unnecessary medical services.

Culotta said including quality standards in fee-for-service contracts is a good idea, but those standards must be detailed, he said.

“We need to do that up front, and we want that to happen,” Culotta said.

He said while fee-for-service gets criticized, there is a limit to what physicians

can make patients do.

For example, the doctor can make a recommendation, a referral and even schedule the appointment with a specialist, Culotta said. But the physician can’t force the patient to go to the appointment.

Heart to Heart, continued from page 1 implant these artificial ventricles, which are connected to your main blood vessels and basically take over the complete functioning of the heart,” Bansal explained. “By this, you remove a lot of medications that are still needed in the left ventricular assist device group, arrhythmia Dr. Hector problems are resolved and Ventura you have an excellent cardiac output, which is actually needed for organ recovery. So, for suitable candidates, I think it would be one of the best devices that we have at this current stage.”

To be a candidate for TAH, patients must have Class III/IV heart failure symptoms, left ventricular ejection fracture of less than 35 percent, early end-stage organ dysfunction, ventricular arrhythmias and hospitalization for heart failure in the past six months. “The device is also suitable for a patient who has had a heart transplant but is failing and needs some support,” Bansal added. “Also, it is indicated for patients with clots in the left side of the heart where left ventricular assist device would not be a good option.”

Ochsner’s patient met these criteria and had the proper chest cavity dimensions for TAH implantation. After 48 hours of advanced training, the multidisciplinary team of anesthesiologists, perfusionists, surgeons and residents was ready for the eight-hour procedure. After connecting the patient to a heart-lung bypass machine, lead surgeon Bansal resected the failing heart. Then, he sewed the new ventricles

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Louisiana Medical News

“We can’t be policemen,” he said.

If the patient doesn’t go to the appointment, a few weeks or months later, he or she ends up in the Emergency Room, and the quality of care measures go out the window, Culotta said.

“The very positive experience with the MedEvolve PM software prompted our decision to expand their services to include Revenue Cycle Management, which has absolutely improved our billing services. Overall a very positive experience, with a few key contacts in the company that are always available and promptly responsive and accountable to our practice.

MedEvolve really does stand out not only in software performance, but particularly in customer service.”

Barry Seibel, M.D., Los Angeles, CA, is a worldrenowned ophthalmic surgeon, author, inventor and frequent consultant to the ophthalmology industry.

and attached them to the main blood vessels. “There’s a long, tedious process with these connections – making sure that there is no leak, making sure that they are extremely hemostatic,” Bansal explained.

“Once that is done, then we have to get these individuals off the bypass machine and make sure that the new heart takes over. So, it’s quite an involved process.”

Following the procedure, the patient adapted well to his new artificial heart.

“He is doing fantastic,” Bansal reported.

“He is eating, he has started to walk, which he had not done since December, he is talking to his family. He is doing everything that you and I do at this stage.

We are gradually increasing his activity levels and, very soon, he is going to the floor.” If all goes as planned, the patient will eventually return home with a Freedom portable driver.

Once patients receive TAH, they are placed back on the heart transplant list.

Nationwide, about 3,500 patients are currently waiting for a donor heart. “Total artificial heart is a bridge to heart transplant,” Bansal explained. “There is actually a person in Europe who was five years out with an artificial heart before he got a heart transplant.”

Ochsner is one of only 40 sites in the U.S. certified for TAH implantation.

“There are probably 1100 done in the whole world,” said Dr. Hector Ventura, section head, Heart Failure and Transplantation at Ochsner. “Ochsner has been at the forefront in the development of advanced heart failure treatments. The Total Artificial Heart is another milestone in the history of Ochsner in serving patients with innovative technologies.”

Bansal believes that patients should be considered for TAH as soon as they are confirmed as candidates. “Whenever we think that the patients are failing medical therapy, that is the time that we should consider advanced options,” he said. “Because, the longer you wait, the more end organ damage happens. Once that happens, then it becomes very critical for these devices and advanced therapies to start to turn patients around.”

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The Move from Social Media Marketing, continued from page 6 lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said.

Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.

Security “Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.”

He added, “Any enterprise-class so-

cial business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”

Avoiding Information Overload Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said.

However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe.

Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.

The Bottom Line With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally.

From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”

Three Trends Driving Change Three trends are driving change in the workplace – social, mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space.

“It’s incredible how powerful each of these trends are alone, and they are all converging,” said Andrew Dixon of Igloo Software. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statistics. “All of their IT requirements will be outsourced and provided to them by the cloud.”

Citing recent research from business and technology research firms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.”

Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Taking the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone professionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent.

Furthermore, half of the tablet-owning doctors have used their device at the point of care.

LSMS

Making Louisiana a Better Place to Practice Medicine Since 1878

Why Senate Bill 55 Must Pass

by LSMS Vice President of Governmental Affairs Jennifer Marusak There are many important bills on the table this legislative session, but none moreso than Senate Bill 55, which provides transparency in the Medicaid program by requiring Vice President, the Louisiana DeGovernmental partment of Health Affairs and Hospitals to re- Jennifer Marusak port certain information about the Bayou Health and Louisiana Behavioral Health Partnership programs to the Louisiana Legislature.

Why is this legislation needed?

Louisiana expends approximately $2.5 billion a year in these two programs.

Currently, there is no reporting or oversight required for either. Therefore, it is imperative that meaningful oversight and reporting are required to ensure our tax dollars are being spent in the most efficient and effective manner possible.

The Bayou Health and Louisiana Behavioral Health Partnership programs were both touted to provide better quality care at a lower cost. As stewards of taxpayer dollars, it is imperative that the legislature ensures these goals are being achieved. Without meaningful reporting to the legislature, this obligation cannot be met.

Furthermore, according to a Voter Consumer Research poll conducted in January of this year, 82% of Louisiana voters said they favor a law requiring greater transparency in the Medicaid program.

including percentage of clean claims paid, average time to pay all claims, and number of claims denied or reduced for certain reasons.

3. Measures that speak to how prescription drug benefits are being managed.

This includes the total number of prescriptions subject to prior authorization and prescription claims subject to step-therapy or fail first protocols.

4. Measures that speak to health outcomes, including the Medical Loss Ratio of each plan and a comparison of specific health outcomes.

5. Measures of provider and recipient satisfaction through recipient satisfaction survey reports and the number of grievances and requests for state fair hearings filed by recipients.

In addition to appropriate measures, the initial report filed by DHH shall include measures from the legacy Medicaid program so that a comparison can be made between Bayou Health, the Louisiana Behavioral Health Partnership, and the traditional Medicaid programs.

Guidance and bulletins for Bayou Health DHH will be required to make public all guidance documents it issues which relate to Bayou Health. All of this guidance is not public today.

Plan amendments and correspondence DHH will be required to make public all state plan amendments and related correspondence with the Centers for Medicare and Medicaid Services within 24 hours of submission or receipt.

What is required to be reported?

Stay up-to-date on the latest information

1. Measures which speak to the viability of each plan, including total number of healthcare providers in each plan, total number of enrolled recipients in each plan, amount of the total payments, and average per member per month payment for each plan.

You can keep abreast of all LSMS legislative efforts by visiting www.lsms.org/advocacy or by becoming a member of the Society, which, in addition to great benefits, allows your voice to be heard on these and other topics in the legislature. Join today by calling 800-375-9508 or emailing membership@lsms.org.

2. Metrics centered around claims payments to providers in the program,

Louisiana Medical News

MAY 2013 • 13

OUtline copy and paste select both sets of words hold shift key and select gradient choose reverse front to back text: 100 Helv. Ultra comp -20 AV(one on right) -100 (between words) stroke .25 pt.

In the News Louisiana Heart Hospital Physicians Group Signs Agreements

LACOMBE-The Louisiana Heart Hospital (LHH) announced that it has recently completed agreements for clinical integration with seven Northshore area physicians.

“These agreements represent an important step in the growth of the Louisiana Heart Hospital integrated delivery system, and we are proud to have these experienced physicians join our group,” “ said Steve Blades, CEO of LHH and Sr. Vice President for Physician Services for Cardiovascular Care Group, the parent company of LHH. The physicians who have signed clinical integration agreements include: Michael C. Finn, IV, M.D., F.A.C.C. Dr. Finn has maintained a private practice in Louisiana since 1976 with Board Certification in Internal Medicine and Cardiovascular Disease. He completed his medical education at Tulane Medical School; Internship at Baltimore City Hospital; C. Residency at U.S. Public Dr. Michael Finn Health Service Hospital, New Orleans; and Cardiology Fellowship at Ochsner Foundation Hospital, New Orleans. He is Clinical Assistant Professor at Tulane University Medical School; Member of the Tulane Vascular and Heart Institute; and Staff Cardiologist, University Hospital, New Orleans. Finn won the American Medical Association’s Physician Recognition Award in 2010.

Cary F. Gray, M.D Dr. Gray has maintained a private practice in Slidell since 1980 with Board Certification from the American Board of Surgery. He received his medical doctorate from Louisiana State University School of Medicine, New Orleans and also Dr. Cary F. Gray completed his residency in general surgery at LSU Medical Center.

He is a Fellow of the American College of Surgeons and a member of the Louisiana State Medical Society, the St. Tammany Parish Medical Society, the Rives Society, and the Surgical Association of Louisiana.

Walter E. Gipson, IV, M.D. Dr. Gipson has maintained a private practice in Picayune, MS since 1996 with Board Certification in Family Practice. He completed his medical education at University of Mississippi School of Medicine. Dr. Gipson holds certifications as a MediWalter E. cal Review Officer and in Dr.Gipson Advanced Cardiac Life Support and Advanced Life Support Pediatrics. Gipson serves as Medical Director of St. Joseph’s Hospice and preceptor 14 • MAY 2013

Louisiana Medical News

at Tulane University Medical Center and University of Mississippi Medical Center.

He is a member of the Mississippi State Medical Association and the American Academy of Family Physicians.

Waseem Muhammad Jaffrani, M.D. Dr. Jaffrani has been practicing in Louisiana for 15 years and holds Board Certification in Internal Medicine and Cardiovascular Disease. He has extensive clinical experience including a Research Fellowship in Heart Failure and Transplantation at Dr. Waseem Ochsner Medical FounMuhammad Jaffrani dation; Internal Medicine Internship, Internal Medicine Residency, Advanced Imaging Fellowship – Cardiology, and Clinical Fellowship – General Cardiology at Tulane University Health Sciences Center; and an Interventional Cardiology Fellowship at Thomas Jefferson Hospital, Philadelphia, PA. David Kaplan, MD Dr. Kaplan has maintained a private practice in Slidell since 1999 with Board Certification from the American Board of Surgery in general and vascular surgery. Dr. Kaplan completed his medical doctorate and residency at Louisiana State University Dr. David Kaplan School of Medicine, New Orleans and completed a vascular surgery fellowship at Mt. Sinai Hospital in New York. He is certified by the Louisiana and Mississippi State Board of Medical Examiners, and the National Board of Medical Examiners and is a Diplomate of the American College of Surgeons. Dr. Kaplan also serves as a clinical instructor of vascular surgery at LSU Medical Center in New Orleans.

Richard J. Sanders, Jr., M.D. Dr. Sanders has maintained a private Family Practice on the Northshore since 1986. Dr. Sanders completed his medical

education at Louisiana State University School of Medicine, New Orleans and performed his residency at WashingtonSt. Tammany Regional Medical Center in Bogalusa. He serves as a preceptor for both Tulane Medical Center and LSU Medical School. Sanders also holds U.S. Patents for Dr. Richard J. Sanders, Jr. the treatment of acne and for the treatment of hair loss.

James Emerson Smith, III, M.D. Dr. Smith has been practicing in Louisiana for over 30 years with Board Certification in Internal Medicine and Cardiovascular Diseases. He completed his medical education at University of Nebraska Medical School, interned in the Tulane Affiliated Residency Program, and completed residencies at the Cook County Hospital in Chicago and Tulane Affiliated Residency Program.

Dr. Smith’s Cardiology Dr. James Fellowship was completed Emerson Smith, III at Tulane Medical School – Touro Infirmary Hospital and he holds a license in Nuclear Cardiology. Smith is an American College or Cardiology Fellow and a member of the Louisiana State Medical Society and the St. Tammany Parish Medical Society.

Bergeron Elected Delegate to the National Conference of the Association of Surgical Technologies

Jay Bergeron, CSFA has, recently, been elected as Delegate to the National Conference of the Association of Surgical Technologies, scheduled for May 21 – 25, 2013 in New Orleans, Louisiana. He is also serving on the Governmental Affairs Committee of the Louisiana State Assembly of the Association of Surgical Technologies. Jay works at Surgery Center, Inc. in Lafayette as a Scrub Tech in the Operating Room, as well as in the Purchasing Dept. of Materials Management.

Cajun Invasion Donates $2,000 To The Louisiana Foundation For Cancer Care

LAFAYETTE - Cajun Invasion, the first dragon boat racing team in Louisiana, recently made a $2,000 donation to the Louisiana Foundation for Cancer Care. The funds will help cancer patients in Louisiana receive much needed treatment and support services, such as transportation to and from radiation therapy appointments. Nancy Duhon, Ann Roberts, and Delores Blaire of Cajun Invasion presented this check to the Foundation and its partner, Oncologics, on March 13, 2013.

These funds are only available for donation because of the fundraising efforts of Cajun Invasion and the generous donations of their many supporters. The organization’s primary fundraiser is the Annual Pink Ribbon Jam – the 4th annual event was held in October 2012 at Blue Moon Saloon.

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In the News

Parkinson’s Disease Therapy at Touro

Fifty-six Percent of LSUHSC New Orleans Medical Graduates Chose To Remain In LA

NEW ORLEANS-–Fifty-six percent, or 104 of 187 LSUHSC New Orleans graduating medical students participating in the National Resident Match Program this year chose to remain in Louisiana to complete their medical training. The LSU Health Sciences Center New Orleans residency programs accepted 138 new residents, and 51 percent of the 65 percent of 4th year medical students entering LSU residency programs will enter LSU Health Sciences Center New Orleans residency programs.

The residency programs at Earl K. Long Medical Center in Baton Rouge have accepted 32 new residents in Emergency Medicine, Internal Medicine-Categorical, Internal Medicine- Preliminary, and OB/GYN. The residency programs at University Medical Center in Lafayette have accepted 16 new residents in Family Medicine, Internal Medicine-Categorical, and Internal Medicine Preliminary.

The Match, conducted annually by the National Resident Matching Program (NRMP), is the primary system that matches applicants to residency programs with available positions at U.S. teaching hospitals and academic health centers. The choices of the students are entered into a software program as are the choices of the institutions with residency programs. All U.S. graduating medical students found out at the same time today where they “matched” and where they will spend their years of residency training.

The percentage of LSUHSC New Orleans medical graduates going into primary care is 43 percent this year. Primary Care specialties included are Family Practice, Internal Medicine, Medicine-Preliminary, Obstetrics-Gynecology, Pediatrics, and Medicine-Pediatrics. OB/GYN is not always included in primary care data; however, in some Louisiana communities the only physician is an OB/GYN. Of the 52 accredited residency and fellowship programs sponsored by LSU Health Sciences Center New Orleans, 25 participated in the Main NRMP Match whose results were released today. They are Anesthesiology, Child Neurology, Dermatology, Emergency Medicine, Family Practice (Kenner, Bogalusa and Lake Charles), Internal Medicine, Medicine-Preliminary, Neurological Surgery, Neurology, Obstetrics-Gynecology, Orthopedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry (Baton Rouge and New Orleans), Radiology, General Surgery, Surgery-Preliminary, Vascular Surgery, Medicine-Pediatrics, and Medicine-Emergency Medicine.

LSUHSC medical graduates training in other states will be going to such prestigious programs as Mayo, Barnes Jewish Hospital, UCLA, Beth Israel Deaconess, Baylor, Duke, Emory, Georgetown, and Vanderbilt, among others.

“Thanks to Parkinson's therapy at Touro, I can enjoy my daily walks again."

Sylvia H.

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Using physical and occupational therapy, LSVT BIG helps patients with issues like walking faster with bigger steps and improving balance. LSVT LOUD, a Parkinson’s-specific speech therapy, helps improve vocal loudness, clarity, and facial expression.

Touro Infirmary offers a comprehensive LSVT program.

For more information about how therapy can help you or a loved one living with Parkinson's, call (504) 897-8557 or visit www.touro.com/LSVT.

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MAY 2013 • 15

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