Louisiana Medical News May 2015

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SOU TH LOU ISIANA ED ITION

On Rounds Physician Spotlight

SGR Fix Marks Start of New Debate

By TED GRIGGS

Dr. Charles Wyatt Getting to the heart of it From a young age, Charles Wyatt was a self-starter. Then, he became a heart-starter. At age 14, he was the youngest CPR instructor trainer ever certified by the American Heart Association for the state of Texas. This achievement foreshadowed his creation of the “Be a Heartstarter” campaign years later ... page 2

Gulf South Quality Network Expands to Acadiana Gulf South Quality Network has officially expanded beyond its New Orleansbased roots to Acadiana. About 18 months ago, the Regional Medical Center of Acadiana and Women’s & Children’s Hospital joined the network ... page 4

The end of the muchdespised sustainable growth rate won’t end physicians’ issues with Medicare payments, but it does provide a new starting point for those conversations.

“We applaud repeal of the SGR. We’ve been preaching that for as long as I can remember,” said Jeff Williams, executive vice president and CEO of the Louisiana State Medical Society. “It will be nice that physicians no longer have to worry about a huge, double-digit decrease (21 percent) being held over their heads every single year.”

Both doctors and politicians had tired of the argument. Since

2003, Congress has passed 17 patches to prevent cuts to physicians’ Medicare payments. The American Medical Association said those patches cost $54 billion, more than it would have to make a permanent fix.

The House passed the bill with little opposition. The Senate had yet to consider the “doc fix” as of press time. A lengthy budget fight left Senate members with little appetite for another, and lawmakers adjourned for Easter without taking up the bill. The Centers for Medicare and Medicaid Services suggested physicians delay billing until the Senate acted rather than accepting a lower payment.

Still, Williams was among the health industry members opti(CONTINUED ON PAGE 8)

Population Health Advances Physicians are buzzing about the new healthcare paradigm

By JULIE PARKER

America’s independent physicians met mid-March in San Antonio, Texas, for the 20th annual national meeting of TIPAAA – The IPA Association of America, the largest trade association serving independent and integrated physicians in the United States.

The focal point: population health, a relatively new front burner issue unfamiliar to many practitioners. Congress included the model as a component of mandates in the Patient Protection and Affordable Care Act (ACA) (See box).

“We covered a lot of ground at our annual meeting to educate independent physicians about population health,” said Al Holloway, founder and president of TIPAAA. “Once we fully understand what it is, then we’ll find tools, products and services that can assist independent physicians in their daily practice.”

One question that repeatedly popped up: What’s the difference between population health and public health?

(CONTINUED ON PAGE 6)

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Physician Spotlight

Dr. Charles Wyatt Getting to the heart of it

By LISA HANCHEy

From a young age, Charles Wyatt was a selfstarter. Then, he became a heart-starter. At age 14, he was the youngest CPR instructor trainer ever certified by the American Heart Association for the state of Texas. This achievement foreshadowed his creation of the “Be a Heartstarter” campaign years later.

When it came to a career choice, Wyatt naturally steered toward the heart. During high school, he completed his EMT, then worked his way through college at Wesleyan University as a paramedic. But, how he got from Texas to New England is another story.

You see, the Houston native was an ice hockey star. At age 15, his high school team reached the national semi-finals.

After playing in New England, he and a few teammates were offered scholarships.

For his senior year, Wyatt transferred to Phillips Academy Andover in Massachusetts, a prestigious prep school. He remained in New England for college, studying biology at another prep school,

Wesleyan. “I had a chance to go to Harvard, too, but Wesleyan was smaller and a better fit for me,” he explained. “I loved it.

It was a great experience.”

While in college, he continued to play ice hockey on his university’s team, serving as team captain his senior year, as well as president of his fraternity. After graduating, he returned to his hometown for medical training at Baylor College of Medicine, where he completed his general surgery internship and residency. In 1991, he served as Chief Resident to renowned heart transplant surgeon Dr. Michael DeBakey.

But, when he attended medical school, he no longer had time for the brutal sport. Instead, he turned to another hobby – music. During junior high and high school, Wyatt had played trumpet in the marching band. After taking a hiatus, he took up the instrument again during medical school.

Following graduation, Wyatt nabbed a cardiac surgery fellowship at the University of Miami Affiliated Hospitals in Florida. “I always kind of knew what I wanted to do,” he said. Afterward, he stayed on for a couple of years as a faculty member at the University of Miami School of Medicine in the Department of Thoracic and Cardiovascular surgery. During his stint in Miami, he was nominated for the Florida Medical Association Outstanding Volunteer Service Award for his work with the Hurricane Andrew Relief program.

Next, he was recruited up North

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again to create a brand new heart surgery program in Michigan. After enduring three years of frigid winters, he and his wife, Noemi, a practicing pharmacist, decided to return to the South for good. He drew a 200-mile circle around Houston, and found a job in Lafayette, La., where he practices at the Louisiana Heart, Lung & Vascular Center on the campus of The Regional Medical Center of Acadiana, an HCA facility. Currently, he serves as director of the Transcatheter Aortic Valve Replacement (TAVR) program. “It’s probably the single most revolutionary advancement in cardiovascular surgery in my lifetime,” he said.

When Wyatt moved to Lafayette, he observed that too many patients were dying of heart disease. So, he decided to take action, launching the “Be a Heartstarter” bystander cardiopulmonary resuscitation program in 1999. Since then, the free one-day program has trained nearly 17,000 people to administer CPR. “When we started this event, the survival rate was one out of 100,” he said. “Now, it’s 35 out of 100.” The next event will be held on May 16, 2015, at the Lafayette Cajundome.

With his busy schedule, Wyatt somehow manages to find time to play in a band. Shortly after moving to Lafayette, he sat in a few times with Blue Soul, which led to his first paid gig at a Mardi Gras Ball in Alexandria. For the past 16 years, Wyatt has played trumpet with Blue Soul at events across the state.

But his outside activities don’t stop there. As sons Chad and Matthew were growing up, Wyatt served as head coach for their travel ice hockey team, Team Louisiana, and led them to a bronze medal in the national championship.

He continued coaching lacrosse at St. Thomas More High School even after they graduated. Wyatt is also a trained pilot and served on the Lafayette Airport Commission for 10 years.

Through all of these endeavors, Wyatt has one goal. “My idea is to give back to the community,” he said. “It’s all about helping others. I’d rather be the second busiest heart surgeon in the city (which he is) and do all of those things for others, than be the busiest heart surgeon and not do anything for anybody.”

Chronic Disease Requires New Care Model

By TED GRIGGS

The current healthcare delivery model is hopelessly inadequate when it comes to managing chronic disease, but a new approach combining team-based care and technology may be the answer.

Two Ochsner researchers discuss how the new model could work in “Healthcare 2020: Reengineering Healthcare Delivery to Combat Chronic Disease.” The article, published in The American Journal of Medicine, was authored by Richard V. Milani, MD, Ochsner Clinical School - Univer- Dr. Richard Milani sity of Queensland School of Medicine in New Orleans; and Carl J. Lavie, MD, Ochsner Clinical School - University of Queensland School of Medicine, and the LSU System, Baton Rouge.

“The current delivery model we have in 2015 is no different than say it was in 1915. It’s basically hospitals and doctors’ offices and you come in and be seen,” Milani said.

The difference is that 100 years ago, the leading health issues and causes of death were acute problems, like pneumonia or a broken arm. Today, chronic disease accounts for 70 percent of deaths in the United States and more than 75 percent of healthcare costs. More than 92 percent of Ameri-

cans over 65 have one or more chronic diseases. Close to half the country will suffer from chronic disease by 2020.

Nationally and globally, the current model does a poor job of caring for these patients, Milani said. The reason? The chronically ill still receive care through an episodic model, visiting doctors’ offices two, three or even four times a year.

That approach is perfect for acute problems, he said. But relying on a few data points doesn’t work very well for a condition that may never go away.

“We need a different model that says ‘OK, we’re going to collect continuous data from you. We’re going to educate you more to help get you more involved in your disease process. And then we’ll work together as a team … to manage that,’” Milani said.

Milani and Lavie call these teams specialized integrated practice units, or IPUs. Each would employ non-physician personnel – pharmacists, advanced practice clinicians, nurses, health educators, dietitians, social workers, counselors, and therapists – organized around the patient’s medical condition.

One of the oldest IPUs is the Coumadin clinic, where clinical pharmacy teams manage the patient’s blood Warfarin levels.

This approach has been proven to lower costs and improve outcomes compared to having the physician directly manage the patient or having a physician oversee a nurse who manages the patient.

The new delivery model would also use

technology, such as apps and wearables, to do a lot of the work, Milani said.

Effectively managing a chronic condition requires capturing data frequently, on at least a weekly basis. But no one can afford to take time off every week for an appointment, and too much of physician time is still spent on things like telling patients to come back to check their blood pressure.

Primary care physicians’ time with patients is limited. Even when a doctor advises a patient to exercise more or eat less fatty foods, for example, few people follow those directions.

Arming the patients with apps and wearables could improve on that, Milani said.

Available technologies allow the capture of blood pressure and blood sugar levels.

If those numbers fall outside of some predetermined national guidelines, an automated alert can be sent to the patient, Milani said.

Patients can take advantage of any number of technologies and communication, whether it be feedback, or competing with a friend on activity levels, or automated “attaboys,” Milani said. The patient can pick the device and the communication that works best for him or her.

Many of these devices offer an important advantage: connection to and through social networks. So two friends can use technology to keep track of each other’s progress, offering encouragement and even competing, all of which can lead to better adherence

to care regimens.

The cost of rolling out the IPU-technology-driven model depends on how much a health system wants to depend on technology to do the ground-level work, Milani said.

There will be an upfront cost, but the savings, mainly through avoided costs, could be significant.

For example, about 40 percent of Louisiana adults have high blood pressure, but only half of them have the condition under control, Milani said. The majority of people with high blood pressure see their doctor at least once a year, which means the problem isn’t access.

On a day-to-day basis, having uncontrolled blood pressure doesn’t look like much of a cost. But longer term, it’s a different story.

High blood pressure is the second-leading cause of kidney failure, which causes dialysis, and the leading cause of heart attacks, strokes and death, Milani said.

All of those problems add enormous healthcare costs, many of which could be avoided with proper disease management, he said. And as patients better control their chronic condition or conditions, they require less frequent management and IPU contact.

Instead of daily or weekly communication with team members, the patient may only require monthly or quarterly communication, Milani said. The data will still be collected, and the patient will still receive a monthly report, but the frequency of the team’s interaction will be reduced.

Louisiana Medical News

MAY 2015 • 3

Gulf South Quality Network Expands to Acadiana

By LISA HANCHEY

Gulf South Quality Network (GSQN) has officially expanded beyond its New Orleans-based roots to Acadiana. About 18 months ago, the Regional Medical Center of Acadiana and Women’s & Children’s Hospital joined the network. More recently, Our Lady of Lourdes Regional Medical Center came onboard.

GSQN is a clinically integrated physician network consisting of physicians in medical and surgical specialties, including primary care. The goal of clinical integra-

tion is to improve the quality of patient care while controlling costs of services.

“We provide technology to collect data, which comes from physician offices, hospitals, payors that we partner with, pharmacies, formularies and ancillary providers,” explained Bill Bopp, president of GSQN. “Our goal is to evaluate current performance in patient care and safety, and then, effectively Bill Bopp deliver patient care. By

gathering and analyzing that data and identifying where there are opportunities for improvement for the physicians and the hospitals, we provide a higher level of care to the citizens of Louisiana.”

The network started in New Orleans about three and half years ago, with area partners including Slidell Memorial Hospital, East Jefferson General Hospital, Lakeview Regional Medical Center, West Jefferson Medical Center, Tulane University Medical Group, Children’s Hospital and Touro. Over 1600 physicians participate in the network. “I anticipate that we

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will continue to grow in the New Orleans area and add another 500 physician,” Bopp projected. “And then, our goal in the greater Lafayette area will probably be to have 400 or 500 physicians participate.

But, we are still in the development stage.”

How does GSQN benefit doctors?

The network allows physician to be able to collect the full continuum of data.

“Currently, the payors have data on the physicians, the hospital has data on the physicians, and other survey tools have data on the patients,” Bopp explained.

“But, the physicians really lack of some of the data that they need in order to be able to tell the full continuum of care. So, we aggregate all of that data together, and then are able to report it back to the physicians in a way that is easy for them to understand, and it’s actionable for them to consider new protocols or new ways to treat patients that provide a higher outcome of care.”

Another advantage is that GSQN is physician-led. “So, the chairperson of our network is a physician, and the governance of the organization is physicianled,” Bopp explained. The hospitals are also at the table, but the majority of the board is physician leadership.”

Feedback from physicians involved in the network has been “really positive.”

“It’s allowing us to give them information that is quick to understand and quick to react to, rather than just getting a stack of charts or graphs which they have to go through and try to understand,” Bopp said. “We streamline that for them. Within GSQN, we have quality analysts, financial analysts, and care coordinators that work with patients who have chronic disease states. We also have a chief medical officer who has conversations with doctors when there is opportunity for improvement.

So, it’s been very well received by physicians. And, I think they see the value as healthcare continues to move away from a fee-for-service environment to more of an accountable care environment where we are looking at quality outcomes and patient health, and trying to move people to a healthier population. They see this as a useful tool to help them be successful in the new environments of healthcare as they continue to change,” he said.

Because GSQN staff does the paperwork, physicians are able to spend more time with patients. “We are trying to create an environment where the physician is spending more time on patient care and less time on reporting and working through paperwork and all of those things that take them away from that patient environment,” Bopp explained. “This is especially important in Louisiana, because there is a shortage of physicians here. And so, our ability to create an environment that allows a physician to spend more patient time and less administrative time helps solve that problem of patients having access to physicians.”

Patient feedback has also been positive. One of the services GSQN provides is patient follow-up. For example, if a pa(CONTINUED ON PAGE 7)

4 • MAY 2015

Louisiana Medical News

Mastering Population Health Thomas Jefferson University offers nation’s first MS-PopH program

By JULIE PARKER

The hottest new advanced degree in healthcare, beyond medical school, focuses on a game changer for the nation’s healthcare delivery system: population health.

Thomas Jefferson University (TJU), home of the nation’s only School of Population Health, received approval March 5 to become the only institution of higher learning in the United States to offer a new graduate-level degree program: Master of Science in Population Health (MS-PopH).

The program is accepting applications for this fall.

“Population health is catching fire.

It’s a raging inferno at the moment,” said David B. Nash, MD, MBA, founding dean of the Jefferson School of Population Health and the Dr. Raymond C. and Doris N. Grandon professor of health policy at Thomas Jefferson University.

Nash, a board-certified internist, became involved in promoting quality improvement and lobbying for healthcare policy change in the 1980s. He joined the university in 1990 as a faculty member; the former university president asked him to build the School of Population Health for the campus, which opened in 2008 as the first U.S. academic institution focused on population health. Already, 25 students have completed the graduate certificate online program, which takes 12 to 20 months to complete. Its focus: to help current and emerging healthcare leaders understand the new population health paradigm. More than 100 students have completed the onsite Population Health Academy, a 40-hour continuing education program, providing an overview of basic concepts in population health.

“Healthcare inside a medical facility is only 15 percent of the story; 85 percent of healthcare happens outside the hospital,” noted Nash. “We have to reach outside the four walls of our hospitals to coordinate with community pharmacies, nursing homes, extended care facilities and the like, and link all of these care providers – from the hospital’s board of trustees to the folks delivering home infusion medication. It’s a big operational challenge. We’re going to have to become a well-oiled, organized, value-generating team.”

Kathy Jordan, president of Jordan Search Consultants, said the new degree program is well-timed.

“The healthcare landscape is shifting more dramatically right now than it has since its inception,” she said. “As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will transform. With an emphasis on proactive preventative care, evidencebased protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume

of patients seen. In some cases, this may require new types of training.”

The comprehensive MS-PopH online graduate degree program will help students develop competencies in five key public health areas – behavioral and social sciences, biostatistics, environmental health sciences, epidemiology and health policy. Students will also develop proficiency in the application of population health skills and principles, culminating in a Capstone project applying theory and lesson in real-world situations.

Already in place at Thomas Jefferson University: a doctoral degree program – PhD in Population Health Sciences –that started four years ago and has 14 students.

The first two graduates will receive their degrees this month.

The doctoral degree is studied onsite, with the goal of preparing leaders with global vision to analyze the determinants of health. Doctoral candidates specialize in one of four areas: health policy, healthcare quality and safety, applied health economics/outcomes research and behavioral/health sciences.

“The PhD in Population Health Sciences isn’t intended for those new to the discipline,” noted Nash. “Preference is given to applicants who’ve completed a master’s degree or master’s level course-

work in appropriate fields of study, such as public health, social work, health policy and behavioral sciences.”

The addition of the MS-PopH program came soon after Stephen K. Klasko, MD, MBA, relocated from the University of South Florida (USF) Morsani College of Medicine and USF Health, where his transformative ideas took the Tampa medical school to unprecedented heights.

Klasko is in his Dr. Stephen Klasko first year as president of Thomas Jefferson University and president/CEO of the Thomas Jefferson University Hospital System, now the largest healthcare system in Philadelphia, Pa., the nation’s sixth largest city.

“We’re moving healthcare from a Blockbuster mentality to a Netflix mentality,” said Klasko, pointing out the university began offering population health “before anybody put population health in the same sentence.”

“At Thomas Jefferson University, we created a whole new mission and vision, where health is all we do,” he explained.

“Our vision is to reimagine healthcare education discovery to create unparalleled value. Jobs will be needed in healthcare

in 10 years that aren’t even yet imagined, and a good many will be in population health.”

Nash, who also serves as a government and private-sector consultant, chairs the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council and is a board member of various healthcare organizations, including Humana.

“The great thing about Dr. Nash’s school, it’s not a Johnny-come-lately. He’s devoted his life to population health,” said Klasko. “In most universities, population health is part of another school and lacks the panache … that puts us at the forefront.”

For additional information on the Jefferson School of Population Health degrees – program content, admissions requirements, deadlines, and tuition and fees – visit http://www.jefferson.edu/ university/population-health/ degrees-programs/populationhealth/about.html.

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Population Health Advances, continued from page 1 “Some view population health as a more modern version of public health, which itself – improving the health of the public – may be a goal, a measurement system, and a conceptual framework that undergirds a profession and a scientific field,” wrote Michael A. Stoto, PhD, in “Population Health in the Affordable Care Act Era,” published by Academy Health (Feb. 21, 2013).

“Population health differs from public health, at least perceptually, in at least two respects,” Stoto explained. “First, it’s less directly tied to governmental health departments. Second, it explicitly includes the healthcare delivery system, which is sometimes seen as separate from or even in opposition to governmental public health.”

David B. Nash, MD, MBA, founding dean of the Thomas Jefferson University School of Population Health, pointed out that population health “builds on public health foundations.”

Among the buildDr. David ing blocks, according to Nash Nash: Connecting prevention, wellness and behavioral health science with healthcare delivery, quality and safety, disease prevention/management and economic issues of value and risk – all in the service of a specific population. Examples: a city, provider’s practice, employee group, hospital’s primary service area or pre-school children.

Identifying socioeconomic and cultural factors that determine the health of

The ACA and Population Health The Patient Protection and Affordable Care Act (ACA) addresses population health in four significant ways: •

Provisions to expand insurance coverage target the advancement of population health by improving access to the healthcare delivery system.

•

Other provisions seek to enhance the quality of care delivered.

•

Lesser known provisions aim to improve prevention and health promotion measures within the healthcare delivery system.

•

The final set promotes community- and population-health based activities, including the establishment of the National Prevention, Health Promotion and Public Health Council, which has already produced the mandated National Prevention Strategy and Prevention and Public Health Fund for monetizing Community Transformation Grants.

populations, and developing policies that address the impact of these determinants.

Applying epidemiology and biostatistics in new ways to model disease states, map their incidence and predict their impact.

Using data analysis to design social and community interventions and new models of healthcare delivery that emphasize care coordination and ease of accessibility.

“When applied to healthcare delivery, population health differs from conventional healthcare by emphasizing value rather than volume of services rendered,” said Nash.

How will population health affect physicians?

Monumentally, said Kathy Jordan, president of Jordan Search Consultants.

“The primary care practice of the future will look much different than it does today,” she said. “Instead of one-on-one encounters between the patient and their provider, the patient interaction process will include phone visits, email consultations, group visits, education programs and encounters with a variety of care team members. Out-of-office contact will become the new norm as patient health improves. Additionally, primary care physicians of the future must exhibit leadership and interpersonal skills, as well as a passion for top-tier service delivery. How well they manage the team will directly translate to how well the health of their patient population is being managed, which will directly impact future compensation models.”

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for incentivized government funding, organizations must prove their commitment to, and implementation of, population health, said Jordan.

“They’ll be required to improve the patient Regina Levison care experience, the overall health of populations, and lower per capita costs of case,” she said. “As a more comprehensively integrated system focused on population health begins to dominate, the healthcare industry, healthcare experience and provider recruitment initiatives must also evolve.”

Enter population health management.

Regina Levison, vice president of client development for Jordan Search Consultants, said that “while population health is defined as the health outcomes of a group of individuals comprising a specific demographic population, population health management is a business model centered on the delivery of comprehensive care and management of total risk.”

The foundational shift in the healthcare experience will morph from an industry driven by reactivity to an industry driven by proactive measures, said Levison.

“The goal of population health is to keep a patient population as healthy as possible and minimize the need for costly interventions, procedures, emergency room visits, and hospitalizations,” she said.

As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will be reconstructed, said Jordan.

“Within this transformation, we’ll see an altered patient and physician experience,” she said. “With an emphasis on proactive preventative care, evidencebased protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume of patients seen.

“Although the results of these initiatives won’t manifest for a decade or more, population health management will almost certainly improve the quality of lives for millions of individuals throughout the country.”

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Help Wanted: Population Health Physician Leaders

By JULIE PARKER

Finding presentable candidates for population health physician leaders is a tall order, especially since many doctors remain unfamiliar with the new paradigm in post-healthcare reform.

Personnel represents one of three key ingredients to implementing population health management. It’s the glue to connecting data and the changing nature of the overall healthcare experience. The hard shift in practice management has healthcare organizations scrambling to secure top-notch population health physician leaders, a move that keeps physician recruiters like those at Jordan Search Consultants quite busy.

“Our clients know the organizations able to most effectively aggregate and distribute data—to collaborators, team members, and even patients themselves—will succeed,” said Kathy Jordan,

Gulf South, continued from page 4 tient has a chronic disease, such as diabetes, network staff will contact the patient to make sure that the patient has regular testing and examinations. “The patients are appreciative of that,” Bopp reported.

“We are also working very hard to make sure that all of the patients that we serve have a primary care physician who is controlling their conditions, so that we can make sure that their care is coordinated, and that we are not missing anything.

We are making sure that we are trying to help that patient have a better outcome and, hopefully, create an environment where the patient has a better lifestyle.”

Lafayette is first region outside of the New Orleans metropolitan area to join the network. Dr. Andy Blalock is the physician leader in the Acadiana area. “Right now, we’ve had a very good response,” Bopp said. “Currently, we are focusing on recruitment of the primary care physicians, and we’re having a very good response.”

GSQN’s next target is North of I-10.

“We are getting ready to start planning development into the Alexandria area,” Bopp revealed. “Rapides Medical Center will probably be the next market that we will enter.”

Now that GSQN has been around for a few years, physicians in these new markets can contact their colleagues in New Orleans to find out how the network benefits them. “I think it helps that doctors in Lafayette and other areas can talk to doctors in New Orleans, and ask them, ‘What’s this all about? Has this added value to your practice? Are your patients seeing better outcomes?’” Bopp said. “It’s been a very good collaborative of doctorto-doctor education. So, we’ve been very excited about it.”

president of Jordan Search Consultants.

“Healthcare systems are now implementing robust software systems and population health management programs that help automate data integration, analysis, reporting, and communications so that real-time evaluations—and adjustments in patient care plans—can be made instantaneously. Having the right IT systems – and IT personnel – in place is critical to advance clinical outcomes, improve care, and lower costs. Organizations with the ability to master data control and predictive analytics to generate decision-driving insights will succeed in population health management.”

Unfortunately, the shortage of primary care physicians (PCPs) – the leaders of population health management – continues to escalate. As population health management becomes the dominant healthcare model, the demand for their roles will be unprecedented.

“As physicians continue to leave the private practice model in favor of employed physician models, cultural fit within an organization will become a key recruitment parameter,” said Regina Levison, vice president of client development for Jordan Search Consultants. “In addition, PCPs will be recruited based on their ability to build consensus, manage teams, and lead a diverse care team to better patient health. Organizations must understand what physicians are looking for clinically, financially, and administratively to ensure a fit with the organization. Physicians who embrace the care team model, understand how to utilize advanced practice providers, and enjoy leadership opportunities will be in high demand. In addition, recruits must understand new incentive and reimbursement structures. Physicians will

be rewarded for meeting care management needs of patients; reimbursement will be tied to quality as opposed to quantity.”

Characteristics of a potential population health physician leader, according to Jordan Search Consultants, include: • A minimum of five to 10 years of practice experience.

• Board certification.

• A good understanding of the way Electronic Medical Records (EMRs) work.

• A plan to help move the population health management team to the next level.

• Mentoring ability.

• Advanced education.

“We’ve changed how we evaluate physician candidates and physician leaders so we can provide a better slate of candidates to our clients,” said Jordan. “We want to assess their ability to embrace population health, their understanding of population health, and their attitude and ability to treat patients under a population health model. We have to dig more deeply. The physician leader of the population health management team will be working at the highest end of their license.

We evaluate their ability to give direction and make assignments to the team and to educate their colleagues. They’ll need to assess where the team is strong, and where it needs additional education, training and support. It’ll be dictated not only by geography, but also by the socioeconomic element of the population being served.”

Clients are thrilled, said Jordan, when the consulting firm finds a candidate who already knows the EMR system they’ve implemented.

“That’s one less bridge to cross,” she

said.

One of the most pleasant surprises Jordan Search Consultants’ recruiters have discovered in physician leader candidate pools is the growing number of physician candidates who have, or are pursuing, advanced business degrees, such as an MBA, perhaps with a concentration in healthcare management, MHA (masters of healthcare administration), MPH (masters of public health), MHI (masters of healthcare informatics), MMM (masters of medical management), or MS-PopH (masters of population health).

“The MMM is a relatively new degree,” Jordan said, adding the MS-PopH degree program is a brand new offering at Thomas Jefferson University, the nation’s only school to offer that particular advanced degree. “They’re educating themselves to lead the charge.”

On the flip side, PCPs who otherwise might be excellent candidates for those positions simply lack time to pursue higher education.

“The rank-and-file practicing physician in a community doesn’t need a degree in population health to see his patients,” said Al Holloway, founder and president of TIPAAA (The Independent Physicians Association of America). “No, that doesn’t make sense. Having an understanding of population health will impact his practice, but he doesn’t need a degree in it.”

The need for these type of leaders is unprecedented, said Jordan.

“As the demand increases, and we continue to have a very limited supply of physician professionals for these leadership positions, automatically the compensation goes up,” she said. “That’s something I hope potential candidates will strongly consider.”

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SGR Fix Marks Start of New Debate, continued from page 1 mistic about the legislation’s chances.

But there are concerns about what the final bill will contain.

“You’re going to have some folks in the Senate that really want to see everything paid for instead of partial offsets. So that will be a sticking point,” Williams said.

The Congressional Budget Office has estiJeff Williams mated that the SGR fix will cost $174.5 billion over the next 10 years.

In addition, Williams said, there is a little anxiety because it’s unclear what awaits on the other side of the repeal.

“The devil you know is better than the devil you don’t know sometimes,” he said.

“The law repeatedly says the secretary of DHHS shall do this and shall do that and has the authority to do this …. No one really knows what that’s going to look like.”

LSMS members’ apprehension, if they have any, boils down to two questions: Are they better off with the reimbursement rate being frozen today at the current level of paperwork? Or will the SGR repeal merely freeze rates while making phy-

sicians fill out five times the paperwork?

Additional reporting requirements and other conditions that take more staff and/or time amounts to a rate decrease, Williams said. Potentially, physicians could find themselves in worse shape.

Williams said it could take three to five years for a physician or a practice that’s heavily Medicare-related to determine whether they are even, better off or worse off than before the repeal.

“It’s too early to tell. The reality is if that’s where we end up, then we all end up back in DC having new conversations,” Williams said.

But instead of arguing about repealing the SGR, the discussion will center on how to adjust the piece of the SGR fix that is still broken, he said.

The fix is kind of a Band-Aid. It freezes the reimbursement rates at the current level, with a built-in 0.5 percent annual increase, Williams said. Physicians can also earn enhanced or bonus payments, but again, no one’s really sure what that’s going to look like.

The details of what must be done to earn the higher payments and what those higher payments entail have yet to be determined, he said.

Critics of the bill say there’s a problem with basing physician payments on outcomes. Doctors pay a penalty if patients ignore medical advice or make poor lifestyle choices, neither of which are under the physicians’ control. Since doctors can’t work for free, they are likely to shed the more troublesome patients. Some physicians may even refuse to treat Medicare members, a group that is growing by roughly 8,000 people each day.

Some worry that the penalty for delinquent taxes – 100 percent – could be a problem.

Williams said the bill’s size, 250 pages or so, and complexity make for some discomfort.

There are always going to be conversations about the payment rate, what’s fair and how to pay for it, Williams said. Regardless of what the new payment model involves, some people will live with it while others will want to make changes.

How they want to make those changes will vary.

Pretty much every specialty society in organized medicine agreed that the SGR was bad and needed to go away, Williams said. There were differences about what should replace that payment model.

Williams said he doesn’t know that any of the reimbursement requirements, unless they’re absolutely awful, will generate the same kind of unified effort.

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8 • MAY 2015

Louisiana Medical News

Legislative Affairs

BY CINDY BISHOP, AND EARL MICHAEL WILLIS

A Look at Healthcare-Related Bills Under Consideration By the time that you read this, the 2015 Regular Session of the Louisiana Legislature will be in full swing. The Louisiana Constitution mandates that the state legislature must adjourn no later than 6 p.m. on Thursday, June 11, 2015, Sine Die. Below, is a partial listing of the legislative healthcare related bills that will be up for consideration this session.

If you would like to review these bills in detail, please visit the Louisiana Legislature’s website at www.legis.la.gov HB 1, Fannin Provides for the ordinary operating expenses of state government for Fiscal Year 2015-2016 HB 77, Ritchie Levies an additional tax on cigarettes HB 79, Burford Provides relative to producers of raw honey in the home for sale HB 83, Jefferson Provides for continuance of nutrition assistance for certain retirees HB 119, Ritchie Levies an additional tax on cigarettes HB 148, Badon Levies an additional tax on cigarettes and tobacco products and dedicates the monies HB 158, Hoffmann Provides relative to promotion of smoking cessation programs and services HB 159, Hoffmann Adds a fee at license renewal for pharmacists and pharmacies and dedicates proceeds to certain pharmacy education programs HB 165, Anders Provides relative to fees collected by the Louisiana State Board of Medical Examiners HB 186, Montoucet Requires that mammography and ultrasound reports provide information regarding supplemental breast cancer screening HB 187, Moreno Authorizes a parish governing authority to levy an excise tax on tobacco products HB 194, Moreno Provides relative to the examination, treatment, and billing of victims of a sexu-

Physicians’ health Foundation oF louisiana

ally-oriented crime HB 205, Gaines Provides with respect to the medical treatment schedule SB 10, Peterson Constitutional amendment to direct DHH to offer health insurance with essential health benefits to every legal resident of Louisiana whose income is at or below 138 percent of the federal poverty level SB 39, Mills Provides for the Louisiana Board of Drug and Device Distributors SB 40, Nevers Requires the Department of Health and Hospitals provide health care coverage with essential health benefits to every legal Louisiana resident whose household income is at or below 138 percent of the federal poverty level Coupled with the fact that our state is facing a huge deficit of $1.6 billion (which some are estimating will reach $2 billion), is the fact that this is an election year and several of our lawmakers are term limited.

Even though this is a “fiscal only session,” since 2015 is an odd numbered year, each one of the 39 senators and 105 state representatives can file up to five non-fiscal bills. Even if you subscribe to Common Core, this adds up to 720 bills. That’s a lot of information to keep up with.

If you have any questions, concerns, or are in need of lobbying assistance we are ready and willing to help. We are a full service governmental relations, lobbying, and association management firm located and headquartered in Baton Rouge, Louisiana.

Please feel free to contact me directly, at 225-933-5435 or cindy.bishop@ checkmate-strategies.com. You can also call our Vice President of Business Development, Earl Willis at 225-454-2209 or earl.willis@checkmate-strategies.com We will be updating you regularly on the pages of the Louisiana Medical News monthly paper. Additionally, Checkmate Strategies publishes a subscription-based newsletter called Health Care Information Services. You can download the subscription form at www.checkmate-strategies. com or email me and I will send you the information.

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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In the News Tumor Registry At LSUHSC Earns Top NCI Honors NEW ORLEANS – The Surveillance Epidemiology and End Results (SEER) Program of the National Institutes of Health’s National Cancer Institute awarded First Place to the LSU Health New Orleans School of Public Health’s Louisiana Tumor Registry for its 2014 and 2015 data submissions. Only five SEER registries received 2014 First Place Awards and only three SEER registries earned 2015 First Place Awards. Only two SEER registries earned both 2014 and 2015 First Place Awards. This is the sixth time LSU Health New Orleans’ Louisiana Tumor Registry has earned this award and the fifth consecutive year. The SEER Program is the most authoritative source of information on cancer incidence and survival in the United States.

The SEER Program evaluates a number of measures of data quality annually, including the completeness and timeliness of cancer cases, the percentage of unknown for key demographic and tumor variables, and patient follow-up rates.

LSU Health New Orleans’ Louisiana Tumor Registry data exceeded the goals in all of the measures.

The primary function of a cancer registry is to record the occurrence of cancer in a population. Information collected includes demographics, tumor characteristics, stage of disease at diagnosis, treatment, and survival. Information on risk factors is usually not available from the reporting sources. However, data from the registry often provide clues to be pursued in special research studies conducted by qualified scientists.

The SEER Program collects cancer incidence and survival data from18 population-based cancer registries in the United States. It is considered to be the standard for quality among cancer registries around the world. Quality control has been an integral part of SEER since

its inception.

Cancer is a reportable disease in Louisiana. Hospitals, pathology laboratories, radiation centers, physicians , nursing homes, hospices, and as well as other licensed health care facilities and providers who diagnose or treat cancer are required by law to report cancer cases to the LSU Health New Orleans School of Public Health’s Louisiana Tumor Registry. The Registry includes the central office with two in-house regions at the LSU Health New Orleans School of Public Health, and regional offices at Mary Bird Perkins Cancer Center in Baton Rouge, Acadiana Medical Research Foundation in Lafayette, and the University of Louisiana at Monroe.

Baton Rouge General Names First Chief Clinical Transformation Officer BATON ROUGE – Baton Rouge General/General Health System announced Kenny Cole, M.D. as one of the region’s first health system Chief Clinical Transformation Officers (CCTO). In this new role, Dr. Cole will lead the health system as it emerges as a regional leader in the transformation of care – taking its current top-rated performance in quality, safety and satisfaction to an all new level in the market.

“Health systems must find innovative ways to continuously excel at providing not only high quality but also its affordability. Dr. Cole’s depth of experience in both the provider and payor industries will bring fresh perspective to Baton Rouge General’s efforts to lead the region in achieving patient-centered solutions that can address some of healthcare’s most complex challenges,” says Mark Slyter, Baton Rouge General/General Health System President and Chief Executive Officer.

With a focus on value, some of the nation’s top health systems such as Geis-

inger, America’s first Accountable Care Organization, have invested in adding CCTOs to their leadership team for aggressively cultivating value-driven clinically integrated physician networks and frontline teams who link the rigor of scientific discovery, how care is delivered, and the way care is reimbursed to hospitals and healthcare providers.

“Baton Rouge General’s longstanding track record for delivering high quality, exceptional patiºent experiences has poised our team for a transformational leader like Dr. Cole,” notes Dr. Flip Roberts, Chief Medical Officer, “and our team looks forward to blazing new trails as we continue the journey toward perfection in patient care.”

Dr. Cole comes to Baton Rouge General/General Health System as a highly trained, highly educated Infectious Disease specialist with advanced degrees from LSU, Dartmouth and executive training from Harvard School of Business. He has served on Baton Rouge General’s Medical Staff from 2001-2013 in various roles such a Medical Director of Infectious Disease and member of Critical Care and Pharmacy Committees. In addition, Dr. Cole was one of Baton Rouge’s first physician Lean Six Sigma Green Belt graduates.

Over the last year of his career while pursuing a Masters in Healthcare Delivery Science at Dartmouth, Dr. Cole served as VP of Care Delivery and Associate Chief Medical Officer at Blue Cross Blue Shield of Louisiana. In this role, he was instrumental in building value-based, collaborative relationships with physicians and providers across the statewide network, focused on achieving better outcomes for its members.

Previously, he served as a private practice internist at Baton Rouge Clinic, where he also served as Chief Quality Officer, Chair of the Internal Medicine Department and an Executive Member of the Board.

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10 • MAY 2015

Louisiana Medical News

In the News Regional Health System Welcomes Human Resources VP LAFAYETTE. – Candice Chopin recently took the helm as Vice President of Human Resources for both Regional Medical Center of Acadiana and Women’s & Children’s Hospital.

In the role, Chopin provides strategic Human Resources support to leaders and employees while creating a desired workplace culture and a Candice Chopin productive workforce.

A 2004 graduate of Ville Platte High School, Chopin graduated four years later from UL Lafayette with a bachelor’s degree in business administration. She joined the Human Resources team at Dauterive Hospital in New Iberia in January 2008 as an intern and rose to the role of Human Resources Director within three short years.

Chopin moved to the role of Senior Human Resources Business Partner at Capital Regional Medical Center in Tallahassee, FL in April 2013. She returned to Acadiana as Human Resources Director for Regional Medical Center and Women’s & Children’s Hospital in October 2014 before taking the helm recently as Vice President of Human Resources for the two facilities.

Touro takes my

of

And my heart beats for New Orleans.

Surgical Oncologist Joins Center For Restorative Breast Surgery and St. Charles Surgical Hospital NEW ORLEANS– Doctors Scott Sullivan and Frank DellaCroce, Co-Founders of the Center for Restorative Breast Surgery (CRBS) and the St. Charles Surgical Hospital (SCSH) in New Orleans are pleased to announce that board certified Surgical Oncologist Dr. William Karl Ordoyne has joined Dr. William Karl their highly skilled group Ordoyne of surgeons. Ordoyne joins fellow breast surgical oncologist Alan Stolier, M.D., FACS and the team of reconstructive surgeons including Frank DellaCroce, M.D., FACS; Scott Sullivan, M.D., FACS; Chris Trahan, M.D., FACS; M. Whitten Wise, M.D. and Craig Blum, M.D. Dr. Ordoyne received his medical degree from Louisiana State University School of Medicine. Following a General Surgery Internship at the Alton Ochsner Medical Foundation, Dr. Ordoyne continued his residency at Ochsner, where he served as the Administrative Chief of Surgery Resident. He then completed a Fellowship in Surgical Oncology at the University of Illinois in Chicago.

Dr. Ordoyne is a fellow of the American College of Surgeons. He most recently served as the Louisiana Inpatient Medical Director for United Healthcare.

Prior to that Dr. Ordoyne practiced at Ochsner Clinic, and Northlake Surgical Associates for 18 years. He also served an appointment as the Cancer Liaison Physician, Commission of Cancer for the American College of Surgeons.

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Louisiana Medical News

MAY 2015 • 11