Louisiana Medical News October 2015

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On Rounds Physician Spotlight Dr. Greg Bizette, Hematology and Oncology

Physician Leader Movement Gaining Momentum Population Health Driving the Change

By LyNNE JETER

Shaving for the Cause When Dr. Greg Bizette decides to support a cause, he jumps in headfirst.

Just look at the photo of his hairless head. He wasn’t always bald – in fact, he shaved his head on a bet. “For Relay for Life, I had a bet with my nurses that if we made a certain dollar amount, I’d shave my head,” he recalled ... page 3

Today, barely 5 percent of hospital leaders are physicians. That percentage is expected to soar in the advent of population health management. According to The Advisory Board Company, 60 percent of hospitals plan to hire more physician leaders over the next five years.

“Putting physicians in leadership roles is critical to making the shift toward value,” said John Combes, MD, president and COO of the American Hospital Association’s Center for Healthcare Governance, noting that multiple studies have found the best performing hospitals are physician-led, and overall hospital quality scores can be

Stage 3 Meaningful Use May Be Delayed It’s still too early to say whether Congress will delay Stage 3 – Meaningful Use – for electronic health records, but support for the idea appears to be growing.

U.S. Rep. Renee Elmers, R-N.C., has introduced a bill that would delay Stage 3 until 75 percent of doctors and hospitals meet Stage 2 meaningful use criteria. ... page 5

up to 35 percent higher when a physician helms the organization.

Administrative decisions made under population health management will directly affect patient care, emphasized Kathy Jordan, president of Jordan Search Consultants.

“In theory, a business-savvy clinician would provide myriad competitive advantages,” she said.

“After all, physicians were trained to put patient care first. If that emphasis can be married with business acumen, everyone wins.”

According to a white paper published by the American As(CONTINUED ON PAGE 4)

Ochsner Venture to Create More ER Access

By TED GRIGGS

A new partnership between Ochsner Health System and Adeptus Health Inc. plans to establish a number of freestanding emergency departments in Louisiana, beginning with the New Orleans area.

“We want to offer a full spectrum of care and see patients when and where they want to be seen,” said Warner Thomas, Ochsner president and chief executive officer. “This partnership is truly an extension of that effort and is expected to ensure that many Louisiana residents will no longer have to drive more than 30 minutes when they need critical, emergency care services.”

Ochsner is joining a growing trend of stand-alone emergency rooms. The (CONTINUED ON PAGE 4)

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Louisiana Medical News

Physician Spotlight

Dr. Greg Bizette, Hematology and Oncology Shaving for the Cause

By LISA HANCHEy

When Dr. Greg Bizette decides to support a cause, he jumps in headfirst.

Just look at the photo of his hairless head.

He wasn’t always bald – in fact, he shaved his head on a bet. “For Relay for Life, I had a bet with my nurses that if we made a certain dollar amount, I’d shave my head,” he recalled. “So not only did they beat that target, but they beat it really really bad. So, not only did I shave my head, but I let my patients do the shaving. I’ve stayed bald ever since.”

The Baton Rouge native knew that he wanted to become a doctor by the time he was in seventh grade. A self-proclaimed “science geek,” he also had a personal experience that piqued his interest in pursuing medicine. “I had an older cousin who suffered from significant kidney disease and had been through a couple of transplants,” he explained. “As I started thinking about medicine as a career and then watched her go through this process, it gave me the drive to want to do that.”

An avid Tiger fan, he majored in biochemistry at LSU then went to LSU Medical School in Shreveport. That followed

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with a residency and oncology fellowship at Ochsner Health System’s main campus in New Orleans. “I found oncology interesting because of the variety of diseases that you can treat,” he said. “As general oncologists, we have to take care of malignancies from all organ systems, and that was very appealing, because I wanted something that was not going to become monotonous, and oncology is an ever-changing area. So, there’s constantly the mental stimulation of new therapies, new drugs and new ways of approaching patients. And, I think that’s one of the things that keeps this specialty particularly fresh.”

After training, Bizette practiced privately in Lafayette, La., then Mobile, Ala. But, he and his wife, Ann, had always wanted to return home. After a colleague told him that Ochsner was building a new

facility in Covington, he jumped at the opportunity.

In 2003, Bizette returned to Oschner, where he was appointed Regional Chairman of Hematology/Oncology on the North Shore. Two years later, he became an ardent supporter of Relay for Life, a team walking/running event sponsored by The American Cancer Society. Following almost 10 years of involvement with Relay for Life, he found another cause – the Moonlight & Miracles Gala.

Moonlight & Miracles benefits programs at the Ochsner Cancer Institute for adult and pediatric cancer patients. In just two years, the event has raised more than $1,400,000 to support cancer research, patient care and survivorship events. “The gala is a really well-done event,” he explained. “It is a large event that allows us to make a large impact in a single period of time. I was able to go last year for the first time and was very impressed. So, that kind of sparked my interest. I will perform any little task that they’ll have me do. I’m looking to get involved.”

The third annual Moonlight & Miracles Gala will be held on November 13, 2015 on the ground floor of the MercedesBenz Superdome.

Outside of philanthropy, Bizette enjoys sports. “Once upon a time when I was skinny and had hair, I played a little bit of competitive racquetball,” he confided.

“But that was a long, long time ago.”

Now, he prefers to be an armchair athlete. “I’m a fantasy football addict,” he admitted. “I’m commissioner of an Ochsner-sponsored league on the North Shore.”

As to his practice, Bizette says that he likes to lighten up his heavy-handed specialty when dealing with patients. “I think most people expect that oncologists are going to be austere and very professional, very stiff,” he observed. “We purposely try to create a practice that isn’t that. This is a difficult group of folks to take care of, not only because the science of their medical illness is difficult, but because managing the personalities and the emotional effects of their disease is a big deal. I think people wander in here and they expect an office devoid of laughter and they expect to see a dark place and a place that is very unpleasant to be. And I think they always are surprised to come into this place, and hear laughter and experience some strange oncologic humor, because we do kind of have peculiar senses of what’s funny.

But, the patients that we treat really embrace that, and they want people to talk to them about things other than their disease process. They want to talk about ordinary stuff – like LSU and Saints football – which is a passion of mine. I think that that they are surprised to find themselves spending a significant portion of their visit laughing and chatting about things that have nothing to do with cancer.”

For more information on sponsorship opportunities for the Moonlight & Miracles Gala, contact Kathleen McCulla, Director of Special Events, at (504) 842-7125 or kmcculla@ochsner.org.

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Louisiana Medical News

OCTOBER 2015 • 3

Physician Leader Movement Gaining Momentum, continued from page 1 sociation for Physician Leadership (AAPL), “Matured physician leadership will be essential for healthcare to continue moving toward higher quality, consistent safety, streamlined efficiency, and becoming value-based.”

The white paper highlighted the link between physician leadership and organizational success: 21 of the 29 pioneer Ac- Kathy Jordan countable Care Organizations (ACOs) that earned bonuses from the Centers for Medicare and Medicaid Services (CMS) were physician-led.

To better identify the growing number of physician roles, the CanMEDS Physician Competency Framework lists these characteristics: medical expert, communicator, collaborator, manager, health advocate, scholar and professional, noted Regina Levison, vice president of client development for Jordan Search Consultants.

“Universities are responding to this description and the need to train physician leaders,” she said, noting that a September 2014 article in Regina The Atlantic, “The Rise of Levison the MD/MBA Degree,” showed how the number of MD/MBA programs has doubled in the past decade.

“Now, more than half of the nation’s 133

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Louisiana Medical News

accredited medical schools allow students to simultaneously pursue an MBA and an MD. In addition, graduate programs in healthcare administration, public health, healthcare informatics, medical management, and population health have sprouted across the country.”

Executive-level titles are popping up in healthcare organizations that require clinical leadership skills to improve population health – chief medical officer, chief of clinical integration, chief integration officer, and chief transformation officer.

“Physicians and medical students are bearing witness to this change and know that to be competitive, leadership and business skills must become as routine as taking a patient’s history and physical,” said Jordan.

Candidates are taking steps to better prepare for physician leadership positions.

For example, more than half of Jordan’s candidates being considering for plum roles have engaged a career coach to help them improve the business side of their CV. “The competition for a physician leadership role is fierce—and rightly so,” said Levison. “These positions will be responsible for defining healthcare in the next decade and beyond.”

In addition to prioritizing candidates with a business, leadership or management degree, Jordan suggests that organizations shortlist physicians with the

following qualities: Listener: A physician leader must be able to listen—and really hear—what colleagues are saying to make informed, collaborative decisions. Good listening skills often translate to enhanced conflict management abilities.

Connector: Part mediator, part listener, part intelligent communicator, a physician leader must be able to build a sense of connectivity among people and across systems.

Learner: A physician leader must demonstrate an insatiable curiosity—about technology, the new value as opposed to volume financials, and cost centers. They must display an interest in broad, strategic matters that will add value to the organization and demonstrate a keen understanding of the competitive landscape and the overall healthcare environment.

Collaborative communicator: A clinical leader must be able to articulate a value proposition to which people want to contribute. This person must be able to communicate effectively at all levels of an organization and to encourage others to share their views in an open and nonjudgmental environment.

Inspirer: With a sense of commitment to a shared purpose, much can be accomplished. That’s why a physician leader must be able to engage, develop, and motivate others to build consensus.

Facilitator: When evaluating for leadership, look for candidates who have skills and experiences that match the organization’s vision. Individuals who are leaders facilitate the success of others.

Identify candidates who seem comfortable in facilitating and navigating change; those will be the nimble leaders that healthcare organizations need.

David Nash, MD, MBA, founding dean of the Jefferson College of Population Health at Thomas Jefferson University, said the list will continue to evolve.

“We’re taking the right steps right now to be successful in the healthcare environment in the near future,” he said. “We’ve taken massive strides toward more comprehensively educatDavid Nash ing physicians who have shown a propensity for leadership, but as the healthcare industry continues to evolve, the qualities of a competent physician leader should similarly change.”

Jordan agrees. “The competent, effectual physician leader appropriately employed by a strategic, visionary organization,” she said, “will create the dynamic needed to successfully navigate this new era of healthcare and improve the health of populations nationwide.”

Ochsner Venture to Create More ER Access, continued from page 1 charge is being led by Ochsner’s partner, Lewisville, Texas-based Adeptus. Adeptus is the biggest freestanding ER operator in the country with 76 locations in Texas, Colorado and Arizona, according to the company’s websites. For the three months ending June 30, Adeptus reported a profit of $10.6 million, or 97 cents per share, on patient revenue of $104.4 million. The company expects patient revenue of $400 million to $405 million for the full year, and earnings per share of $1.10 to $1.15.

There are two types of freestanding emergency departments: hospital outpatient departments, also known as an offsite hospital-based emergency departments, and independent freestanding emergency centers, according to the American College of Emergency Physicians.

The former are owned and operated by medical centers or hospital systems.

Under federal law, if the center or hospital system accepts Medicare or Medicaid payments for emergency services at the hospital outpatient department, the freestanding ER must follow the Emergency Medical Treatment & Labor Act. That means accepting patients regardless of their ability to pay.

The independent freestanding emergency centers are typically owned, in whole or part, by companies or individuals. These facilities don’t have to accept all comers and rely on payments from private insurers.

Dr. Howard Mell, a spokesman for the American College of Emergency Physicians, said the hospital outpatient de-

partments can provide a great option and a much-needed alternative for any areas short of hospitals.

“If it is a hospital-based one and comes with all of the bells and whistles that that entails, and so it is federally recognized and can bill Medicare and Medicaid, then it is a wonderful solution,” Mell said.

The offsite hospital-based departments allow the provider to treat patients with the full resources of a hospital, including arranging follow-up visits through the hospital’s on-call list of physicians, Mell said. And that offsite emergency treatment comes at a lower cost.

Mell compared freestanding ERs to building a hospital for the cost of an urgent care clinic, he said. The major drawback for offsite hospital-based emergency rooms is that family members have to drive farther to visit patients.

Ochsner Health is Louisiana’s largest nonprofit healthcare system, with 25 owned, managed and affiliated hospitals and more than 50 health centers.

Ochsner says its freestanding emergency rooms will welcome all patients and accept all forms of insurance, including Medicare and Medicaid. The stand-alone emergency rooms will operate 24 hours a day, seven days a week. The health system expects that its nearest facility will serve as the transfer hospital if inpatient treatment is required.

Mell said the independent freestanding centers that won’t accept Medicare and Medicaid aren’t necessarily a bad option.

But, he added, they require “a whole lot more regulation” to make them a good option.

In addition to Texas, Colorado and Arizona, independent ERs have been established in Rhode Island and Delaware.

Georgia passed a law in 2014 to allow the centers. According to ACEP, the independent model is being considered in California.

Mell and other experts say the standalone ERs offer a partial solution to the issue of access to care in rural and inner cities. Hospital closures in those areas have made it more difficult for residents to find care.

But critics say the freestanding ERs aren’t being built in those areas. Instead, the centers are popping up in areas where few uninsured people live. The result is fewer paying patients in hospital ERs. However, Ochsner and Adeptus point to the most recent survey by the American College of Emergency Physicians, which found that emergency visits are increasing as well as the severity of injuries and/or illnesses.

The survey results underscore the growing need for additional access points for emergency care, according to Ochsner and Adeptus.

And supporters say freestanding ERs offer other advantages, including putting emergency care closer to patients in Accountable Care Organizations; reducing crowding at nearby ERs; increasing training for medical students and residents; and offering another option for emergency care.

Stage 3 Meaningful Use May Be Delayed

By TED GRIGGS

It’s still too early to say whether Congress will delay Stage 3 – Meaningful Use – for electronic health records, but support for the idea appears to be growing.

U.S. Rep. Renee Elmers, R-N.C., has introduced a bill that would delay Stage 3 until 75 percent of doctors and hospitals meet Stage 2 meaningful use criteria. The Senate Committee on Health, Education, Labor and Pensions is expected to issue its own bill to fix the Meaningful Use program by the end of the year.

The American Medical Association, Medical Group Management Association and the American Hospital Association are among the groups calling for a delay.

Among other things, the groups say more time is needed to evaluate the impact of Stages 1 and 2, and that more providers need to get to Stage 2 before the Centers for Medicare & Medicaid Services finalize Stage 3.

“We’re definitely in support of delaying Stage 3,” said Rebecca B. Dowdy, vice president of the Louisiana Hospital Association. “It would definitely help a lot of our Rebecca B. hospitals.”

Dowdy Under the proposed rule, all providers would have to meet the

Stage 3 objectives in 2018. Those requirements include protecting electronic health information, e-Prescribing and computerized provider order entry and increasing interoperable health data sharing among providers.

Getting to Stage 2 has already proven extraordinarily expensive, according to the AHA. Hospitals spent an estimated $47 billion each year on IT between 2010 and 2013.

The LHA doesn’t have exact figures on how many of its members could meet the standard or how much funding they might lose if the regulations are enacted, Dowdy said. But the regulations’ impact could fall most heavily on rural hospitals.

In addition to a lack of resources, these hospitals have to figure out a way to recruit expertise in Health Information Technology, a field that’s still emerging and where the knowledge base and the number of workers remains limited.

“Most of our rural hospitals may have one or two IT individuals,” Dowdy said.

“So they definitely rely heavily on the vendor component to get them where they need to go, which isn’t always the best situation to be in if you’re purchasing goods.”

For example, at least two of Louisiana’s rural hospitals recently learned their EHR vendor is dropping out and won’t support Stage 3.

So the hospitals are stuck with a huge

investment in resources and capital in a product they must now abandon, Dowdy said. They have no choice but to find a new vendor and a new EHR product.

“The hospitals didn’t say how much it would cost them, but it’s a complete repurchase. They weren’t able to leverage any of their prior investment,” Dowdy said. “So it was literally starting from ground zero and rebuilding. That’s sizable…. We’re talking a million-plus.”

In addition to writing off a seven-figure investment, the hospitals find themselves behind the curve for adopting the EHRs, Dowdy said. The facilities have to select a new vendor and get back up to speed at a time when the remaining EHR vendors are scrambling to meet their existing customers’ needs and a rapidly approaching deadline.

There were supposed to be safeguards built in to prevent this from happening.

The Certification Commission for Health Information Technology was created to certify EHR vendors. But the nonprofit ceased to exist in late 2014.

“I guess that falls under best-laid plans,” Dowdy said. “You can safeguard as much as you want, but you can’t stop a vendor from going out of business.”

You can’t stop a vendor from buying a rival or merging either. And you can’t stop a vendor from dumping its Health IT Meaningful Use solutions.

The entire situation has been compli-

cated by all of the changes at the Office of the National Coordinator for Health IT. There has basically been a different coordinator for every stage of Meaningful Use, Dowdy said.

“You think you know where it’s going, and a different person comes in and their leadership is different and they change the requirements,” Dowdy said. “All of a sudden you’re going in a completely different direction than what you thought. I can only imagine what that’s doing to the vendor community as far as their five-year strategic plans.”

Physicians may be in a more precarious situation than rural hospitals.

Although more than 80 percent of doctors are now using electronic health records, less than 10 percent could meet the Stage 2 Meaningful Use requirements in 2014, according to the AMA. Most of those EHRs don’t allow physicians to exchange patient information with other parts of the healthcare system.

Physicians are weighing the penalties against the amount of time and money they have to invest in electronic health records, and many are dropping out of the Meaningful Use program, according to the AMA. For more information visit www.healthit.gov/providersprofessionals/how-attainmeaningful-use

Louisiana Medical News

OCTOBER 2015 • 5

NEUROLOGY

Finding Neuronal Needles in the Haystack Technology Opens the Door to More Data, Potentially More Answers

By CINDY SANDERS

With 100 billion neurons in the brain, singling one out can be a Herculean task – much like finding a needle in the haystack.

However, new technology by Utah-based Blackrock NeuroMed LLC can make that undertaking easier … and potentially help researchers find answers, or at least point

to new questions to ask, in the quest to better understand a host of neurologic disorders.

“What makes us really unique is we have the capability of recording signals from individual neurons in the brain,” said Andy Gotshalk, CEO of Blackrock NeuroMed, a pioneering EEG monitoring technology company headquartered

in Salt Lake City.

Where standard EEG technology measures the energy of tens of thousands of neurons at once, Blackstock’s technology also measures and records signals from each tiny neuron, allow-

Andy Gotshalk

ing clinicians and researchers unprecedented precision in identifying underlying causes of disruption in the brain’s natural circuitry.

Using a large forest with millions of trees as an analogy for the human brain, Gotshalk said traditional EEG alerts physicians and researchers if there is a fire in a large sector of the forest or if a disease has struck thousands of trees. The current standard of care picks up on those large signals, he explained.

“But if there was just one tree on fire or had a disease, traditional EEG would not pick that up … but our equipment can,” he said of being able to drill down to signals from a single neuron.

The Cervello® EEG/LTM systems combine research and clinical applications to allow data collection on epileptic patients with surgically implantable electrodes. While the electrodes aren’t anything new, Gotshalk said the way Blackrock’s amplifiers work to pickup extremely small signals and then get those signals from the brain to the computer display monitor without interference is unique. The system incorporates three primary technologies – an electroencephalogram, a high-definition video camera, and a data-recording device that can monitor the brain’s electrical activity.

And, Gotshalk continued, “It’s done with precise synchronization – these signals are very quick; they’re on a millisecond scale – making sure a clinician knows when these neurons are firing.”

Gotshalk noted there are already a significant number of epileptic patients being monitored across the country with implantable electrodes. The American Association of Neurological Surgeons (AANS) estimates nearly 30 percent of patients with epilepsy are considered medically resistant and are not well controlled by diet and medication. From this pool of patients, many will be evaluated through noninvasive monitoring, but a portion will go on to have subdural or depth electrodes implanted for more precise monitoring.

With the Blackrock technology, hours and hours of brain data collected while waiting for a seizure can now be processed with the hope that the information will offer new insights into how the brain works. Gotshalk said the technology could help clinicians better see when and where seizures are starting and how they are progressing across the brain.

However, the goal for the collected images and data is not only to impact the treatment of epilepsy but also other conditions including ALS, Alzheimer’s, depression, and Parkinson’s.

“Central to our company’s mission is unraveling the mystery of what causes different neurological disorders,” Gotshalk stated. “It’s technology like ours that is going to give clinicians and researchers (CONTINUED ON PAGE 10)

6 • OCTOBER 2015

Louisiana Medical News

WHO’S TENDING OUR DOCTORS?

Streamlining Prescription Management Synchronizing Patient Prescriptions Could Save Practices an Hour Daily

By LYNNE JETER

Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.

Consider a patient on multiple medications who might generate several phone calls throughout the year as each medication comes due for renewal. Multiply it by hundreds of patients with chronic illness seen by a typical primary care physician, and it could quickly add up to thousands of phone calls every year. At two or three minutes per call, demands on the staff to manage prescription renewals could easily add up to an hour daily of unnecessary work.

An easy solution: a streamlined approach to prescription management. Instructions on how to effectively manage the practice change are available online free via www.STEPSforward.org through the American Medical Association (AMA).

“Streamlining prescription management allowed me to go home earlier,” said Christine A. Sinsky, MD, FACP, an internist with Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois, and the AMA point person for STEPS Forward, its ambitious new initiative offering physicians strat- Dr. Christine Sinsky egies to revitalize their medical practices and improve patient care. “It’s made a huge difference not only with my personal time, but it’s also meant less inconvenience to patients and more personal time for them to do things other than worry about getting prescriptions refilled.”

In a study published in 2012 by Sinsky and Thomas A. Sinsky, MD, “A Streamlined Approach to Prescription Management” in Family Practice Management, the top priority is to eliminate waste.

“The work of prescription renewal has become so ingrained in practice that many physicians no longer recognize it as waste,” said Sinsky. “In fact, physicians commonly renew scripts for an arbitrary number of refills, thus guaranteeing unnecessary work for themselves and their staff a few months later.”

Physicians often use prescriptions as a prompt for patients to schedule subsequent appointments, a practice that burdens itself with unnecessary phone calls for prescription renewals and appointment scheduling, while also increasing the chances of patient non-adherence.

“A less organized approach to prescription renewal may have worked 20 years ago, when patients had fewer chronic conditions and took fewer medications,”

said Sinsky. “Now, more than 40 percent of patients over age 65 are on five or more medications.”

Synchronizing prescriptions around the annual visit – providing sufficient refills to last until that time, and insuring the next annual visit is scheduled at the conclusion of the current annual visit – will take care of all those problems, said Sinsky.

“In our experience, it’s not uncommon for a group of six to eight primary care physicians to hire one full-time nurse whose main responsibility is prescription renewals,” she said. “This nursing time could be wisely deployed for advanced medical home activities, such as direct patient care, self-management support, or population management.”

A rough, conservative calculation suggests that if all practices implemented yearly, synchronized, bundled renewals, more than 46 million hours of primary care physician and staff time could be saved every year, noted Sinsky.

Most states limit prescription renewals to 12 months. A few states have a longer time period, such as a 15-month window, which further streamlines prescription management.

Policy makers could facilitate the elimination of waste by modifying state regulations to allow prescription renewals for an interval longer than 365 days.

“Several states already provide this important expanded window for renewals: Idaho and Maine (15 months), Iowa (18 months), and Oregon and California (two years),” Sinsky pointed out. “This allows patients and their physicians to balance insurance coverage rules – mammograms can’t be obtained more than once every 365 days, for example – and patients’ personal schedules with prescription renewal

constraints.”

In summary, simple prescription renewal workflow changes in primary care practices, accompanied by modification of some state pharmacy regulations, would

go a long way toward eliminating a source of significant waste in the U.S. healthcare system, improving the work life of nurses and physicians, and increasing access to primary care services, said Sinsky.

State-by-State Prescription Refill Limits in Medical News Markets Alabama: Limits refills for controlled substances.

Arkansas: Limits refills for controlled substances and also prohibits refills on a non-controlled substance after one year from the date of issue of the original prescription.

Florida: Limits refills for controlled substances and also prohibits refills on a non-controlled substance after one year from the date of issue of the original prescription.

Kentucky: Limits refills for controlled substances and also allows prescriptions marked “prn” or “ad lib” to be refilled up to one year from the date of the original prescription. Also prohibits refilling a prescription after one year from the date of issue of the original prescription.

Louisiana: Limits refills for controlled substances and requires all prescriptions for drugs other than controlled dangerous substances to expire one year from the date of issue of the original prescription.

Mississippi: Limits refills for controlled substances and also prohibits refilling prescriptions after 12 months from the date of issue of the original prescription.

Missouri: Limits refills for controlled substances and also prohibits filling or refilling any prescription after one year from the date of issue of the original prescription without consulting the prescriber.

North Carolina: Limits refills for controlled substances and also allows prescriptions marked “prn” to be refilled up to one year from the date of the original prescription.

Tennessee: Limits refills for controlled substances and also prohibits prescriptions marked “refill at will” from being refilled after the expiration of time specified or one year from the date of the original prescription, whichever falls first.

SOURCE: “A Streamlined Approach to Prescription Management” by Thomas A. Sinsky, MD, and Christine A. Sinsky, MD, FACP.

Louisiana Medical News

OCTOBER 2015 • 7

NEUROLOGY

Using Deep Brain Stimulation to Treat OCD Patients

By LYNNE JETER

ST. LOUIS–On July 6, world-renowned neurosurgeon Richard Bucholz, MD, led a team at SSM Health Saint Louis University Hospital in St. Louis, Mo., to perform deep brain stimulation (DBS) to treat obsessive compulsive disorder (OCD) for the first time in the Centers for Medicare & Medicaid Services’ (CMS) Region VII. “The outcome of this test case for the region has been extremely gratifying,” said Bucholz, vice chairman in the department of neurosurgery and K. R. Smith Endowed Chair in Neurosurgery at Saint Louis University (SLU), of the middle-age male patient, housebound by the disorder and unresponsive to medication. “This patient is rejoining society, not exhibiting previous compulsions, and seems to be doing extremely well.”

In a DBS procedure, mostly known for treating Parkinson’s patients, speciallytrained neurosurgeons implant tiny electrodes through dime-sized incisions into areas of the brain that control movement.

In a second procedure, the electrodes are attached to an implanted generator that

Dr. Richard Bucholz with the OR team preparing for a DBS case.

dispatches signals to the electrodes in the brain. Later, a neurologist programs the generator to determine the optimal setting for normalizing brain activity to alleviate tremors, stiffness, slowness, involuntary movements and gait problems.

“A tremor from Parkinson’s is an excess motor activity in the brain,” explained Bucholz. “Similarly, compulsions from

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OCD are excess thoughts in the brain.

Suppressing those thoughts through DBS is very similar to what we’ve done for years in treating movement disorders.”

In 2009, the U.S. Food and Drug Administration (FDA) approved DBS for treating OCD. Last year, a group of experts published a clinical guideline in Neurosurgery, recommending DBS for cases of OCD unresponsive to medication.

“I wasn’t really surprised the FDA approved DBS for treating OCD because the benefits of intervention in this area have been well known for a long time,” said Bucholz. “Also, results from pilot studies in the few (U.S.) centers that have done this for several years have been quite remarkable. I was a bit surprised that Medtronic, the research sponsor, decided to put this out as a humanitarian device exception, a special way of releasing a product that can only be placed under research protocol and in approved centers, as opposed to a more general release.”

As a result of the special designation, Saint Louis University Hospital remains one of few academic centers in the nation allowed to perform DBS for OCD. “We’ve been enrolled in the study for some time and set up a committee to review potential candidates for this procedure,” he said. “It’s taken us a while to come up with individuals with all the appropriate indications for intervention.”

Appropriate candidates are determined by refractoriness and incapacitation, said Bucholz, who at press time had additional cases scheduled by the end of September.

Whether the newly FDA-approved procedure will be covered by insurers has been highly debatable, said Bucholz.

“There’s never been a test case in the regional group that covers St. Louis to determine reimbursement,” he explained.

“That’s proven a challenge. Other Medicare review groups for other geographic areas of the U.S. have demonstrated reimbursement for this intervention, given

the suitability based on criteria. We’ll see whether this test case gets reimbursed.”

CMS Region VII covers Missouri, Kansas, Iowa and Nebraska.

Bucholz became world known for his invention of StealthStation, an imageguided navigational device to improve surgeons’ abilities to access the brain and navigate complex neural and vascular anatomy. Developed in his St. Louis garage in 1990, the platform was FDA-approved in 1996, the same year Medtronic acquired it.

StealthStation, now in its seventh revision as the S7 Surgical Navigation System, is commonplace in operating rooms around the globe that routinely house cranial surgery.

“StealthStation is the necessary infrastructure to perform DBS very accurately, precisely, and safely,” he said. “This common instrument allows neurosurgeons to intervene in the brain with stimulators, viruses, tissues, implants … you name it.”

Among other innovations for Bucholz, a National Academy of Inventors (NAI) Fellow: a special collar that holds the patient’s head throughout the procedure in a way that makes patients who are awake during surgery feel more at ease.

The collar replaced the cumbersome frame used by some neurosurgeons.

Positive outcomes of DBS cases for OCD have opened the door to treating a variety of conditions in the burgeoning field of neuromodulation. Bucholz is working closely with a group to develop an implantable device to treat rheumatoid arthritis and Crohn’s disease through the use of a stimulator placed on a nerve. But potential DBS treatments of some conditions remain sidelined.

“For example, there’s extreme interest in using DBS for patients with debilitating depression, but controversy remains about where to place the electrode for maximum effect,” said Bucholz. “Two centers have proposed two different areas of the brain to stimulate, but for now, studies don’t support either location.”

Regardless of ongoing debates in medical circles about which conditions to treat with DBS, Bucholz said it offers milestone relief for OCD sufferers.

“We know the target of the brain and it’s working quite well,” he said. “The more we learn about the brain, the more we can think about intervening to reverse debilitating conditions. It’s a rewarding time to see DBS transform the way people can lead their lives.”

Bucholz is the SLUCare functional neurosurgeon who leads DBS surgery at SLU Hospital; SLUCare neurosurgeon Pratap Chand, MD, who specializes in movement disorders, collaborated on the landmark surgery. The SLUCare Physician Group team also includes Lauren Schwarz, MD, a neuropsychologist who works with patients considering DBS.

HEALTH EDUCATION

Covering the Healthcare Education Spectrum News of Note in Training Innovations

the AACN’s fall meeting on Monday, Oct. 26. For information on the findings, visit the organization’s website at aacn.nche. edu.

By CINDY SANDERS

By mandate and practical necessity, healthcare professionals are lifelong learners. Whether at the starting point of undergraduate or graduate education or further along in careers and looking to hone skills, a wide array of resources exist to help providers be better prepared to deliver effective, efficient care.

A number of national organizations are looking ahead to assess the way professional teams will need to interact within the delivery system of the future to dispense the highest quality of care, along with ways to help communities and patients take a more interactive role in managing their health.

AMA Expanding Med Ed Initiative Less than two years after the American Medical Association (AMA) launched an initiative to reshape medical education in America, the national organization has announced funding for up to 20 additional medical schools to join the AMA’s Accelerating Change in the Medical Education Consortium.

The consortium was originally created in 2013 with an $11 million grant initiative to 11 of the country’s top medical schools. Each of the participants is looking at innovating curriculum redesign to better prepare medical students to deliver care in today’s evolving healthcare landscape.

At the Indiana University School of Medicine, leaders have created a virtual healthcare system (vHS) and are using a teaching electronic medic record to ensure competencies in system-, team- and population-based healthcare, as well as clinical decision-making. At Vanderbilt University Medical Center, the new curriculum looks to create master adaptive learners who will engage in self-assessment and adapt to change throughout their medical career. The Vanderbilt program is also embedding students in the healthcare workplace from the earliest phases of undergraduate medical education. A synopsis of all 11 current programs is available at changemeded. org.

“In such a short amount of time, our consortium schools have made impressive strides toward creating the medical school of the future. Many of the schools have already implemented new curriculum models that are supporting innovative training for 7,000 medical students who will one day care for more than 12.2 million patients each year,” said AMA President Steven J. Dr. Steven J. Stack Stack, MD. He continued, “It is because of this tremendous progress that

Dr. Susan Skochelak addresses the need to fundamentally transform the way we train physicians in America. The AMA has recently announced it will extend grant funding as part of the organization’s Accelerating Change in Medical Education initiative.

we’ve decided to collaborate with more medical schools and continue on the path to spreading innovation across the entire medical education system to close the gaps that exist between the way physicians are educated and how healthcare will be delivered in the future.”

As part of this second phase of the Accelerating Change in Medical Education initiative, the AMA is calling on medical schools to build upon and implement the education models created by the 11 founding consortium schools, as well as offer unique projects that can be shared with medical schools nationwide.

A national advisory panel is currently reviewing grant proposals, which were due last month. Proposals are being evaluated with an eye toward: • Developing flexible, competencybased pathways, • Teaching and/or assessing new content in healthcare delivery science, • Working with healthcare delivery systems in novel ways, • Making technology work to support learning and assessment, • Envisioning the master adaptive learner, and • Shaping tomorrow’s leaders.

“Bringing systemic change to our medical education system as we know it will require many more partners and many more schools,” said AMA Group Vice President for Medical Education Susan E. Skochelak, MD, MPH. “We are excited about the high level of interest that we’re seeing from medical schools for changing and enhancing medical education in our country and look forward to growing the community of innovation that we’ve created with new ideas and fresh perspectives from additional medical schools.”

AACN Futures Task Force Last year, the American Association of Colleges of Nursing established the Futures Task Force with a broad charge to develop recommendations to ensure the nursing workforce meets future demands, and that the national organization stays at the forefront of innovation in nursing education.

The final report will be presented at

HCEA The Health Care Education Association (HCEA) – a multi-disciplinary organization of professional healthcare educators who look to improve outcomes through evidence-based education for patients, families, staff and the community – is prepping for the organization’s 2015 conference Oct. 15-17 in Indianapolis.

“Education on the Fast Track: Transforming the Patient Experience” will focus on patient engagement and the ways in which educators and healthcare workers impact the healthcare experience. Among the 21 breakout sessions at the biannual meeting are discussions on generational diversity and teaching adolescents how to evaluate health information, explaining numbers and risk with patients, working with the LGBT community, and several sessions emphasizing health literacy strategies.

A conference roundup will be posted after the event, and past educational conference summaries are available online through the Education Center tab at hcea-info.org. In addition, the website’s Resources tab includes links to publications, educational tools, and the organization’s Learning Center Network.

Legislative Affairs

BY CINDY BISHOP

New DHH Rules Coming on Line The September 2015 State Register contains the following rules promulgated by the Louisiana Department of Health and Hospitals: • Disproportionate Share Hospital Payments Inpatient Psychiatric Services Reimbursement Rate Reduction, effective October 1, 2015 • Facility Need Review, effective September 20, 2015 • Home and CommunityBased Services Waivers New Opportunities Waiver Emergency Opportunities, effective October 1, 2015 • Inpatient Hospital Services Children’s Specialty Hospitals Supplemental Payments for New Orleans Area Hospitals, effective October 12, 2015 • Inpatient Hospitals Services Non-Rural, Non-State Hospitals

Children’s Specialty Hospitals Reimbursements, effective October 12, 2015 • Pharmacy Benefits Management Program Methods of Payment, effective September 29, 2015 • Office of Workers’ Compensation – Medical Treatment Guidelines, effective October 1, 2015 To view Emergency Rules on our website, go to www.doa.la.gov/ Pages/osr/emremr.aspx 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.checkmatestrategies.com

Louisiana Medical News

OCTOBER 2015 • 9

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Finding Needles, continued from page 6

better data and a much better understanding of how the diseases are manifesting themselves so we can provide better solutions.”

While still in the early stages – the company was spun out from Blackrock Microsystems in 2012 – Gotshalk said there are already major installations throughout the Epilepsy Monitoring Units at Cedars-Sinai, Swedish Medical Center Seattle, Children’s Hospital of Wisconsin, and Children’s of Alabama in Birmingham. In addition, individual pieces of monitoring equipment are being used by a number of researchers, including some at UCLA. Recognizing this is new technology, Gotshalk said the company is moving slowly to ensure clinicians are comfortable with the system’s clinical use, which still allows them to view traditional EEG data while simultaneously giving them the new ability to monitor individual neuron signaling. However, he reiterated, the hope is absolutely that researchers and physician-scientists will take advantage of this expanded data with an eye toward impacting other neurological conditions.

“The goal is to get a much better understanding of how the brain is functioning … which hopefully will give us better insight when the brain isn’t functioning properly,” he concluded.

In the News Memorial Welcomes Rheumatologist Gurjot Basra, MD LAKE CHARLES-Memorial Medical Group welcomes Gurjot Basra, MD, a fellowship-trained rheumatologist, to its staff. She will see patients at her office, located at 2770 3rd Avenue.

Dr. Basra received her medical degree from Mata Dr. Gurjot Basra Gujri Memorial MedicalCollege in India. She then came to the United States where she completed her internal medicine residency at the UniversityofTexas Medical Branch in Galveston where she received the award for Outstanding 2nd Year Resident and was named a Top 5 intern.

She went on to complete her rheumatology fellowship at Baylor College of Medicine in Houston, during which time she received additional training in musculoskeletal ultrasound through the Ultrasound School of North American Rheumatologists (USSONAR). She is board certified in internal medicine through the American Board of Internal Medicine.

Dr. Basra is a member of the AmericanCollege of Physicians and the American College of Rheumatology. Much of her research has been published in medical journals such as The Rheumatologist

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and Arthritis and Rheumatism. She treats patients for a variety of rheumatic conditions including rheumatoid arthritis, gout, lupus, Sjogren’s Syndrome and osteoporosis.

New CEO named at St. Martin Hospital BREAUX BRIDGE – Lafayette General Health (LGH) has announced the appointment of Karen O. Wyble as Chief Executive Officer at St. Martin Hospital, effective today. Wyble brings years of experience in the medical industry to her new position. Bryan Laperouse, FACHE, served as Interim Karen O. Wyble CEO of the hospital during the candidate search.

In Wyble’s most recent position, she served as Regional Vice President of Operations at LHC Group. Her role was to operationalize teams for the home healthpartnered agencies while developing the concepts for the referral process.

Prior to her role with LHC Group, she was Chief Operating Officer of Heart Hospital of Lafayette (HHL)/Vice President of Cardiovascular for Our Lady of Lourdes Regional Medical Center. Under her leadership, HHL earned a Top 50 Cardiovascular Hospital Award from Thomson Reuters in 2012.

Wyble began her work in healthcare at Lafayette General Medical Center, when she was a Critical Care Registered Nurse from 1991 to 1996, Case Manager from 1996 to 1997, Manager of Telemetry and ICU from 1997 to 1999, Director of Cardiology from 1999 to 2002, Administrator of Cardiology and Pulmonary service lines from 2002 to 2004, and Assistant Vice President of Nursing from 2004 to 2005. With her as Director of Cardiology, LGMC was named a Top 100 Cardiovascular Hospital three times.

After earning her Bachelor of Science in nursing at Loyola University in New Orleans, Wyble earned two master’s degrees, in Healthcare Administration and Business Administration, from the University of St. Francis in Joilet, IL. She is currently pursuing a Master of Science degree in Nursing at Loyola.

“I look forward to being a part of this great team of excellence that has aligned a philosophy of commitment to service all of our communities through Lafayette General Health,” says Wyble.

With her various roles in healthcare, Wyble has served in senior leadership and executive positions, and at the front lines of care delivery. Lafayette General Health says it is looking forward to her bringing that expertise to help St. Martin Hospital continue to achieve new benchmarks in quality outcomes. “We are thrilled to have someone so experienced to take the lead at St. Martin Hospital,” says David L. Callecod, FACHE, President of LGH. “We know she’s going to serve that hospital and the people of St. Martin Parish very well.”

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In the News Lafayette General Welcomes General, Bariatric Surgeon LAFAYETTE – Lafayette General Health welcomes General Surgeon Robert Autin, M.D., to the practice of Drs. Philip Gachassin, Dennis Eschete, Jr., Daniel Carroll and Michael Horaist. Dr. Autin will be practicing General, Dr. Robert Minimally Invasive and Autin Bariatric Surgery at Lafayette General Medical Center and Lafayette General Surgical Hospital.

A cum laude undergraduate of the University of Louisiana at Lafayette in biology, Dr. Autin earned his Doctor of Medicine degree from Louisiana State University Health Sciences Center in Shreveport. He did his Fellowship in minimally invasive and bariatric surgery at Albany Medical Center in Albany, NY, and his residency in general surgery at New York Methodist in Brooklyn, NY. Professional societies that Dr. Autin belong to include the American College of Surgeons and the American Society of Gastrointestinal and Endoscopic Surgeons.

Dr. Autin’s office is located inside Lafayette General’s Medical Office Building, 1000 W. Pinhook Rd., in Suite 310. His office hours are: Monday through Thursday, 9 a.m. to 5 p.m., and Friday 9 a.m. to 12 p.m.

Dr. LeBlanc earned his medical degree at Louisiana State University Health Sciences Center in Shreveport, LA, where he finished first in his class. While there, he furthered his medical education by completing his residency through the Department of Otolaryngology – Head and Neck Surgery.

Specializing in medical conditions related to the ear, nose and throat, Dr. LeBlanc treats sinus and ear infections, tinnitus, tonsillitis, thyroid disorders, and hearing loss in both children and adults. He also performs minimally invasive sinus proce-

dures and surgeries, with special interest in the more complicated surgical cases.

Opelousas General Health System Welcomes Dr. Chad Rossitter OPELOUSAS- Opelousas General Health System is pleased to welcome Dr. Chad Rossitter to its medical staff.

Dr. Rossitter has joined Kidney Consultants of Louisiana—the practice of Drs. Paul Miller, Michael Liu and Raphael Higginbotham. He received his medical degree from the University of Sini Eusta-

tius in St. Maarten and completed his Internal Medicine Residency at University Medical Center in Lafayette, LA. Most recently, he Dr. Chad completed a Fellowship Rossitter in Nephrology at Houston Methodist Hospital in Houston, TX and specializes in Interventional Nephrology procedures.

Dr. Rossitter’s office is located at 927 East Prudhomme in Opelousas.

WELCOME, DR. ARDOIN

Adding Expertise to One of the Finest Pulmonology Groups in the Region.

Lake Area Medical Center Welcomes Dr. Blake LeBlanc, ENT LAKE CHARLES — Lake Area Medical Center welcomes Blake LeBlanc, M.D. an Otolaryngologist (ear, nose & throat specialist) to its medical staff. Dr. LeBlanc has joined the medical practice of Brad LeBert, M.D. and Bridget Dr. Blake Loehn, M.D., at the ENT LeBlanc & Allergy Clinic located at 1920 W. Sale Road in Building F, Suites 3 & 4 in Lake Charles.

LUNG CANCER IS THE DEADLIEST CANCER IN THE WORLD.

Lourdes Physician Group welcomes Justin Ardoin, MD. A Jennings native, Dr. Ardoin graduated from LSU School of Medicine in New Orleans and completed a fellowship Justin Ardoin, MD

at LSU Health—Shreveport. He has joined our team of pulmonologists, playing a role in directing care in the

ICU, working with the attending physician, critical care nurses, respiratory therapists and other specialists to provide medical treatment as well as spiritual care. Their work results in improved patient survival rates and quality of care, decreased procedure complications and increased medication safety. Our commitment to critical care continues with ongoing efforts to expand Lourdes Physician Group with the region’s top talent.

WE CAN CHANGE THAT. The American Lung Association is leading the fight against the deadliest cancer there is—lung cancer.

Join the fight by giving a gift to the American Lung Association today.

314-645-5505 x1009 | 1-800-LUNG-USA www.breathehealthy.org 1118 Hampton Ave., St. Louis, MO 63139

Mehandi Haran, MD Richard Fei, MD Frank Courmier, MD

Putting primary care well within your reach

For clinic hours and appointments call 337-470-3040.

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www.LourdesRMC.com

Louisiana Medical News

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OCTOBER 2015 • 11