Louisiana Medical News Sept 2013

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

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On Rounds Physician Spotlight

Obamacare May Boost Medical Malpractice Risks

By TED GRIGGS

A flood of newly insured patients triggered by the Affordable Care Act and changes to the healthcare delivery system could expand the risks that medical professional liability companies and physicians face, according to the Casualty Actuarial Society.

Kevin Bingham, an associate of the Casualty Actuarial Society and principal at Deloitte in Hartford, Conn., said 78 percent of all doctors had either a private practice or operated with one other doctor in 1978. In 2013, only 30 percent of doctors were following that business model.

Meanwhile, an estimated 32 million Americans who don’t have insurance now are expected to gain coverage under the Affordable Care Act. “There may be fewer doctors to care for a greater number of patients,” according to Brian Ingle, a Fellow of the Casualty Actuarial Society and executive vice president with Willis Re. Inc. in New York City.

Bingham and Ingle were among the experts who spoke at the society’s annual Seminar on Reinsurance, held June 6-7 in Bermuda.

Medical Professional Liability insurance policies provide financial protection for doctors and other healthcare practitioners against lawsuits alleging negligence or errors and omissions on the providers’ part that result in harm to their patients. The United States market for the coverage has been profitable in recent years.

Dr. Christopher Trahan

Making patients whole again Growing up in Abbeville, Christopher Trahan was inspired to help people by his grandfather, Harold George Trahan, a general practitioner, and his father, Harold George Trahan, Jr., an internist. “I basically saw the difference they were able to make in people’s lives and how much pride they took in it,” he recalled. “And, I enjoyed helping and getting to know people.” ... page 3

Embrace Change and Change Strategy Healthcare will change more in this decade than it has in the past 50 years, and Louisiana’s health quality leaders should adopt a strategy based on things changing, according to health futurist and medical economist Jeffrey C. Bauer ... page 5

(CONTINUED ON PAGE 8)

TRANSPARENCY

Shining a Light on Physician, Industry Relationships Physician Payments Sunshine Act Now in Effect

By CINDy SANDERS

If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see.

The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value.

‘Applicable manufacturers’ are defined as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available.

“The Sunshine Act generally applies when physicians or teaching hospitals receive trans(CONTINUED ON PAGE 6)

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2 • SEPTEMBER 2013

Louisiana Medical News

ent

Physician Spotlight

Dr. Christopher Trahan Making patients whole again

By LISA HANCHEy

Growing up in Abbeville, Christopher Trahan was inspired to help people by his grandfather, Harold George Trahan, a general practitioner, and his father, Harold George Trahan, Jr., an internist. “I basically saw the difference they were able to make in people’s lives and how much pride they took in it,” he recalled. “And, I enjoyed helping and getting to know people.”

While attending college at Baylor University in Waco and LSU in Baton Rouge, he realized that medicine was his calling. “I just really never saw myself doing anything else,” he said. “I loved working with my hands, so I knew from a relatively early age that I wanted to become a surgeon.”

After completing medical school at LSU in New Orleans, Trahan did his internship at Charity Hospital, followed by a residency in otolaryngology – head and neck surgery at LSU. It was during his residency that he developed an interest in treating cancer patients. “We were doing these major cancer surgeries, and

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the part that I really enjoyed the most was the microsurgical types of reconstruction with the head, neck and the face,” he explained.

During his residency at LSU, Trahan’s mentor, Dr. Dan Nuss, steered him toward plastic surgery. So, Trahan did a two-year plastic surgery fellowship at the University of Nebraska and Creighton University School of Medicine in Omaha, where he was mentored by Dr. Perry Johnson. It was there that he discovered his niche for breast reconstructive surgery. “I felt that the patients I made the best connection with were breast cancer patients,” he shared. “My chairman and several of the other physicians who trained me felt that I had a knack for doing those reconstructions. And, I was very passionate about it.”

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In his first year of training, he got a call from Drs. Scott Sullivan and Frank DellaCroce with the Center for Restorative Breast Surgery at the St. Charles Surgical Hospital in New Orleans. “We immediately hit it off,” he said.

In 2007, Trahan joined CRBS. “I just really enjoyed the aesthetic approaches to making people whole again,” he said. “That was the brass ring for me. And, once I began focusing on how to get there with techniques advanced by my partners, I was able to do really what I loved.”

At the Center, Trahan and his partners perform about 20 reconstructive breast surgeries per week on cancer patients from all over the world. Among their innovative techniques are DIEP (abdomen), SIEA, Hip Flap and GAP (gluteal region) Flap procedures, as well as the nipple-sparing mastectomy. “I think what separates us from other facilities is our wealth of experience and our complete and total dedication to restoration of the breast,” he explained. “We are the only group around that offers the full gamut of options for your own tissue. And, we are the only hospital in the world that’s solely dedicated to reconstruction of the breast.

This is all we do every day. But then, it’s our passion.”

Trahan says that the feeling he gets after treating a patient is indescribable.

“There is absolutely nothing more fulfilling than knowing that you’ve made somebody whole again,” he said. “The goal is to not only restore their breast, but to restore their body as well. To be able to give somebody that and give them their life back with their spouse and their family and their social life – I don’t think that there’s one word that I could pick that would do it justice.”

From his female patients, Trahan has learned how devastating a mastectomy can be. “It’s hard for a man to understand how a mastectomy or even a partial mastectomy affects a woman,” he said. “It’s a big blow to their femininity. We’ve had so many women that have come to us who have had mastectomies and pretty much suffered in silence after being told, ‘You should just be happy that you’re alive.’

And yet, they have to look at themselves in the mirror after they get out of the bathtub or the shower, and they are still emotionally distraught over it. So, when you are able to restore them, it’s amazing to see these women transform.”

In his personal life, Trahan has been married to fellow Abbeville native Britlyn for 15 years. They have two boys – Beau, age 11, and Jack, 7. Trahan enjoys attending sporting events, hunting, fishing and traveling. But, beneath his laid-back demeanor is a diverse personality. “I am much more type A than people perceive,” he said. “I am also a huge country music fan and hip-hop is growing on me.”

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Making Geriatrics a Primary

National expert discusses decade of change in high demand specialty

By LYNNE JETER

TALLAHASSEE— Ken BrummelSmith, MD, almost bypassed specializing in geriatrics because of the lack of educational opportunities at medical schools during the early 1970s, when he attended, and the lack of geriatric residency slots nationwide. Instead, it was a chance encounter that sculpted his career path and enabled him to establish the nation’s first Department of Geriatrics for an allopathic school.

“My first job after fellowship was teaching a family medicine residency, and my director told me about the Society of Teachers of Family Medicine having a conference on teaching geriatrics in the family medicine residency program, and said it was going to be a big deal someday. When asked Dr. Ken if I’d go and see what I Brummelcould find out about it, Smith my first thought was, wow! A free trip to Boston! I really didn’t have much knowledge about geriatrics then,” said Brummel-Smith, past president of the American Geriatrics Society, and founding chair of the Department of Geriatrics at the Florida State University College of Medicine (FSU-COM). “After getting enthused at the conference and involved in developing educational programs, I switched from family medicine to geriatric medicine.”

Since then, the field of geriatrics has exploded. As baby boomers have aged, the need for geriatricians grows. Currently, 38,000 geriatricians are projected to meet the country’s needs.

“We’re at 7,000 now,” said BrummelSmith. “The main problem is we don’t have enough applicants. When I started in 1980, hardly anyone believed it was worth talking about. Now, there’s interest from the general public, but not enough interest from medical students. Lack of money and prestige are two reasons why.”

To address the shortage, BrummelSmith routinely encourages high school groups pursuing medical paths to strongly consider geriatrics.

“I always give them data that says: if you look at the top income to the lowest income, geriatricians are at the bottom of the scale,” he said. “We actually make less money with a specialty in geriatrics than we would in our primary specialty of family medicine or internal medicine. But interestingly, you can line up the reverse in job satisfaction. Geriatrics has the highest; neurosurgeons, among the highest paid, have the lowest. We tell them to think

about paying your bills and your loans, but don’t think you need to sacrifice your life to do it. Choose a specialty you love rather than one that pays well. And you’ll be happy the rest of your life.”

Brummel-Smith also ensures that all FSU-COM medical students have rotations in geriatric medicine in the school’s community-based curriculum model.

“Otherwise, if you took 1,000 people in a community, 700 would have a reason for thinking about their health during that month,” he explained, referencing the well-known study, “The Ecology of Care,” which first appeared in the New England Journal of Medicine in 1961, and was recently revisited with similar results.

“About 300 would have contact with the healthcare system in some way. About 100 would be admitted to a hospital, and one would go to an academic teaching medical center. So the population of patients who are taken care of, and the doctors taking care of them in an academic medical setting, is almost completely unreal realty. Then medical graduates after residency go into practice where the real situation is. For family medicine physicians, 30 percent will be geriatric patients.

For internists, it’s 40 to 50 percent. And they’re just not prepared for it. So during medical school and residency, students get a negative view of geriatrics because you’re not seeing that many older patients in academic medical centers, and they hardly ever see geriatricians as role models. Combined with the negative financial incentives, and the negative emotional incentives that a lot of academic doctors put on geriatrics, it doesn’t surprise me that few people choose geriatrics.”

The tide is slowly turning in favor of geriatric medicine. CMS has elevated geriatrics to primary care status, paying $38,500 per resident annually, a 10 percent payment bonus from $35,000. The shift from production- to value-based medicine will also make a difference.

South Carolina has adopted a student loan repayment program as an incentive for geriatricians, a move Brummel-Smith hopes other states will emulate.

“In general, there’ll never be enough geriatricians to take care of all people over the age of 65,” he said.

Even though baby steps are helpful, it remains problematic for geriatricians, who don’t fit the standard productivity model of many medical groups.

“Geriatric patients don’t fit into the 15-minute visit model,” he explained.

“Older patients have more medical needs and take longer for each appointment.

Also, the way our healthcare system is working right now and the way of reim(CONTINUED ON PAGE 10)

Embrace Change and Change Strategy

By TED GRIGGS

Healthcare will change more in this decade than it has in the past 50 years, and Louisiana’s health quality leaders should adopt a strategy based on things changing, according to health futurist and medical economist Jeffrey C. Bauer.

Part of that strategy involves shifting from predicting to forecasting, Bauer told attendees of Jeffrey C. eQHealth Solutions 2013 Bauer Medicare Quality Summit in Lafayette. Bauer, vice president, forecasting & strategy, Affiliated Computer Services, was the summit’s keynote speaker.

Predicting, based on trend analysis, produces a single future that dictates a single strategy, he said. Predicting is fine if nothing is going to change. It’s also scary and boring.

Forecasting is based on the realm of possibilities, assumes there will be changes and projects multiple outcomes. Forecasting is exciting and fun.

Instead of locking providers into preparing for a single, predicted outcome, forecasting empowers strategy to influence different outcomes, Bauer said. Health quality leaders can customize solutions rather than applying a one-size-fits-all approach.

Four trends will define the upcoming changes in the healthcare system, Bauer said.

• A revolution in medical science is shifting providers’ core function from acute care to disease management. Personalized, predictive medicine will become the new clinical paradigm. Therapies will be matched to each patient’s specific disease characteristics.

• New information and communications technologies are transforming business models and production processes.

Telemedicine, or virtual visits, will replace a big chunk of hands-on care.

• The end of growth in healthcare spending will restructure the providerpatient relationship. Governments and employers are near the limits of their ability and willingness to spend more on care.

Patients won’t have the disposable income to pay more, which will force providers to rationalize pricing.

• Problems with government-driven reform will compel providers to develop successful futures on their own. The legislation is flawed and faces legal challenges.

The Obama administration and Congress lack the resources to complete the tasks the legislation requires.

One solution?

Replace the mantra “fix the way care is delivered” with fix the way we analyze data, communicate and buy stuff, he said.

Replace traditional operations with efficient and effective production processes independent of government-directed health reform.

Waste makes up 21 percent to 47 percent of health spending.

Health leaders need to imagine a health system that does things right all the time and start building it now, Bauer said.

To do so, health leaders must take a number of steps, including: • Aggressively move in desired new directions, not limited by health reform’s laws and regulations • Find partners who agree to ensure the shift from volume to value within a fixed budget • Create multi-stakeholder partnerships committed to fixing the way health care is delivered • Establish employee health benefits as a leading force for quality-assuring creative destruction • Commit to long-term relationships, five years and longer, that allow time to meet goals and share savings • Collectively create integrated systems built on foundations of modern medical science and information communications technology.

• Intensively focus all efforts on producing the best healthcare that 17 percent of the country’s Gross Domestic Product can buy • Have fun working with marketplace partners to create the world’s best health care system.

The summit also featured four Learning and Action Networks.

The networks are the eQHealthhosted gatherings of healthcare providers statewide to share best practices, evidencebased tools, success stories and resources to improve the healthcare of Louisianians, said Edie Castello, eQHealth president and chief executive officer.

The Learning Action Networks featured were Emergency Department Impact on Catheter-Associated Urinary Tract Infections; Cardiac and Health Information Technology; Broadening the Scope: Community Organizing for Health; and Dementia Alternatives: Brain-friendly Environments.

EQHealth’s mission is to improve quality and healthcare using information and collaboration to enable change.

“We motivate providers by using interactive training methods. We teach health coaching around the state and use participants actively in the delivery, letting them try out their new skills in a safe environment,” Castello said. “We offer tips and suggestions for enhancing their performance. Interactive learning is the best way to ensure that providers are engaged and will retain the information that is presented to them.”

Many of the healthcare providers eQHealth works with are featured on videos posted on YouTube, Castello said. The videos are customized to the specific provider’s community and then shared with other providers around the country.

For example, as crawfish season geared up, eQHealth posted a video featuring a cardiologist from a South Louisiana Coumadin clinic. The video showed the cardiologist teaching Cajuns about how salt and seasonings could affect congestive heart failure patients.

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SEPTEMBER 2013 • 5

Shining a Light on Physician, Industry Relationships, continued from page 1 fers of value from applicable manufacturers, and the applicable manufacturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group.

Baker, who practices in the firm’s Atlanta office, pointed out the manufacturer doesn’t actually have Tom Baker to receive financial benefit in exchange for the ‘value transfer,’ which can take a wide variety of forms, including donated items, payment to a physician for consulting services or expenditures for entertainment. “It’s enough that it might influence a physician,” he noted.

“The Sunshine Act is about transparency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clinical trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judgment in terms of ordering an item or service for which federal reimbursement is available.”

Baker said the policy is to shine a light on interactions that could be construed to unduly influence a physician or teaching hospital and to ferret out conflicts of interest. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be influenced by the value transfer,” he continued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the reported data next fall.

The Back Story Championed by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over potential conflicts of interest within the industry. These conflicts were highlighted by several egre-

gious incidents involving clinical trials and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied.

Grassley publicly described a number of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct financial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while researching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million each in outside income while heading up several NIH grants.

Outside of these flagrant examples, the concern persists that much smaller gifts might also influence medical decisions. Earlier this year, Pew Charitable Trust published Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Strategic Data). Of that amount, $25 billion was spent directly marketing to physicians.

After unsuccessfully introducing the legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking deadlines

by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual reporting going forward.

What is a Transfer of Value?

With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or

12 Key Exemptions to the Reporting Rule Certified and accredited CME. Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees.

Product samples that are not intended for sale and are for patient use.

Educational materials that directly benefit patients or are intended for patient use.

The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days).

Items or services provided under a contractual warranty in the purchase or lease agreement for a device.

The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity.

Discounts including rebates.

In kind items for use in providing charity care.

A dividend or other profit distribution from, or ownership or investment in, a publicly traded stock or mutual fund.

Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding.

A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.

teaching hospital must be reported. Additionally, indirect transfers through an intermediary or third party are also subject to reporting.

There are 14 main reporting categories. These include consulting fees, compensation for services other than consulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or investment interest, di-

rect compensation for serving as faculty or a speaker for a medical education program, honoraria.

Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual report, but most meals, tickets, or gifts probably will fall under one of the reporting categories considering the $10 threshold.

“The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of AntiKickback statute prosecution,” Baker said.

“It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added.

The law also requires applicable manufacturers and GPOs (group purchasing organizations) to report ownership interests by physicians or their immediate family members. It should be noted, however, that purchased industry stocks and mutual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported.

If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does.

Ultimately, a patient whose doctor recommends a specific device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal financial interest in your healthcare beyond (CONTINUED ON PAGE 8)

6 • SEPTEMBER 2013

Louisiana Medical News

ONCOLOGY

New Lines of Research

NCI Data Set Opens Access to Cancer-Related Genetic Variations

By CINDY SANDERS

How will this breast cancer drug react in patients that are HER2 positive? Will this new lung cancer therapy work in a patient with multiple genetic variations?

Finding answers to those questions just got a bit easier with the rollout of a vast data set of cancer-specific genetic variations by scientists at the National Cancer Institute (NCI). Yves Pommier, MD, PhD, chief of the Laboratory of MoDr. Yves lecular Pharmacology Pommier at the NCI, was one of three lead researchers on the study, published July 15 in Cancer Research, that pinpointed more than six billion connections between cell lines with mutations in specific genes and the drugs that target those genetic defects. Paul Meltzer, MD, PhD, chief of the Genetics Branch at the Center for Cancer Research and James Doroshow, MD, director of the Division of Cancer Treatment and Diagnosis, were the other principal investigators.

Pommier explained the new database builds upon the NCI-60 cancer cell line collection, which is comprised of nine different tissues of origin – breast, ovary, prostate, colon, lung, kidney, brain, leukemia and melanoma. In their Cancer Research article, the authors note the NIC-60 panel is the most frequently studied human tumor cell line in cancer research and has generated the most extensive cancer pharmacology database worldwide.

“Most of the cell lines are from cancer tissues that are hard to treat and are usually resistant to therapy,” he said. “The genomic database is unmatched and enables researchers to mine all the gene expression in relationship to a drug.” Pommier continued, “Each drug has a different profile in the cell line because they act on different targets.”

In this most recent study, the investigators sequenced the whole exome of the full NCI-60 cell lines to define novel cancer variants and deviant patterns of gene expression in tumor cells. “The whole genome for the cell line has never been done before,” he said. “Many, many genes had never been sequenced.”

The researchers cataloged the genetic coding variations, developing a list of possible cancer-specific gene aberrations. The group then used the Super Learner algorithm to predict the sensitivity of cells with variants to more than 200 anti-cancer drugs … those approved by the FDA and those still under investigation. By studying the correlation between

the gene variants – such as TP53, BRAF, ERBBs, and ATAD5 – and anti-cancer agents including vemurafenib, nutlin and bleomycin, the researchers were able to predict outcomes, showing one of the many ways the data could be used to validate and generate novel hypotheses for future investigation.

Access to the data is freely available through multiple sources including the CellMiner and Ingenuity websites. By opening up the scalable data on the whole genome sequencing and drug connectivity, Pommier and his colleagues hope to help other researchers connect cancer-specific gene variants with drug response to move the science forward. “It’s an evolving system,” he said, adding that profiles on drugs in clinical trials will be added to the database as information becomes available to keep the data set current.

In explaining how the system works, Pommier said a researcher interested in a specific agent could plug that drug into the database. “You’ll get the profile activity of the drug, and then you can ask if there is any match to any specific gene mutations,” he said. From there, Pommier continued, the researcher could query, “Are these cells more resistant or receptive to the drug?”

Getting those answers rapidly should help researchers move major lines of oncology drug development toward personalized medicine to achieve optimal outcomes in a safer, more efficient and effective manner. With the added knowledge provided by the data bank, Pommier said researchers might separate patients into groups based on their genetic profile and therefore be able to use specific drugs in a more rational manner.

“Between a targeted drug and a clinical application, you need a verification in the middle,” he stated. That’s just what this new database offers.

Are You CONNECTED?

LSMS

Making Louisiana a Better Place to Practice Medicine Since 1878

The 2013 Picture of Health

by LSMS Communications Associate Christopher LeBouef

On Thursday, September 19, the Louisiana State Medical Society will host its second annual Picture of Health event at the Renaissance Hotel in Baton Rouge.

The keynote speaker, Emily Friedman, will address the forces reshaping healthcare right now, including PPACA, the SGR debate, HITECH, as well as demographic changes in medicine and society.

LSMS Communications Associate Christopher LeBouef

The 2013 Picture of Health: Setting the Scene for Louisiana’s Healthcare aims to educate and inform physicians and leaders of the healthcare community on current national trends and legislative changes that affect the way healthcare is delivered, from the perspective of the physicians.

Managers and administrators of physician practices, large clinics, and other healthcare facilities, as well as allied healthcare community organizations, will hear from national and local experts regarding: • National health system reform; • The ABCs of ACA - Preparing for 2014; • Tort reform and the medical malpractice environment; and • Legislative changes effecting Bayou Health and Medicaid.

Registration fees are $85 for LSMS members, $135 for non-members, and $25 for medical students and residents. The registration fee includes a continental breakfast, lunch, and refreshments. To register, visit picture-of-health.eventbrite.com.

If hotel accomodations are needed, please call the Renaissance Hotel at 225-215-7000 or reserve your room at renaissancebatonrouge.com.

Friedman is an independent writer, lecturer, and health policy and ethics analyst based in Chicago.

She is originally from Los Angeles, where she received a BA in English in 1968 from the University of California at Berkley. Since then, she has received numerous awards, including the 2011 and 2012 Top 5 Speaker designation in healthcare.

She is a contributing editor to Hospitals and Health Networks and contributing writer for the Journal of the American Medical Association.

She is most noted for her work in health policy, healthcare reform initiatives, insurance and coverage issues, ethics issues for providers and leaders, and the relationship of society with its healthcare system.

Friedman is a consultant on information dissemination to the Agency for Health Care Research and Quality, US Department of Health and Human Services.

Other speakers and topics include Lawrence Braud, MD, Physicians Foundation Board member (National Trends in Physician Workforce); Charles W. Hilton, MD, LSU School of Medicine Associate Dean for Academic Affairs (GME Update); Greg Waddell, JD, LSMS General Counsel (Bayou Health/ Medicaid Update); and F. Jeff White, MD (Medical Malpractice Update).

Louisiana Medical News

SEPTEMBER 2013 • 7

Obamacare May Boost Medical Malpractice Risks, continued from page 1 Earlier this year, LAMMICO, LouisiThe company’s financial strength and ana’s largest medical malpractice insurance the lessons drawn from 31 years of claims firm, paid a sixth consecutive dividend to analysis allow LAMMICO to offer effecmore than 6,000 policyholders in Louisitive strategies to reduce adverse events and ana and Arkansas. The company, which claims in perioperative, labor and delivalso offers coverage in Texas and Missisery, emergency, and inpatient settings, sippi, returned 10 percent of policyholders’ he said. Collectively, the company’s Risk premiums from 2009 to 2011 and had two Management staff has more than 50 20 percent dividends in 2008. years of experience in hospital risk manDr. Thomas H. Grimstad, president agement. and chief executive officer of LAMMICO, The team’s diverse backgrounds said it’s true that an increase in workload and experience equips LAMMICO’s in a compressed period of Risk Management staff to understand the time can certainly lead to unique risk management challenges faced error. by hospitals, physicians, dentists and ad“That’s why LAMvanced and allied healthcare providers.

MICO has strategically According to the Casualty Actuarial prepared for PPACA (the Society, PPACA could mean other presPatient Protection and sures for medical malpractice insurers.

Affordable Care Act) by Doctors’ shift to hospital employment Dr. Thomas enhancing our custom- H. could cut medical professional liability Grimstad ized products and serfirms’ premium revenue. Half of all hospivices,” Grimstad said. tals self-insure, Ingle said. This means that The insured physicians who serve on doctors who were buying MPL policies will the company’s board and committees have no longer need to do so. made live risk-management seminars, weMedical Professional Liability insurers binars and online continuing education could also see greater risks as nurse practicourses available to other LAMMICO tioners and physician assistants are asked to members, Grimstad said. The combined handle a greater workload than they have educational offerings will help LAMMICO in the past, according to Casualty Actuarial insureds mitigate future risks.

Society panelists.

While other medical professional liIn addition, just because more people ability insurers may fail to respond to the have health insurance doesn’t mean that erosion of their traditional customer base the general public will reduce its reliance and uncertainty of healthcare reform, on hospital emergency room visits. MassaLAMMICO embraces this latest challenge, chusetts healthcare law,1:15 which somewhat 13-563-0001 LCHCC Classic 2013 AD_4.88x6.38 2s.pdf 1 7/11/13 PM Grimstad said. resembles the Affordable Care Act, had not

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Louisiana Medical News

had that effect, according to experts who spoke at the Casualty Actuarial Society’s reinsurance seminar.

Grimstad said LAMMICO has seen dramatic changes take place in healthcare delivery over the past three decades, and the company has successfully adjusted and adapted to each.

The company now insures more healthcare practitioners than ever before, he said. LAMMICO offers coverage for physicians, acute care hospitals, specialty hospitals, medical facilities, nurse practitioners, physicians assistants, CRNAs and other healthcare providers.

Grimstad said physicians who work for hospitals have the right to negotiate to keep LAMMICO as their MPL carrier.

The agreement can be part of the physician’s employment contract.

“We work closely with policyholders who later decide to have our coverage follow them - wherever they practice – because they believe in LAMMICO’s strong history of aggressive legal defense and financial strength,” Grimstad said.

LAMMICO also offers a self-insured endorsement.

“Whether doctors are practicing individually or a member of a medical group that currently self-insures their medical professional liability, LAMMICO can transfer this risk to a fully insured (first-dollar) policy – including coverage for prior acts,” Grimstad said. “This affordable approach helps reduce the uncertainty of unknown liability costs.”

Shining a Light, continued from page 6 the physician’s professional services,” Baker pointed out.

Disputing a Report So what happens if your name appears on a report, and you disagree with the data?

Baker said CMS is going to notify physicians of all their reported relationships.

Once access is granted to the online portal housing the consolidated report, a physician should have at least 45 days to challenge the data and try to resolve the dispute with the reporting entity.

Those who cannot agree will be given an additional 15 days to come to a resolution before the information is made public.

If no agreement can be reached, the data will be published but flagged as disputed.

Physicians cumulatively have up to two years to dispute reports even after the data is published.

“While physicians aren’t required to track transfers of value, they are encouraged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.”

Baker pointed out you might not think you received an influential ‘gift’ from a device manufacturer by grabbing a bite of lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of asking to see the bill, it would be difficult to gauge the cost per person at the table; and without a copy of the receipt, it would be difficult to dispute the reported item.

“As a practical rule, doctors probably aren’t going to be good at refuting the evidence,” Baker said.

However, he added, CMS has created a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers.

“Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.

Timeline Data accumulation for 2013 has already begun. Below is a timeline of upcoming key dates in the process.

• Jan. 1, 2014: Anticipated launch date for CMS physician portal where doctors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manufacturers and GPOs about disputes in accuracy.

• March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. • June 2014: Anticipated access to individual consolidated reports from 2013.

Physicians have a minimum of 45 days by law to seek corrections or modifications to the information by contacting manufacturers/GPOs through the portal.

• September 2014: Searchable reports are published and open to the public.

Be Prepared “The act itself is vexing,” said Baker.

Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly.

“The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who accidentally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable information face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million.

“Physicians need to know other people are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”

More Information for Physicians The American Medical Association has put together the “Physician Sunshine Act Tool Kit” with additional information on the new requirements, a webinar and links to the free mobile app. To access the kit, go online to www. ama-assn.org/go/sunshine.

CHS Gobbles HMA

Acquisition will create the nation’s largest for-profit hospital chain per facility number of our industry,” said CHS CEO Wayne Smith. “Our complementary markets and the ability to form networks in key states, along with the synergies that will be available to us, can create value for the shareholders of our companies, the communities we serve, our employees and medical staffs.”

Both companies’ boards of directors unanimously approved the definitive merger agreement.

The deal would give HMA shareholders a 16 percent stake in the new company. Before the market opened on July 30, the day of the announcement, HMA shares fell 6.9 percent to $13.89; CHS stock rose 2.4 percent to $48.35.

By LYNNE JETER

FRANKLIN, Tenn. – Federal subpoenas, contract disputes, lower admissions, rising bad debt, and a reduction in surgeries contributed to a move that industry watchers now say was predictable.

On July 30, Community Health Systems (Nasdaq: CYH), a Franklin, Tenn.-based hospital operator, announced plans to acquire Health Management Associates Inc. (NYSE: HMA), a Naples-based hospital group that, ironically, had been on a spending spree acquiring struggling hospitals.

In late March, Fortune magazine had named HMA among the World’s Most Admired companies in Health Care: Medical Facilities for the second consecutive year and fifth time in seven years.

HMA has also been named the leading company for two subcategories in 2012: Use of Corporate Assets and Social Responsibility.

Yet soon after HMA CEO Gary Newsome announced retirement plans in May to preside over a Uruguay mission with the Church of Jesus Christ of Latterday Saints, rumblings swept through Wall Street that the fiscally struggling public company might be the target of a takeover.

In a May 31 note to investors, Chris Rigg, an analyst with Susquehanna Financial Group, was cautiously optimistic that CHS might be pursuing HMA, estimating the company could be acquired for $18.50 a share, a premium to HMA’s shares that had recently traded near $14.

“We would be surprised if a transaction were announced in the very nearterm,” he noted. “We don’t believe CEO Gary Newsome would be leaving the company in July if a formal auction process, which we expect HMA would conduct, were currently underway. That being said, we believe Community is the best-positioned name in the hospital group to operate HMA rural focused hospital assets.”

The Engagement In a power play, the move became official when CHS announced plans to acquire HMA for $3.9 billion in a deal valued at $7.6 billion, creating the nation’s largest for-profit hospital chains in terms of number of facilities.

“This is the second biggest hospital deal announced this summer,” said healthcare industry consultant George Paul, antitrust partner with White & Case.

In June, Dallas-based Tenet Healthcare Corp. (NYSE: THC) announced its acquisition of Nashville, Tenn.-based Vanguard Health Systems (NYSE: VHS) in a

pact valued at $4.3 billion.

“This deal is part of a growing wave of hospital consolidation, as hospitals seek ways to diversify and lower costs in anticipation of a sea change occurring in the healthcare industry with the implementation of the Affordable Care Act, uncertainty over how states will handle Medicaid coverage and reimbursement, and Medicare changes,” he said.

Paul emphasized that under Obamacare, scale will matter greatly as hospitals seek to cope with reimbursement changes and as consumers become increasingly price sensitive. “Insurers will pressure hospitals to become more efficient than ever, and as a result, it’s not surprising to see these two companies merge,” he added.

With a similar focus on non-urban locations, CHS leases, owns or operates 135 hospitals around the country. With HMA’s 71 hospitals, CHS would have 206 acute-care hospitals.

The antitrust review will focus on highly localized markets, Paul pointed out.

“While the two parties overlap in 29 states, it doesn’t appear that they have substantial overlaps on a localized level,” he explained. “The Federal Trade Commission (FTC) will focus on how many patients in an area would likely view the two operators as substitutes for each other in terms of location, quality and specialties.

Where the two are close substitutes, the FTC could seek divestitures if it were to find that patient choice may be limited.”

The new CHS would be rivaled only by its across-town neighbor, Nashville, Tenn.-based Hospital Corporation of America (HCA), which has fewer hospitals (162), yet reports higher revenue. Last year, HCA raked in $33 billion; CHS and HMA had a combined $18.9 billion.

“This compelling transaction provides a strategic opportunity to form a larger company with a diverse portfolio of hospitals that is well-positioned to realize the benefits of healthcare reform and to address the changing dynamics

The Unraveling The relationship between HMA and its largest shareholder (14.6 percent), Glenview Capital Management, a hedge fund managed by billionaire Larry Robbins, had soured in recent months.

Glenview, a private investment management firm established in 2000 with more than $6 billion of assets, also owns nearly 10 percent of CHS. Robbins had been critical of HMA’s sluggish financial results and “unconstructive” executive behav-

ior, pointing to HMA CFO Kelly Curry.

Glenview had tried to replace HMA’s entire board of directors with eight candidates in a Fresh Alternative campaign to revitalize the company. In June, Glenview had written HMA about “significant room for improvement,” which it said had fallen short in its financial performance for more than a decade.

“Under the supervision of the sitting board, HMA lacks the financial acumen to deliver on its projections,” Glenview released in a July 30 statement. “Unfortunately, this continues to be the case.”

Another Nashville, Tenn.-based hospital group, LifePoint Hospitals (NASDAQ: LPNT), had also expressed interest in acquiring HMA. Smith said he considered keeping CHS an independent company and explored partnerships with other companies but decided acquiring HMA would “create value for the shareholders of our companies, the communities we serve, our employees and medical staffs.”

The Next Step Until the merger is completed – the target deadline is March 31 – John Starcher Jr., president of HMA’s Eastern Group with 23 hospitals in seven states, (CONTINUED ON PAGE 10)

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SEPTEMBER 2013 • 9

Making Geriatrics a Primary, continued from page 4 bursement, you’re not being paid to make a patient well. You’re paid to provide certain services. And many things that need to be done aren’t strictly medical. There’s coordination with long term services and supports and social issues and all sorts of things.”

For example, on a recent clinic day, Brummel-Smith spent an hour with the wife and daughter of a geriatric patient who was too demented to understand his condition.

“We wanted time to have an in-depth discussion about care planning,” he said.

“I couldn’t bill for that because under

Medicare rules, you can only bill for the patient’s care if the patient is there. But we were doing deep patient care planning that was very emotionally difficult, and it’s going to lead not only to a very good outcome as he nears the end of his life, but also it’ll help save CMS a lot of money for unnecessary care he wouldn’t want in the first place. There’s no way I could bill for that.”

The PACE Elderplace Program in Oregon, which Brummel-Smith led before relocating to Florida, used a global-capitated model he calls “the ultimate model for reimbursement.”

“If the capitation is fair – and that doesn’t mean exorbitant or skimpy – then you can appropriately care for the patients, and let the geriatric team and the patient decide the right treatment rather than having insurance companies make the decisions,” he said. “We were free from all billing constraints, and we knew we had a certain amount of money to care for all our participants. We had quality measures to meet – some were patientgenerated – so we were doing things they wanted, not just what we thought was good for them. It really was the perfect way to practice medicine.”

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Louisiana Medical News

Overall, there’s an upside to the gap of supply and demand of geriatricians.

Even though geriatrics is labeled for patients over the age of 65, most seniors up to age 74 are relatively healthy and don’t need a geriatrician, Brummel-Smith said.

“The perfect patients for a geriatrician are those above age 75, and especially those with multiple chronic conditions and long-term care needs, such as dementia, and the kinds of problems that are very difficult for internists and family physicians to take care of in a standard 15-minute visit,” he said, pointing out the American Geriatric Society considers the specialty both a primary care and consultation model.

“We manage primary care for that population of complex and frail elders, and consultations to other physicians for the ‘younger’ old people,” he explained, “and for older people who are generally receiving good care from their primary care provider.”

CHS Gobbles HMA, continued from page 9 will step up as HMA interim CEO. HMA’s projected second-quarter earnings show a drop of .05 percent in net revenue to $146 billion, attributing the discouraging fiscal picture to low admissions, increases in observation stays, higher bad debt, a reduction in surgeries, and the federal government’s sequestration. Same-hospital admissions were predicted to fall 6.7 percent, compared to the second quarter of 2012.

In its first-quarter financial filing, HMA reported it had received a subpoena from the U.S. Securities and Exchange Commission (SEC) for documents involving accounts receivable, billing writedowns, contractual adjustments, reserves for doubtful accounts, and revenue. In May and June, HMA received three more subpoenas from the HHS’s Office of Inspector General related to the process by which the company admits people from its emergency department. The new subpoenas supplemented ones the company received in 2011. Another subpoena was issued on physician relationships. In December, a CBS “60 Minutes” segment focused on HMA’s aggressive policies aimed at increasing admissions and “disgruntled former employees.” No stranger to the federal pressure-cooker, CHS recently received a new subpoena for similar allegations from the Department of Justice.

Read Louisiana Medical News Online: LOUISIANA MEDICAL NEWS.COM

Unprecedented Accomplishments

Stephen Klasko sets model for academic medical centers in an age of reform and austerity

By LYNNE JETER

TAMPA, Fla. – In less than a decade, Stephen Klasko, MD, has transformed the medical school at the University of South Florida into an institution – USF Health – with unique partnerships, innovative collaborations, aggressive planning, and clearly outside-the-box thinking.

This month, Klasko is leaving USF Health to lead Thomas Jefferson University and the TJUH System in his hometown of Philadelphia, Penn., the first person selected to head both institutions. He laid the groundwork for turning Tampa Bay – the home of USF Health – into a true medical destination.

“We obviously have a great faculty and staff. But there’s also something more,” said Klasko, dean of the USF Morsani College of Medicine and CEO of USF Health. “In most places, a president and board really try to micromanage health sciences. (USF CEO) Judy Genshaft (PhD) and our board promised when I came here in 2004 from Philly they were going to give me the keys to create the medical school and health sciences center of the future. They fulfilled that promise. We’ve taken some calculated risks and done some things statewide even with local pressure.”

When Klasko joined USF, the university had four separate colleges. Four or five deans had passed through the doors in a decade. Klasko was immediately challenged with budget cuts. Since 2004, the medical school has lost 43 percent of its state funding, while four new medical schools have opened in Florida.

“The reason I was able to do so much was because our supportive team didn’t back down the first time somebody didn’t like what we did,” explained Klasko.

“Health is different than other academics.

Having a president and board that wanted USF Health to be the best, the most creative and innovative institution made it easier for me to get things done.”

In 2012, Klasko brought in Steve Liggett, MD, a pioneer in the emerging field of personalized medicine, to direct the newly created USF Health Personalized Medicine Institute. Then he helped craft an innovative, public-private strategic alliance with Florida Hospital to boost the quality of patient-centered care and improve outcomes in cardiology, breast health, neuroscience and surgical oncology. He also helped engineer a record gift – $37 million by Frank and Carol Morsani – whose name now precedes the new College of Medicine. To cap the year, he opened the nation’s first-of-its-kind Center for Advanced Medical Learning and Simulation (CAMLS).

“We cannot transform this whole healthcare system, reduce admissions, create better quality, and have less mistakes without the ability, like the airline taught us, to simulate those models, not just technically, but also from a teamwork prospective,” said Klasko about CAMLS. CBS

‘‘

Some have complained that (healthcare) isn’t like it was before. Guess what? It wasn’t that great before! Things are better. We’ve got to stop whining. We can’t count on the government to solve our problems.”

– Stephen Klasko, MD, Dean, USF Morsani College of Medicine; CEO, USF Health.

“Sunday Morning’s” Charles Osgood called the training a “stress test simulating real life-and-death circumstances” for emerging surgeons.

And that list doesn’t include perhaps USF Health’s greatest triumph via its partnership with The Villages, the nation’s first community-led, primary care-driven Accountable Care Organization (ACO) for Medicare Advantage patients.

“It’s also probably the nation’s first true university-community partnership,” said Klasko, adding that 40 family doctors will partner with USF as exclusive specialists. At press time, 31 family doctors had been hired. Earlier this year, USF Health contracted with United Healthcare to manage the insurance product.

“The Villages has received national attention, and we’ve even had venture capitalists come see how we’re going to serve 90,000 people,” he said. “If we save $3 million by providing healthcare more efficiently and effectively, $1 million will go back to the insurance company, $1 million will go back to USF, and $1 million will go back to the community. It’s a reinvestment in the local healthcare community that everyone can see. It’s very, very exciting.”

Also, Klasko generated $2 million from Hillsborough County for the USF Health Byrd Alzheimer’s Institute. The state has earmarked $20 million toward the USF Health Heart Institute. With the Moffitt Cancer Center, a teaching affiliate of USF, USF Health has the only oncampus, NCI-designated Comprehensive Cancer Center based in Florida. “There’s probably no place in the country that has that concentration,” he said.

Remarkably, Klasko brought these initiatives to fruition during a time of economic sluggishness and incredible turmoil in the healthcare industry.

“While everyone else was fighting the Affordable Care Act, we’ve taken another approach,” he said. “We’ve asked ourselves: What can we do now? Each of those accomplishments wasn’t happenstance.

For example, we think it’s ridiculous that

we still accept medical students based on their science GPA, MCAT scores, and ability to memorize organic chemistry formulas. We have a program now where we’re choosing students based on emotional intelligence. We think 10 years from now, it’ll be obvious that if you have a robotic surgeon, he’ll be component. If you have a doctor, he can communicate well. Today, that’s not the case. So we built CAMLS.” Nationwide over the next decade, Klasko predicts more partnerships will emerge – probably some surprising ones – between universities and communities.

“It’s obvious that university higher-ups will no longer be able to sit in their ivory towers and hope that communities will send all their patients to them and charge whatever they want,” he said. “People will

be rewarded with better care, not more or less care.”

Changes in medical care via personalized medicine are already taking hold, said Klasko.

“For example, we’re already changing cardiology treatments based on genomics,” he said. “This gets back to where everything comes together. At The Villages, our goal within 18 months is that all 90,000 residents will be on a common electronic health record, along with their history, physical and genetic data. For example, Steve (Liggett) has just done a polymorphism study about people at risk for Alzheimer’s. We’ll go the Villages and do an analysis of all 90,000 people who are all normal but have that genetic combination.”

Klasko attributes USF Health’s philanthropic successes, such as the $37 million gift to establish the Morsani College of Medicine, and the Morsanis’ additional contribution of $2 million to create the Klasko Institute for an Optimistic Future in Healthcare, to “an optimistic approach during a challenging time.”

“Some have complained that it’s not like it was before. Guess what? It wasn’t that great before! Things are better. We’ve got to stop whining. We can’t count on the government to solve our problems,” he said.

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In the News Robert Duarte, MD, Joins Orthopaedic Specialists LAKE CHARLES- Memorial Medical Group welcomes Robert Duarte, MD, an orthopaedic surgeon with total joint specialization, to their staff. He will join orthopaedic surgeons Drs. Brett Cascio, Nathan Cohen, Paul Fenn and Lawrence Weber; orthoDr. Robert Duarte paedic trauma surgeon Dr. Thomas W. Axelrad; and physiatrist Dr. Michael Lane, on the staff of Orthopaedic Specialists.

Dr. Duarte received his bachelors

degree from Nova Southeastern University in his hometown of Fort Lauderdale, Florida where he also served as a teaching assistant in both physics and organic chemistry. He then received his medical degree from Florida State University College of Medicine in Tallahassee, and went on to complete his residency in orthopaedic surgery from Louisiana State University Health Sciences Center in New Orleans, where he also served as a dissection lab instructor. Most recently, Dr. Duarte returned to Florida to complete his fellowship in adult orthopaedic reconstruction and arthritis surgery from the Florida Orthopaedic Institute in Tampa.

As a total joint specialist, Dr. Duarte is experienced in joint reconstruction and replacement, and is trained in state of the art surgical technology including computer navigation and MAKO® robotic surgery. He is also experienced in hip and knee resurfacing, osteotomy and muscle sparing surgical approaches, such as direct anterior hip replacement. He has participated in research studies on osteoarthritis and total knee replacement.

Although he specializes in total joint repair, Dr. Duarte will also be taking general orthopedic cases.

Edward Jeffries, MD, Named Baton Rouge General Physicians COO BATON ROUGE- Edward Jeffries, MD, was recently named Chief Operating Officer for Baton Rouge General Physicians. Dr. Jeffries has served as Chief Medical Officer of Baton Rouge General Physicians since 2009. In addition to his current role as Chief Dr. Edward Medical Officer for the netJeffries work, Dr. Jeffries will oversee the daily operations of Baton Rouge General Physicians. Dr. Jeffries is a graduate of Louisiana State University School of Medicine and is certified by the American Board of Family Practice.

Dr. Jeffries has practiced family medicine in the Baton Rouge area for more than 35 years and has served in various roles including President of the Louisiana Academy of Family Physicians and Chief of Family Medicine for Baton Rouge General.

Khaled Nour, MD, Joins Digestive Health Center LAKE CHARLES- Memorial Medical Group welcomes Khaled Nour, MD, a gastroenterologist board certified by the American Board of Internal Medicine. Dr. Nour joins fellow gastroenterologist Dr. Frank Marrero at the Digestive Health Center.

Dr. Khaled Nour Originally from Egypt, Dr. Nour received his medical degree from Kuwait University, where he also completed his internship. He then moved to the U.S. to complete residency in internal medicine at St. Joseph Mercy Hospital in Oakland, Michigan. He later completed a research fellowship in hepatology at the University of Michigan before serving as Chief GI Fellow and completing an additional GI and hepatology fellowship at Louisiana State University in Shreveport.

Prior to joining Memorial Medical Group, Dr. Nour had a private gastroenterology practice in Reno, Nevada, and most recently in Athens, Georgia.

Christopher Rodrigue, MD joins Thibodaux Regional Medical Staff

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THIBODAUX- Thibodaux Regional Medical Center is pleased to announce the addition of Christopher Rodrigue, Jr., MD, obstetrician/ gynecologist, to the active medical staff. Dr. Rodrigue has joined the practice of Thibodaux Women’s Center.

A native of Thibodaux, Christopher Dr. Rodrigue earned his Dr. Rodrigue, Jr. Bachelor of Science degree from Louisiana State University, and received his medical degree from Louisiana State University Health Science Center in Shreveport. Dr. Rodrigue completed his Residency in Obstetrics/Gynecology at Ochsner Clinic Foundation in New Orleans.

In the News LA Tumor Registry At LSUHSC Receives $1.3 Million From NCI NEW ORLEANS- The Louisiana Tumor Registry (LTR) at the LSU Health Sciences Center New Orleans School of Public Health has been awarded a $1.3 million contract by the National Cancer Institute to continue its work as a SEER (Surveillance, Epidemiology and End Results) Program-designated cancer registry.

There are 18 competitively awarded SEER cancer registries in the United States.

“The SEER Program is the most authoritative source of information on cancer incidence and survival in the United States,” said Dr. Elizabeth Fontham, Dean of the LSUHSC-NOLA School of Public Health. “Continued designation recognizes the excellence of our Louisiana Tumor Registry and confirms the exceptionally high quality of its data.”

The SEER Program collects cancer incidence and survival data from 18 population-based cancer registries covering about 28% of the U.S. population. 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 the State of Louisiana. Hospitals, private pathology laboratories, radiation centers, physicians, nursing homes, hospices, other licensed health care facilities and providers who diagnose and/or treat cancers are required by law to report cancer cases to

the LTR. The Registry includes the central office located at the LSU Health Sciences Center New Orleans and eight regional offices. Each regional registry is responsible for ascertaining all cancer cases from all possible sources in its region. The central office provides training, ensures high quality data by consolidating and editing records of abstracts, and manages statewide database, as well as analyzes the data and conducts special studies.

The primary function of a cancer registry is to record the occurrence of cancer in a population. To achieve this goal, the LTR has established inter-state data exchange programs with nineteen states to receive data on Louisiana cancer patients who are diagnosed and/or treated at outof-state facilities. Information collected

by LTR includes demographic data, tumor type, stage of disease, tumor markers, treatment, and survival. Information on risk factors is usually not available from the reporting sources. However, data from the registry often provides clues to be pursued in special research studies conducted by qualified scientists with external funding.

“This funding allows us to continue providing Louisiana citizens, health professionals, policy makers and others required information for cancer prevention and control, and building infrastructures and capacities to support more cancer research, including cancer care delivery research,” notes Xiao Cheng Wu, MD, MPH, LSUHSC

Associate Professor of Epidemiology, Director of the Louisiana Tumor Registry, and Principal Investigator of this NCI contract.

“Our data are used for prevention, early detection, treatment, and survival which, in turn, contribute to the development of national policy and efforts.”

University.

Dr. Mikulla is a member of the Calcasieu Parish and Louisiana State Medical Societies, the New Orleans Academy of Ophthalmology, the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery.

He specializes in diseases and medical conditions of the eyes, surgery of the eye, with special interest in the treatment of glaucoma and cataracts.

Opthalmologist Brian Mikulla, M.D. Joins Lake Charles Medical Staffs LAKE CHARLES– Surgicare of Lake Charles and Women & Children’s Hospital (WCH) are pleased to welcome ophthalmologist Brian Mikulla, M.D. to their medical staffs.

After enjoying seven years of living in Louisiana, Dr. Mikulla decided Dr. Brian to make Lake Charles his Mikulla home and has joined the medical practice of Donald Falgoust, M.D. of Falgoust Eye Medical & Surgical located at 1980 Tybee Lane in Lake Charles, near the WCH campus.

Originally from Pittsburgh, Penn., Dr. Mikulla received his Bachelor’s degree in Biochemistry from the University of Notre Dame in Notre Dame, Ind. and his Master of Business Administration and Doctor of Medicine degree from Tulane University in New Orleans, La. He furthered his medical education by completing an Internal Medicine internship and a threeyear Ophthalmology residency at Tulane

Taylar Childress-McKeithen, MD, Joins Baton Rouge General Physicians BATON ROUGE- Taylar ChildressMcKeithen, MD, has joined Baton Rouge General Physicians.

A Louisiana native, Dr. Childress-McKeithen earned her medical degree from Louisiana State University Health Sciences Center in Shreveport. She Dr. Taylar Childresscompleted her residency McKeithen in obstetrics and gynecology at Louisiana State University Health Sciences Center at Woman’s Hospital in Baton Rouge. Dr. Childress-McKeithen is a member of the American College of Obstetrics and Gynecology.

Dr. Childress-McKeithen joins Dr. Jo Anne Barrios, Dr. Evelyn K. Hayes, Dr. Kimberly Neathamer-Guillory and Dr. Jane B. Peek at Baton Rouge General Physicians Obstetrics and Gynecology.

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REMEMBER September is Pediatric Oncology Awareness Month!

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After frequently traveling out of state for her treatment, Stevie Cheramie and her family finally found a facility close to home that offered nationally recognized standards for the treatment of childhood cancer. And with its 95 percent success rate, the Pediatric Hematology & Oncology Program at Women’s & Children’s Hospital proved to them that children are being cured through top-notch care — right here in Acadiana.

Witnessing special treatment from a special group of experts, led by Dr. Ammar Morad, made Stevie and her mommy and daddy realize that home really is the best medicine.

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In the News Elaine M. Junca Women’s Imaging Centre Receives National Quality Certification LAFAYETTE – The Elaine M. Junca Women’s Imaging Centre, an affiliate of Lafayette’s Women’s & Children’s Hospital, recently received national certification for quality patient outcomes for the second year in a row.

The National Quality Measures for Breast Centers Program, a quality initiative of the National Consortium of Breast Centers Inc., awarded national certification to the Women’s Imaging Centre for its commitment to providing the highest level of quality breast health care to patients in the Acadiana communities it serves.

“This certification places the Women’s Imaging Centre among the elite breast imaging centers in the nation,” said Mary Reed, Women’s Imaging Centre Director. “More than 1,000 participating breast imaging centers submit quality outcomes data focused on 30 separate parameters.

To continue to receive this certification is indeed a great honor.”

Measuring and comparing quality performance is essential in assessing patient care and allocating resources where improvement is desired. In today’s dynamic healthcare industry, breast centers are faced with providing quality care while simultaneously keeping costs under control.

A center’s staff must not only be familiar with existing standards of care, but must also be aware of new advances in technology. The Elaine M. Junca Women’s Imaging Centre has taken a major step to ensure they provide the best possible quality care to breast patients in the communities it serves.

The National Consortium of Breast Centers promotes excellence in breast healthcare for the general public through a network of diverse professionals dedicated to the active exchange of ideas and resources. It serves as an informational resource and provides support services to those rendering care to people with breast diseases through educational programs, newsletters, a national directory and patient forums.

Tony Dennis, MD, Joins North Oaks Physician Group HAMMOND- Ear, Nose and Throat Physician D’Antoni “Tony” Dennis, MD, has joined North Oaks Physician Group effective Monday, Aug. 12. Appointments for new patients of all ages are being scheduled with Dr. Dennis at North Oaks ENT & Allergy Dr. Tony Dennis Clinic in Hammond and North Oaks Multispecialty Group in Livingston.

Dr. Dennis and his colleagues, Drs. Jeffrey LaCour and Jacques Peltier, are skilled in the diagnosis and treatment of disorders of the ear, nose and throat. Dr. Dennis also specializes in the treatment of allergies.

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Louisiana Medical News

“The beauty of what I do is that I can treat patients of all ages. I enjoy carefully listening to my patients’ concerns and helping them, step-by-step, to successfully manage their health,”Dr. Dennis shares.

Dr. Dennis earned his medical degree through the Louisiana State University Health Sciences Center in Shreveport. He completed an internship and residency in Otorhinolaryngology (ear, nose and throat) through the Louisiana State University Health Sciences Center in New Orleans.

The North Oaks ENT & Allergy Clinic is located on the 3rd floor in Suite 301 of the North Oaks Clinic Building on the North Oaks Medical Center campus at 15813 Paul Vega, MD, Drive in Hammond.

The North Oaks Multispecialty Group is located on the 2nd floor of the North Oaks-Livingston Parish Medical Complex at 17199 Spring Ranch Road in Livingston.

Dr. Meza to Head Regional Hyperbaric Program LAFAYETTE – Dr. Luis A. Meza recently took the helm as Medical Director for the Hyperbaric Medicine program at The Regional Medical Center of Acadiana.

Dr. Meza, a well-known Lafayette physician who specializes in Hematology/ Oncology, expressed his excitement at taking the Dr. Luis A. Meza reins of the program and lead it into a new level of successful outcomes and growth for Acadiana families.

“An estimated 5 million Americans suffer from chronic open sores that could be healed with hyperbaric therapy,” he said. “Diabetic and poorly vascularized patients with wounds who receive hyperbaric therapy experience greater tissue sparing. Hyperbaric therapy makes it possible for the treating physician to eliminate or reduce the extent of limb amputation, in turn allowing the patient to preserve functionality.”

Diabetic and other patients with sores and wounds that time just won’t heal can be treated in four state-of-the-art hyperbaric chambers at Regional Medical Center of Acadiana.

Hyperbaric Oxygen Therapy-trained physicians and technicians are present at all times to monitor each treatment session. Sessions last an average of two hours. The frequency and number of visits will vary depending on the patient’s condition.

Standard & Poor’s Upgrades Touro Infirmary Bond Rating NEW ORLEANS- Standard & Poor’s Rating Services announced today that they have upgraded Touro Infirmary’s “BB+” issuer credit rating (ICR) to “BBB.” According to Primary Credit Analyst Karl Propst, “The rating upgrade reflects our view of Touro’s improving financial position due to its robust 2012 operating margin and the corresponding improvement in balance sheet metrics. It also re-

flects our opinion of the system affiliation agreement signed with Children’s Hospital in New Orleans (AA-/Stable), under which Touro has received financial support for its capital spending needs as well as other benefits,” continued Mr. Propst.

Standard & Poor’s is optimistic that the Children’s affiliation and management’s initiatives to restrict expense growth and generate additional revenues will allow Touro to sustain the rating and possibly lead them to further raise the rating over time.

Touro is a proud member of Louisiana Children’s Medical Center (LCMC), which is a local integrated not-for-profit academic healthcare system with cash reserves in excess of $1 billion. LCMC also owns and operates Children’s Hospital, currently manages the Interim LSU Hospital, and in 18 months will open and operate the $1.2 billion University Medical Center. LCMC currently operates more than 620 inpatient beds with a staff of more than 5,400 employees.

EDITOR & PUBLISHER Scott Cavitt scott@louisianamedicalnews.com 337.235.5455 ADVERTISING SALES Brandy Cavitt brandycav@gmail.com 337.235.5455 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Ted Griggs, Lisa Hanchey, Lynne Jeter, Cindy Sanders

St. Elizabeth Hospital Names New Chief Nursing Officer GONZALES- St. Elizabeth Hospital recently named Yvonne Pellerin, RN, MSN, NE-BC, as its new Chief Nursing Officer and Vice President of Patient Care.

“We are very pleased to have Yvonne join St. Elizabeth,” said Robert Burgess, President and Yvonne Pellerin Chief Executive Officer.

“We had several strong candidates for this position, but Yvonne’s experiences and philosophies fit well within the culture of our community and organization.

Her passion for quality, safety, patient satisfaction, and compassion will serve us well,” he said.

Pellerin holds a Diploma of Nursing from Lutheran Medical Center School of Nursing, Cleveland, Ohio, and a Bachelors of Science Degree in Nursing from the University of South Florida in Tampa.

She earned her Masters of Science Degree in Nursing from Benedictine University in Lisle, Illinois, where she focused on Leadership, Management, and Finance.

Pellerin has worked as a nurse since 1983 where she began her career as a staff nurse at Deaconess Hospital in Cleveland. She brings with her over 19 years in management experience having served in various nursing supervisory positions in hospice, hospitals, and industry in Florida and Illinois. Prior to joining St. Elizabeth, she most recently served as the Nursing Services Manager and Co-Director of Patient Care Facilitators at Memorial Medical Center in Springfield, Illinois.

Pellerin has also served as an Assistant Professor for clinical leadership students in cooperation with Illinois State University. She is a Board Certified Nurse Executive by the American Nurses Credentialing Center (ANCC), and is trained in the principles of LEAN and Six Sigma to ensure highest quality outcomes with minimal variation.

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

TAVR enables the placement of the Edwards Sapien balloon-expandable aortic heart valve into the patient via a catheter-based transfemoral or transapical delivery system, eliminating the need to perform sternotomy to replace the diseased valve.

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

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

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

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

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

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SEPTEMBER 2013 • 15

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