Lousiana Medical News September 2015

yOUR PRIMARy SOURCE FOR PROFESSIONAL HEALTHCARE NEWS SEPTEMBER 2015 / $5

SOU TH LOU ISIANA ED ITION

On Rounds Physician Spotlight Dr. Mihail Borrisov

New Health IT Council Pushes for Improvements

By TED GRIGGS

Metal Man Growing up during the Communist regime, Bulgarian native Mihail “Misho” Borrisov had limited exposure to American media. Back then, all movies and music were heavily censored.

“It was being filtered, but we were still exposed to the better quality of entertainment,” he recalled. “Our impression of America was ‘Oh, you go there and leave with shovels of money.’” ... page 3

The AMA Steps Up with STEPS Forward Ambitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care Several years ago, Christine A. Sinsky, MD, FACP, made two significant timesaving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests ... page 6

A new 17-member Health Information Technology Advisory Council has been assembled to help Louisiana take the next step in building on the existing HIT infrastructure.

The first advisory council helped guide the design of the Louisiana Health Information Exchange, a statewide platform that allows providers and hospitals to share electronic health records with other providers taking care of the same patients.

“HIT Advisory Council 2.0 is focused on building the infrastructure that’s been developed, but it’s much, much broader than where we started,” said Cindy Munn, chief executive officer of the Louisiana Health Care Quality Forum.

“Now it’s a matter of looking at ‘how can we best leverage this foundation to further promote ad(CONTINUED ON PAGE 4)

REIMBURSEMENT

MGMA Releases Latest Provider Compensation Data

By CINDy SANDERS

In late July, the Medical Group Management Association (MGMA) released findings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating officer of the national organization for healthcare administration and medical practice management. “For the last 25 years, we’ve also

been specializing in the space of physician compensation and non-physician compensation.”

Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary care physician increases outpacing those of specialists (3.56 percent increase vs.

2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compensation of $241,273 for primary care physicians.

The 2015 benchmarking report included information on nearly 70,000 providers across the United States. In addition to geographic diversity, Evenson said the data was representative of both large and small (CONTINUED ON PAGE 4)

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Louisiana Medical News

Physician Spotlight

Dr. Mihail Borrisov Metal Man

By LISA HANCHEy

Growing up during the Communist regime, Bulgarian native Mihail “Misho” Borrisov had limited exposure to American media. Back then, all movies and music were heavily censored. “It was being filtered, but we were still exposed to the better quality of entertainment,” he recalled. “Our impression of America was ‘Oh, you go there and leave with shovels of money.’”

One genre of U.S. music made quite an impression on the young Misho – heavy metal. His love of headbanging bands like Scorpions and Pink Floyd led him to switch from the piano to the guitar as his instrument of choice. “In Bulgaria, it’s almost mandatory to plan an instrument,” he explained.

“My mother played the accordion, and my father played the guitar. I initially started with piano, then transitioned to a classical guitar after high school. I’ve always been a heavy metal fan, and that expanded my ability.”

When the Berlin Wall finally came down in 1990, Pink Floyd’s smash hit “Another Brick in the Wall” proved particularly poignant for Bulgaria’s formerly Communist nation. But with this newfound freedom came some unexpected consequences for the newly democratic society. “The transition from communism to democracy was very hard on our country,” Borrisov recalled. “The majority of the imports had been coming from the USSR, and that dried up. So, you had shelves that were empty. You had people without jobs. It was tough.”

Fortunately, the Borrisovs had an aunt in Miami who served as the family’s entrée into the United States. At age 11, Misho, who knew no English except for the alphabet, moved to the U.S. with his mother and father on a tourist visa. “We came right after Hurricane Andrew hit,” Borrisov recalled. “We never even heard about it, because Bulgaria only had two channels – the Bulgarian and the Russian channels.” With less than $4,000 to his name, Borrisov’s father, who had been an engineer and vice president of the largest factory in Bulgaria, found a job at an antique store through a man he met in English class. The elder Borrisov worked his way up from stock boy to general manager, passing his strong work ethic along to his son. Occasionally, Misho would help his father in the shop, developing a

love of antique relics himself. That led to a stamp and coin collecting hobby, with his most prized possession being a $500 solid silver note which weighs nearly a pound.

Eventually, Misho’s father got a green card, and his family was allowed to officially stay in the U.S. “There was a lottery where 50,000 people were granted a green card,” Borrisov explained. “After five years, my dad won the lottery. That literally was like, ‘We won the lottery!’ Life has

been a bunch of strokes of luck for us.”

As he grew up in the U.S, Misho discovered an affinity for science, majoring in biology at Barry University in Miami. But it wasn’t until he made a C in zoology that his deep-seeded ambition kicked in. After retaking the course during summer school and acing it, he decided to work even harder to pursue his ultimate goal: becoming a doctor.

After graduating, Borrisov attended at the University of Sint Eustatius School of Medicine in the Netherlands Antilles. He then landed a residency at LSU-New Orleans. “The culture in New Orleans is second to none,” he observed.

“Plus, it reminded me of life back home. Because Sofia is one of the only countries in the world that has trolleys like New Orleans. It just felt like home.”

During his residency in internal medicine, Bossonov learned about hospitalists.

“Internists work primarily in clinics, and I abhor clinics,” he revealed. “I like the inpatient setting. So, being a hospitalist was perfect. Hospitalists only work about six months out of the year; it’s like seven on, seven off.”

Four years ago, Borrisov became a

hospitalist at Lafayette General Medical Center. “It was amazing,” he gushed.

“The staff is amazing, the nurses are superb – everything clicked. Every year since I’ve been there has provided new opportunities for growth.” After LGMC partnered with LSU, he became a clinical assistant professor for the residency program. Additionally, he serves as assistant medical director, associate medical director at Schumacher Group, and medical director for Amerigroup.

While working at LGMC, Borrisov spotted Kateyln Maybrier, a hematology/ oncology nurse hailing from Eunice, La. “She looked like a beauty queen,” he recalled fondly. After being officially introduced by their hairdresser, the two started dating. The couple is planning a January wedding in Katelyn’s hometown.

Now that Borrisov is settling in to his life as a hospitalist, he has found time to pursue his hobbies, including CrossFit, basketball, swimming – and music. As a musician, he garnered two “Superior” evaluations in piano and one in classical guitar ensemble. His fiancé presented him with his most treasured piece, an acoustic guitar. Back in Miami, he has a Stratocaster electric guitar. While he primarily plays classical guitar, he occasionally belts out some heavy metal tunes at home. “Classical is the most melodious to me, it’s so soothing” he revealed.

“Heavy metal is a little difficult to play on this guitar. But, you can still jam out.”

Borrisov truly loves his work as a professor and hospitalist. “When you teach residents, it forces you to stay ahead in your studies,” he said. “When you have great outcomes, it doesn’t feel like work.”

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Louisiana Medical News

SEPTEMBER 2015 • 3

New Health IT Council Pushes for Improvements, continued from page 1 vancement of Health IT in Louisiana and use that to produce quality outcomes and reduce costs?’”

The Quality Forum and the state Department of Health and Hospitals formed the new Advisory Council.

Members include Ann Kay Logarbo, MD, medical director/United Healthcare Community Plan of Louisiana; Bernie Clement, chief informa- Cindy Munn tion officer/Thibodaux Regional Medical Center; Beverly HardyDecuir, section chief/Medicaid Quality Management, Statistics & Reporting/ DHH; Brian Richmond, chief technology officer/ Quality Forum; Cheryl Tolbert, CHRS, president & CEO/Louisiana Business Group on Health; Cian Robinson, executive director/Lafayette General Foundation; Hank Fanberg, associate vice chancellor/South Louisiana Community College; Jinger Greer, chief financial officer/Richland Parish Hospital; Joseph Foxhood, director, Center for Population Health Informatics, Office of Public Health; Juzar Ali, MD, FRCP(C) FCCP, chief medical officer, LSU Health; Lemar Marshall, chief operating officer/North Oaks Obstetrics and Gynecology LLC; Linda Holyfield, RN, MSN, president & CEO/P&S Surgical Hospital and Specialty Management Services of Ouachita; Marcia Blanchard, vice president of operations/ Quality Forum; and Mary Ellen Pratt,

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FACHE, CEO, St. James Parish Hospital. Contributing members include: Jamie Martin, marketing & communications manager/ Quality Forum; Nadine Robin, HIT program director/ Quality Forum; and Rosalyn Christopher, EHR Medicaid program manager/DHH. Munn said the concept is the same that the Quality Forum has always had: Bring the payers, providers, consumers and employers to the table. Listen to their concerns and recommendations.

Figure out what plan of action makes the most sense. Share that information with the state’s Congressional delegation, state Legislature, and DHH. Get policymakers’ feedback and suggestions about other HIT developments.

Munn said some of the major challenges Advisory Council members face include: • Health IT developers charging fees that make it too expensive for most providers to send or receive Electronic Health Records.

“It’s become a significant burden on the providers, and it prevents them from being able to participate or it’s a significant barrier,” Munn said.

• Some vendors haven’t been able to keep up with the changing regulations.

One of the strengths of the Advisory Council is that each of the specific groups can share what their challenges are, Munn said. The Quality Forum can then pass that information along to the Louisiana Congressional delegation, DHH and state legislators.

• Interoperability remains a significant problem for Health IT. A big part of the problem is cost, Munn said. But the vendors of some systems are unwilling to work with other vendors to allow the IT systems to share information. And in some cases, the software just is not capable.

Part of the problem, Munn said, is that no data-sharing standards had been established when the national Health IT push began.

The result has been significant challenges for everyone, Munn said.

Vendors were sharply criticized in a recent report to Congress by the Office of the National Coordinator for Health Information Technology. The report says, in so many words, that the vendors’ recalcitrance flies in the face of the Health Information Technology for Economic and

Clinical Health Act. The federal government has spent more than $28 billion since the act’s passage in 2009 to speed the development of HIT, the report says. The goal of the law was to remove the barriers so that an interoperable, learning health system could be created.

The legislation and other efforts, ideally, would lead to a system where electronic health information is available and can be securely and efficiently shared, the report says.

Another issue that has bubbled up, although it is not yet considered a major problem, involves shortcomings in the process for certifying vendors’ HIT systems.

Some of the companies originally certified have failed. Others have systems that can pass certification, but in “real-life scenarios” the systems don’t work.

Those issues are the reason that Congress is discussing postponing the Stage 3 requirements for meaningful use or partially implementing them, Munn said.

The Stage 3 requirements include protecting health information; e-prescribing; giving patients electronic access to their data; and health information exchange.

MGMA Releases Latest Provider, continued from page 1 practices, various ownership structures including hospital-based providers, and more than 170 specialties.

Evenson said the collected data is important for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

Todd Evenson While primary care physicians enjoyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view.

Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012.

“Will primary care physicians be compensated at the same levels as specialists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Primary care physicians are truly the lynchpin of the new practice model as we move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be productivity based,” explained Evenson. “In 2012, 50 percent of respondents said they were on a 100 percent productivity based compensa-

Louisiana Medical News

tion plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data highlights the gradual shift toward rewarding practitioners for improved operational efficiencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physician compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over volume concept that physicians seem to be embracing is really beginning to pay off for them.”

He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per capita cost of healthcare, improving the health of populations, and improving the patient experience of care.”

Evenson said those in the behavioral health sector are also seeing improved compensation as their work complements that of primary care providers in managing a population’s health.

The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likelihood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evident in the MGMA compensation survey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Evenson said, noting that now puts psychiatrists

roughly equivalent to their primary care counterparts.

Economic forces of supply and demand are another issue factoring into physician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensation rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between 46,000 and 90,000 physicians by 2025.

In addition to compensation figures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data allows those in healthcare to dissect the information in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing better care by understanding your colleagues’ activities in the industry,” Evenson concluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataDive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare management will be explored in depth at MGMA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn.

Louisiana’s Co-op Fails After Less Than 2 Years

By TED GRIGGS

The Louisiana Health Cooperative Inc., one of 23 nonprofit health plans created through a $2.4 billion Obamacare loan program, is going out of business.

It was the second Consumer Operated and Oriented Plan to fail. The CO-OP that offered coverage in Iowa and Nebraska went belly up earlier this year. An analysis by insurance ratings giant A.M. Best suggests that almost all the other CO-OPs are facing financial headwinds. Only one of the plans had turned a profit during the first nine months of 2014.

Insurance Commissioner Jim Donelon said the department has regulators onsite, monitoring the Metairiebased company’s activities. He expects that will continue through the end of 2015.

Donelon said he could not comment on whether the department has placed the coopera- Jim Donelon tive into receivership.

“They announced on their own that they’re in run-off, and you can conclude what you will from that,” Donelon said. “I will simply state that we’re doing what the law requires us to do in the instance of a failing company.”

The CO-OPs were created to generate competition for traditional insurers on state and federal health insurance exchanges. The nonprofits began offering coverage on Jan. 1, 2014.

The Louisiana plan received close to $66 million in low-interest federal loans.

But the nonprofit wasn’t able to generate the kind of enrollment numbers it needed to stay in business.

The cooperative hoped to enroll 28,106 members in 2014 but was only able to sign up 7,773 members. In 2015, the health plan enrolled a little less than 14,500 members.

Chief Executive Officer Greg Cromer issued a statement in late July saying LAHC isn’t growing enough to maintain “a healthy future.”

By acting now, the cooperative will be able to keep all of its policies in force through 2015 and cover all of its claims and operating expenses, Cromer said.

The health plan lost $20.8 million in 2014, according to Insurance Department records. The plan took in a little less in premiums than it paid in provider and pharmacy benefits, but fell well short of covering the $16.3 million in administrative expenses and claims adjustment costs.

Donelon said the department regulated the cooperative like any other HMO. Additional oversight, he said, could not have prevented the company’s problems.

However, some experts say the same law that set up the CO-OPs also makes it harder for them to succeed.

The CO-OPs, like other health insurance startups, had to acquire state licenses, build a network of providers, price their plans competitively without any of their own claims data, and build brand recognition and trust.

The Louisiana plan had to outsource most of that work initially.

The company paid Beam Partners, which sponsored the cooperative, and related entities more than $7 million for that work in 2013, Donelon said.

The Insurance Department is reviewing those contracts, he said. But none of his regulators have suggested there were issues with the consulting arrangement.

Those contracts were approved by the cooperative’s board, Donelon said. In effect, Beam functioned as a third-party administrator for the cooperative until it could bring on its own people.

Beam exited after a year, Donelon said, and the cooperative is no longer paying the consulting firm.

Experts say the federally created plans were saddled with additional regulatory burdens that other startups don’t face.

For example, the Affordable Care Act prevented the CO-OPs from using any of their federal loans for marketing, according to the Commonwealth Fund, a think tank that advocates for a high-performing healthcare system. In addition, the plans have to make sure a majority of their members are individuals and small businesses, less profitable customers than large employers.

Other challenges include: A five-year loan payback period, which doesn’t give plans much time to build their businesses.

A much smaller loan budget. Policymakers, including the White House, reduced the CO-OP loan funding by twothirds, leaving the available money far short of what experts recommended.

Allowing insurance companies to maintain plans that didn’t meet Affordable Care Act requirements. This meant the CO-OPs were left to draw from customers who had more health issues and higher costs.

The Louisiana Health Cooperative’s demise leaves Louisiana with five insurers offering coverage through the federal health insurance exchange. Blue Cross and Blue Shield of Louisiana, which covers more than 125,000 people; Aetna Health Inc., with around 7,500 customers; Humana Health Benefit Plan of Louisiana Inc., more than 6,800 members; Vantage Health Plan, around 7,500 members; and UnitedHealthcare Life Insurance Co., about 1,300 people.

Donelon said the remaining insurers will be able to pick up the slack in 2016.

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Louisiana Medical News

SEPTEMBER 2015 • 5

WHO’S TENDING OUR DOCTORS?

The AMA Steps Up with STEPS Forward Ambitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

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.

Several years ago, Christine A. Sinsky, MD, FACP, made two significant time-saving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The first: taking a streamlined approach to prescription manage- Dr. Christine Sinsky ment.

Second: taking proactive planned care measures with patients via previsit laboratory tests.

“Just making a single change – prescription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes

of nursing time per doctor per day,” said Sinsky, an internist and partner in Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois.

Sinsky is also the point person at the American Medical Association (AMA) for an ambitious new initiative offering physicians strategies to revitalize their medical practices and improve patient care.

The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recommendations and go home earlier by reengineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction physicians derive from their work is

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Louisiana Medical News

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quickly eroding as time continues to be taken away from direct patient care because of grueling, bureaucratic obstacles.

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent,” said AMA CEO James L. Madara, MD. “That’s why the AMA is taking a hands-on approach to meeting their day-to-day concerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four Dr. James L. Madara key areas: practice efficiency and patient care, patient health, physician health, and technology and innovation.

Specifically, the modules cover these topics: • Conducting effective team meetings • Creating strong team culture • Electronic health record (EHR) implementation • EHR software selection and purchase • Expanding rooming and discharge protocols • Improving blood pressure control • Improving physician resiliency • Medication adherence • Panel management • Preventing physician burnout • Preventing type 2 diabetes in at-risk patients • Pre-visit laboratory testing • Pre-visit planning • Starting lean healthcare • Synchronized prescription renewal • Team documentation Each module requires only snippets of time to study either online or printed in PDF format for a more traditional approach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, participants must view the module content in its entirety, successfully complete the quiz

answering four of five questions correctly, and complete the evaluation.

Modules include steps for implementation, case studies and downloadable videos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effective team meetings begins with a 10-step process: • Identify the team.

• Meet routinely and “on the clock.”

• Agree on ground rules.

• Set a consistent meeting agenda.

• Rotate meeting roles.

• Solve problems as a group.

• Record action steps, owners and due dates.

• Practice good meeting skills.

• Have fun!

• Celebrate success.

Under ground rules, helpful hints include starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for their time. To stay on topic and maintain efficiency during the dedicated meeting time, it’s suggested that: “if the discussion wanders, the chair or other member can say, ‘Let’s take that offline,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Management Association (MGMA) issued a practice innovation challenge, seeking more high-value, easy-to-adopt, and transformative medical practice solutions. Proposals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to having the ideas developed into future STEPS Forward modules. Winners will be announced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.”

Legislative Affairs

BY CINDY BISHOP

Studying Healthcare Delivery in the State Of Louisiana

On Friday July 31, 2015 the House Concurrent Resolution 129 task force met at the Louisiana State Capitol.

Alma Stewart with the Center for Health Equity, gave a PowerPoint presentation entitled Louisiana Healthcare Delivery System. During the 2015 regular session of the Louisiana Legislature, Rep. Regina Barrow passed House Concurrent Resolution 129 to study healthcare delivery for the Greater Baton Rouge region.

The composition of the task force is as follows: • The Mayor president of East Baton Rouge Parish or his designee; • The CEO of the Baton Rouge Are Foundation or his designee; • Two members of the Capital Region Legislative Delegation; • The CEO of the Our Lady of the OLOL or his designee; • The CEO of the Baton Rouge general health system or his designee; • The CEO of the Lane Regional Medical Center or his designee; • The CEO of Ochsner Health Sys-

tem or his designee; • The Coroner of East Baton Rouge Parish or his designee; • The administrator of the Easton Rouge Parish Emergency Medical Services or his designee; • The CEO of the Baton Rouge Area Chamber or his designee; • The president of the Louisiana AFL/CIO or his designee; • The lead organizer of the Together BR or his designee; • The President of the Capital Area Medical Society or his designee; • A member of the Campaign for Health Equity or his designee; • The Secretary of the Department of Health & Hospitals or her designee; • The director of the Louisiana budget project or his designee; • The chairman of the board of directors of Woman’s Hospital Foundation or his designee.

Additionally, Rep. Pat Smith authored House Concurrent Resolution 170 during the legislative session which establishes a commission to study health-

care delivery in the state of Louisiana.

According the World Health Organization, a well-functioning healthcare system does five things: Improves the health status of individuals, families and communities; defends the population against what threatens its health; protects people against the financial consequences of ill-health, provides equitable access to people-centered care making it possible for people to participate in decisions affecting their health and health system.

Coletta Barrett, RN, representing Our Lady of the Lake Regional Medical Center said that OLOL is working with Capital Area healthcare providers and have agreed to address the following tenets: Providing the Right Access for the Right Care at the Right Time; Behavioral Health; Obesity; HIV Rate.

Barrett said that they that they have conducted focus groups on providing healthcare in the greater Baton Rouge area.

Teri Fontenot said what we are calling healthcare is really medical care. She referred to the body of work that Mayor

Kip Holden and other stakeholders have put together. It can be found online by Googling Healthy Baton Rouge. Fontenot said that if you look at the emergency room visits from Baton Rouge, almost 50 percent of the visits were for medical conditions or ailments that are preventable. She said that we need to do all that we can to ensure that citizens are healthy.

The meetings held on July 31 were organizational meetings. I will keep you apprised of further developments on House Concurrent Resolution 129 and House Concurrent Resolution 170.

Legislative Affairs content is provided by Checkmate Strategies, publisher of Health Care Information Services. All content © Checkmate Strategies and Louisiana Medical News, LLC. For more information, readers may contact Cindy Bishop at 225.923.1599 or P.O. Box 80053, BR, LA 70598, or send email to destiny362@aol.com. Our website is www.checkmate-strategies.com

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SEPTEMBER 2015 • 7

PEDIATRICS

At the Intersection of Education and Healthcare

By CINDY SANDERS

According to statistics from the Centers for Disease Control and Prevention, one in 68 children falls somewhere on the autism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost five times more common in boys (1 in 42) than girls (1 in 189). Additionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still Mark no cure for ASD, reClaypool search has shown early intervention can have a significant impact on a child’s development and ability to more fully interact with peers at school.

It’s at this intersection of education and healthcare where Educational Services of America (ESA) offers resources to help these children thrive.

Headquartered in Nashville, Tenn., the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primarily with public school systems,” he said, noting the company partners with about 250 different systems. He added ESA also works directly with some state governments and insurance carriers.

“Providing quality services to children and young adults who need them is

more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in business for more than 15 years, Claypool said many of the programs being used have been around much longer with measurable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early intervention space,” Claypool explained. “Autism is a very dynamic disability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.”

Today, EAP reaches four times the number of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Carolina and Tennessee in the Southeast.

“We’re growing very rapidly,” Claypool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied Behavior At the heart of the program is the use of Applied Behavioral Analysis (ABA).

“We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive living skills including self-care, toileting, understanding time and money, and honing work skills.

“The same model of behavioral therapy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of children diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable outcomes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to have their potential unlocked,” he continued.

That was certainly true for one South Carolina mom. Told it would be best to find her son a residential program because he would never function on his own, she took matters into her own hands and became the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with

autism will perform at that level, Claypool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the Individuals with Disabilities Education Act requires public school systems to identify preschool children with special needs.

However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with autism to find another way to have their children identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law.

“That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than education systems to bridge the gap.”

According to the Autism Health Insurance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law.

While the specifics vary from state-tostate, each of the mandates requires insurers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of enacting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016. Additionally, the federal government has recently told all states their Medicaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

For More Info & Referrals For more information on autism and other programming by Educational Services of America, go online to esa-education.com.

For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

8 • SEPTEMBER 2015

Louisiana Medical News

Telemedicine: A Virtual Compliance Jigsaw Puzzle

By LYNNE JETER

Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprecedented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“Perhaps we shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services, a 4,000-member group with physicians in all 50 states. “High speed internet connections are now the norm. Services like Facetime and Skype are more popular than ever.

Under continued pressure to cut costs and cope with declining reimbursements, administrators believe telemedicine offers a tool for increasing efficiency. Patients also like the convenience and increased options that flow from telemedicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compliance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

Licensure Medical providers “must be licensed by, or under the jurisdiction of, the Medical Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so the medical provider does not accidentally practice in a state without a license.”

Professional Liability Most professional liability insurance policies provide state-specific coverage, meaning that if a provider accidentally practices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested. “Another consideration relates to cyber issues.

Traditional medical malpractice policies provide little to no coverage for electronic breaches. The nature of a telemedicine generates exposures to a variety of cyber risks.

Any practice moving forward with offering telemedicine should have a comprehensive cyber insurance policy.”

Standard of Care It’s imperative to note that telemedicine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stating: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physician-to-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological condition? If the condition is normally photographed when a patient is in the office, then the practice should be ready to capture the same quality of image via telemedicine.

Each step of the consultation should be planned in advance to ensure it is equal in quality to an in-office evaluation.”

Patient Privacy Sacopulos said it’s also important to note that any form of electronic communication with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text messaging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines specifically state: “Physicians should meet or exceed applicable federal and state requirements of medical/health information privacy, including compliance with HIPAA and state privacy, confidentiality, security, and medical retention rules,” said Sacopulos, adding that FSMB Guidelines suggest maintaining written policies to address: • Privacy; • Healthcare personnel who will be processing messages and patient communications; • Hours of operations; • Types of transactions that will be permitted electronically; • Required patient information to be included in the communication, such as patient’s name, identification number and type of transaction; • Archival and retrieval; and • Quality oversight mechanisms.

“Finally, telemedicine practitioners are

cautioned to periodically evaluate their policies and procedures to insure they remain current and readily accessible,” he said.

“FSMB informs us that electronic communications received from patients must be maintained within secured technology password-protected encrypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to assume that additional patient privacy requirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem Insurance experienced earlier this year,” he said.

“Studies show that medical identity theft grew at an alarming rate in 2014. Government officials, including the FBI and California Attorney General, have specifically cautioned medical providers that their patients’ electronic data is at risk for hacking and theft. All of this should serve as a warning to telemedicine providers to comply with existing state and federal regulations.

Telemedicine providers should also anticipate increasing privacy standards.”

Informed Consent Before practicing telemedicine, a medical provider should obtain appropriate patient informed consent. The informed consent document should: Clearly state the patient’s identity; Clearly state the physician’s identity and qualifications; Specify the scope of activities the practice will be using telemedicine technologies to fulfill, such as patient education, prescription refills, and scheduling appointments; The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/ or treat the patient; The patient should acknowledge the possibility of, and hold harmless the medical provider for, any technology failures and/or interruptions; The practice should, as part of the informed consent process, provide information on the telemedicine technologies privacy and security standards, such as the inscription of data and firewalls; and The informed consent document should specify express patient consent to forward patient information to a third party if necessary.

Referrals for Emergency Service “The FSMB suggests that telemedicine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos. “This emergency protocol should cover possible scenarios when patients require acute care.

How and where referrals are to be made should be covered in this protocol.”

State-Specific Requirements The scope of permissible telemedicine varies significantly by state. Some states

specifically require a physician/patient relationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much attention at the moment,” said Sacopulos. “The American Medical Association is in the process of adopting a Code of Ethics for physicians who provide clinical services through telemedicine. Texas has recently issued new telemedicine guidelines to its practitioners.

All of this should serve as a warning to those interested in telemedicine to consult with their State Board of Medicine before engaging in telemedicine activities.”

Physicians’ Telemedicine Checklist Physicians interested in electronically interacting with their patients should first work their way through this checklist: • Examine the electronic communication between the practice and its patients. From patients portals to staff testing, a complete picture is needed of the practice’s electronic communications before engaging in telemedicine; • Make sure forms of electronic patient communications are HIPAAcompliant and secure; • The internet may know no bounds, but a medical license does.

Be careful not to provide medical services to individuals who live in states in which there’s no license; • Check with the State Board of Medicine to determine state-specific telemedicine limitations; • Develop a specific informed consent document that complies with state requirements and also the Federation of State Medical Board’s suggestions; • Develop a list of disclosures to provide to prospective patients before engaging in telemedicine services; and • ºMake sure there’s adequate insurance coverage. Check with a professional liability carrier and secure a cyber-insurance policy.

“With advanced planning and a little effort, you’ll be able to weave your way through the compliance requirements to practice telemedicine, leaving you and your patients to enjoy the benefits of a telemedicine practice,” said Michael J. Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services.

SOURCE: Michael J. Sacopulos, JD.

Louisiana Medical News

SEPTEMBER 2015 • 9

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In the News Brandi Basso, MD, Joins North Oaks Primary Care Clinic in Denham Springs DENHAM SPRINGS- Local Family Medicine Physician Brandi Basso, MD, has joined North Oaks Primary Care Clinic in Denham Springs.

Certified by the American Board of Family Medicine, Dr. Basso comes to North Oaks Physician Group with more than six Dr. Brandi years of experience servBasso ing Livingston Parish. She offers personalized care for adults and children, ages 2 and older, through regular check-ups, immunizations, screenings and preventive medicine.

A Southeastern Louisiana University graduate, she earned a medical degree from the American University of the Caribbean School of Medicine in St. Maarten, and completed a residency and internship through Baton Rouge General Family Medicine.

“One of the most important relationships you can have is the one with your doctor – so it’s my mission to build strong relationships with each of my patients,” Dr. Basso shares. “I want you to feel comfortable discussing your health with me, so we can decide together what’s best for you.”

Nurse Practitioner Michelle Civello also practices with the clinic, which is located at 31839 La. Highway 16, Suite B. Clinic hours of operation are 7:30 a.m. to 4:30 p.m. Monday through Friday. For more information about North Oaks Physician Group’s network of primary, walk-in and specialty clinics, visit www.northoaks. org.

Children’s Hospital and LSUHSC Announce New Chair, Pediatrics Department Head NEW ORLEANS- Children’s Hospital and LSU Health Sciences Center (LSUHSC) are proud to announce the appointment of Raymond G. Watts, MD, as Professor and Head, Department of Pediatrics at LSUHSC and Chair of Pediatrics at Children’s Dr. Raymond G. Watts Hospital of New Orleans.

“We are excited Dr. Watts is bringing his expertise, energy and commitment to academic medicine and children’s health to LSU and our clinical partners, particularly LCMC Health and Children’s Hospital,” said Steve Nelson, Dean of LSUHSC School of Medicine. “He has tremendous depth and breadth of experience in medical education; clinical care delivery and patient care quality initiatives which will directly benefit Children’s as well as our patients,” said Mary Perrin, CEO and President of Children’s Hospital.

Dr. Watts, a native of Louisiana, is currently the Hugh J. Morgan, Jr, Endowed Chair for Pediatric Hematology/ 10 • SEPTEMBER 2015

Oncology and Professor at the University of Alabama in Birmingham (UAB). He is a graduate of Northeast Louisiana University and LSU School of Medicine Shreveport. He trained at the University of Arkansas and the University of Alabama in Birmingham. He served active duty in the US Air Force Medical Corp and while in the service participated as a medical educator at the University of North Dakota in Grand Forks. He has been a faculty member at UAB since 1988, participating at some level in virtually every facet of UAB’s and Children’s of Alabama operations. He is board certified in Pediatrics and Pediatric Hematology Oncology.

Dr. Watts’ research emphasis involves natural history studies in pediatric hematology and oncology, clinical outcomes and innovative therapies for posttransplant lymphoproliferative disorder and hemophilia clinical research. He serves as Director of the UAB Pediatric Hemophilia Clinic and serves on the State of Alabama Hemophilia Oversight Committee. Dr. Watts has been recognized for clinical excellence by selection as one of the “Best Doctors in America” from 2001 to the present.

Dr. Watts, an avid LSU fan, is expected to join LSU School of Medicine in New Orleans and Children’s Hospital in December 2015.

Seaside Healthcare Names Shannon Ost VP BATON ROUGE- Shannon L. Ost has been named Vice-President of Government and Regulatory Affairs for Seaside Healthcare, a Louisiana corporation headquartered in Shreveport with Corporate offices in Baton Rouge, Louisiana. Johnny Patout, Shannon L. Ost Chief Operating Officer for Seaside Healthcare announced Ms. Ost’s appointment.

A native of Adrian, Michigan, Shannon Ost earned her BS in Child Psychology from the University of Minnesota, Minneapolis, Minnesota, and her MA in Counseling Psychology, with specialization in Marriage and Family Therapy, from the University of St. Thomas also in Minneapolis. A licensed Professional Clinical Counselor and Marriage and Family Therapist, Ms. Ost’s career spans 15 years in both the public and private sectors in the field of counseling and mental healthcare service delivery.

In her professional career, her roles included that of individual and family therapist, intake specialist, clinical case coordinator, case manager, clinical supervisor, clinical consultant and director of network development. Her past affiliations included work with CIGNA Behavioral Health in Minnesota and Magellan Health Services of Baton Rouge, Louisiana.

In her role with Seaside Healthcare,

Louisiana Medical News

Ms. Ost will be responsible for developing and maintaining relationships with the State of Louisiana and its employee base, Bayou Health plans, Magellan Health Services, and various commercial insurance carriers in the state of Louisiana.

Additionally, she will coordinate oversight of all professional credentialing and contracting activities with Seaside Healthcare while serving as a liaison between the corporation and various stakeholders.

Seaside Healthcare was established in 2009 and is headquartered in Shreveport, Louisiana. It is the parent corporation over a broad geographic network of healthcare services and providers spanning the state of Louisiana and including inpatient and outpatient mental health or substance abuse counseling and treatment services. More information on Seaside Healthcare can be found through their website at www.seasidehc.com

LGH Welcomes New Physician LAFAYETTE – Lafayette General Health welcomes Tyler Perrin-Bellelo, M.D., to the LGMD Physician Group – Internal Medicine. Dr. Bellelo will be located in the Grant Mollett Medical Arts Plaza, at 459 Heymann Blvd., in close proximity to other Lafay- Dr. Tyler PerrinBellelo ette General Internal Medicine physicians, including Drs. Michael Alexander, Bradley Chastant II, Milton Jolivette, Jr., Juan Perez-Ruiz, Karen Smith, Angela Snow and Thomas Voitier II. She is a graduate from LSU in Baton Rouge, where she obtained her Bachelor of Science degree in Kinesiology. She then earned her Doctorate of Medicine Magna Cum Laude from the American University of Antigua College of Medicine in Antigua, West Indies. She completed her residency training with LSU at University Hospital & Clinics, and was named Internal Medicine Resident of the Year for the academic year of 2013-2014.

Professional organizations that Dr. Bellelo belongs to include the American Medical Association, American College of Physicians, Louisiana State Medical Society and Lafayette Parish Medical Society.

Dr. Bellelo brings to Lafayette General an understanding of disease prevention and the promotion of health as well as extensive knowledge and training in the effective treatment of common as well as complex problems that encompass all body systems. She takes pride in providing compassionate, comprehensive care to the people of Acadiana whether in the office or during hospitalization.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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In the News LSU HEALTH Awarded Tumor Detection & Treatment Patent NEW ORLEANS– The US Patent and Trademark Office awarded Michael Lan, PhD, Professor of Pediatrics/Genetics at LSU Health New Orleans, and his former LSU Health New Orleans colleague, Mary Breslin, PhD, US patent number 9,090,907. The researchers built a segment of genetic material (DNA), called a construct, that can be used to both diagnose and treat neuroendocrine cancers.

The construct contains genetic elements only activated when inside neuroendocrine tumor cells, but not normal cells, allowing for the precise detection and killing of neuroendocrine tumors.

The genetic material contains an element that functions specifically in neuroendocrine tumor cells to turn on a suicide gene and/or a diagnostic reporter gene. Additional genetic elements increase the specificity of this construct’s activity when delivered into neuroendocrine tumors through infection with an adenovirus. The construct was tested in a mouse tumor model with neuroendocrine lung cancer and demonstrated that neuroendocrine lung tumor growth was suppressed following treatment.

The advantages of the construct include increased specificity and safety without affecting efficacy. The construct can be placed in multiple viral delivery systems and can be used to infect a wide range of tumor cells.

“My laboratory has studied a neuroendocrine (NE) tumor specific marker, INSM1, for the past twenty years,” notes Dr. Michael Lan, LSU Health New Orleans Professor of Pediatrics/Genetics, whose lab is at the Research Institute for Children at Children’s Hospital New Orleans.

“INSM1 marker plays an important role in neuroendocrine tumors. Our construct has the ability to restrict the expression of reporter and/or suicide genes in tumors that we targeted. Clinically, it could be a novel strategy for the detection and treatment of NE tumors.”

According to the National Cancer Institute, neuroendocrine tumors form from cells that release hormones into the blood in response to a signal from the nervous system. Neuroendocrine tumors may make higher-than-normal amounts of hormones, which can cause many different symptoms. These tumors may be benign (not cancer) or malignant (cancer). Some examples of neuroendocrine tumors are carcinoid tumors, islet cell tumors, medullary thyroid cancer, pheochromocytomas, neuroendocrine carcinoma of the skin (Merkel cell cancer), small cell lung cancer and large cell neuroendocrine carcinoma (a rare type of lung cancer).

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SEPTEMBER 2015 • 11