Mississippi Medical News June 2015

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PHYSICIAN SPOTLIGHT PAGE 2

Philip Scurria, MD ON ROUNDS

Anderson Regional Cancer Center Makes ForwardLooking Addition TomoTherapy system offers helical delivery of radiation dose Like watching an apple ripen to perfection, Scott Anderson, MD, knew the time was right to pluck the newest technology in radiation therapy ... 3

Five Ways Millennials Have Shaken Up Healthcare They prefer alternative to single-source, PCP favored by older generations The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down ... 4

ONLINE: MISSISSIPPI MEDICAL NEWS.COM

Legislative Wrap - Part 1 State OKs unique bill to create provider-sponsored health plans

The PSHP will be designed to function as an insurance company, one that will be able to compete with existing managed-care organizations (MCOs).

Even though PSHPs have been set up in other communities around the country, none are as ambitious as the one proposed for Mississippi, Moore emphasized.

“We have several states watching what we’re doing,” he said. “PSHPs have been used in a number of places successfully, but not on as large a scale as we’re doing. We’re talking about setting up a statewide PSHP and having it coordinated through an entity that will be separate from MHA.” As proposed, the Mississippi PSHP will be set up as a not-for-profit entity.

“Its principal place of business will be Mississippi, and as part of the push to get this adopted by the state lawmakers, we said this will be a Mississippi company staffed with Mississippi people who’ll be taking care of Mississippi patients. We just feel that’s extremely important in what we’re doing.”

By JONATHAN SCOTT

EDITOR’S NOTE: This marks the first of a two-part series that takes a look at healthcare-related legislation from the 2015 session of the Mississippi Legislature. The second part will provide an overview of other healthcare bills that came before state lawmakers.

While Tim Moore recently noted the 2015 session of the Mississippi Legislature “could’ve gone better” for Mississippi Hospital Association (MHA) members, the association managed to get a priority item on its legislative wish list approved: a bill that allows for the creation of provider-sponsored health plans (PSHP).

“We’re intrigued and excited about the opportunities, not only for the providers, but also for the patients,” said Moore, MHA CEO of Senate Bill 2441, passed by state lawmakers during the session that ended in April. “This provider-sponsored health plan is an opportunity to be a bigger part of developing a new delivery system that focuses on quality and outcomes.”

(CONTINUED ON PAGE 6)

New UMMC Chief Plans Focus on Collaboration

For LouAnn Woodward, challenging first month doesn’t alter core mission

By LUCy SCHULTZE

In February, LouAnn Woodward, MD, was appointed as vice chancellor for health affairs and dean of the School of Medicine at the University of Mississippi Medical Center.

The following month, the state Institutions of Higher Learning chose not to renew former

UMMC dean Dan Jones, MD, as chancellor of the University of Mississippi in Oxford. The IHL cited problems at UMMC as its reason.

Woodward, an emergency medicine physician, previously served for five years as vice chancellor for health affairs and vice dean for the School of Medicine. She has been a member of the (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Philip Scurria, MD

By LUCy SCHULTZE

In the nearly 20 years since he became Vicksburg’s first psychiatrist, Philip Scurria, MD, has seen the arrival of many more medications for treating mental illness than existed a generation ago.

But just as important a change has been the evolution of how his work is perceived in the community around him.

“A lot of people were not really open to seeing a psychiatrist when I first moved here,” said Scurria, who arrived in Vicksburg in 1996.

“I had a guy once call me at home one night to ask if he could come see me at my house, so that no one would see him walking into my office,” he recalled. “I politely said no. But over the years, I’ve seen the community grow much more open and supportive about treating mental illness.”

Before his arrival, psychiatrists from Jackson would visit Vicksburg to see patients, but Scurria was the first to live and work in the community.

While he was raised just 40 miles west of Vicksburg in the small town of Delhi, La., he hadn’t planned to return to the area for his medical career. He had spent the prior 15 years in New Orleans, with medical school at Louisiana State University School of Medicine where he stayed on for his residency in psychiatry.

Scurria then served as interim residency training director at LSU in New Orleans before moving to Vicksburg.

“I never thought I would move back,” he said. “Then an opportunity opened up here, when the hospital had just opened an inpatient unit. I really enjoyed teaching, but I felt like it was time for a change and Vicksburg has been a wonderful place JNLMSMed-2 to live.” JNLMSMed-2

Today, Scurria maintains an outpatient practice as part of Merit Health River Region. He most commonly treats depression and anxiety, as well as seeing some patients with bipolar disorder.

His shift to an outpatient-only practice came about a year ago. While he still serves as a consult liaison for the hospital, he was thankful for a chance to have a less-intense schedule.

“Inpatient work is just very demanding,” he said. “And because we have a shortage of psychiatrists, I had gotten to be busier than I thought was healthy for me. Having some other doctors wanting to do hospitalist work allowed me the chance to shift my practice to outpatient.”

According to Scurria, Mississippi has about half the psychiatrists needed to serve its population. Most of those are located in the major population areas such as Jackson, Hattiesburg and the Gulf Coast, he said.

“That’s the difficult thing about being in Mississippi, and in most places, actually: There are so few psychiatrists, we are all so

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JUNE 2015

busy,” he said, adding that in one recent letter he received from a recruiting firm, there were 160 open psychiatry positions around the country it was seeking to fill.

Among reasons for the shortage, he said, is the fact that psychiatrists’ medical toolbox was very limited until recent decades.

“For a long time, because psychiatry didn’t have a lot of medications to use, and not a lot of people went to them,” he said. “Treating the mentally ill was deemed more the realm of psychologists.”

That began to change in the 1960s with the introduction of tricyclic antidepressants, he said. The change accelerated in the 1980s with the introduction of Prozac and other selective serotonin reuptake inhibitor (SSRI) antidepressants.

Medical advancements have yielded antidepressants that are safer and more tolerable than those in the past, he said.

“Since then, there has been a lot more interest in the treatment of mental illness, as well as a lessening of the stigma of having a mental illness,” Scurria said.

“Hopefully more people now realize that it is a sickness that can be treated, rather than a character flaw or some sort of spiritual deficiency.”

Despite having more medical therapies to rely upon, Scurria makes psychotherapy a larger part of his practice than most psychiatrists do today.

“Our training program at LSU was a very psychodynamic program, with eight to 10 hours of psychotheraphy work each week in the fourth year of residency,” Scurria said. “I found out it’s really the fun part of being a psychiatrist. The medications are interesting, and they do help people. But to me, there’s nothing more special than a patient telling you some-

thing that they have never told a human being before in their life.

“They trust you enough to share that information, so that you can help them overcome what they’re facing.”

On behalf of his patients and his field, Scurria has devoted efforts to advocacy over the course of his career. He serves as a deputy representative for a 16-state area in the assembly of the American Psychiatric Association (APA) and is also a pastpresident of the Mississippi Psychiatric Association.

“Many of our challenges go back to that old stigma: ‘People are just crazy; they’re not really ill,’” he said.

“That’s why we have to continue to work hard to achieve parity in insurance coverage. It has been a really difficult battle for us. Mississippi has done a lot to try to make that happen, and on a federal level, it’s happening, too. But we’re still not treated equally.”

In the APA, Scurria has been named a distinguished fellow, the association’s highest honor for members.

Outside of his practice and advocacy work, Scurria enjoys spending time with his wife, Cindy Scurria, PhD, who chairs the English department at Alcorn State University. They have three grown children and one grandchild.

Scurria takes part in a weekly card game with friends who’ve played together for a decade. He and his wife enjoy LSU football games, amateur photography, and singing in the choir at Crawford Street United Methodist Church.

His shift to outpatient work has allowed him to focus more on those outlets.

“At 55, I’m in the last third of my career, so it was time for me to slow down,” he said. “For me, it’s about quality of life.

I have enough toys; I have everything I need and most of what I want. Balance in life is important, and I think there’s a lot of burnout among physicians because of the constant pressure to make more and more money.

“At some point, you have to decide: It’s about quality, not quantity.”

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Anderson Regional Cancer Center Makes Forward-Looking Addition TomoTherapy system offers helical delivery of radiation dose

By LUCY SCHULTZE

Like watching an apple ripen to perfection, Scott Anderson, MD, knew the time was right to pluck the newest technology in radiation therapy.

“I’ve been following this technology for more than 10 years,” said Anderson, radiation oncologist at Anderson Regional Cancer Center in Meridian, which this spring debuted the first Accuray TomoTherapy® system in Mississippi.

Anderson said the center’s decision to upgrade from its standard linear accelerator happened just as the TomoTherapy technology matured. The cancer center’s new system for Intensity Modulated Radiation Therapy (IMRT) follows two years of planning, construction and installation and represents about a $4 million investment.

“When I first began Dr. Scott following the technology, Anderson the concept appealed to me, but I saw the inherent limitations in where the technology was at that time,” he said. “It took the development of a colli-

mated head — which allows you to sharpen the edges of the radiation dose and reduce treatment times — to truly make the device a useful clinical entity.”

With that refinement in the new TomoHDA™ model, the cancer center was ready to make the leap.

The system blends the movements and functions of a linear accelerator and a computerized tomography (CT) scanner, providing a helical delivery of radiation dose with real-time imaging. It offers an improvement over systems which move in

a single-plane arc to deliver radiation, because it allows for the delivery of high doses of radiation with minimal impact upon surrounding tissues.

“You can really see what you’re doing as you’re doing it, and know that you’re hitting your target,” Anderson said. “It works well for stereotactic body radiotherapy and any sort of ablative radiotherapy. It provides a real advantage when you’re treating larger tumors and trying to prevent the dose from hitting adjacent structures in the body, or when you’re treating multiple tu-

mors that are close together and trying to protect the intervening tissues.”

The system is also offering new options in palliative care, he said, such as in the case of patients who have already been treated for a recurrent bone mass on the spine. TomoTherapy’s targeted dose can help eradicate the patient’s pain without causing damage to the spinal cord.

From Anderson’s perspective, the addition of the new system continues a history of forward-looking investments by Anderson Regional Cancer Center and its predecessor, Meridian Radiation Oncology Center. The practice was acquired by Anderson Regional Medical Center in 2000.

Anderson joined the practice in 1992 and remains its only radiation oncologist alongside five medical oncologists.

“A center’s reputation is built upon what equipment you have and on the personal reputation of the physicians and how you interact with those who refer to you,” he said. “We’re not a very big department, but we work very hard to ensure that our care is equivalent to anybody else’s.

“If I send people to MD Anderson in Houston or to the University of Alabama (CONTINUED ON PAGE 8)

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Five Ways Millennials Have Shaken Up Healthcare

They prefer alternative to single-source, PCP favored by older generations percent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 percent) visited their PCP significantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically. “Quick Care” availability has been recognized as a top priority by many healthcare organizations, and even large retailers and several pharmacy chains. Millennials expressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

By JULIE PARKER

The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down.

In a recently released survey commissioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, webbased diagnostic tools and research about treatment options have a role in healthcare decisions for millennials, replacing the single-source, primary care physician (PCP) favored by older generations.

“As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital channels that are consistent with their experiences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially considering that much of the growth in the

healthcare payments industry has been driven by a rise in patient responsibility.

Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fastpaced, technology-driven generation.”

Growing trends among the millennials that are driving change in healthcare include:

Speedy delivery

When it comes to the drive-thru generation, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14

Word-of-mouth marketing

Nearly 50 percent of millennials and Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 percent of baby boomers and 28 percent for seniors.

“The timely management of social media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a constant challenge for all practices. Get-

ting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”

Kick the tires online before buying

Half of millennials and 52 percent of Gen X-ers checked online information about their insurance options during their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company representative (38 percent) before selecting their plan.

Good faith, upfront estimates

One of five people surveyed by PNC listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more inclined (41 percent) to request and receive estimates before undergoing treatment.

Only 18 percent of seniors and 21 percent of boomers reported asking for or receiving information on costs upfront. Unfortunately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

“What we’ve found with our clients in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insurance coverage education due to the need to comply with healthcare reform requirements and for the sake of improving the profitability of the practice,” added Print.

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All age groups agreed that medical care is too expensive (79 percent) and healthcare costs are unpredictable (77 percent). But more than half of millennials (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).

“What we’ve found locally,” added Print, “is that with many patients neglecting their care due to costs, practices are addressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.”

PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.

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Helping Men Get Healthy

By CINDY SANDERS

American men live sicker and die younger than their female counterparts.

However, Men’s Health Network is working to change the status quo by reaching out to men where they work, live, play and pray.

“We want to make sure we are every place where men can be reached,” stated Ana N. Fadich, MPH, CHES, vice president of Men’s Health Network (MHN).

It’s mission critical, she noted, given some of the sobering statistics about men and their Ana N. Fadich well-being. Men have lower rates of health insurance coverage, a higher prevalence of death rates for nine of the 10 leading causes of death, fewer physician visits and cultural barriers to seeking help.

“A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have had a sustained, negative impact on men’s health in the United States. To reverse this trend, MHN is employing a number of strategies in an effort

to impact health in five key areas: • Reducing premature mortality of men and boys, • Enhancing physical and mental health of men for happier, fuller, healthier lives, • Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote healthcare services and healthy choices.

The Weaker Sex

While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls.

However, she continued, “Once they hit (age) 34, the numbers for men begin to decline. At retirement age, there are about 80 men to every 100 women.”

In general, men’s life expectancy tends to be five years less than that of women – 76.3 vs. 81.1 years, according to the latest data from the National Vital Statistics System. For non-Hispanic black males, life expectancy is even lower at 71.6 years. Additionally, the gender gap widens during teenage years and early 20s when

more men than women are lost to accident, violence and suicide.

In fact, suicide across all age groups is more prevalent in men. In 2013, men had a suicide rate of 20.2 vs. a rate of 5.5 for women. That year, death by suicide was 77.9 percent male compared to 22.1 percent female, according to the 2013 CDC Fatal Injury Report.

A December 2013 report from the U.S. Department of Justice noted the nation’s homicide rate fell to 4.7 homicides per 100,000 residents in 2011, the lowest level since 1963. Even so, of the 14,610 homicides in 2011, men accounted for 11,370 victims. From 2002 to 2011, the average homicide rate for males was 3.6 times higher than that of females, and young adults ages 18 to 24 had the highest homicide rate of any age group.

Changing Trends

Fadich said strategies including national awareness and educational campaigns, partnering with providers and organizations nationwide, and conducting screenings at events where men gather all enhance MHN’s efforts to change those trends.

From experience, Fadich noted, when a man is asked why he hasn’t gone to the doctor, the answer more often than not is because he can’t afford the time away from work. The answer, she contin-

ued, is to bring the ‘doctor’s office’ to the workplace. Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said. “Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.”

Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country.

The organization and its partners also have a strong presence at sporting events and in churches. “That’s where we do a lot of screenings and events – in the ‘play and pray’ portion of our mission,” Fadich said. She noted they have worked with the National Football League, National Basketball Association, and Major League Baseball in an attempt to reach men and boys.

Churches also play a key role in getting the message across. “A lot of the folks we reach are underserved and minority populations, and they are very connected to their churches,” she explained. Fadich added, “We always recommend they speak to their healthcare provider, but we get the conversation started.”

Provider Push

Fadich said physician visits really (CONTINUED ON PAGE 6)

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Legislative Wrap - Part 1, continued from page 1 Initially, Moore pointed out, the PSHP measure was misunderstood by some around the state. For instance, some were concerned that the plan was going to be paid for with either state or federal funds.

“That isn’t the case and never was,” Moore said.

Instead, the PSHP will simply be another managed-care product; however, this one will differ from others because it will be “driven, operated and governed by providers,” he said. These providers include physicians, hospitals and other caregivers around the state.

The not-for-profit Tim Moore entity will be, according to the measure, “owned and governed exclusively by (either) a not-for profit Mississippi hospital or physician industry or trade association in which the majority of the hospitals or physicians within the state are members, or a combination of not-for-profit Mississippi hospital or physician industry or trade associations that represent a majority of the hospitals or physicians within the state, and licenses Mississippi hospitals or physicians who participate in the Mississippi Medicaid Program.”

The bill also states that “hospitals owned by the state and hospitals owned by local government entities” can provide

funds for the establishment and operation of this provider-sponsored health plan.

“This means that public hospitals, like University Medical Center and Forrest General Hospital and Gulfport Memorial Hospital and Greenwood Leflore, could invest and be a part of this entity,” Moore said. “So that’s a real positive thing.”

The PSHP must also meet the same requirements as an insurance company or HMO. The MHA had initially wanted the PSHP to be a third option under Mississippi Coordinated Access Network (MississippiCAN). The Mississippi Division of Medicaid set up the Mississippi coordinated care network. The state Medicaid Division is contracting with only two coordinated care organizations - Magnolia Health and the UnitedHealthcare Community Plan.

Even though an earlier version of the PSHP measure contained wording that would have allowed this new entity to be a third coordinated care organization, state lawmakers removed that option in the PSHP bill that was ultimately adopted.

“That creates some obstacles for us, and we’ll just have to find some ways to deal with them,” Moore said.

Still, MHA is looking forward to making this recently approved measure a reality. To assist them with the work that lies ahead, the hospital association plans to continue working with the members of Evolent Health of Arlington, Va.

“At a board meeting in April, we agreed to bring back Evolent Health, which helped us with our Mississippi Provider-Sponsored Medicaid Health Plan Playbook,” Moore explained.

This playbook has served as the overall guiding force in this initiative.

The playbook is on MHA’s website, but Moore said the guide is in the process of being updated to reflect the changes state lawmakers made in the PSHP bill to get it approved.

As the PSHP takes shape in the coming months, MHA will be working closely with State Insurance Commissioner Mike Chaney and his staff to ensure all necessary steps are being taken to make the plan a legal entity.

Once Chaney’s office offers its input, MHA will then make sure healthcare providers in the state are OK with any changes made to the PSHP. “We’ll continue to have meetings with providers, and those providers in-

clude physicians, pharmacists, behavioral health, home health, hospitals, clinics - essentially everyone who touches a Medicaid patient,” Moore said. “We’ll talk about how to do this in a way that works for everyone. Certainly, No. 1, is that it works for the patient, and then we back up to ensure we can make it work for the providers.”

Ideally, PSHP supporters want to get enough done in the next six months so that they can return to lawmakers at the start of the 2016 legislative session in January and show that they are doing exactly what they said they would do.

If the process manages to avoid any major hurdles, Moore hopes that by June 2016, requests for proposals will be issued to those who want to provide the critical managed-care organization part of the PSHP. “We’ll see if we’re ready then or not, but that would be ideal if we’re moving forward at that pace,” Moore said.

Helping Men, continued from page 6 drop off for men after they age out of a pediatrician’s office. After that, she noted, “Women get called all the time for their pap smear or mammogram. Men aren’t getting those kinds of calls.”

Knowing that physician encounters aren’t as frequent, the hope is that providers will start deeper conversations with men about family history, diet, prostate and testicular cancer, and other health concerns any time an opportunity presents … whether it’s after a sports injury, work accident or a collegiate STD scare.

“We want men to start thinking about health at a younger age and recognize what they are doing now will affect health in their 50s and 60s,” Fadich said.

Men’s Health Month

Fadich noted Men’s Health Week – the week leading up to Father’s Day – started in 1994 and was signed into law

by President Bill Clinton. “We encourage men to wear blue during that week in recognition of men’s health,” said Fadich, who added the number of events has grown so significantly over the years that one week is no longer sufficient. “Now we use the entire month of June to raise awareness about men’s health.”

To request materials and resources or to learn how to partner with MHN, go online to menshealthnetwork.org or call (202) 543-MHN1 (6461).

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In April, Rep. Markwayne Mullin (R-Okla.) and Rep. Donald Payne, Jr. (D-N.J.) were announced as co-chairs of the newly re-authorized Congressional Men’s Health Caucus of the American Public Health Association.

Rep. Markwayne The Caucus is dedicated to raising awareness of male health Mullin issues, encouraging men and boys to take an active role in their personal health, and promoting legislation that has a positive impact on the health of American men, boys and their families. The bipartisan Caucus, which was formed in 2010, works closely with Men’s Health Network to ensure issues affecting men and boys have a place in government healthcare priorities.

“After witnessing my father lose his battle to colorectal cancer, it became my mission to raise awareness about the importance of Rep. Donald Payne preventive care and to help reduce health disparities across diseases from cancer to diabetes,” said Payne.

Co-chair Mullin added, “I consider fitness a necessity to a good life so I’m proud to help lead the Men’s Health Caucus in its mission to promote healthy living across the country. It’s incredibly important that our nation’s youth understand how to exercise and eat right so that they can live healthy, productive lives.”

The Caucus has established a Prostate Cancer Task Force, which is charged with increasing awareness of the disease. The group is also conducting outreach to three groups with especially high risk of developing prostate cancer – AfricanAmericans, veterans exposed to Agent Orange, and individuals with a family history of the disease. Additionally, the Caucus, in conjunction with Men’s Health Network, has led briefings on a number of topics impacting men’s health and will continue these efforts to educate Congress and the general public.

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The Challenge: Getting Paid

This partner in patient receivables doesn’t send invoices until hospitals save money

By JULIE PARKER

As the American culture shifts to grind more financial responsibility onto patients, hospitals are facing more costly hurtles.

A few sobering facts: 81 percent of true self-pay responsibilities are never recovered; 75 percent of patient responsibilities are never collected; and self-pay is the third most frequent payment method after Medicaid and Medicare. On average, only 10 percent of patient receivables is collected at the time of service. More than half of all bad consumer debt relates to medical bills, leading an unprecedented number of patients to file for bankruptcy protection.

“Hospitals have been dealing with self-pay for some time, but not in the volume or dollars we see now,” said Sheila Schweitzer, CEO of PatientMatters, a 30-year veteran in healthcare administration – half on the payor side; half on the provider end. “The cash at stake is substantial and harder to collect than a third party. It’s imperative to have a patient receivables strategy in place, or bad debt and charity care will continue to skyrocket.”

David Shelton, COO of PatientMatters pointed out the predicament: “The

challenge we must address is helping our hospitals adapt, and adapt quickly.”

For Schweitzer, PatientMatters was preceded by CareMedic Systems Inc., a healthcare technology revenue cycle firm with 1,600 hospitals and 1,000 ancillary facilities at the time it was sold in 2009.

CareMedic successfully brought to market the first enterprise class revenue management system: the electronic Financial Record (eFR).

“Even though we focused on thirdparty billing and management, it became very obvious that patient receivables would be the next big challenge,” said Schweitzer, noting that in 2007, only 4 percent of revenues were coming from patients. By 2011, patient revenues averaged 32 percent. “The problem was growing really fast. Hospitals and physicians just aren’t accustomed to healing patients and then asking for money.

We felt there had to be a real behavior change of hospital staff and patients to improve the collection ratio of patient receivables.”

Schweitzer and her executive team researched the market and couldn’t find a company with the technology infrastructure that adequately supported the data needed to convert patients’ complexities around their coverage.

“We found that even the tightest-run patient access departments are having difficulty getting their arms around the evolving patient receivable,” she said. “The fact is, though healthcare reform may be a notable accelerant, the issue runs much deeper. Hospitals are seeing their revenue sources change completely as patients leapfrog private insurance (as) the thirdlargest payor.”

Before opening PatientMatters, Schweitzer made two strategic acquisitions, including MASH (Medical Advocacy Services for Healthcare), a Medicaid eligibility service since 1988, and Kramer Technologies, a technology firm.

“We took our time to really understand our market and hone our training, communications and processes to satisfy the hospitals and the patients,” she said.

“We’re very bullish on where we are.”

Since the firm opened in 2012, revenues have reached $25 million and employment tops 200. Based in Orlando, with offices in Houston and Ft. Worth, Texas, PatientMatters has hospital partnerships across the United States. The most recent hospital contract inked was St. Luke’s Cornwall Hospital, with campuses in Newburgh and Cornwall, NY. “We guarantee cost savings,” said Schweitzer. “We put resources on staff at

the hospital. We only generate revenue after the hospital has seen an improvement. We’re not subscription- or feebased. We actually align with the hospital.

We only win when they win.”

PatientMatters focuses strongly on the unique market of community hospitals, which cannot afford to have high patient receivables to continue to provide a sustained high level of care.

“We feel so strongly that community hospitals are vital to this country,” said Schweitzer. “They’re usually the largest employer in the community and provide very good care. We worked on modeling our processes and approach for that midtier market.”

PatientMatters places personnel with significant hospital operations experience in contracted hospital roles such as executive director of patient access and patient advocates.

“We bring in statements we’ve carefully and thoughtfully designed with great input from focus groups of patients,” she explained. “On the back of the statement, we describe what everything means. We bring in many programs to help patients find ways to pay their bills.

We find that most patients want to pay their bills if they understand what they’re being charged.”

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New UMMC Chief Plans Focus on Collaboration, continued from page 1 UMMC faculty since 1995.

Mississippi Medical News spoke with Woodward during her second month in her new role.

What effect has the IHL’s action in March had at UMMC? Has the situation changed the mission and challenge you face as its new dean?

“It definitely has not been the first month I was expecting. Many of our faculty members, students, residents and employees here knew Dr. Jones well and worked with him when he was here, and continued to have a relationship with him since he’s been in Oxford. On a personal level, we are sad, because we will miss that opportunity for his continued leadership.

“As far as the mission of the medical center — that hasn’t changed. And the challenges we face here, to a large degree, are tied to things that are happening at the national level, like funding of healthcare delivery and of graduate education. That certainly hasn’t changed. Likewise, our greatest challenges continue to relate to health outcomes in Mississippi.”

You’ve responded to IHL’s references to financial problems at UMMC. What do you feel like is most important for the state medical community to know about what UMMC has done to remedy issues about bookkeeping and contracts?

“First of all, we are financially strong.

That’s a word that can mean a lot of different things, but the bottom line is: We’re financially stable. We always have more needs and desires than we have resources, and that will not change. We’re not an institution that has a 10-percent margin.

We hope this year to end around a 2- or 2.5-percent margin — and for an academic medical center, that is very strong.

“The particular issues that came up around contracts were really tied to the fact that, 10 years ago, we had a manual and decentralized process for how we managed our contracts. We’ve been working for a long time to change that, and the process started before Dr. Jones left here to go to Oxford.

“We did a major implementation of Lawson products to get us on an electronic platform. We also put in an electronic health record system using Epic. We’ve invested over $100 million in resources and infrastructure to make our process more centralized and electronic.

“So we are in a good place now, and we’re always working to improve. The one thing I want to make sure people understand is that at no point were there any activities that were deemed to be illegal. In every case, we got what we paid for. There were some sloppy processes along the way, and those have been greatly improved and centralized.”

Former UM Chancellor Robert

Khayat in an editorial condemned the IHL’s decision and admitted that Jones had been the only UM chancellor to actually understand the operation of UMMC. Is it time for a different model of governance for UMMC? “I’m not in a position where I can say ‘yes’ or ‘no.’ We are large. We are complex.

We are very different than the other institutions that fall into the IHL bucket. Just from the standpoint of our budget: The $100 million we’ve invested in electronic infrastructure is larger than some colleges’ entire budgets.

“So, we are very different. That’s why, a couple of years ago under the leadership of Dr. Keaton and Dr. Jones, the IHL established a Health Affairs Committee so that we would have the opportunity to meet with them once a month and be able to talk in more depth about things that are happening here. That’s been a positive activity.

“However, if there are forces that feel like we need to go in a different direction, this is not a decision that needs to be made in a couple of days. It needs to be studied carefully and deliberately, thinking broadly about the different consequences. We’re not unique in the fact this discussion is happening around us; the same conversation is happening at other academic medical centers around the country. There isn’t a clear ‘best model.’

“It’s also important to point out that, although we are a very different kind of institution, the University of Mississippi is our parent institution, and maintaining that connection is very important to us.”

If the state medical community could do one thing to advocate for the improvement and advancement of UMMC for the sake of healthcare in Mississippi, what would that be?

“Dr. Keaton did a lot of work during his five years in helping the medical community and others understand what we do and the services we provide. I think one way he really left his mark was in getting the word out that we belong to everybody.

We want to provide the services that might not be provided elsewhere, and we want to keep Mississippians in Mississippi for their healthcare to the degree possible. He laid that groundwork, and we are poised now to do some really positive things for Mississippi.

“It’s my intent over this first year to pull together interested parties, and then to carefully select measurable health outcomes that we might impact. We have a pilot program going on now in Sunflower County, using telemedicine to help control diabetes.

The results are preliminary, but they’re very positive in terms of what might be accomplished. If we can take the lessons we’ve learned in this pilot and partner with others on projects like this, we’ll be able to make a big difference.

“I want to see entities across the state come together to tackle some of our biggest health challenges and work toward some very specific goals. Mississippi ranks the worst in everything, and one organization on its own cannot make an impact on that.

But with multiple organizations all pulling in the same direction, our state can look a little different five years from now. If we don’t do it, who will?”

Anderson Regional, continued from page 3

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at Birmingham, they send them back. We can treat almost anything that would be sent to us — and what we can’t, we will send the patient to whoever is best in the United States at providing the treatment they need.”

In terms of keeping up with the latest technological advances, Anderson has learned there’s a balance to staying up-todate without getting too far ahead. Over the years, he has held back from pursuing new treatments like intravascular brachytherapy or endorsing expensive systems for proton therapy.

“Sometimes technologies are shortlived after the initial studies come out showing they don’t offer a real benefit for enough patients,” he said. “You wouldn’t want to rush and put a proton center here in Mississippi, because it would be a waste of money.”

Having watched the TomoTherapy technology evolve since its acquisition by CyberKnife™ maker Accuray gave Anderson confidence that the timing was right.

“TomoTheraphy has become their main product, while the CyberKnife is somewhat more passé,” he said. “In the coming years, you’ll see more and more people purchasing these units, because the company now has the cash infusion and the product is good. They also have good sup-

port for the product, which was a problem earlier but has been corrected.”

The process of installing the system involved reconfiguring an older linear accelerator vault and its supporting rooms within the original part of the cancer center’s facility. A specialized team from Chicago came in to precisely cut the pattern for the new device in the floor, then the area was rebuilt to meet all shielding requirements.

“It was better than building a new vault,” Anderson said, “but it wasn’t inexpensive.”

The process was made more convenient by the fact the layout of the building allowed for a temporary partition to be erected between the construction zone and the rest of the cancer center, where treatments continued as usual using two additional linear accelerators.

“There’s nothing wrong with our standard linear accelerators, and they continue to be our workhorses,” Anderson said. “As we refine our techniques around the new TomoTherapy system, it will become our workhorse.

“The bottom line for us, each time we advance our technology, is not to buy today’s midgrade. We try to stay on the cutting edge and look ahead to where technology is going in the next five years.” mississippimedicalnews

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The Competing P’s: Provision & Payment Changing reimbursement for new models of care

By CINDY SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.”

Nashville-based Sheidy said the Cen- Dion Sheidy ters for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years.

In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and dupli-

cation. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment.

Value-based purchasing includes payments in categories two through four.

The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps.

We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to value-based payment.

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax

survive and get implemented as it stands today?”

That question, he added, probably won’t be answered until after the presidential election.

The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.”

He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through statements around the move to the 80 percent

(value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short window of time.

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GrandRounds Anderson Regional Medical Center Announces New CEO Anderson Regional Medical Center announced John G. Anderson, FACHE, as the new President and Chief Executive Officer.

Anderson has served as Interim CEO since August 2014. Anderson was first named as a Vice President in 1990, with adJohn G. Anderson ditional responsibilities as Vice President of Operations from 2008-2011. In 2011, Anderson was named Vice President and Administrator of Anderson Regional Medical Center- South, roles he continued to fulfill during his time as Interim CEO. Prior to joining the Anderson system in 1990, Anderson served as Assistant Administrator of Tift Regional Medical Center and CEO of Tift Regional Foundation, Tifton, Georgia, as well as Assistant Administrator, Brookwood Medical Center, Homewood, Alabama.

Anderson is a Fellow of the American College of Healthcare Executives (FACHE), the nation’s leading professional society for health care leaders. He is a graduate of the University of Mississippi with a Bachelor’s of Science in Psychology, and he has a Master’s of Science in Health Administration from the University of Alabama at Birmingham.

Anderson is a member of the Mississippi Hospital Association (MHA), the MHA Legislative Action Committee, and he is a board member of East Central Healthnet. Anderson is a past Board President and Campaign Chair for the

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United Way of East Mississippi. He currently serves as Board President for the Mississippi Industry for the Developmentally Disabled-Meridian Division.

Baptist Golden Triangle Names New Chief Financial Officer Baptist Memorial Hospital-Golden Triangle has named Pam Richardson as its new chief financial officer. Richardson has worked at Baptist Golden Triangle since 2002 as both assistant controller and controller.

She replaces David Pam Richardson Webb, who took a similar job in South Carolina. Former Assistant Controller Thomas Steadman will replace Richardson as Controller.

A native of Columbus, Richardson is a 1994 graduate of Columbus High School and earned a bachelor’s degree in accounting from Mississippi University for Women.

Richardson has a strong background in finance working as a staff accountant at T.E. Lott and Company in Columbus and a Trust Accountant at NBC in Columbus before coming to Baptist.

Richardson lives in Columbus and in her free time enjoys spending time with her family and her dog. She is a member of the Healthcare Financial Managers Association.

Waites Elected to Board of Trustees Thad F. Waites, MD, FACC, a boardcertified cardiologist with Hattiesburg Clinic Cardiology, was recently elected to the Board of Trustees of the American College of Cardiology (ACC).

The ACC is a professional organization that works to improve cardiovascular health through education,research, quality care and health policy. As a member of the Board of Trustees, Dr. Waites is one of 31 elected members who govern the college and are responsible for managing all business to help carry out the organization’s mission.

Waites was elected to the board in 2014 to serve a five-year term. In his previous term on the board, Waites served ex-officio as secretary of the college and chairman of the board of governors.

Waites practices interventional cardiology with an emphasis on catheterbased treatment of heart diseases. He is currently director of the cardiac catheterization laboratory at Forrest General Hospital.

Memorial Physician Clinics Welcomes Cardiologist Bassam R. Baroudi, MD Memorial Physician Clinics is pleased to welcome Bassam R. Baroudi, MD, FACC, FSCAI, in practice at Memorial Physician Clinics – Coast Heart Institute.

Dr. Baroudi earned his medical doctorate at the University of Damascus

Medical School in Syria. He completed his internship and residency in internal medicine at Meridia Huron Hospital – Case Western Reserve University Affiliate, Cleveland, Ohio; and Dr. Bassam R. Baroudi completed a fellowship in Cardiology at the Case Western Reserve University Metro Health - Mt. Sinai Medical Center, Cleveland, Ohio.

Dr. Baroudi is board certified in cardiology and interventional cardiology.

He has been a member of Memorial Medical staff since 1997.

St. Dominic’s Receives Target: Stroke Honor Roll Elite Award The American Heart Association/ American Stroke Association presented St. Dominic’s with the “Get with the Guideline-Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll Elite” in April in the St. Dominic Hospital auditorium.

The award recognizes the hospital’s commitment and success to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines founded on the latest scientific evidence.

To receive the Gold Plus Quality Achievement Award, hospitals must achieve 85 percent or higher adherence to all Get with the Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get with the GuidelinesStroke quality measures.

For a hospital to qualify for the Target: Stroke Honor Roll Elite award, it must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA (the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke). If given intravenously in the first three hours after the onset of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. St. Dominic’s earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

Clarification In an April story titled “Benefitting Central Mississippi” there was a statement that Scott Whittemore and Charlotte Dupre were removed from their positions in an executive shakeup. They report that they resigned. Representatives of Merit Health declined further comment. We apologize for any error.

PUBLISHED BY: SouthComm, Inc. ASSOCIATE PUBLISHER Kathy Arich karich@mississippimedicalnews.com Ad Sales: 601.941.3075 ACCOUNT EXECUTIVE Perry Patterson LaCour placour@mississippimedicalnews.com Ad Sales: 601.941.1603 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Julie Parker jparker@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak James Osborne, Christie Passarello

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The Mississippi Heart and Vascular Institute at St. Dominic’s is a leader in providing cardiovascular care to Central Mississippi.

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