Mississippi Medical News August 2013

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August 2013 >> >> $5 December 2009

PHYSICIAN SPOTLIGHT PAGE 3

W. Ashley Hood, DO ON ROUNDS

Incentivizing Medical Professionals Mississippi leaders increasing residency slots, growing MD population

By LyNNE JETER

BlueBin Bound

Hospitals embrace lean supply system as part of ‘continuous improvement’ process Expensive technology not needed. Barcodes are the key.

Get rid of the warehouse. And take doctors and nurses out of the inventory control process ... 5

HAI ‘Kryptonite’

Novaerus technology called ‘the most significant development in HAI prevention in decades’ TAMPA – When West Gables Health Care Center Administrator Marco Carrasco learned about a new technology to reduce healthcare-acquired infections (HAI) at the 120-bed skilled nursing facility in Miami, where the median age is 86 and the average short-term stay is 32 days ... 7

ONLINE: MISSISSIPPI MEDICAL NEWS.COM

True, Mississippi ranks last in physicians and primary care providers per capita, and number 43 for total residents and fellows in Accreditation Council for Graduate Medical Education (ACGME) programs per capita, according to the Association of American Medical Colleges (AAMC) 2011 State Physician Data Book.

But those low posts in the national scope are changing. State incentives for physician recruitment and residencies are underway, and the number of residencies for medical school graduates is rising annually, thanks to collaborative efforts between state government and University of Mississippi Medical Center (UMMC) leaders.

“In the early 1980s, we had 150 students per class,” explained LouAnn Woodward, MD, (CONTINUED ON PAGE 8)

Provident Care

Crossroads Clinic and Mississippi Center for Justice see immediate response to state’s first medical-legal partnership benefitting HIV/AIDS patients

By LyNNE JETER

At the Mississippi State Department of Health’s Crossroads Clinic at the Jackson Medical Mall, Arti Barnes, MD, moves rapidly between patients. Even though her pace is brisk in the hallway, Barnes takes time with each patient, many with HIV/ AIDS. The Jackson site is one of few in the state to not only treat patients with HIV/AIDS, but to also actively recruit them.

Coming Soon!

Now the clinic has a legal partner in an unlikely union between lawyers and doctors.

“People living with HIV who visit a provider are less likely to spread it, and being able to curb the virus is critical in an environment like Mississippi, where STDs are rampant,” said Barnes, an infectious disease specialist at Crossroads Clinic, and assistant professor of medicine at the University of Mississippi Medical Center (UMMC). “The (CONTINUED ON PAGE 11)

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PhysicianSpotlight

W. Ashley Hood, DO

By LUCY SCHULTZE

For W. Ashley Hood, DO, seeing the ranks of fellow osteopathic doctors grow alongside those of MDs is an encouraging development for healthcare in Mississippi.

“I think it’s just a really exciting time in general for the entire state,” said Hood, a Jackson OB/GYN who chairs the women’s-health program at William Carey University-College of Osteopathic Medicine in Hattiesburg.

“To have two medical schools in Mississippi is huge, and we are very excited to be graduating our first class next year,” Hood said. “We hope to retain many of the DO students here in Mississippi.

“Osteopathic medical schools traditionally graduate more students interested in meeting the primary care needs of our population. There is an enormous need for primary care, especially in rural areas.”

In practice since 2006, Hood holds a central position in the growing community of osteopathic practitioners in Mississippi.

He is currently serving a two-year term as president of the Mississippi Osteopathic Medical Association, which represents more than 300 osteopathic physicians and more than 400 medical students. He has also served on a number of councils and committees for the American Osteopathic Association.

Hood’s own practice is based in his office at the Baby Suites at River Oaks Hospital. He is also on staff at Woman’s Hospital and St. Dominic’s Hospital.

He utilizes osteopathic manipulative treatments often in his practice, from applying lumbar and sacral treatments for pregnant women with low back pain or sciatica, to providing treatments that alleviate carpal tunnel syndrome or reduce the frequency of

tension headaches and migraines.

“I use osteopathic manipulative treatments alongside conventional medical management to care for my patients. There does exist evidence-based research that shows osteopathic manipulative treatment helps treat low back pain in pregnancy,” Hood said. “There are also many other studies that support using manipulation to accompany conventional medicine in many other areas of healthcare. However, there is a great need for continuing research in the field of osteopathic manipulation.”

The osteopathic approach is one Hood adopted through the mentorship of a Jackson physician, Sam Fillingame, DO. “When I was interested in medical school, he took me under his wing and had me shadow him in his clinic,” Hood said.

“He talked to me about looking at medicine as a way to restore the body to its natural structure and help the body heal itself , in addition to learning the evaluation and

medical management of many diseases.

“I fell in love with the philosophy and now get to use those techniques and treatments in my office.”

Hood received his doctor of osteopathic medicine degree from the Kansas City University of Medicine and Biosciences-College of Osteopathic Medicine. He returned to Jackson for his internship and residency in OB/GYN. A native of Mississippi, Hood moved often with his family as the son of a Baptist preacher. He was born in Natchez and spent time in Laurel before his family settled in the Florida panhandle for much of his youth.

The family moved to Canton, where Hood graduated from Canton Academy.

He went on to Mississippi College in Clinton for his undergraduate degree in biology.

After his medical training, Hood practiced briefly with another physician before choosing to establish his own clinic.

“I literally didn’t have a paperclip to my name,” said Hood, who opened his solo practice in June 2008. “People are still amazed at how I started my own business, but it was just necessary. I had a great deal to learn about the business of medicine.”

To cut costs, Hood has been able to share a lab, ultrasound room and sonographer with a colleague across the hall, William Bush, MD, who also allowed Hood to see patients in his clinic for two weeks while he got his own operation up and running.

Hood was able to join an eight-physician call group, which makes covering the unpredictable evenings and weekends of an OB/GYN practice possible.

“If I didn’t have a call group, life would be much harder,” he said. “It’s a good thing to have other willing physicians that I trust to care for my patients.”

Hood’s practice continues to grow. He recently added onto his waiting room and received approval to expand his practice with another physician or two as well as a nurse practitioner in the near future.

“A lot of our patients like the feel of a smaller office, so I don’t want to get too big,” he said. “They seem to appreciate a more personal experience from myself and my staff.”

Five years out from his bold move, Hood is thankful for the way his practice has become established.

“I never set out of residency saying, ‘I think I’ll set out as a solo OB/GYN,’” he said. “It was definitely scary, but it has worked out wonderfully.”

Likewise, Hood is hopeful for the continued growth of osteopathic medicine in Mississippi. His role with the WCU College of Osteopathic Medicine includes teaching women’s-health lectures to second-year students and having third- and fourth-year students perform rotations at his practice.

Next steps for the state, he said, include developing new opportunities for graduate medical education.

“We are hoping to see some residency programs start up in places like Hattiesburg, Laurel and Gulfport,” Hood said.

“There are some wonderful hospitals in our state that would be big enough to actually train interns and residents. I hope we see that develop soon.”

Outside of work, Hood enjoys playing golf and spending time with his family. He also plays piano and trumpet, and is an active member of Crossgates Baptist Church in Brandon.

He and his wife, Summer, have a busy life with four children including Taylor, 17; Hannah, 14; McKenzie, 11; and Kingston, 3.

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Understanding Your Motivational Drivers

By MARTIN WILLOUGHBY

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Recently, I have spent a good amount time with an elderly family member helping her navigate the medical system and deal with her failing health. As I interacted with multiple medical facilities, physicians, nurses, and social workers, I was reminded of the critical role that teamwork plays in providing quality care for patients. I often see teamwork expressed as a core value or part of a mission statement for organizations. They realize that poor teamwork can lead to disastrous results. In the medical field, poor teamwork can lead to wasted resources, unnecessary medical problems and even death.

Teamwork is a great slogan and its importance is evident. However, I believe creating a functional team requires a little closer analysis. Whenever a team comes together to accomplish a task, it is essentially a group of individuals who each bring their own attitudes, experiences, and personalities to the project. Because we each bring our own “baggage” to the table, creating a high performance team can be a real challenge. Russian Novelist Leo Tolstoy wrote in Anna Karenina, “Happy families are all alike; every unhappy family is unhappy in its own way.”

Similarly, dysfunctional teams tend to be dysfunctional in their own way. Organizations spend billions each year attempting to make their teams more “functional.”

Unfortunately, these initiatives can do little or no lasting good if they don’t get to the root of the challenge.

Families have a hard enough time functioning smoothly and the members are knit together by blood or legally. In a workplace setting, it is a real challenge to get people to align around common goals. One of the biggest obstacles is the “I” problem. As the old locker room slogan states – There is no I in TEAM! We are essentially selfish creatures and most come into a team setting focused on their own needs. One of the worst things you can say about a professional athlete is that he or she is a “selfish” player. There is no way to win championships with selfish play. Similarly, there is no way to be successful in business over the long term with ego driven and selfish behavior.

Even when the “I centric” view is not overtly selfish, it can also manifest in being “blind” to other personality types and communication styles. We tend to incorrectly assume everyone is just like us. In my work with Dr. Paul White, au-

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thor of The Five Language of Appreciation in the Workplace, I have gained a much better understanding of how we all receive appreciation differently, and if you want to effectively show someone appreciation it needs to be in their specific “language.”

I have mentioned in this column before the importance of the Platinum Rule which means that we treat people in the way that they want and deserve to be treated. In a team setting, this has particular importance. It shifts the focus off the individual and on to his or her teammates.

We start to consider other people’s needs and work to meet them.

The harsh reality in life is that the only person you can truly change is yourself. Therefore, one of the ways that YOU can be a better teammate is to become self-aware. Do you know your own personality, communication style, and personal needs? If you do, then you can share that information with your teammates and hope they will honor them. You can also ask questions of your teammates to learn more about them and what really motivates them.

The military figured out a long time ago how to give people a crash course in teamwork. They put people through boot camp which compresses the time frame for people to “figure each other out” and learn how to get along for the common good. That is the goal of many teambuilding exercises as well, although most are too short to have an impact.

One tool I am very excited about to help cut through the learning curve for team members is an assessment my colleague Dr. Carl Hicks recently created in collaboration with Birkman International®. This assessment entitled “Understanding My Motivational Drivers” produces a short report which provides information on the following: (a) How to manage me, (b) How to talk to me, (c) Biggest mistakes you can make with me, (d) How to incentivize me, and (e) Motivating me for best performance. I now provide my assessment report to people I am collaborating with on projects as a “cheat sheet” on how we can best work together which saves significant time and energy.

Consider the teams that you are formally or informally a part and their current state. Are they on their way to becoming high performance teams? If not, consider how you might take the lead by becoming aware of your motivations and style and help others to recognize and appreciate their differences. You may just be the catalyst for helping to take your team to the next level!

Martin Willoughby is a serial entrepreneur, author of the book Zoom Entrepreneur, and a business consultant.

Direct questions to Martin at martin. willoughby@butlersnow.com

mississippimedicalnews

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BlueBin Bound

Hospitals embrace lean supply system as part of ‘continuous improvement’ process

By LYNNE JETER

Expensive technology not needed.

Barcodes are the key. Get rid of the warehouse. And take doctors and nurses out of the inventory control process.

In 2009, Charles Hodge gave that advice on ways to streamline hospital supply inventory, when he served as chief procurement officer and vice president of supply chain management at Seattle Children’s Hospital, a major pediatric referral center in Seattle, Wash.

At the time, Hodge was in the midst of a four-year journey to implement BlueBin, a smarter inventory process involving barcodes, simple bins and basic wire racks at key traffic areas and points of care. He had developed BlueBin after working in the automotive industry for 15 years, and transferring its lean manufacturing processes to the healthcare industry’s supply management realm.

Hodge’s just-in-time inventory system eliminated the hospital’s need for its $5 million, 40,000-square-foot warehouse and millions in inventory. In its first year, the $200,000 system achieved a $2.5 million return, said Hodge.

Particularly because the supply management process was new to the hospital industry, executive sponsorship was criti-

cal for BlueBin to succeed, said Hodge.

“There’s no substitute for executives who are firmly committed to continuous process improvements,” he said. “Make sure you secure their strong support and communicate your results early and often to keep the momentum in place.”

Supply Chain Process Redefined

Hodge, the primary architect of

BlueBin, may perhaps seem to be an unlikely source of such an innovative, low startup cost supply management system.

His career began in 1993, after earning a business administration degree from California State University. An MBA from the same university in 2001 helped him traverse growing roles of responsibility in capital equipment, electronic chemicals, and automotive manufacturing sectors.

Before joining Seattle Children’s Hospital and Research Institute, he served as regional director in charge of supply chain management operations for Sutter Health’s peninsula coastal region, and a member of the health system’s corporate

strategic sourcing group.

“I took the lessons learned from kanban systems and applied them to elements of patient flow and care delivery,” said Hodge. “After I implemented the BlueBin system at Seattle Children’s Hospital, other hospitals started calling me, asking how we did it, and the timing seemed right to start my own consulting firm.”

With the BlueBin system in five hospitals across the nation, from brand new to nearly 160 years old, Hodge said consulting groups are keen to learn more about the kanban conversion from the automotive to the healthcare industry.

“For example, Joan Wellman & Associates, the consulting firm for Nemours Children’s Hospital in Orlando, brought us together,” he said. “When hospital leaders start to think about hospitals more like a manufacturing environment, the supply chain bubbles up as a problem because traditional management systems (like the par cart and automation methods) haven’t been changed in decades, and they just don’t work very well. They only work because clinicians and technicians are heavily involved in managing their own supply chains.

“Our program says no to that. Get those folks back to the patients, the bed(CONTINUED ON PAGE 6)

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BlueBin Bound, continued from page 5 sides, and the families. Let the supply chain do it all, and more efficiently. No inventory. No stat calls. No urgencies.

No ‘hey, where is this?’ No off-contract purchases. It saves a lot of money, space and time, and gives that time back to the patient.”

One Hospital’s Lean Journey

When Nemours began its lean healthcare cultural transformation journey in 2008, the executive team huddled to define very specific and focused strategic goals, while also aligning all associates in the organization around those goals.

“We’ve achieved great results but still had variation in those results, and we wanted to find something that would really help us catapult our work in a constant quest for perfection in everything we do – the highest quality, no safety errors, a 100 percent engaged workforce. Clearly, we’re focused around quality and patient care and safety, engaged people, and stewardship,” said Mariane Stefano, vice president of service and operational excellence for Nemours, whose healthcare career began “as a nurse, rummaging through supply closets.”

As part of this quest, hospital leaders began seeking a more efficient and effective management system for medical supplies, the second largest expense for most health systems, accounting for up to 20 percent of hospital costs. They were en-

This is Charles Hodge from BlueBin touring healthcare/hospital representatives during the GEMBA Walk at Nemours.

couraged to learn about Seattle Children’s Hospital recapturing an estimated 48,000 hours for patient care instead of scavenger hunts for needed supplies. The executive team embarked on a study trip to Autoliv, a manufacturer of air bags and other components for the automotive industry, followed by a “totally fascinating” tour of the Toyota plant in Kentucky to see how lean tools and principles impacted the end product, said Stefano.

The team’s next stop: Seattle Children’s Hospital, now a 400-bed pediatric hospital that’s been on a lean journey

since the late 1990s.

“We saw firsthand how these tools that were being used in the automotive manufacturing industry could easily be applied to a healthcare environment,” said Stefano. “We knew the tools and principals of a lean environment could really help in terms of problem solving, removing waste and inefficiencies from our system, and making sure that everything stays focused on the customer.”

When the team returned to the east coast and gathered around the Nemours table, “we knew this is exactly what we

needed as part of our organizational transformation journey. We were sold on it once we saw how it worked.”

Nemours implemented BlueBin three months before the children’s hospital opened last October, a timeline that proved challenging and in hindsight was “way too fast,” said Stefano, primarily because of changes in the vendor and supplier distribution flow.

“It was a very fast process and we had bumps in the road,” she explained. “We had to change our main supplier to make sure we had suppliers that would work in this type of Demand Flow system and would be willing to deliver supplies daily rather than weekly, and in the quantity we needed instead of bulk. If we need 10 Band-Aids for a supply unit, that’s now what we get.”

The investment of upfront manpower implementing the system “will be recouped 10 times over,” said Stefano.

“One, you’re no longer holding inventory so that cost decreases; two, the most powerful point of the BlueBin system is that it takes the clinical staff totally out of the supply management work.

Demand-Flow Supply Replenishment Model

In early June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA (CONTINUED ON PAGE 12)

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HAI ‘Kryptonite’

Novaerus technology called ‘the most significant development in HAI prevention in decades’

By LYNNE JETER

TAMPA – When West Gables Health Care Center Administrator Marco Carrasco learned about a new technology to reduce healthcare-acquired infections (HAI) at the 120-bed skilled nursing facility in Miami, where the median age is 86 and the average short-term stay is 32 days, he immediately contacted the Tampa-based company that developed it.

Soon after, Carrasco implemented Novaerus, the first scientifically-proven system for airborne infection control, HAI and disease prevention. Encased in small, inconspicuous units, Novaerus provides continuous airborne infection control by passing air through its patented disruptive plasma field. The process emits billions of harmless electrons that destroy the protein bio-films of viruses. It also breaks down the cell walls of bacteria, and denature mold, allergens and odors.

Cost effective, each unit requires less energy than a 40-watt light bulb. Environmentally, Novaerus eradicates nearly 100 percent of all airborne pathogens and

reduces microbial surface counts by up to 90 percent.

“We’re on the cusp of the next significant advancement in medical technology, and once healthcare facilities across the country are able to follow our lead, I expect we’ll finally see a reversal in the ever-growing numbers of HAI cases,” said Carrasco.

For a before-and-after comparison, West Gables Health Care Center had 485 admissions, of which eight patients were re-hospitalized for pneumonia during the

second half of last year. During the first two months of this year with Novaerus technology, Carrasco noticed enhanced quality outcomes and a significant reduction in re-admissions. Of 115 total admissions during that time frame, only three patients were re-hospitalized for pneumonia.

But the real eye-opener, Carrasco said, occurred in the room of a tracheotomy patient who was highly susceptible to infection as the opening in her neck healed.

“Every case is unique, but these patients are at a high risk of infection because of the openings and tubes in their necks,” he said.

“The fact … this patient recovered and went home sooner than what we consider to be the standard length is remarkable.”

Odor control is a bonus, said Carrasco.

“When you first enter our building, you notice the air feels fresh and is completely absent of any odor,” he explained.

“The Novaerus units eliminated odors in the common room and hallways, allowing us to forgo the use of harsh chemicals that simply masked smells.”

U.S. Rollout

Launched just before Christmas in Florida, the response to Novaerus has been incredible, said company CEO Kevin Maughan, who met Carrasco during the Florida Health Care Association’s (FHCA) annual convention last year. By late spring, 15 percent of Florida’s skilled nursing facilities (SNF) had implemented Novaerus.

Kevin “Ninety-five percent Maughan of those who’ve tried the Novaerus system are customers,” said Maughan, who stumbled across the technology being used in the aerospace industry in 2008. “I’d eyed it for the infection control industry, of which some $15 billion is spent on surface cleanliness and hand hygiene. Yet the negative outcomes based on HAIs cost about $40 billion. It seemed the market had a problem with that. As I did more research, I learned that almost no one was treating the air.”

Maughan rolled out Novaerus in the U.K. and Ireland in 2009. After a clinical trial showed a 68 percent reduction in en(CONTINUED ON PAGE 10)

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Incentivizing Medical Professionals, continued from page 1 2013 Main Residency Match Results (PGY-1) by Specialty for Mississippi Anesthesiology: 8 of 8 Child Neurology: 1 of 2 Emergency Medicine: 9 of 9 Family Medicine: 17 of 17 Internal Medicine: 28 of 28 Internal Medicine/Pediatrics: 4 of 4 Neurological Surgery: 2 of 2 Neurology: 4 of 4 Obstetrics and Gynecology: 6 of 6 Orthopedic Surgery: 4 of 4 Otolaryngology: 3 of 3 Pathology: 2 of 2 Pediatrics: 14 of 14 Psychiatry: 6 of 6 Radiation Oncology: 1 of 1 Radiology-Diagnostic: 5 of 4 Surgery, General: 9 of 11 SOURCE: National Resident Matching Program®.

associate vice chancellor for health affairs at UMMC, of the fluctuation in class size over the last few decades. “By the mid1980s, nationally, they were predicting too many doctors, so our size dropped to about 100 students per class, a number that stayed in place for about 20 years. Then in the early 2000s, the AAMC put out shortage projections for the physician workforce and encourLouAnn aged medical schools Woodward to see if they could accommodate a 30 percent increase in class size.”

In 2003, Woodward, also a professor of emergency medicine, stepped up from residency program director to associate dean for academic affairs, when Dan Jones, MD, was dean of the University of Mississippi School of Medicine in Jackson.

“As a group, we took a hard look at our physician workforce,” said Woodward. “We knew that if we had a 30 percent increase and everyone else did too, we were still going to be last! Our plan was for a more aggressive increase than 30 percent. Our target is to grow to 160 to 165 per class, and then stop and reassess the state’s needs.”

In 2005, bolstered by results from an in-depth analysis of the applicant pool, the medical school began growing its class size in increments of five. This year, the entering class has 135 students.

AMA’s Short List

“We’re on a trajectory to hit our goal,” said Woodward.

Retention King

On the flip side, Mississippi ranks high for physician retention -- third in the nation for percentage of in-state medical school matriculants and fourth for percentage of physician retained in the state from undergraduate medical education.

“We only take Mississippians, though we’re not mandated by the legislature or external forces to do that,” said Woodward. “Our mission is to produce excellently trained physicians who will take care of Mississippi patients. We feel the best formula is to get people who are dedicated to the region. I grew up in Carroll County. Who’s going to practice there? Mostly likely, someone who grew up there, or has a family connection to the community.”

All 135 members of the School of Medicine’s Class of 2016 are Mississippians, selected from 368 applicants, the largest pool in the medical school’s history.

“We sometimes take a little heat for that decision (of only taking Mississippians),” said Woodward. “For right now, it’s the right thing to do, to stack the deck by starting with Mississippians who are dedicated to making Mississippi better.”

Of 106 fourth-year medical students, 45 will remain at UMMC for their residency training.

To boost the in-state number of residency slots and maintain the state’s high physician retention rate, Gov. Phil Bryant unveiled the “1,000 New Doctors by 2025” campaign last year, along with a $10 million commitment in Community Development Block Grant funds via the Mississippi Development Authority to UMMC to expand its School of Medicine. State lawmakers authorized the construction of a new $63 million, 151,000-square-foot teaching facility on the UMMC campus to provide space for larger medical class sizes. The five-story building is slated to be finished in 2016.

With 8.3 doctors per 10,000 residents, compared to the national average of 12.8 physicians per 10,000 residents, Mississippi must add 1,330 primary care physicians to its workforce to raise its percapita doctor count to the national average.

(CONTINUED ON PAGE 9)

Nationally, to help fill the gap between first-year residents and residency slots, the American Medical Association (AMA) in mid-January announced a $10 million competitive grant initiative, “Accelerating Change in Medical Education,” to be distributed over the next five years to fund projects that support a significant redesign of undergraduate medical education.

Eighty-two percent of the nation’s 141 accredited medical schools submitted proposals.

At its annual meeting in June, the AMA selected 28 applicants to submit full proposals. Of those, only three schools are in the South, two in North Carolina and one in Florida.

Medical schools invited to submit full proposals: • Duke University School of Medicine • Florida International University Herbert Wertheim College of Medicine • Indiana University School of Medicine • Jefferson Medical College of Thomas Jefferson University • Mayo Medical School • Michigan State University College of Human Medicine • New York University School of Medicine • Oregon Health & Science University School of Medicine • Pennsylvania State University College of Medicine • Rush Medical College of Rush University Medical Center • Sanford School of Medicine of the University of South Dakota • Southern Illinois University School of Medicine • The Brody School of Medicine at East Carolina University • The Warren Alpert Medical School of Brown University • University of California - Davis School of Medicine • University of California - San Francisco School of Medicine • University of Colorado School of Medicine • University of Connecticut School of Medicine • University of Massachusetts Medical School • University of Miami Leonard M. Miller School of Medicine • University of Michigan Medical School • University of Minnesota Medical School • University of Toledo College of Medicine • University of Utah School of Medicine • University of Wisconsin School of Medicine and Public Health • Vanderbilt University School of Medicine

Medical school in Mississippi remains a bargain. Annual tuition costs approximately $20,649.

Even though medical school enrollment is 30 percent less than the national average, the number of full-time faculty members (590) is roughly average for all medical schools. The deadline for applications to the University of Mississippi School of Medicine is Oct. 15.

• Yale University School of Medicine

Collaboratives: • Baylor College of Medicine Texas A&M Health Science Center College of Medicine • University of Minnesota Medical School University of California - San Francisco School of Medicine University of Colorado School of Medicine University of Utah School of Medicine • Texas Tech University Health Sciences Center School of Medicine Medical College of Wisconsin Mercer SOURCE: American Medical Association.

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Incentivizing Medical Professionals, continued from page 8 “Mississippi needs more phy“We spend a lot of time sicians, and we cannot on the message that ‘Missiswait any longer,” said sippi wants you back,’” said Woodward. “It’s good for Bryant, who had iniour students to get out of tially called for expandta a ® D the state and gain other exing the state’s healthcare h nd Matc lts a ncy Resu ain Reside periences. We don’t want economy in his inauguM 2013 a completely homegrown ral State of the State adstate. It’s also good for us dress, and commissioned to attract young people the Mississippi Economic Council to study the issue. from other states. But The resulting report, “Bluewe have a solid hanprint Mississippi Health Care: dle on students who go to medical school and do An Economic Drive,” identified their residency in Mississippi.” four ways to benefit Mississippians: workforce development, quality of Keeping Pace life, business sustainability, and creation The medical school has kept pace of economic wealth. with residency positions at the same rate Last year, state lawmakers authorized the class size has expanded, said Woodthe creation of the Office of Physician ward.

Workforce (OPW) at UMMC to assess “Over time, we’ve found the best forphysician workforce needs and to increase mula for us is to have a ratio of 100 to the number of medical residency pro110 percent,” she said. “If we have that grams offered throughout the state. The 100 to 110 percent ratio, it allows the stustate is now seeking an executive director dents who want to stay here to do their for the new office. residency here.”

“Our retention rate isn’t just a blip on Among the challenges of gaining the radar screen for the last few years,” more residency positions: Medicaresaid Woodward, a graduate of the School funded residencies essentially have been of Medicine who completed her residency frozen since 1997, and controversy contraining at UMMC. “We’ve historically tinues to cloud the national outlook. done a great job of keeping our doctors For example, Elliott S. Fisher, direcin Mississippi. If we continue that, and I tor of the Dartmouth Institute for Health believe we will, we’ll be able to meet those Policy and Clinical Practice and co-digoals. The variable in that whole equarector of the Dartmouth Atlas of Health tion is that we have to have them do their Care, said the problem isn’t a shortage of residency in Mississippi. Of graduates physicians; it’s a failure to organize care. who leave the state to do their residency, “The problem facing healthcare we only get about half of them back ultitoday isn’t that we need more doctors,” mately practicing in Mississippi.” he said. “The problem is that we still get The resident training stage is when care the old-fashioned way, which makes young physicians begin making profesit appear that we need more doctors.” sional connections and getting job offers, Yet the AACM Center for Workshe noted. force Studies reported that an aging baby boomer generation will lead the United States to a shortfall of at least 90,000 docThe Mississippi State tors by the end of the decade.

Medical Association (MSMA) “We’ve had to be creative,” said Woodward.

“Every once in a while, CMS will host its 145th Annual will open a window to expand residency Session Business Meeting positions that meet certain criteria, and Aug. 16-17 in Jackson. For we’ve applied for those special opportumore information, visit www. nity positions.”

MSMAonline.com.

Other factors contribute to the bigpicture look at Mississippi’s residency and 2013 Aprilw.nrmp.org ww

Congressional Action Status To address the gap of medical school graduates who won’t match to a residency program, legislation was reintroduced in March in both houses of Congress to create new residency positions for Medicare-supported training slots via the Resident Physician Shortage Reduction Act of 2013. Senators Bill Nelson (D-Fla.), Chuck Schumer (D-NY) and Harry Reid (D-Nev.), and Representatives Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.) led the reintroduction of the bills (S. 577, H.R. 1180) to create the additional GME positions, according to the AMA. (At press time, GovTrack estimated a 1 percent chance of S. 577 moving from the Senate Finance Committee, and a zero percent chance of H.R. 1180 moving from House committees.)

physician workforce status. Next May, William Carey University College of Osteopathic Medicine, a private school in Hattiesburg, is slated to graduate its first class of DOs. The G.V. (Sonny) Montgomery VA Medical Center in Jackson funds some 80 residency positions. The Keesler Air Force Base in Biloxi also funds some residency slots; however, the military typically reassigns post-residency doctors out of state. North Mississippi Medical Center in Tupelo provides eight family medicine residencies.

“That still leaves a gap,” said Woodward, noting that growing the residency program is a two-step process. “Let’s say I’m a pediatric program director and I want more residents. First thing, I’ll go to our accrediting body and prove the need.

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The pediatric resident review committee may determine we can increase the number from 10 to 12. Then you have to find the money.”

For the last decade at UMMC, in part because of its organizational structure and clinical and educational enterprise components, the medical school has supported $5 million annually through clinical enterprise growth in education programs.

“Not all medical schools are structured like ours, and may not have the relationship with hospitals like we do. We’re fortunate that our hospital leadership is also very committed to education,” she said. “If not for that, we couldn’t have grown our residency programs as we’ve grown our medical school.”

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HAI ‘Kryptonite’ continued from page 7 vironmental MRSAs (Methicillin-resistant Staphylococcus aureus) at a London hospital with Novaerus, the U.K. National Health Service selected it as last year’s leading air Smart Solution for HAIs. “We see ourselves as a complementary and cost-effective component of good nursing care,” said Maughan, noting that HAIs kill more people annually than breast cancer, prostate cancer, and automobile accidents combined.

Maughan expedited the introduction of Novaerus to the market at an affordable price after a family member of a scientist working on the technology required a leg

amputation from an HAI. The company’s medical model involves leasing the equipment to healthcare facilities for three to five years. The typical cost to a SNF is roughly $2,500 a month, Maughan said.

“There are no startup fees or hidden costs or expenses,” he added. “It’s Medicare cost reportable, and we also have a money back guarantee.”

Early Inkling

Without thinking about it consciously during his formative years, Maughan’s foray into searching for a better way to fight HAIs began in childhood, after hear-

ing tales of frustration about it from his medical family– his father, an MD; his grandfather, a pediatric surgeon; and his great grandfather, a general surgeon.

“There hasn’t been one significant development in infection control since the late 19th century,” he said, knowing early on that “as bacteria become more resistant to traditional medicines and procedures, technology must play a role in their eradication.”

Infection control companies have developed technologies that create hydrogen peroxide-based fogs or vapors to reduce the risk of cross-contamination of infec-

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tious diseases associated with using a rag, wipe or sponge. Because they’re labor-intensive, Novaerus doesn’t consider those solutions competition in the marketplace.

“Time is money, more than ever,” said Maughan. “Labor is so expensive, and time spent on HAI control by the nursing staff could be spent on other patient care needs. This technological solution requires no labor costs. By comparison, our solution is very inexpensive.

It works 365/24/7.”

To prevent aerial dissemination, technology can accomplish what medicine and standard HAI prevention practice cannot, such as eradicating airborne and surface pathogens and significantly reducing microbial surface counts, said Maughan.

• In 1867, British surgeon Joseph Lister began using carbolic acid as an antiseptic in surgical procedures, significantly reducing mortality rates from infection by 30 percent within a decade. Before, a patient could undergo a procedure successfully only to die from a postoperative infection, ward fever.

• In the mid-to-late 19th century, various infection control protocols were developed and adopted, which remain vigorously enforced today: hand-washing, using heat to sterilize surgical instruments, and surgical masks. Medicine won significant battles against infectious diseases, including the eradication of tuberculosis.

• But in the mid-20th century, bacteria started fighting back.

In 1947, only a few years after the advance of mass production penicillin, Staphylococcus aureus was discovered, one of the earlier bacteria indicating penicillin resistance. In 1961, Methicillin-resistant Staphylococcus aureus (MRSA) was first detected in Britain. Now, half of all MRSA infections in the U.S. are resistant to penicillin, methicillin, tetracycline and erythromycin.

• More recently, worldwide outbreaks of infectious diseases such as H5N1, severe acute respiratory syndrome (SARS), and H1N1 have emerged. Earlier this year, the Centers for Disease Control and Prevention (CDC) issued a warning around the growing threat of “nightmare superbugs” that are untreatable because they’re resistant to even the most powerful antibiotics.

The CDC reports this class of superbug – Carbapenem-resistant Enterobacteriaceae (CRE) – has been found only in nursing homes and hospitals.

• About 4 percent of acutecare hospitals, and 18 percent of long-term acute care hospitals in America, reported at least one case of dangerous CRE bacteria – germs that are resistant to most ‘last-resort’ antibiotics.

SOURCE: Novaerus.

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Provident Care, continued from page 1 reason people don’t get into care or seek access to free medication is because they have problems we don’t quite understand – social, financial, legal, and emotional – and our hope is to tackle one part of it.”

When Jackson attorney Marni von Wilpert approached Barnes about collaborating on Mississippi’s first-ever medical-legal partnership to provide free civil legal services to people living with HIV/ AIDS, Barnes quickly Dr. Arti pitched the concept to Barnes higher-ups, who gave it their full support. The partnership officially began in April.

“The whole purpose of the partnership is for patients with HIV/AIDS to get into care,” said Barnes. “Improved survival benefits the entire community, and those who visit a provider are even less likely to spread the disease.”

Von Wilpert, Skadden Legal Fellow at the Mississippi Center for Justice, came up with the partnership idea after serving as a social worker with the Peace Corps in Botswana, a flat landlocked and sparsely populated country in South Africa that gained its in- Von Wilpert dependence from Great Britain in 1966. Covered two-thirds by the Kalahari Desert, it’s morphed from one of the world’s poorest nations to a burgeoning economy, in part because of diamond mining and bank competition.

“I did HIV work there, and realized people faced so many barriers that required legal intervention to go to the doctor,” she explained, noting that nearly 100 medical-legal partnerships comprising the National Center for Medical-Legal Partnership use the same model. “If they lost their home, they no longer had an address where we could even pick them up to take to the doctor. Their health would be affected by this legal problem.”

To better help people living with

HIV/AIDS, von Wilpert earned a law degree. Soon after she joined the nonprofit public interest law firm in Jackson, she realized many of her clients were also Barnes’ patients.

“Both of us aim to help low-income people with HIV,” she said. “When I realized the connection, I thought we could work together. I brought this partnership idea to the table, and now here we are.”

Civil Rights Issue

The medical-legal partnership involves a joint agreement with the Mississippi Center for Justice, Crossroads Clinic, UMMC, and the Jackson Medical Mall Foundation. The medical mall provides office space for the center, which primarily focuses legal assistance on HIV-statusrelated discrimination in housing and employment.

“Discrimination against folks who have HIV has become so pervasive, it’s a civil rights issue at this point,” said von Wilpert. “We targeted people first with HIV/AIDS because of the stigma discrimination of this particular disease. It leads to a lot of issues that you don’t find with other diseases such as cancer and diabetes. We’re hoping to expand it to other issues such as family law practice, and work with pediatric centers at the university and other practices for general legal help partnerships. We’ve been thrilled to work with UMMC, happy to be here to help, and glad to add many partners along the way.”

The Crossroads Clinic staff gives HIV patients a survey to complete while they’re waiting for their medical appointment.

The questionnaire addresses issues such as privacy, which could impact their employment status. “If they want to seek legal aid, it triggers a referral to the Mississippi Center for Justice,” explained Barnes.

By the end of the first two months of the partnership, von Wilpert was receiving two or three referrals weekly.

“Civil legal needs have a direct affect on patient health,” said von Wilpert.

“Much of what we do is making sure patients stay in care. Poverty, educational level, employment opportunities or discrimination are all social determinants of a person’s health, although they may not be in the traditional parameters of the healthcare profession to treat. They may have a legal remedy, so we can all work together to help the community.”

Clearing Hurdles

The medical-legal partnership fills an unmet need typically unaddressed by healthcare providers, said Barnes.

“Any patient, regardless of HIV, may not gain access to care because of needs we don’t address at all as healthcare providers,” she said. “Do we ask patients, for example: did you lose your job? Are you not able to get transportation to the doctor’s office because of your health condition? If healthcare providers know a concept like this exists, it would hopefully prompt them to start a conversation with their patients beyond their physical condition.”

Financial challenges remain a stumbling block to care.

“At least 25 to 30 percent of our patients have no insurance,” said Barnes.

“They’re on federal assistance for their medication and have to fall close to the poverty line to qualify.”

Nearly half of HIV patients at Crossroads Clinic rely on Medicaid. Another 30 percent have Medicare, Barnes said. “You can imagine a huge section of this population is dependent on public benefits and can’t afford private insurance,” she said.

Another obstacle to care for HIV patients: marginal health literacy.

“Our healthcare system is so difficult to navigate that even those who qualify for public benefits aren’t accessing them,” said Barnes. “Then you have the ones with financial resources and private insurance – and also a tremendous risk of losing their job and therefore their private insurance because of HIV. When it turns out they have HIV, they may be disqualified based

on the grounds of a pre-existing condition.

If they’re financially stable enough to even apply for private insurance, they probably won’t qualify for public programs like Medicaid or Medicare. Paying $2,000 a month for HIV medication is a huge burden for them. We’re hoping we can inform them of such discrimination and teach them how to navigate the system.”

The mental health component of HIV/AIDS patients remains a weak link, said von Wilpert.

“The national movement is trying to see how we can better track and categorize results of our partnerships,” she said. “At a national conference last year, a question raised involved how reducing patient stress could help immensely with the compliance of patients keeping appointments, keeping up with their medications, court filings and everything. But how do we document a patient’s reduction of stress? Even though we can’t quantify it, (patients/clients) tell us it helps tremendously. Reducing patient stress definitely improves their quality of life.”

For more information, contact Sharon Morris at the Mississippi Center for Justice via (769) 230-2835 or smorris@ mscenterforjustice.org.

Fast Facts about HIV/AIDS • Mississippi ranks 49th in funding civil legal services.

• Jackson has the nation’s fourth highest HIV infection rate.

• Even though African Americans comprise 37 percent of the state’s population, the group accounts for 78 percent of new infections.

SOURCE: Centers for Disease Control and Prevention.

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GrandRounds Wilson family honored for $1 million in giving The Methodist Rehabilitation Center Board of Trustees recently gathered to recognize $1 million in cumulative giving to the Wilson Research Foundation at MRC from the family of the late Earl. R. Wilson, one of the founders of MRC .

Wilson was the catalyst for the creation of Methodist Rehabilitation Center.

And when the Jackson hospital opened in 1975, Wilson began 25 years of service as board chair- Presenting a framed resolution to honor the family of the late Earl R. Wilson: from left, Matthew Holleman III, chairman of the MRC Board of Trustees; Chris Blount, director of the Wilson Reman. search Foundation; Ann Wilson Holifield; Wilson Holifield; and Mark Adams, president and CEO Two months of MRC. before Wilson’s death in 2000, the hospital was named one of America’s best by U.S. News & World Reports, a source of immense pride for the Jackson businessman, said his family.

In the years since, Wilson’s family has continued his legacy. His widow, Martha Lyles Wilson of Madison, serves on the foundation board. Daughter Ginny Wilson Mounger of Jackson is chairperson of the foundation board. Daughter Ann Wilson Holifield of Ridgeland is a trustee of the hospital. Daughter Amy Lyles Wilson of Nashville, Tenn., volunteers public relations counsel. And grandson Wilson Holifield of Birmingham, Ala. is a member of Methodist Accessible Housing Corporation, a sponsored entity of MRC. All have also contributed generous financial support, resulting in the board’s May 23 resolution honoring their “unprecedented service and philanthropy.”

Established in 1988 with a seed gift from the H.F. McCarty, Jr. family, the nonprofit Wilson Research Foundation has provided nearly $5 million in grants for clinical research studies, all from local philanthropic gifts. And the research scientists at Methodist have brought in an additional $8 million in government and industry research dollars, achieving 230 peerreviewed publications to date.

Still, there’s much left to accomplish and Blount hopes the Wilsons’ example will inspire others to contribute to a $3 million campaign to fund research, technology and education programs to help the thousands of people with disabilities both here at home and across the world.

BlueBin Bound, continued from page 6 Health, the University of Michigan Health System, and Vancouver Coastal Health – converged at Nemours in Orlando to see BlueBin in action.

• A dedicated supply technician uses barcode scanning to initiate the automated supply management process.

• Supply areas are stocked with two bins for a particular supply.

• The front bin holds a specified level of supplies.

• When the last item of the front bin is used, nurses place it in a designated holding area, triggering a replenishment order.

• Then, nurses pull the second bin to the front.

• Before the second bin is emptied, the first bin’s supplies will have already been reordered, restocked and replaced in the supply area.

BlueBin has also been implemented at Mercy Hospital and Medical Center, Chicago’s first hospital, and Presbyterian Hospital in Albuquerque, NM. “Before we implemented BlueBin, our store rooms were being overused and 12

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we weren’t centralizing the purchase of supplies,” said Rick Cerceo, executive vice president and COO of Mercy, a 410bed acute care facility – Chicago’s first hospital – that transitioned to BlueBin in mid-2011. “Our staff was running out of supplies, which delayed procedures and patient care. This forced nurses to start ordering their own supplies and supply rooms began bulging at the seams because they were so afraid of running out. Now I can say these problems are completely gone; the process has been amazing.”

When Martin Health South implemented BlueBin, the rollout schedule began last summer in various ICU areas and concluded in February.

“Before, things were just wherever there was a spot for it,” said Linda Landers, a patient care technician in the surgical intensive care unit (SICU) at Martin Health South in Stuart. “Now there’s a flow to it.”

Nemours’ Alfred I. duPont Hospital for Children in Wilmington, Del., is the sixth location deploying BlueBin technology. mississippimedicalnews

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GrandRounds Comprehensive Pain Center of MS Expanding The Comprehensive Pain Center of Mississippi, based in Jackson, broke ground on a new, state-of-the-art pain clinic, surgery center and wellness spa that will provide a complete approach to pain management and the well-being of its clients. The new, 17,000-square-foot facility will be located in Madison. It is slated to open later in 2013.

The Pain Center was founded in 2008

by Dr. Kevin Vance, whose approach to his specialty was formed when he was a fellow in interventional pain medicine at the renowned MD Anderson Cancer Center in Houston, Tex. The board-certified specialist returned to Jackson to open a pain clinic that would be unique to the metro area.

Comprehensive Pain Center opened with the idea of providing a complete, multidisciplinary approach to the well-being of its patients, incorporating the most modern techniques and treatments, combined with holistic or integrative medicine approaches.

The center has grown ever since.

Today, it has two nurse practitioners and 20 support staff, all of whom have extensive pain management experience.

And Dr. Vance and his team provide diagnostic evaluations for all types of pain, including acute, chronic, neuropathic and cancer pain, among others. Treatment is individualized based on DNA testing and patient histories. The Center is equipped with the most advanced Fluoroscopy C-Arm, an X-ray image intensifier that empowers its team to more easily provide treatment for issues that previously required either invasive procedures or costly trips to surgical facilities.

At the new center, Dr. Vance and his staff will continue to offer everything from the latest pharmacologic treatments to advanced interventional procedures, such as radiofrequency ablation and spinal cord stimulators. Dr. Vance also performs minimally invasive spinal treatments, such as epidural steroid injections and nerve blocks.

The new center will up the ante in the broad treatment options department by offering a state-of-the-art outpatient surgery center and a wellness spa. The new spa, Thrive, will offer therapeutic massage therapy, acupuncture and relaxing spa and other wellness services.

SRHS Heart Services Team One of Nation’s First to Implant Newest Device for Cardiac Pacing

A new type of BIOTRONIK cardiac defibrillator, recently approved by the Food and Drug Administration, has been performed by the Heart Services team at Singing River Health System (SRHS), helping patients with heart rhythm care needs on the Mississippi Gulf Coast.

This procedure, one of the first implants in the country and the first in the state of Mississippi, was performed on Friday, March 22 at Ocean Springs Hospital by

Hugo Quintana, MD, of the Southern Mississippi Heart Center.

Known officially as BIOTRONIC Lumax 740 DX System, this newly available singlechamber ICD uses a single thin flexible wire, called a lead, to deliver an electrical pulse to the heart when the heart rate becomes dangerously fast and then returns the heart to its proper function. The innovative device can sense vital changes in heart rhythm in both the atrium and the ventricle of the heart through its single lead, offering an enhanced way of gaining important and useful atrial signal information without the risk of implanting multiple leads.

The DX System also integrates with BIOTRONIK Home Monitoring ® allowing physicians to remotely follow their DX patient’s clinical and device statuses daily, at anytime, anywhere in the world. The cellularbased system has demonstrated the ability to detect clinically relevant events, including silent, asymptomatic arrhythmias, and device related issues, allowing for earlier medical intervention. The diagnostic capabilities of the DX System combined with Home Monitoring ® makes this a simple, yet sophisticated system for cardiac rhythm management.

(L-R): Comprehensive Pain’s Dr. Kevin Vance, Laura Tinsley of Century Construction of Tupelo, Miss., and Comprehensive Pain Practice Administrator Angel Vance.

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GrandRounds Biloxi Regional Medical Center Earns Quality Respiratory Care Recognition Biloxi Regional Medical Center has earned Quality Respiratory Care Recognition (QRCR) under a national program aimed at helping patients and families make informed decisions about the quality of the respiratory care services available in hospitals.

About 700 hospitals or approximately 15 percent of hospitals in the United States have applied for and received this award. Biloxi Regional Medical Center has received this award for seven years in a row.

SRHS Expands Robotic Surgery Procedures

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Singing River Health System has recently expanded its utility of the da Vinci Surgical System, including adding single-site gall bladder to current robotic procedures.

John D. Bailey, MD, general surgeon, has been performing the singleDr. John D. site procedures for apBailey proximately five months at Singing River Hospital. These robotic procedures typically offer a shorter recovery period, less scarring and less pain to these patients. Other physicians with South Mississippi Surgeons are now performing robotic surgeries too.

SRHS is performing hysterectomies (some single site), single-site gallbladder, prostatectomies, nephrectomies, partial nephrectomies, and various other less common procedures with the da Vinci Surgical system.

Singing River Health System and George Regional Health System Extend Partnership for Specialty Care

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Singing River Health System and George Regional Health System have extended the partnership that increased the availability of medical specialty services in George County and surrounding areas for another five years.

In May 2010, SRHS opened the George Regional Specialty Center, located at 57 Dewey St. in Lucedale. SRHS provides the following specialty care at the specialty center: neurology, pain management, sleep medicine, Hospice of Light, orthopedics, surgery, and Behavioral Health services. Over the last three years, SRHS has also begun providing hospitalist and emergency services to George Regional Hospital.

In addition to Singing River Hospital and Ocean Springs Hospital, Singing River Health System includes a network of primary care providers in Jackson and Harrison Counties, as well as a comprehensive cancer center, neuroscience center, cardiovascular services program, and other centers of excellence.

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