Mississippi Medical News Sept 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Hannah Gay, MD

ON ROUNDS MSMOC Weighs In Zurich 2012 Concussion Consensus Statement focuses on concussion definition, onfield recognition, management and tools The importance of clinical suspicion for identifying a concussion cannot be overstated, says orthopedic surgeon Austin Barrett, MD, of the Mississippi Sports Medicine & Orthopaedic Center (MSMOC) ... 9

New Lines of Research

NCI Data Set Opens Access to Cancer-Related Genetic Variations How will this breast cancer drug react in patients that are HER2 positive?

Will this new lung cancer therapy work in a patient with multiple genetic variations? ... 11

HMA Hospitals Changing Hands Community Health Systems acquires Florida-based hospital operator in historic deal

By LyNNE JETER

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

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

In late March, Fortune magazine had named HMA among the World’s Most Admired companies in Health Care: Medical Facilities for the second consecutive year and fifth time in seven years. HMA had also been named the leading company for two subcategories in 2012: Use of Corporate Assets and Social Responsibility.

Yet soon after HMA CEO Gary Newsome announced retirement plans in May to preside over a Uruguay mission with the Church of Jesus Christ of Latter-day Saints, rumblings (CONTINUED ON PAGE 8)

Golden Anniversary

Hattiesburg Clinic celebrates 50 years and status as the state’s largest privately-owned multispecialty outpatient clinic On May 8, Hattiesburg Clinic CEO Tommy Thornton honors the 10 founding members and their families at a ceremony commemorating the silver anniversary.

By LyNNE JETER

HATTIESBURG—Clark, Conerly, Gable, Gillespie, Guice, Huddleston, O’Neal, Pearson, Raulston, and Tatum.

The physicians who opened the doors of the Hattiesburg Clinic on May 1, 1963, need no first names. In the small university setting in the Pine Belt, everyone knew them, including (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Hannah Gay, MD

By LUCY SCHULTZE

Hannah Gay, MD, has been the subject of global attention since the March announcement that an HIV-infected baby in her care had been functionally cured of the virus.

Ironically, though, that’s not the career achievement she ranks most highly.

“We’re now at a point in Mississippi where we rarely see a child who becomes infected at birth, and that is the biggest success,” said Gay, an associate professor of pediatrics at the University of Mississippi Medical Center.

“If we can prevent the baby from becoming infected, we don’t have to worry about curing him later.”

Developing a system to identify and treat HIV-infected women during pregnancy has allowed Gay and her colleagues to virtually halt the spread of the virus to newborns in the state.

When her career at UMMC began in 1994, the transmission rate in Mississippi from mother to child was 25 to 30 percent, she said. Over the past 12 years, that rate has dropped to less than 2 percent overall, while none of the women who have received adequate treatment have passed the virus on to their babies.

“That speaks to the efficacy of treating moms during pregnancy, and that really is our big focus – to make sure these moms are identified during pregnancy and get them into effective treatment,” Gay said. “Still, we always have a few that fall through the cracks.”

That was the case with the baby girl whose story has ultimately been celebrated across the global research community.

Since the mother had no prenatal care and did not know she was HIV-positive, she was not plugged into the now-efficient treatment system that exists between UMMC and the Mississippi State Department of Health.

The child was born HIV-positive, and Gay began an aggressive treatment regimen for the baby – only to have the mother drop out of the treatment relationship and fail to continue providing therapy to her child.

By the time Gay reconnected with the mother and child, she fully expected the baby would have the virus again and possibly already have sustained damage to her immune system.

“When that turned out not to be the case, I was initially very confused,” said Gay, who sought further analysis from colleagues at the Johns Hopkins Children’s

Center and University of Massachusetts Medical School.

“Using the ultrasensitive tests that they have available, they were able to determine, in fact, that the baby did not have detectable replication-competent virus in her viral reservoirs,” Gay said. “It’s the first case that’s been reported like this in a child

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quickly.”

Such a goal wasn’t even on the horizon when Gay began practicing in 1994 at UMMC, where she had received her medical degree and completed her training.

A native of Jackson, she had returned with her husband and four young children after six years of mission service in Ethiopia. The position in UMMC’s pediatric HIV clinic was one she took chiefly because it was meant to be part-time.

“It remained part-time for almost two months,” Gay laughed. “So much for staying home with my children. But fortunately, my husband was able to do that, so I was able to get into a very rewarding career.”

In the Department of Pediatrics, Division of Infectious Diseases, Gay stepped into the task of implementing the program to identify and provide therapy to pregnant women, based on new findings that transmission could thereby be halted.

Over the years, Gay and physician colleague Ben Nash, MD, have gathered a team of nurses and a data manager who together make the pediatric/perinatal HIV program function smoothly. The Mississippi State Department of Health has also proven a critical partner in establishing an effective prevention system.

“A lot of people totally underrate our health department, but we have an excellent one,” Gay said. “They’re out there in the communities, and it’s the health(CONTINUED ON PAGE 10)

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at all – and the first case in anybody achieved through the usual type of therapy.”

Gay and her colleagues knew their report would set abuzz the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta, where they presented their findings in March.

What they didn’t expect was how far the media would carry the story.

Over the past six months, Gay has been profiled by outlets like USA Today and interviewed by a host of newspapers and wire services from around the world. In April, she was named to Time magazine’s annual list of the 100 most influential people in the world.

Gay, who’s known for her quiet, thoughtful manner, describes the whole experience “bizarre.”

“It has made life interesting,” she said. “But also, as it turns out, it has really helped to push this whole idea of searching for a cure to the forefront – in the minds of both researchers and those who fund the research.

“We’re thrilled that research toward a cure is moving forward that much more

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Golden Anniversary, continued from page 1 this writer, who was delivered by adding new physicians. “Everybody one of the founding members of that was brought into the clinic was what’s now the state’s largest priwell-trained, well-qualified, and vately-owned multispecialty outpacompassionate,” he said. “Those tient clinic. were the three main things we Their feat is remarkable, espelooked for – and honesty.” cially because group practices were Organizational difficulties chalfairly rare in South Mississippi durlenged the young group. ing the 1960s.

“At the time we were building, “The 10 physicians who came we could’ve obtained the area out to together to form Hattiesburg Clinic the next street for $125,000,” said did so because they saw a need in the late Charles Guice, MD. “We the community for a multispecialty couldn’t afford it!” clinic – a place where they could When asked about the clinic’s The founding physicians on the first anniversary of the Hattiesburg Clinic. serve patients with the concept that longevity and growth, Conerly the whole person is the ideal to bring shared the group’s secret: “We were that about,” said Hattiesburg Clinic CEO like family. We had to trust each other to The late Glen Pearson, MD, wanted Tommy Thornton. make good decisions.” patients’ “welfare physically, mentally, The late Lamar Gillespie, MD, once Today, Hattiesburg Clinic has more economically, spiritually bettered by the said, “We thought that specializing and than 300 physicians and providers reprefact of our existence.” The late Frederick having different areas of treatment would senting approximately 45 specialties, and Tatum, MD, explained: “We were just be an advantage.” a staff of approximately 2,000, caring for trying to do good.” “(I told Richard Clark) we could stay patients in 18 counties in South MissisConerly added: “Our philosophy in here … in our spot and take in more sursippi. starting Hattiesburg Clinic follows a quote geons as the need arose. We could … have A new Dermatology-South clinic and I once heard from a fellow doctor: ‘We that be our choice of lifestyle forever, or two buildings for pediatrics and a childon’t treat the illness that the patient has; we could be a part of forming something dren’s clinic are being built. A location we treat the patient who has the illness.’ really bigger and get satisfaction out of in Bellevue will house several Hattiesburg I’ve always followed that philosophy.” that,” recalled Dawson Conerly Jr., MD. Clinic specialties. Over the years, HatHattiesburg Clinic began with 25 emThe late Ramsey O’Neal, MD, tiesburg Clinic has pioneered specialty ployees to assist the 10 doctors. “Before we “didn’t really have a concept of a big services that are one of the first to Missiscould add a new physician, all of us had clinic,” said his son, Kelly O’Neal, MD, a sippi. The Neurological Research Center to agree to take a pay cut to support the Hattiesburg Clinic OB-GYN like his dad. contributed greatly to the international new doctor until they got on (their) own,” “It seemed to evolve when there was a launch of Amyvid, a new drug for Alsaid Clark. need for Hattiesburg to have a particular zheimer’s patients, while the Cardiology The late Gerald Gable, MD, said in specialty.”

CARE Program provides arguably the 2004 the group was highly selective about

most comprehensive, cost- and time-efficient heart disease screening. (See companion articles.)

“At one point, I thought, maybe in my lifetime, we’ll become 30 to 35 physicians,” said Conerly. “I just never thought it would get this big. It makes me feel proud.”

Mississippi Specialties Hattiesburg Clinic services offered first in the state: • Exilis Elite: A non-invasive procedure that uses radio frequency to reduce fat and tighten skin.

• Breast Tomosynthesis: A 3-D imaging technology that allows better visualization for improved detection of breast cancer.

• Canaloplasty: A lower-risk surgical technique used to reduce pressure for patients with glaucoma.

• Symplicity Trial: A clinical trial used to provide additional information about a medical device intended to help treat high blood pressure in patients whose blood pressure isn’t controlled, despite treatment with multiple blood pressure medications.

• Neurological Research Center: A facility of Hattiesburg Clinic, NRC provides patients in South Mississippi access to leading-edge clinical trials.

SOURCE: Hattiesburg Clinic.

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Cardiology CARE Focus Hattiesburg Clinic develops innovative screening test for coronary artery disease

By LYNNE JETER

HATTIESBURG – For $125 and 90 minutes’ time, Pine Belt residents may determine their risk assessment for cardiovascular disease.

Hattiesburg Clinic Cardiology, a 14-member practice in a joint project with the Forrest General Hospital Spirit of Women Program, began offering the Cardiovascular Assessment Risk Evaluation (CARE) in October 2010.

“We worked for two years to come up with a screening procedure that’s comprehensive, affordable and respectful of

ment from Hattiesburg Clinic administrators, who helped us make the out-of-pocket expense affordable to our local residents.”

Craig Chancellor, NP, helped Messer develop program protocols, and is one of four cardiology mid-level providers who manage the CARE Clinic and provide indepth counseling to patients.

“We also provide patients with access to an online program so that when they get home, they can plug in their numbers as positive changes occur – diabetic levels improve, blood sugar levels improve, smoking cessation -- and the program will reflect how those changes have improved their

“Ours may be the most comprehensive, cost-effective and time-efficient program of its kind in the state.”

– Thomas Messer Jr., MD, Administrative Medical Director of Cardiology, Lead Cardiologist, CARE Program, Hattiesburg Clinic.

patients’ time,” said Thomas Messer Jr., MD, administrative medical director of cardiology and lead cardiologist for the CARE Program at Hattiesburg Clinic. “At the end of 90 minutes, patients are armed with information and an understanding of their risk for heart disease.

If patients know they have coronary artery disease, they can better prepare for making choices and staying healthy – before events occur, Messer said.

“For example, perhaps someone’s had a heart attack and can stave off a second one if their cholesterol is in a certain range, or control diabetes tighter to minimize the risk of making plaque,” he said. “We want patients to leave our clinic empowered.”

Coronary artery disease made national headlines in late July, when 53-yearold radio personality Kidd Kraddick died suddenly while attending a golf tournament in Louisiana benefitting his children’s charity, Kidd’s Kids. Preliminary autopsy results from the Jefferson Parish Coroner’s Office showed he died of cardiac disease.

“He didn’t know he had the disease,” said Messer. “Like many busy people, he may have sloughed off minor symptoms. Some people are intimidated about going to the doctor, and the expense, especially because most people have high deductibles through their insurance provider these days.”

The CARE assessment involves a Cardiac CT Calcium Score, lipid profile, fasting blood sugar, EKG, calculation of BMI, and risk assessment.

“We modeled our product on a center in California that we heard from at an American Association of Cardiovascular Administrators conference,” said Messer.

“The group went over the logistics with us, and the hurdles. We had a strong commitmississippimedicalnews

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risk of heart disease,” said Messer.

Because only three to five patients are scheduled daily at the CARE Clinic, patient schedules typically run on time.

“An important part of the process is not making patients wait after they’ve been fasting,” said Messer.

Because the assessment is self-pay, the information goes into the patient’s electronic medical record, but the patient isn’t required to divulge the information to their primary care provider – it’s highly recommended.

“At $125, many people gift the assessment to their loved ones, typically parents or grandparents who may not otherwise take the time or have the spare money or inclination to arrange it themselves,” said Messer. “The Spirit of Women has done a great job promoting the CARE screening program.”

Also, because the assessment is self-referral, patients deal directly with the CARE Clinic.

“Pick the day and time slot,” said Messer. “You don’t need three people in the middle of that process.”

Only a few people have left the CARE Clinic for admission to the hospital for emergency procedures because their visit resulted in the knowledge of advanced coronary artery disease.

“The program is getting a lot of respect from the community,” said Messer, adding that the CARE Clinic also offers Hattiesburg Clinic employees the assessment at a reduced rate. “The medical community has also been very supportive. A couple of hospitals in Jackson have similar programs, but ours may be the most comprehensive, cost-effective and time-efficient program of its kind in the state.”

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Releasing Amyvid Neurological Research Center at Hattiesburg Clinic plays role in Lilly’s release of promising Alzheimer’s diagnostic tool

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HATTIESBURG—When neurologist Ronald Schwartz, MD, CPI, began conducting cutting-edge clinical trials for Alzheimer’s patients at the Neurological Research Center (NRC) at Hattiesburg Clinic nearly a decade ago, he might not have guessed the level of participation would lead to a medical breakthrough for the healthcare industry: Amyvid, the first and only radioactive diagnostic tool used to evaluate patients for Alzheimer’s disease and other causes of cognitive decline.

The U.S. Food and Drug Administration (FDA) approved Amyvid™ in early 2012 for Eli Lilly and Company, a drug that’s used in conjunction with Positron Emission Tomography (PET) imaging to evaluate the level of amyloid plaques in the brain. “Amyvid’s method of binding to amyloid plaques provides a visual indication of the presence or absence of plaques in the brain, contributing to a more conclusive diagnosis,” said Schwartz, director of the NRC, who participated in the initial autopsy study where the Dr. Ronald tracer was validated.

Schwartz With major pharmaceutical companies ushering Alzheimer’s drugs into the pipeline, NRC has several promising Alzheimer’s studies in the works.

“We’re a flagship site for a new solanezumab trial that started in early August for the leading anti-amyloid immunotherapy drug,” said Schwartz. “Hopefully, this phase III pivotal trial will finally determine if this medication, and this treatment strategy, will be effective.”

Setting the Stage Hattiesburg Clinic recruited Schwartz in 2001, impressed by his neurology residency at the Albert Einstein College of Medicine, and fellowship in behavioral neurology at the University of Florida. “My overriding interest was always to have a specialty (dementia) practice,” said Schwartz. “If we could break in as a clinical trial site, we would be in the unique position of offering our patients access to leading-edge therapies.

At that time, the industry began shifting its research studies focus from academic centers to practices with larger patient populations, like ours.”

With its onsite resources – imaging center (MRI, PET), labs, ancillary and support services – Hattiesburg Clinic has the ideal environment to support clinical trial protocols, said Schwartz.

“Some of the biggest challenges relate

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Amyvid: How it Works PET scans with minimal to no plaques are inconsistent with a diagnosis of Alzheimer’s disease, decreasing the likelihood that a patient’s symptoms are due to Alzheimer’s. Those with Alzheimer’s disease produce positive scans with moderate to high levels of amyloid plaques. These levels may also be present in patients with other types of neurological conditions and older people with normal cognition.

to the process of carving out a research program within the confines and culture of a large, clinical practice,” he said.

Schwartz knew the timing was ripe because pharmaceutical companies are focusing on early stage Alzheimer’s drugs for disease modification.

“In the clinic, it can be frustrating to have patients who continue to decline while on available medications,” he said.

“As a physician, you feel helpless. When you can transition patients into clinical trials, that helplessness evolves into optimism and hope. It changes the dynamic from what’s right now an incurable disease to discussions about early diagnosis, biomarkers, amyloid imaging and neurotherapies. The conversation shifts into a more dynamic, positive approach to the disease rather than as a clinician having to say, ‘I’ve got nothing for you.’ It keeps patients engaged, looking for the next available therapy.”

Even though Schwartz undertook the first Alzheimer’s clinical trial in 2005, the NRC at Hattiesburg Clinic wasn’t officially established until several years later. “It’s been a maturation process of a good eight years to get the entire program where it should be,” he said. “Productive trial sites are defined by an effective staff.

The NRC currently has an excellent team that’s been working together on AD trials for several years and is able to maintain high levels of recruitment and retention.”

Schwartz also pointed out that Alzheimer’s studies are “procedurally complex because the disease is slow-moving.”

“To see a change, you have to anticipate trials lasting 18 months and extending to several years,” he said. “Motivated subjects are truly the key to any successful research protocol.”

Schwartz has received patient referrals from hundreds of miles away, including the University of Mississippi Medical Center, New Orleans, Meridian, and Mobile, Ala. (CONTINUED ON PAGE 12) mississippimedicalnews

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HMA Hospitals, continued from page 1 swept through Wall Street that the fiscally struggling public company might be the target of a takeover.

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

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

The Engagement

In a power play reminiscent of the 1987 blockbuster movie, “Wall Street,” the news became official when CHS announced plans to acquire HMA for $3.9 billion in a deal valued at $7.6 billion, creating the nation’s largest for-profit hospital chains in terms of number of facilities.

“This is the second biggest hospital deal announced this summer,” said healthcare industry consultant George Paul, antitrust partner with White & Case. In June, Dallasbased Tenet Healthcare Corp. (NYSE: THC) announced its acquisition of Nashville, Tenn.based Vanguard Health Systems (NYSE: VHS) George Paul in a pact valued at $4.3 billion.

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

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

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

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

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

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

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

“This compelling transaction provides a strategic opportunity to form a larger company with a diverse portfolio of hospitals that is well-positioned to realize the benefits of healthcare reform and to address the changing dynamics of our industry,” said CHS CEO Wayne Smith.

“Our complementary markets and the ability to form networks in key states, along with the synergies that will be available to us, can create value for the shareholders of our companies, the communities we serve, our employees and medical staffs.”

Both companies’ boards of directors unanimously approved the definitive merger agreement. The deal would give HMA shareholders a 16 percent stake in the new company. Before the market opened on July 30, the day of the announcement, HMA shares fell 6.9 percent to $13.89; CHS stock rose 2.4 percent to $48.35.

Mississippi Impact

If the sale goes according to plan, 10 HMA Mississippi hospitals, including five in the Metro Jackson area, will move to the CHS portfolio. But Todd Lupton, CEO of HMA’s Jackson group, said the ownership switch shouldn’t prompt significant changes in daily operations, adding that “it’ll be very beneficial to all the hospitals involved” and “together, we’ll be part of an even stronger company.”

HMA owns Central Mississippi Medical Center in Jackson, Crossgates River Oaks Hospital in Brandon, Madison River Oaks Medical Center in Canton, and River Oaks Hospital and Woman’s Hospital, both in Flowood. It also manages Natchez Community Hospital, Biloxi Regional Medical Center, Gilmore Regional Medical Center in Amory, Northwest Mississippi Regional Medical Center in Clarksdale and Tri-Lakes Medical Center in Batesville.

CHS spokeswoman Tomi Galin wasn’t as straightforward, saying it’s “too early to discuss any possible changes.”

CHS operates two hospitals in Mississippi – River Region Health System in Vicksburg and Wesley Medical Center in Hattiesburg.

Smith said he considered keeping CHS an independent company and explored partnerships with other companies but decided acquiring HMA would “create value for the shareholders of our companies, the communities we serve, our employees and medical staffs.”

The ownership change also won’t slow the progress of a lawsuit filed in June

by HMA’s Mississippi hospitals against Blue Cross Blue Shield of Mississippi for improperly reducing inpatient services (CONTINUED ON PAGE 10)

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MSMOC Weighs In

Zurich 2012 Concussion Consensus Statement focuses on concussion definition, on-field recognition, management and tools

By LYNNE JETER

The importance of clinical suspicion for identifying a concussion cannot be overstated, says orthopedic surgeon Austin Barrett, MD, of the Mississippi Sports Medicine & Orthopaedic Center (MSMOC).

“If there’s any question or uncertainty about it, medical personnel would do well to follow the ‘if in doubt, sit them out’ guideline,” said Barrett. “The long-term Dr. Austin consequences of further Barrett neurological injury far outweigh those of sitting out for a game.”

Barrett and sports medicine specialists at MSMOC, the state’s first full-service orthopedic specialty practice, agree the 2012 Concussion Consensus Statement doesn’t differ significantly from the 2008 statement. The changes focus on concussion definition, on-field recognition, management and offering tools to assist with recognition, such as SCAT3 and the child SCAT3.

The 2012 Concussion Consensus Statement was derived from the 4th International Consensus Conference on Concussion in Sport, held last November in Zurich. Every four years, the International Ice Hockey Federation, International Olympic Committee, International Rugby Board, International Federation for Equestrian Sports, and FIFA (International Federation of Association Football) host the conference, which results in an updated concussion consensus statement. “(The 2012 statement) also addresses several questions that we currently don’t know the exact answers to, but will hopefully learn in the future,” said Barrett.

For example, one question posed in the 2012 statement concerns the role of concussions in the development of CTE (chronic traumatic encephalopathy), an entity that’s gained much attention, particularly in American football players and boxers.

“In the most recent report, the individual role of concussions in the development of CTE has changed slightly from the previous report,” said Barrett. “While it’s true that no direct cause-and-effect relationship between concussions and CTE has yet been found, this doesn’t mean that a relationship doesn’t exist. Many factors likely play a role in CTE, and we must continue to be mindful of the potential contribution of concussions to this entity.”

Among high-profile, self-inflicted deaths in recent years are professional athletes Junior Seau, Derek Boogard, Dave Duerson, who may have been the only one to commit suicide and leave instructions donating his brain for the study of CTE. Former NFL quarterback Jim McMahon, who revealed in 2010 that he is suffering from memory loss, has agreed to donate his brain to science after his death. “Back then, it was just tape an aspirin to your helmet and you go back in,” said McMahon, leader of the Chicago Bears’ 1985 Super Bowl-winning season. mississippimedicalnews

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Barrett emphasized that concussions are “potentially serious neurological injuries that are now justifiably gaining worldwide attention.”

“They’re a major contributor to sports injuries, with the CDC estimating that roughly 175,000 to 300,000 of the 1.7 million worldwide traumatic brain injuries (TBIs) annually are related to sports or recreation,” he said, adding the 2012

statement’s “listing of signs and symptoms of a concussion is also helpful to those not accustomed to them. These can be very subtle, and the report does well to note that LOC (loss of consciousness) isn’t required for the diagnosis.”

The 2008 conference resulted in the development of the Sport Concussion Assessment Tool (SCAT2), a standardized method of evaluating athletes ages 10 years

and older for concussions. The laymanfriendly SCAT3 recognized in the 2012 statement has a background section and is much more streamlined with clinician instructions on its own page, rather than after each section.

“It includes a great protocol for graduate return to play for athletes with a concussion, as well as how to handle those with more serious or prolonged symptoms,” said Barrett.

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HMA Hospitals Changing Hands, continued from page 8 payments to the hospitals. Blue Cross Blue Shield has declined to comment on the lawsuit.

“To my knowledge, the lawsuit is going to proceed as scheduled,” said Tom Kirkland, an attorney for HMA hospitals.

Soon after the suit was filed, Blue Cross Blue Shield announced the Mississippi HMA hospitals would soon be categorized as “out of network.”

That deterrent may not matter much, since House Bill 374, passed in the last legislative session, provides clinics the opportunity to have patients reassign their insurance payments if the clinic is an outof-network provider. The new law, which became effective July 1, would allow the insurance payment to go directly to the provider rather than the patient. It would benefit physicians who aren’t in the Blue Cross Key Physician network.

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The Unraveling

The relationship between HMA and its largest shareholder (14.6 percent), Glenview Capital Management, a hedge fund managed by billionaire Larry Robbins, had soured in recent months. Glenview, a private investment management firm established in 2000 with more than $6 billion of assets, also owns nearly 10 percent of CHS. Robbins had been critical of HMA’s sluggish financial results and “unconstructive” executive behavior, pointing to HMA CFO Kelly Curry.

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

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

Another Nashville, Tenn.-based hospital group, LifePoint Hospitals (NASDAQ: LPNT), had also expressed interest in acquiring HMA.

The Next Step

Until the merger is completed – the target deadline is March 31 – John Starcher Jr., president of HMA’s Eastern Group with 23 hospitals in seven states, will step up as HMA interim CEO. HMA’s projected second-quarter earnings show a drop of .05 percent in net revenue to $146 billion, attributing the discouraging fiscal picture to low admissions, increases in observation stays, higher bad debt, a reduction in surgeries, and the federal government’s sequestra-

tion. Same-hospital admissions were predicted to fall 6.7 percent, compared to the second quarter of 2012.

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

Physician Spotlight: Hannah Gay, MD, continued from page 3 department nurses who see these women at church or at the grocery store and know when somebody gets pregnant – and can get them in for prenatal care and testing.”

Today, renewed hope for ultimately defeating HIV makes Gay’s daily efforts even more rewarding, as other recent studies from around the world also help point the way to a cure.

“I’ve seen it go from the time when HIV was a death sentence, to the time when it has become a chronic treatable illness,” she said.

“At the time I first started, when I had a child who was newly diagnosed, I had to sit down with the family and say, ‘We will keep your child healthy as long as possible – and then we will do our best to keep your child comfortable.’

“In just a period of a few years, we went from that situation to the point where I could say, ‘If you will work with me and be very diligent in giving these medications, your child can live a long, healthy life.’

“The extreme difference there has, of course, made it very rewarding to be in this field.”

Outside of her work, Gay enjoys needlework and is an active member of Trace Ridge Baptist Church. She and her husband, Paul, have four grown children and one grandchild.

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New Lines of Research

NCI Data Set Opens Access to Cancer-Related Genetic Variations

By CINDy SANDERS

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

Finding answers to those questions just got a bit easier with the rollout of a vast data set of cancer-specific genetic variations by scientists at the National Cancer Institute (NCI).

Yves Pommier, MD, PhD, chief of the Laboratory of Molecular Pharmacology at the NCI, was one of three lead researchers on the study, published July 15 Dr. Yves in Cancer Research, that Pommier pinpointed more than six billion connections between cell lines with mutations in specific genes and the drugs that target those genetic defects. Paul Meltzer, MD, PhD, chief of the Genetics Branch at the Center for Cancer Research and James Doroshow, MD, director of the Division of Cancer Treatment and Diagnosis, were the other principal investigators.

Pommier explained the new database builds upon the NCI-60 cancer cell

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

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

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

The researchers cataloged the genetic coding variations, developing a list of possible cancer-specific gene aberrations.

The group then used the Super Learner

algorithm to predict the sensitivity of cells with variants to more than 200 anti-cancer drugs … those approved by the FDA and those still under investigation. By studying the correlation between the gene variants – such as TP53, BRAF, ERBBs, and ATAD5 – and anti-cancer agents including vemurafenib, nutlin and bleomycin, the researchers were able to predict outcomes, showing one of the many ways the data could be used to validate and generate novel hypotheses for future investigation.

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

In explaining how the system works, Pommier said a researcher interested in a specific agent could plug that drug into the database. “You’ll get the profile activity of the drug, and then you can ask if there

is any match to any specific gene mutations,” he said. From there, Pommier continued, the researcher could query, “Are these cells more resistant or receptive to the drug?”

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

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

Read Mississippi Medical News Online: MISSISSIPPI MEDICAL NEWS.COM

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GrandRounds River Oaks Hospital Announces New COO L. Dwayne Blaylock, President and CEO of River Oaks Hospital, announced that Heather Sistrunk, RN, BSN, MHSA, of Brandon had been named Chief Operating Officer of River Oaks Hospital, a 160 bed

Heather Sistrunk

facility located in Flowood. Prior to this role, Sistrunk served as the Southern Division Director of Quality and Clinical Implementation for Health Management Physician Network (HMPN). She has more than seventeen years of health care experience and began her career as a nurse in the Coronary Care Unit at Mississippi Baptist Medical Center. She also served as Administrative Director in Cardiovascular Services at Mississippi Baptist Medical Center be-

fore joining HMPN. Sistrunk received a bachelor’s degree in Nursing from Mississippi University for Women and a master’s degree in Health Services Administration from Mississippi College. She is a member of the American Academy of Medial Administrators, Mississippi Organization for Nursing Executives and the American College of Cardiology. She also served pro-bono as the Executive Director of the Mississippi

Releasing Amyvid, continued from page 6 Global Picture Because slightly more than half of patients with dementia have Alzheimer’s disease, noted Schwartz, the key to improving treatment protocols rests in a more specific diagnostic tool that segues into the neuroscience industry’s understanding of biomarkers.

“Having a specific diagnostic tool, that’s a whole paradigm shift in testing for Alzheimer’s disease,” he said.

Unfortunately, insurance companies haven’t yet consented to coverage for these tools, such as Amyvid, Schwartz noted.

“It’s still new,” he said. “However, if current trials are successful, we’ll be treating Alzheimer’s patients very differently in next five to 10 years, and saving money in the long run.”

In 2011, Congress passed a law to develop a national approach to Alzheim-

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Alzheimer’s: A Difficult Diagnosis Alzheimer’s and other causes of cognitive impairment share many overlapping symptoms including memory loss, visuospatial ability, executive function and behavior and language deficiencies. Because a definitive diagnosis of Alzheimer’s disease is usually determined through an autopsy, physicians rely on medical history, clinical examination and a variety of diagnostic tools when evaluating patients.

er’s disease, a strong step to promoting a national conversation. New alliances are quickly forming, such as the unique partnership between the Alzheimer’s Association and the Society of Nuclear Medicine to draft a consensus statement on neuroimaging.

“Last summer, diagnostic criteria that was 20 to 25 years old was revamped,” said Schwartz. “One of many questions is: what criteria should we have in place as a society? Screening for colon cancer with a colonoscopy at age 50 has become a standard procedure. Do you start amyloid screening at 60, with or without certain risk factors?

Those type of answers blend into politics and money. Participation in clinical trials is how we’ll move forward towards a better, more informed plan for managing the upcoming Alzheimer’s epidemic.”

Healthcare Alliance.

NewSouth NeuroSpine Selected to Introduce Innovative Spine Imaging Technology

Physicians at NewSouth NeuroSpine are among the first in the nation to introduce a groundbreaking new spine imaging technology that yields more precise images of the spine in motion and enables physicians to better diagnose and manage back pain for their patients. The Vertebral Motion Analysis (VMA) technology, developed

by Ortho Kinematics, Inc., uses fluoroscopy to capture real-time images of the spine, while the patient is guided through a preset range of motion. The technology was approved by the Food and Drug Administration in December 2011, and NewSouth NeuroSpine is one of just four non-hospital facilities nationwide to offer the now commercially available technology to patients.

The VMA utilizes a patented Motion Normalizer device, which provides powered passive trunk bending while the patient is standing and lying down. Patients grip handlebars during the test and the ‘motion normalizing’ technology gently moves them through a specified range of motion to capture a true picture of the spine’s ability to flex and bend. The 30-minute procedure is ideal for assessing patients with suspected instability of the lower lumbar spine in a weight bearing or non-weight bearing posture.

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GrandRounds Agreement Signed, UMMC Patients With Blue Cross Insurance Remain In Network

Leaders at the University of Mississippi Medical Center signed a new oneyear agreement with Blue Cross and Blue Shield of Mississippi, ending six months of negotiations with the insurer.

With the agreement in place, patients insured through Blue Cross can continue to receive in-network care at UMMC. The existing contract was set to expire Aug. 28.

“We were very concerned about how this issue was going to impact our patients.

While UMMC needs equitable reimbursement for the highly specialized services we provide, the last thing we wanted to do was to inconvenience or cause hardship for our patients.”

Citing reimbursement substantially below its peer institutions in neighboring states, Medical Center administrators engaged Blue Cross in negotiations earlier this year.

As the state’s only academic medical center, UMMC provides advanced care not available at other Mississippi facilities, including the state’s only Level 1 Trauma Center, only children’s hospital and children’s trauma services, only level IV neonatal intensive care unit and its only organ transplant services, among many others.

Together with the Mississippi State Department of Health, UMMC leads the state’s medical response during disasters.

The availability of these services benefits all Mississippians.

As well, UMMC cares for the state’s most complex medical cases, which often require multi-disciplinary teams of experts and sub-specialists.

UMMC initially set a June 28 deadline to reach an agreement or terminate its contract. Negotiators extended it to July 17, and again through August 28.

Memorial Hospital at Gulfport Recognized Nationally as First in Mississippi Memorial Hospital at Gulfport ranked as the best hospital in Mississippi, according to U.S. News & World Report. U.S. News released its 24th annual Best Hospitals rankings, recognizing hospitals that excel in treating patients who need an especially high level of care. Memorial was ranked #1 of 116 hospitals that serve the residents of Mississippi.

U.S. News also listed Memorial among the top hospitals in the nation for Diabetes and Endocrinology care. It was the only hospital in Mississippi to receive national recognition in any of the 16 medical specialties studied by U.S. News. Memorial ranked 42nd nationally in this category, which measures Diabetes and Endocrinology patients’ survival, safety and volume, as well as nurse staffing. Only 147 hospitals in the U.S. received a national ranking for any of the medical specialties that were measured.

Six other specialties at Memorial were rated as high-performing. These included Gastroenterology and GI Surgery, Geriatrics, Nephrology, Neurology and Neurosurgery, Pulmonology and Urology.

The hospital scored high in patient safety, “demonstrating commitment to reducing accidents and medical mistakes,” according to U.S. News. Patients also gave Memorial scores higher than national and state averages in patient satisfaction categories. These rankings are designed to help patients and their families identify the best places to seek high-quality care within their community and health insurance network. To determine the rankings, U.S. News analyzed data for nearly 5,000 healthcare facilities nationwide.

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Rush Foundation Hospital Achieves Prestigious Iso 9001:2008 Quality Certification Rush Foundation Hospital has recently been notified that it has been certified as an ISO 9001:2008, Quality Management Systems compliant organization. This certification is accredited by DNV Certification Inc. of Houston TX. Rush Foundation Hospital is one of only three hospitals in the state and one of only fifty in the nation to achieve this distinction.

ISO 9001 is a standard related to quality management systems and is designed to help organizations ensure that they meet the needs of patients, medical staff members and employees.

Chuck Reece, Executive Vice President and Chief Operating Officer of Rush Health Systems noted that the procedures and standards that are learned and implemented during the ISO 9001:2008 evaluation process allow Rush Foundation Hospital to develop more sustainable quality performance.

To become certified as ISO 9001:2008 compliant, Rush Foundation Hospital, Women’s Healthcare Center, and Rush Rehabilitative Services underwent a 36 month evaluation process that included development of a formal quality management system (QMS), management systems review, employee training, process documentation, establishment of process metrics and a pre-audit initial assessment; all of which are required to be in compliance with the ISO 9001:2008 standard. The process culminated in a four-day registration audit by DNV. A certificate of registration was issued to the organization on May 23, 2013.

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GrandRounds Reece named chairman of MHA Board of Governors

Chuck A. Reece, President of Rush Foundation Hospital and Executive Vice President and Chief Operating Officer of Rush Health Systems, was recently elected Chairman of the 2013-2014 Mississippi Hospital Association (MHA) Board of Governors during MHA’s 82nd Annual Lead- Chuck A. Reece ership Conference.

Mr. Reece has held numerous administrative positions within Rush Health Systems since 1972. He is a graduate of Mississippi State University and the Executive MBA program at Vanderbilt University.

First Mohs surgeon in North Mississippi

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.

Advanced Dermatology & Skin Cancer Associates has expanded into DeSoto County, Miss. The new clinic, located in Olive Branch, expands the practice’s dermatology practice. The DeSoto location opened in April 2013, with the Medi Spa that opened in July. ADSCA is the only Mohs surgery clinic in North Mississippi between Jackson, Miss. and Memphis, Tenn.

The DeSoto clinic offers complete dermatological and cosmetic services, including Mohs surgery, which boasts a 99 percent cure rate for skin cancer, including melanoma. It is the first clinic to offer Mohs surgery in North Mississippi. It will also be home to a medical spa offering non-surgical cosmetic procedures, which is a new addition to ADSCA’s business. The DeSoto location has 12 patient rooms and a medical spa, and employs a dermatologist, aesthetician and physician assistants available for same-day and next-day appointments.

Moore Named NMMC President

Tim Moore has been appointed as president of North Mississippi Medical Center-Tupelo, a 650-bed regional referral center that is the largest, private, notfor-profit hospital in Mississippi.

Since April 2012, Moore has served as vice president Tim Moore of North Mississippi Health Services’ community hospitals, working closely with the facilities in Eupora, Iuka, Pontotoc and West Point, Miss., as well as Hamilton, Ala. Moore came to Tupelo from Meridian, where he had served as system vice president of regional operations for Rush Health Systems since March 2007. Prior to that, Moore was affiliated with NMHS, serving as administrator of North Mississippi Medical Center-West Point from 2003-2007.

A native of Forest in Scott County, Moore holds an associate’s degree in radiological technology from Meridian Community College and a bachelor’s degree in industrial science from Mississippi State University. He earned a master’s degree in health care management from the University of New Orleans in 2003.

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HEALTH CARE REFORM DECLINING TOP LINE REVENUE

DELIVERY MODEL CHANGES PHYSICIAN COMPENSATION RISKS EVERY DAY IS A CHALLENGE

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