St Louis Medical News June 2015

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PHYSICIAN SPOTLIGHT PAGE 2

George Hruza, MD ON ROUNDS

Steps Physicians May Take to Manage Stress Two constructs are often foundational in dealing with frustrations and finding happiness Finding positive meaning in the daily grind of medical practice may seem like a tall order these days. Reducing stress while maintaining happiness may also sound like a far-fetched idea ... 4

Five Ways Millennials Have Shaken Up Healthcare They prefer alternative to single-source, PCP favored by older generations The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down ... 5

Mastering Health Informatics

Logan University responds to growing niche focused on healthcare technology and administration

By JULIE PARKER

CHESTERFIELD—Logan University is rolling out a new master’s degree program focused on healthcare technology and administration for the New Health Economy.

Designed to address the rapidly interlacing sectors of information system design, data management, health policy and public health issues, the Master of Science degree in Health Informatics (MSHI) is geared to healthcare professionals needing more expertise in three focal points: healthcare, information technology and business.

Graduates of the MSHI program will have the needed skills and education for leadership posts affecting the design, development and use of patient and enterprise-wide data systems at hospitals, medical groups and clinics, health insurance organizations, research, policy or-

ganizations, hardware and software vendors, internet companies, and others affiliated with the healthcare sector.

“The MSHI is a fairly new degree with only a few schools around the country offering accredited programs in it,” said Sherri Cole, PhD, founding dean of the College of Health Sciences at Logan University.

“Certificate programs for healthcare information have been around for a while. With the influx of changes post-healthcare reform, it became a degree program popping up around the country. However, ours is unique because it focuses more on science and prepares students for leadership roles compared to health information management, which is more hands-on as a supervisor in the field.”

With population health management quickly becoming America’s dominant healthcare model – and an unprecedented demand for their (CONTINUED ON PAGE 8)

St. Louis Medical Market Report Positive absorption past two quarters

By JULIE PARKER

Even though the average vacancy rate and lease rates haven’t varied much for medical office space, there’s good news squirreled in CRBE’s 2015 1Q St. Louis Medical Marketview report.

“The absorption has finally been positive for the past two quarters,” said Ann Dulle of CRBE’s healthcare and office real estate services.

The vacancy rate for medical office properties in the St. Louis metro area, covering buildings with 10,000 square feet or more, plus sublease space, was 14.6 percent in the first quarter of the year.

(CONTINUED ON PAGE 6)

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PhysicianSpotlight

George Hruza, MD

By LUCy SCHULTZE

Since shifting from full-time academic medicine into private practice more than 15 years ago, dermatologist George J. Hruza, MD, lectures around the world and retains a part-time teaching role.

But his mission to give back by training others has been best expressed in the dermatological surgery fellowships he’s offered to young physicians – one each year, over 21 years.

“Working with fellows is a much more rewarding way to teach,” said Hruza, a clinical professor in the Department of Dermatology at Saint Louis University School of Medicine.

“You become a mentor, and the interaction is much more intimate in a day-to-day setting for a whole year,” he said, adding that the relationship has often yielded opportunities to add new approaches and procedures to his practice.

“I find it’s a two-way street,” he said.

“I may do something the same way for 10 or 15 years, and then a new person comes in who is very interested in learning and asks, ‘Why do you do it that way?’ If the answer is, ‘Because that’s how I’ve always done it,’ they may come up with a different perspective. Often, they’ve taught me new ways of doing things.

“By yourself, you can get in a rut. But having all these fellows has helped to keep me sharp.”

Of course, he said, enjoying that kind of relationship with a fellow in training calls for careful selection on the front end.

“It does depend on the quality of the fellow, so hopefully, you choose well,” he said.

“I’ve been very fortunate. The overwhelming majority of them, we worked really well together and it made for a great year.”

For Hruza, pursuing a balance between private practice and academic medicine has provided an opportunity to broaden his own reach in helping others.

“As one person, I can help some patients,” he said. “But if I can teach a bunch of other people to do the things I do, a lot more people can be helped. To me, that’s always been important.”

Hruza spent 11 years on the faculty of Washington University School of Medicine, where he led the dermatologic surgery section as part of the Department of Otolaryngology/Head and Neck Surgery; the Department of Surgery, Division of Plastic/Reconstructive Surgery; and the Department of Medicine, Division of Dermatology.

Hruza’s area of specialty is in dermatologic surgery for skin cancer, particularly the Mohs micrographic surgery. His private practice, Laser & Dermatologic Surgery Center Inc., is based in Chesterfield and offers a full range of dermatological services, including laser and cosmetic procedures.

For the past four years, the practice has been housed in a new building on Chesterfield Parkway East, where Hruza’s practice shares facilities and an accredited surgery center with another dermatology group. While he is able to perform most procedures in-house, Hruza remains on active staff of Barnes-Jewish West County Hospital and St. Luke’s Hospital.

Hruza holds a medical degree from New York University School of Medicine and completed his internship at New York Hospital through Cornell University. He spent his dermatology residency at New York University Medical Center, followed by a clinical and research fellowship in laser surgery at Massachusetts General Hospital with Harvard University School of Medicine in Boston.

He ventured into the Midwest in 1987 for a fellowship in Mohs surgery at the University of Wisconsin in Madison, then settled in St. Louis. In 1998, he earned an MBA from Washington University.

Hruza’s path into medicine was laid by his parents, both of whom were physicians. He was born in Prague, Czech Republic, behind the Iron Curtain during the Communist era and escaped with his family at age 10.

“I was so young, they didn’t even tell me what we were doing,” he recalled.

“They just said, ‘We’re visiting your uncle in Yugoslavia for Christmas. Pack your favorite toys and your stamp collection.’”

Hruza’s father, a research scientist and pathologist, was already in the United States as part of an exchange program.

To guarantee his return, the Communist government was holding his family’s passports. Hruza’s mother, a pediatrician who became a psychiatrist in the United States, along with his uncle led Hruza and his

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older sister on a circuitous route through several eastern European countries.

Ultimately, a guard who couldn’t read the Czech language mistook the papers they had for permanent visas, allowing them passage to Sweden. The family spent four years there before finally gaining permission to rejoin Hruza’s father in the United States. They settled in New York.

Today, Hruza takes full advantage of the freedom of travel he now enjoys. His family recently trekked to Iceland, and he and wife Carrie, an optometrist, make an annual tradition of helicopter skiing in British Columbia.

Their blended family includes four children: Stephanie, 21; Paul, 19; Hope, 19; and Rose, 15.

Helping to bring the siblings together after the Hruzas wed six years ago was Carrie’s success in winning the Mrs. Missouri America pageant and in ranking as a finalist in Mrs. America.

“The kids encouraged her to sign up for the pageants,” Hruza said. “To get their seats to support her, they sat all day in front of the doors to be at the head of the line. They loved the whole experience.”

Hruza’s activities outside his practice include a dedication to organized medicine. He is a past president of the St. Louis Metropolitan Medical Society and is treasurer of the Missouri State Medical Association. He serves as president of the American Society for Dermatologic Surgery and travels to Washington at least three times a year to advocate on behalf of physicians.

“We’re under huge pressure from regulators, legislators and insurance companies as far as how we take care of our patients,” he said.

“It’s really had a detrimental effect on the doctor-patient relationship. My way of trying to deal with that is being very involved in organized medicine to try to make a difference as far as preserving, protecting and enhancing the doctorpatient relationship. I try to do my part to hopefully help.”

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Steps Physicians May Take to Manage Stress Two constructs are often foundational in dealing with frustrations and finding happiness

By JULIE PARKER

Finding positive meaning in the daily grind of medical practice may seem like a tall order these days. Reducing stress while maintaining happiness may also sound like a far-fetched idea. Yet it’s possible to minimize the emphasis on the challenges of practicing medicine post-Obamacare, while also maintaining harmony in life, said Stuart Slavin, MD, MEd, associate dean for curriculum and professor of pediatrics at Saint Louis University (SLU) School of Medicine.

“First, physicians can look at their work Dr. Stuart environments and see Slavin if there are any obvious places where unnecessary stressors or nonvalue added work exists” and make a concerted effort “to change those practices,” said Slavin, a SLU alum who completed residency training in pediatrics at UCLA, where he served as a faculty member for 17 years before returning to St. Louis.

For example, if someone asks why something’s done a certain way and the only answer is because “that’s how it’s always been done,” chances are good that the process is flawed and perhaps unnecessary, said Slavin.

“The second broad area is to utilize skills to better handle the stresses inherent in the practice – and in life -- that cannot be eliminated,” he said.

Slavin pointed to helpful mental health tools that don’t require a substantial time commitment. In many instances, the tools require no extra time at all to use, once a pattern has been established.

“Mindfulness and metacognition are

two constructs that are in many ways foundational in dealing with stress and finding happiness,” he said, noting that Jon Kabat Zin defined mindfulness as “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally.”

“It means being in the moment, being able to direct one’s attention in the way that you want and not being distracted by intrusive thoughts about the past or the future,” Slavin explained. “It means feeling fully engaged in whatever you’re doing.”

The traditional approach to developing mindfulness is through meditation.

“If you have the time and discipline to do this, that’s great, but the reality is that many physicians aren’t able to do so,” he said. “The key is that mindfulness can also be developed through informal practice in daily activities.”

Examples include eating a meal in a mindful way by paying attention to the tastes and textures of the food, walking purposely by noting the rhythm of one’s footsteps, or focusing on the feeling of warm water as it hits the body during a morning shower instead of thinking about all the things to come in the very busy day ahead.

“The key is working in whatever way you can to focus your attention and awareness on what you want to focus on,” said Slavin.

The second foundational construct – metacognition – involves the practice of examining one’s thoughts and feelings.

“The reality is that we have very predictable and often toxic ways of thinking, particularly about ourselves,” said Slavin.

“Being able to objectively examine our thoughts and feelings is essential in managing stress.”

Beyond these foundational con-

structs, Slavin suggested several skills for physicians’ mental health toolbox: Positive emotions may be cultivated through a very easy practice called “three good things.” Before nodding off for the night, jot down three good things that happened during the day. “Do this for eight weeks and you’re likely to feel happier in your life,” he encouraged.

Negativity bias. “We’re hardwired as humans to allow negative events in our lives to have more impact than positive ones,” he said. “Simply recognizing this fact can help one keep perspective and not allow isolated negative events to outweigh all the good ones that occur.”

Cognitive restructuring. “We often go through life with the basic belief that adverse event equals outcome. This is incorrect,” Slavin emphasized. “Adverse event – plus our emotional reaction – equals outcome. Our emotional reaction is the only thing we often can control in any way to influence an outcome. We have very predictable ways of distorting reality – catastrophizing, black-and-white thinking, and predicting the future in negative ways – that don’t serve us well. Recognizing our cognitive distortions, counteracting and disputing these negative thoughts are critical skills to possess.”

Emotional self-regulation. Slavin uses an exercise he calls “grocery line mindfulness” to practice emotional selfregulation. “I used to get ridiculously frustrated in grocery lines that were moving slowly as I was certain that I always chose the wrong line,” he explained. “With ‘grocery line mindfulness,’ one can follow these simple steps: recognize feelings of frustration and distress, pause, observe the situation dispassionately, and decide if you want to feel frustrated or whether

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those feelings are serving you well. Most times, you’ll be able to say that it’s not worth feeling frustrated. The more you experience making this a choice, the more you’ll be able to control your emotions in this and other settings – and not have these (negative) feelings be automatic.”

Finding meaning. Discovering or boosting fulfillment and meaning in work is perhaps the best antidote to burnout.

“I firmly believe that being a physician is an extraordinary privilege,” said Slavin.

“The more one can embrace the profound moments of beauty, compassion and generosity of spirit in practice, the more fulfilling and rewarding practice will be.”

It’s easy for physicians to become dispirited by the realities and demands of practice, Slavin empathized.

“One should remember that burnout and depression don’t have to be inevitable outcomes,” he said. “The best path to avoiding these outcomes and finding some measure of happiness and fulfillment in practice is up to you. The path isn’t an easy one, but it’s one worth pursuing.”

Editor’s Note: This article is a prelude to a national series aimed at supporting the well being of medical students, interns, residents and physicians from the extraordinary levels of stress they face.. The series will launch next month with a look at how Stuart Slavin, MD, MEd, associate dean for curriculum at the Saint Louis University (SLU) School of Medicine, implemented practices to help medical students build resistance to stress and maintain happiness after a May 2008 study showed an alarming rate of students reporting high levels of anxiety, depression and suicidal ideation.

In 2013, Slavin captured a prestigious national teaching award for his work as architect of curriculum reform to dramatically improve the overall well-being of SLU medical students. The in-depth series will also review steps other medical schools nationwide are taking to address mental health wellness.

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Five Ways Millennials Have Shaken Up Healthcare

They prefer alternative to single-source, PCP favored by older generations cent of baby boomers and 28 percent for seniors.

“The timely management of social media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a constant challenge for all practices. Getting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”

By JULIE PARKER

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

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

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

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

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

Speedy delivery

When it comes to the drive-thru generation, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14 percent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 percent) visited their PCP significantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically.

“Quick Care” availability has been recog-

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Kick the tires online before buying

nized as a top priority by many healthcare organizations, and even large retailers and several pharmacy chains. Millennials expressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

Word-of-mouth marketing

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

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

Good faith, upfront estimates

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

Only 18 percent of seniors and 21 percent of boomers reported asking for or receiv-

ing information on costs upfront. Unfortunately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

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

Kicking care down the road.

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

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

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

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St. Louis Medical Market Report, continued from page 1 The market report, covering approximately 4 million square feet of rentable building space, showed the average direct asking rate for medical/office space for the first quarter was $21.75 per square foot; and $22.02 per square foot for full-service, pure medical space – slightly lower than 2014 4Q. Net absorption for the first three months of 2015 was 26,119 square feet, with the West County submarket, followed by the Central County submarket, showing the greatest market activity.

Movement dominating 2015 market activity involves Tenet Healthcare Corporation, The Willows at Brooking Park,

BJC Health Care, Washington University, and recently approved certificates of need (CONs).

Tenet, operator of Des Peres Hospital and St. Louis University Hospitals, unveiled a joint venture with United Surgical Partners International (USPI), with 17 locations in the metro area. The five-year deal with an option to buy forms the nation’s largest ambulatory surgery provider.

The Willows at Brooking Park, a retirement community in Chesterfield, revealed plans for a $27 million expansion.

The 110,400-square-foot development calls for 45 new apartments, a theater, indoor

pool, fitness center, spa, wine cellar, art studio and gallery, library and billiards/ game room. Willows’ owner, St. Andrews Resources for Seniors System, anticipates construction to begin next year.

BJC Health Care and Washington University is building a new half-million square foot, 12-story office building to house administrative and support staff, mainly on its primary campus in St. Louis.

BJC Health Care has also reportedly agreed to acquire the Mineral Area Regional Medical Center to operate as an extension of the group’s existing Parkland Health Center in Farmington.

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Also, Mercy Hospitals, part of the nation’s fifth largest Catholic healthcare system, is reportedly in negotiations with Herman Area District Hospital to expand their current affiliation. In March, Lincoln County Medical Center officially joined Mercy.

The first quarter of 2015 continued the trend of the last few years’ surge of expansion and new facility CON applications and approvals.

Newly approved CONs for assisted living facilities in St. Louis County include Waterford’s $15 million, 88-bed facility; Provision Living at Des Peres Road’s $14 million, 60-bed facility; Avalon Memory Care’s sixth expansion with a $5.4 million, 60-bed facility; The Grove in Creve Coeur’s second expansion with an $18 million, 75-bed facility; and PVL Quarry’s fourth extension with a $13 million, 60bed facility.

Newly approved CONs for assisted living facilities in St. Charles County include St. Peter’s Memory Care’s fourth expansion with an $8.3 million, 70-bed facility; Cedarhurst Assisted Living and Memory Care’s $17.4 million, 99-bed facility; and WingHaven Retirement’s $28 million, 90-bed facility and an 80-bed skilled nursing facility.

Northside Urgent Care Hospital’s $6.9 million, 3-bed facility represents the sole CON-approved urgent care hospital in the first quarter.

In overall commercial office news, DTZ’s 2015 1Q Office Market Snapshot showed how the year began similar to the start of 2013 and 2014, with overall negative absorption in the first quarter, primarily as a result of Bank of America’s consolidating and downsizing of various large offices and ConAgra vacating 77,000 square feet to market as available sublease space downtown. The report predicted the last quarter of the year is likely to end similar to the previous two years with significant positive absorption.

Since 2011, Class A suburban office space has absorbed more than 1 million square feet, including Energizer’s plan to move into 44,000 square feet in the second quarter as part of its expanding footprint in St. Louis.

The outlook, according to DTZ, calls for suburban Class A properties to continue driving market forces, resulting in increased asking rates and fewer concessions. Parking issues, smaller footprints, and increased competition for Class A space may preclude Class B buildings from benefitting from the trickle-down effect.

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The Competing P’s: Provision & Payment

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Changing reimbursement for new models of care

By CINDY SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes.

Now the not-so-good news … we have to figure out how to pay for it.

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

Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment.

Value-based purchasing includes payments in categories two through four. The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018.

Additionally, HHS hopes to have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

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

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac stlouismedicalnews

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tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.

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

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

“The government … through statements around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

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

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

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

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The Challenge: Getting Paid

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

By JULIE PARKER

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

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

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

David Shelton, COO of PatientMatters pointed out the predicament: “The challenge we must address is helping our hospitals adapt, and adapt quickly.”

For Schweitzer, PatientMatters was preceded by CareMedic Systems Inc., a healthcare technology revenue cycle firm with 1,600 hospitals and 1,000 ancillary facilities at the time it was sold in 2009. CareMedic successfully brought to market the first enterprise class revenue management system: the electronic Financial Record (eFR).

“Even though we focused on third-party billing and management, it became very obvious that patient receivables would be the next big challenge,” said Schweitzer, noting that in 2007, only 4 percent of revenues were coming from patients. By 2011, patient revenues averaged 32 percent. “The problem was

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growing really fast. Hospitals and physicians just aren’t accustomed to healing patients and then asking for money. We felt there had to be a real behavior change of hospital staff and patients to improve the collection ratio of patient receivables.”

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

“We found that even the tightest-run patient access departments are having difficulty getting their arms around the evolving patient receivable,” she said. “The fact is, though healthcare reform may be a notable accelerant, the issue runs much deeper.

Hospitals are seeing their revenue sources change completely as patients leapfrog private insurance (as) the third-largest payor.”

Before opening PatientMatters, Schweitzer made two strategic acquisitions, including MASH (Medical Advocacy Services

for Healthcare), a Medicaid eligibility service since 1988, and Kramer Technologies, a technology firm.

“We took our time to really understand our market and hone our training, communications and processes to satisfy the hospitals and the patients,” she said. “We’re very bullish on where we are.”

Since the firm opened in 2012, revenues have reached $25 million and employment tops 200. Based in Orlando, with offices in Houston and Ft. Worth, Texas, PatientMatters has hospital partnerships across the United States. The most recent hospital contract inked was St. Luke’s Cornwall Hospital, with campuses in Newburgh and Cornwall, NY. “We guarantee cost savings,” said Schweitzer. “We put resources on staff at the hospital. We only generate revenue after the hospital has seen an improvement. We’re not subscription- or fee-based. We actually align with the hospital. We only win when they win.”

PatientMatters focuses strongly on the

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

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

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

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

Mastering Health Informatics, continued from page 1 roles – an MSHI degree graduate could be considered the “gatekeeper to help drive population health decisions,” said Cole.

“Logan developed this degree because we recognize the critical role health informatics plays Dr. Sherri in healthcare delivery, Cole now and in the future,” she said. “This degree will train professionals who understand how healthcare is delivered and how technology can be used to its fullest potential to ensure high quality patient care.”

Beginning this fall, the MSHI degree program will be offered in a hybrid format,

with a combination of Tuesday and Thursday or Monday and Wednesday evening classes (6-9 pm) on the 112-acre Logan University campus, and a third course online.

“MSHI students will remain on their schedule until they reach their specialization areas,” said Cole.

After accumulating 24 credit hours of core coursework, MSHI students may choose between four concentrations: health policy and management; public health; quality systems (improving quality outcomes of a healthcare enterprise); and healthcare compliance (legal and regulatory compliance issues).

Graduates are eligible to sit for the Certified Professional in Health Information & Management Systems (CPHIMS) exam.

“Historically, degrees are very fo-

cused,” said Cole. “If you have a degree in informatics or computer science, that’s what you know. Any type of healthcare degree focuses on the care of patients. Combining the two, you’d hire a business or computer science person to work in the healthcare field, which would require a lot of on-thejob training. Likewise, if you had someone in the healthcare industry who wanted to know how to get data flow and processes going in a more efficient manner and tried to learn computer science, it’s a foreign field to them.

“Having someone in the middle with processes in place for a smooth transition and greater efficiency means that healthcare delivery for patients’ quality of life is increased,” said Cole.

Because the degree program is for high-level leaders, students must have nine semester credit hours of coursework in business, accounting, management, math, statistics, or computer science, said Cole.

“It’s better if students coming into the program have a combination of work experience and professional development courses,” she said.

Cole joined Logan University from Aultman Hospital in Canton, Ohio, where she was the founding dean for Aultman College. As director of radiology with five practice areas, she successfully ushered the change from film to digital imaging.

“This particular degree program fills a gap that has been creeping along and now taking flight,” she said. “Universities across the U.S. are trying to build a pathway for this degree. We’re ready and enthusiastic about starting the MSHI degree program soon.”

Logan University, founded in 1935 with the flagship Doctor of Chiropractic Degree program, has two other graduate degree programs in place: nutrition and human performance, and sports science and rehabilitation. stlouismedicalnews

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Helping Men Get Healthy

By CINDY SANDERS

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

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

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

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

“A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have had a sustained, negative impact on men’s health in the United States. To reverse this trend, MHN is employing a number of strategies in an effort to impact health in five key areas: • Reducing premature mortality of men and boys, • Enhancing physical and mental health of men for happier, fuller, healthier lives, • Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote healthcare services and healthy choices.

The Weaker Sex

While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls. However, she continued, “Once they hit (age) 34, the numbers for men begin to decline. At retirement age, there are about 80 men to every 100 women.”

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

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

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

enhance MHN’s efforts to change those trends.

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

Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said.

“Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.” Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country.

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

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

Provider Push

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

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

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

Men’s Health Month

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

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

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

Changing Trends

Fadich said strategies including national awareness and educational campaigns, partnering with providers and organizations nationwide, and conducting screenings at events where men gather all

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

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

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

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

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

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The Sleep Apnea Epidemic A new diagnostic tool

By SARAH BOND PADDOCK The Centers for Disease Control and Prevention state that insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity and depression. It’s estimated that about 70 million Americans suffer from chronic sleep problems with sleep deprivation associated with injuries, chronic diseases, mental illnesses, poor quality of life and well-being, increased health care costs, and lost work productivity. The Centers for Disease Control also indicate that for 2008-2009, 29.7 percent of Missouri adults reported not getting enough sleep 14 out of the last 30 days. The prevalence of self-reported insufficient sleep was higher among women than men.

According to the American Sleep Apnea Association, sleep disorders, including sleep apnea, have become a significant health issue in the United States.

It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstruc-

Phil in the Blanks

By SHELLY BANGERT

According to the Healthcare Finance News website, incorrect information is one of the top five reasons medical claims are rejected by payers. Medical claims must be submitted with accurate patient names, addresses and dates of birth. Even one misplaced letter in a patient’s name can cause the claim to be rejected, resulting in resubmissions and delays in payment.

Consider, for example, the confusion that can arise over alternate spellings of common names. Is it Philip or Phillip?

The full name for golfer Phil Mickelson is Philip, with one L, but TV host Phil Donahue is Phillip with two L’s. Basketball coach Phil Jackson is a one-L Philip, but rock and roll pioneer Phil Everly was a two-L Phillip. Incorrect spellings of these names on claim forms would result in rejected claims.

Errors of this type highlight the importance of using a medical claims clearinghouse to scrub claims in advance. A clearinghouse will catch simple errors, so claims can be easily corrected before they are submitted to payers.

Shelly Bangert is director of revenue cycle management at Hawthorn Physician Services Corp. in St. Louis. Shelly can be reached at sbangert@ hawthorngrp.com.

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tive sleep apnea undiagnosed. Obstructive sleep apnea (OSA), which represents the great preponderance of the cases, when left untreated can lead to high blood pressure, chronic heart failure, atrial fibrillation, stroke and other cardiovascular problems; it is associated with type 2 diabetes and depression; and is a factor in many traffic accidents and accidents with heavy machinery.

As more patients are becoming aware of their sleep health, it’s no wonder why over 8.2 million U.S. patients in 2010 visited their doctors to talk about sleep, with 5.8 million visits resulting in a sleep apnea diagnosis.

With sleep apnea awareness on the rise, physicians will likely become the first point of contact for those suffering from perceived poor sleep, with patients looking for guidance on how they can simply and finally feel rested. While sleep apnea may not always be the cause of a patient’s lack of sleep, most studies find that in the majority of cases, it is.

As with any disease, screening patients who might be at risk can lead to a healthier, more rested and safer patient population.

In August 2014 the first disposable sleep apnea screening device was launched in St. Louis as part of a pilot program with Walgreen’s pharmacies.

ApneaStrip™ is a new medical device that is designed to affordably screen patients for the risk of sleep apnea in the comfort of their own home. This FDA approved product requires a prescription and is currently available at St. Louis and surrounding area Walgreen’s pharmacies for under $30.

The strip was created to address the growing need to easily and objectively identify potential sufferers of sleep apnea.

This self-contained device is prescribed to the patient, worn during sleep and will indicate with either a flashing red light (high risk) or a flashing green light (low risk) the patient’s sleep apnea risk the next morning. A clinical study was performed at Clayton Sleep Institute, comparing the strip to an in-lab PSG which found, in 101 patients, that it had a sensitivity and specificity of 91 percent.

Although the strip will not replace the need for a sleep study, it can help identify if sleep apnea is present and should be further evaluated, or if it can be ruled out as a concern. For patient populations already suffering, or showing indications of other linked chronic conditions such as Type II diabetes, cardiovascular disease, hypertension and high blood pressure, screening patients for sleep apnea risk can now be checked easily and affordably.

Sarah Bond Paddock can be reached at sarah@ sleepsense.com

GrandRounds Diet or Exercise to Reduce Diabetes Risk?

In a paper recently published in Diabetes Care, Saint Louis University associate professor of nutrition and dietetics Edward Weiss, Ph.D, and colleagues found that, though people often think of the benefits from exercise, calorie restriction and weight loss as interchangeable, it appears that they may all offer distinct and cumulative benefits when it comes to managing Type 2 diabetes risk.

The SLU study enrolled sedentary, overweight, middle-aged men and women who were assigned to one of three groups designed to reduce weight by 6-8 percent through calorie restriction, exercise or a combination of both.

Researchers recorded the participants’ insulin sensitivity levels, a marker for diabetes risk that measures how effectively the body is able to use insulin.

The investigators found that both exercise and calorie restriction had positive effects on insulin sensitivity. Most interestingly, the group that did both saw two times the improvement in insulin sensitivity than either of the single-approach groups.

The study suggests that both exercise and calorie restriction have additive beneficial effects on glucoregulation (the steady maintenance of glucose, or sugar, in the body).

Weiss said that in a way the exercise group was the control group. It was already known that exercise can improve glucoregulation, both through weight loss and through mechanisms that are independent of weight loss so that means that even if you don’t lose weight, exercise helps.

On the other hand, it often has been assumed that calorie restriction improves glucoregulation simply because it leads to weight loss.

For this reason, it was somewhat surprising to researchers when they found that exercise-induced weight loss did not lead to greater improvements in glucoregulation than calorie restriction alone.

What they found is that calorie restriction, like exercise, may be providing benefits beyond those associated with weight loss alone.

If this is true, researchers would expect that the combination of exercise and calorie restriction (with participants still losing between 6 and 8 percent of their weight, like the other groups) would lead to even more improved glucoregulation than either of the other groups alone.

This is, in fact, what the results of the third, exercise and calorie restriction combination group confirmed.

This study says you can be healthier if you exercise and eat the right amount of food. There is more to be gained by including both approaches in your life.

Other researchers on the study include Stewart Albert, Dominic Reeds, Kathleen Kress, Uthayashanker Ezekiel, Jennifer McDaniel, Bruce Patterson, Samuel Klein and Dennis Villareal.

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GrandRounds Hawthorn Expands Responsibilities for Stan Hosler Hawthorn Physician Services Corporation announced that it is expanding responsibilities for Stan Hosler to include headquarters support for marketing communications. Mr. Hosler is based in Marietta, Georgia. He joined the Hawthorn team in 2012 to oversee business development activity in the southeast.

Hosler will continue in his business development role while producing new content for the company and for external publications.

Mr. Hosler has over thirty years’ experience in sales, marketing and communications. He has held several headquarters sales, sales training and marketing positions at Contel Corporation (GTE) and The Coca-Cola Company, and has served as president of Stylus Communication Resources, a marketing communication firm.

and conditions such as diabetes, obesity and the late effects of radiation therapy.

Scientists find new link between diabetes and Alzheimer’s Researchers have uncovered a unique connection between diabetes and Alzheimer’s disease, providing further evidence that a disease that robs people of their memories may be affected by elevated blood sugar, according to scientists at Washington University School of Medicine in St. Louis.

Shannon Macauley, PhD, and David Holtzman, MD, neurology researchers at Washington University School of Medicine in St. Louis, have found a new link between Alzheimer’s disease and diabetes.

Their research, in mice, suggests elevated blood sugar can harm brain function.

While many earlier studies have pointed to diabetes as a possible contributor to Alzheimer’s, the new study – in mice – shows that elevated glucose in the blood can rapidly increase levels of amyloid beta, a key component of brain plaques in Alzheimer’s patients. The

buildup of plaques is thought to be an early driver of the complex set of changes that Alzheimer’s causes in the brain.

The research is published May 4 in The Journal of Clinical Investigation.

Results suggest that diabetes, or other conditions that make it hard to control blood sugar levels, can have harmful effects on brain function and exacerbate neurological conditions such as Alzheimer’s disease, said lead author Shannon Macauley, PhD, a postdoctoral research scholar.

Wood’s Named Chairman of Physicians’ Health Committee We are pleased to announce the appointment of William L. Woods, MD, FACC, as the new Chairman of the Physicians’ Health Committee, the oversight committee for the Missouri Physicians Health Program. The Missouri Physicians Health Program is sponsored by the Missouri State Medical Association.

Dr. Woods succeeds Charles Sincox, MD, FAAFP, Medical Director for the Missouri Physicians Health Program. Dr. Woods has served as a member of the Physicians’ Health Committee for one year. He was a founding member and partner of Missouri Cardiovascular Specialists, and has been in practice since 1989. He practices as an interventional cardiologist at the Missouri Heart Center and is board certified in cardiology and interventional cardiology. He is a native of Columbia, Missouri, and a graduate of Washington University School of Medicine.

Wound Care Center by Des Peres Hospital Welcomes Dr. Viktor Ballada Viktor Ballada, MD, has joined the Wound Care Center by Des Peres Hospital.

Dr. Ballada is the clinic’s medical director, responsible for achieving clinical results at the center which offers some of the most advanced treatment practices and protocols to reintroduce the body’s innate ability to heal. He is board certified in Internal Medicine and has specialized in wound management and hyperbaric medicine since 2009.

The Wound Care Center by Des Peres Hospital offers treatments including hyperbaric oxygen therapy, negative pressure therapies, bioengineered tissues and biosynthetics.

According to the National Institutes of Health, chronic wounds affect about 6.5 million patients in the U.S. and the incidence is rising fueled by an aging population and increasing rates of diseases stlouismedicalnews

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EVERY PATIENT IS UNIQUE. Saint Louis University Physicians know this. That’s why we have teams of specialists to listen to, treat, and care for patients. And why our physicians began combining traditional medical imaging with 3D printing. The result puts a custom-made, true-to-life model in our surgeons’ hands before any incisions are made. It’s a part of Informed Medicine – our philosophy that reconnects the science of medicine, with the soul of it.

See how informed medicine makes a difference at SLUCare.edu

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