M ay / j u n e 2 0 13
Nova Neurosurgical Brain & Spine Specialists Two Leading Neurosurgical Practices Unite to Achieve New Heights in Care
Also in This Issue PSA Guidelines Internal Marketing
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Editor’s Note
Choice Decisions Collaboration rather than competition has a nice ring, especially when it comes to health care delivery. It’s said to be part of the strategy behind the formation of Nova Neurosurgical Brain & Spine Specialists, our cover story this month. The merger of Vanguard Brain & Spine Specialists and Carolina Neurosurgery created the Triad’s largest neurosurgery practice. Together, the new Nova offers a more comprehensive scope of services and subspecializations, and opportunities for collaboration beyond its walls are being pursued. So the Nova medical teams have a greater ability to deliver integrated treatment plans, with the goal of improved outcomes. While the merger that formed Nova Neurosurgical allows its medical staff to enjoy the qualities of working independently from a health care system, it gives referring physicians and their patients a choice. And that’s healthy.
Editor Heidi Ketler, APR Contributing Editors June DeLugas Amanda Kanaan Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Edward N. Rampersaud Jr., M.D. Joe Reddy Photography - Kendal Murphy
Also in this issue of The Triad Physician, we have a number of contributing editors, including Dr. Andrea Lukes, who discusses uterine fibroids and the promise of treatment advances. Duke University Health System urologic oncologist Edward Rampersaud Jr. takes exception to the American Urological Association’s reassignment of PSA screening guidelines. Interior designer June DeLugas shares her excitement about the resurgence of traditional
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News and Columns Please send to info@triadphysician.com
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Category
4
COVER STORY
Nova Neurosurgical Brain & Spine Specialists Two Leading Neurosurgical Practices Unite to Achieve New Heights in Care
m ay / j u n e 2 013
7
V ol . 2 , I s s ue 2
FEATURES Interior Design
New Trends in Home Furnishings Create Refreshing New Possibilities
15
Men’s Health
Statistics Mean Nothing to Patient on the Wrong End of Them
June DeLugas tells us what’s in: quality, traditional furnishings;
Dr. Edward Rampersaud Jr. suggests narrowing the band of
textures; bold color or monochrome; metallic finishes; ottomans;
people treated for prostate cancer rather than of those who
and more.
are tested for it.
DEPARTMENTS 8 Practice Marketing
11 Women’s Health
The Power of Internal Marketing: 3 Ways to Grow Your Practice from Within
16 Practice Management
Medical Board Contest Challenges Licensees to Polish Their Profiles
Meaningfully Using Your EHR
Uterine Fibroids: What Can a Woman Do?
12 Statewide
13 News
- 2013 Editorial Calendar - Events - Welcome to the Area
On the cover: Nova Neurosurgical Brain & Spine Specialists is now comprised of these 11 neurosurgeons, who offer a range of specialized expertise “under one roof.”
May/June 2013
3
Category Cover Story
Nova Neurosurgical Brain & Spine Specialists Two Leading Neurosurgical Practices Unite to Achieve New Heights in Care James R. Hirsch, M.D.
“Our collective organization can deliver
Specialists is the union of two of the most
David S. Jones, M.D.
greater continuity of care to a larger
respected neurosurgical practices in the
Albert K. Bartko III, M.D.
geographic area, from one primary location
Piedmont Triad: Vanguard Brain & Spine
Paul C. Harkins, Ph.D., M.D.
and two satellite locations in Burlington and
Nova
Neurosurgical
Brain
&
Spine
High Point,” says Dr. Stern.
Specialists and Carolina Neurosurgery. The two merged Jan. 1 to form one of the state’s
“Merging allows our larger group to now
largest independent neurosurgical groups.
venture into more subspecialization, both in
“The bottom line is, we offer 99 percent of
This has enabled the continued delivery
terms of managing more complex vascular
the services that any major medical center
of an exceptional and expanding array
cases and different types of tumor cases
offers, so there is no need to leave the
of inpatient and outpatient neurosurgical
and also further developing a center of
county for those services,” says Randy O.
services in a changing health care climate.
excellence for spinal care,” says Henry A.
Kritzer, M.D. “We have more physicians in
“Andy” Pool, M.D., formerly with Carolina
our group than any other group in the state,
Neurosurgery.
except for Charlotte. Actually, there aren’t
“Our vision for the future is that this merger
many l1-man groups in the country.”
is not the end point; it’s a beginning for building an outstanding, fullspectrum
neurosurgical
What hasn’t changed is the philosophy
offering
for our community,” says Joseph
of
D. Stern, M.D., F.A.C.S., formerly
exceptional and personalized patient
of Vanguard. “We want to provide
care. These roots go back four decades
one-stop
services
to 1971, with the formation of Guilford
for our community and to have a
Neurosurgical Associates. The name
depth of talent and availability in all
was changed to Vanguard in 2007 to
neurosurgical specialty areas.”
reflect a forward-thinking philosophy
neurosurgical
both
practices
to
provide
and a determination to remain on The Nova Neurosurgical medical
the cutting edge of technology and
team includes 13 board-certified phy-
technique. Carolina Neurosurgery was
sicians – including 11 neurosurgeons
founded in 1993 by Dr. Kritzer.
– with a range of specialized expertise all “under one roof” at 1130 N.
“We want to provide all services
Church St. in Greensboro. The physi-
at all times as a way to eliminate
cians are:
inefficiencies and effectively use health
Ernesto M. Botero, M.D., F.A.C.S.
care dollars, and this merger allows
Robert W. Nudelman, M.D., F.A.C.S.
us to do that better,” says Dr. Stern.
Henry J. Elsner, M.D., F.A.C.S.
“We have the opportunity to expand
Randy O. Kritzer, M.D.
services and potentially deliver more
Henry A. “Andy” Pool, M.D.
– being more available to patients
Jeffrey D. Jenkins, M.D., F.A.C.S.
is one of the exciting possibilities of
Kyle L. Cabbell, M.D.
our merger. We really are focused on
Gary P. Cram Jr., M.D.
patient care and outcomes.”
Joseph D. Stern, M.D., F.A.C.S.
4
The Triad Physician
Dr. David Jones consulting with a spine surgery patient.
“As our group has become larger, we now have a larger pool of patients and experience of more practitioners from which to draw. We can use that to move beyond anecdotal results to more true data, with regard to outcomes and effectiveness,” says Dr. Pool.
Collaboration and Expansion Nova’s business model is strengthened by cooperative partnerships with Cone Health. “Our combination was in the spirit of collaboration, which is more productive than competition. We can provide more comprehensive
services
if
we
work
together,” says Dr. Stern. Importantly, the merger enhances Nova’s 24-7 hospital call coverage service, he says.
Dr. Robert Nudelman (left) and Dr. Gary Cram discuss a brain scan.
A movement disorders practice with Cone Health is one of several collaborative
facility at 3812 North Elm St. in Greensboro;
seeking care for back and neck problems.
efforts under way. Dr. Stern will work
or at Moses H. Cone Memorial Hospital.
“While we do the vast majority of spinal
with a fellowship-trained neurologist who
surgery in our area, not all of our patients
specializes in Parkinson’s disease and
Greensboro Specialty Surgical Center is the
tremors in identifying the best treatment
typical site for pain injections, peripheral
approaches for these patients.
nerve surgery and simple neck and back
Diagnostic Services
require surgery.”
surgery. Cone Memorial Hospital has four
State-of-the-art imaging technology and
Stereotactic radio surgery, in which a
dedicated neurosurgical operating rooms,
techniques – including magnetic resonance
concentrated dose of radiation is delivered
a unit that offers 23-hour observation stays
imaging using a high-field GE 1.5 Tesla MRI
directly to brain tumors and intracranial
for extended outpatient recovery, a neuro-
and X-ray – are available. “We welcome
abnormalities using a narrow X-ray beam,
intensive care unit and an inpatient unit.
new patients who come without studies,”
is another collaborative clinic. Nova is
says Dr. Stern. The digital results are then
working in conjunction with radiation
“We’re fortunate in this area, in that we have
available to all physicians with access to
oncology at Cone Health Cancer Center.
a strong commitment from the hospital with
Cone Health PACS (picture archiving and
“This is another area that we’re excited
regard to neurosurgical care,” says Dr. Pool.
communication system).
“We’re excited about the hospital’s plans to
Fluoroscopy, an X-ray procedure that
help us upgrade those facilities in the near
projects live images onto a monitor, is an
future and to develop a neurosurgical center
important anatomical guide used during
of excellence,” Dr. Stern says.
minimally
about. We’ve done over 100 cases in the last year,” Dr. Stern says.
Surgical Services Nova Neurosurgical offers state-of-the-art technology
and
proven
neurosurgical
invasive
and
microscopic
surgical procedures, as well as many types
expertise, including advanced non-surgical,
Full Spectrum of Care
minimally invasive and complex surgical
Nova Neurosurgical offers the convenience
care for spinal disorders and cranial
of a comprehensive range of onsite services
Electromyogram (EMG) studies are used
conditions, as well as peripheral nerve
that include diagnostic services, physical
to detect abnormal electrical activity of
damage.
therapy and pain management services and
muscle, which can occur in muscular
are integrated, as needed, to form patient
dystrophy,
treatment plans.
pinched nerves, peripheral nerve damage,
Depending
on
the
complexity,
the
of diagnostic tests, such as discography.
procedure is scheduled either in the
inflammation
of
muscles,
amyotrophic lateral sclerosis, myasthenia
Nova Neurosurgical office; at Greensboro
According to Dr. Stern, the majority of
Specialty Surgical Center, a freestanding
patients come to Nova Neurosurgical
gravis, disc herniation and other conditions.
May/June 2013
5
he is experienced in providing non-operative spine care, musculoskeletal and sports medicine and electrodiagnostic testing. Dr. Harkins completed his fellowship in interventional/chronic pain at the Carolinas Pain Institute. Having earned a doctorate in molecular biology and biochemistry from Wesleyan University, he also has special expertise in pharmacology. Physical Therapy and Durable Medical Equipment Nova Neurosurgical works in partnership with Hand and Rehabilitation Specialists of North Carolina to assist patients with recovery and pain management. The full-service physical therapy practice has a location across the hall from Nova Neurosurgical. This affiliation enables the Nova physicians At center, Dr. Joseph Stern and Dr. Kyle Cabbell (right) perform spine surgery.
to more closely monitor their patients for preventive, pre-operative and post-operative treatment.
Nerve conduction studies, which measure
formerly within Carolina Neurosurgery.
the electrical conduction of motor and
Referrals Are Welcome
sensory nerves, can indicate the location
Drs. Bartko and Harkins work collabora-
“Our practice draws patients from the Triad,
and seriousness of a pinched nerve. The
tively with members on Nova Neurosurgical
extending east past Burlington and north into
interpretation of nerve conduction studies
patient care teams. They are skilled at deter-
southern Virginia,” says Dr. Pool. “Virtually
is complex, as different pathological
mining if patients with back pain should be
all of our patients have been initially
processes result in changes in latencies,
referred to a surgeon or a physical therapist
evaluated by another physician who has
motor and/or sensory amplitudes.
and if they should be treated with injections
had the opportunity to perform a work up
or other therapeutic modalities. They also
in order to aid our neurosurgical evaluation;
A slowing nerve conduction velocity (also
have great expertise in providing all types
so we have developed relationships with
called NCV and one of the measurements
of in-office spinal injections, including epi-
many different referring physicians.”
in a suite of tests) indicates damage to the
dural steroid injections, discography and
myelin. A slowing motor or sensory latency
sympathetic blocks, as well as controlling
“They say, ‘there are three things that make
across the wrist indicates focal compression
post-surgical discomfort and pain.
a great practice: availability, ability and
of the median nerve, called carpal tunnel
affability.’ I think that being available to our
syndrome. Slowing of all nerve conduction
In addition to soothing pain, the selective
referring physicians and to patients and
in more than one limb indicates generalized
nerve root block and facet block can be used
being as accommodating as we can are part
diseased nerves, or general peripheral
as a diagnostic tool to confirm a diagnosis. If
of that,” says Dr. Kritzer. “As a bigger group,
neuropathy, a common disorder of those
a block indicates a diagnosis of facet-related
we can do that better.”
with diabetes mellitus.
pain, other procedures can be performed to extend the duration of pain relief. Spinal
Nova Neurosurgical is at the same
Multidisciplinary Pain Management
cord stimulators and intrathecal medication
location as the former Vanguard practice.
The formation of Nova Neurosurgical
pumps are small implantable systems for
Former Carolina Neurosurgery offices in
also represents an expansion of pain
chronic pain.
Burlington and High Point will be open for
management services provided by Paul
appointments on Fridays.
C. Harkins, Ph.D., M.D., formerly with
Dr. Bartko was the first physician in
Vanguard; and Albert K. Bartko III, M.D.,
Greensboro to perform radiofrequency
More information is available at (336) 272-
of Carolina Pain Management, a practice
neurotomy. In addition to pain management,
4578 or online at NovaNeurosurgical.com.
6
The Triad Physician
Interior Design
New Trends in Home Furnishings Create Refreshing New Possibilities By June DeLugas
This spring, the High Point Market
Textured, stippled and distressed finishes
flourished with an air of excitement and
on furniture and accessories can be used
optimism that was indeed contagious.
to accentuate a room. Monochromatic
The market boasts the latest trends and
and light neutral color palettes are still en
fashions in home furnishings, textiles,
vogue and will always look sophisticated.
accessories,
lighting
and
innovative
products for the home or office.
For those who must have color, never fear: blues, oranges, bold yellows and
June DeLugas, an interior designer in Clemmons, is known for creating award-winning homes that reflect the special relationships she develops with each client. Her retail showroom and design firm is open Monday through Friday from 10 a.m. to 5:30 p.m. and on Saturdays by appointment. You also can visit her website and blog online at junedelugasinteriors.com.
Traditional furniture continues to make a
jewel tones are more popular than ever.
tremendous comeback with 18th century
Gray with teal, turquoise, raspberry and
lines being touted as “brightest and best.”
salmon are just a few of the many bold
It seems as though the consumer has
color trends this season. Metallic fabrics
Ottomans are the new “perfect little black
realized that disposable furniture just
and finishes reflect glamour and style in
dress” this year. They come in a variety of
doesn’t work as well as heirloom pieces.
textiles and accessories.
styles and color and offer the consumer many new ways to utilize space and provide additional seating when needed.
High quality is in, as people want to
Rug options have expanded with indoor/
get the most value for their purchases.
outdoor rugs made from exciting new
The resurgence of traditional furniture
materials that not only look fabulous, but
If you are looking for a way to get out of
doesn’t mean the furniture looks dated;
are moderately priced and available in a
the ’80s, try searching the web or current
exciting prints, lots of color and natural
virtual rainbow of colors that one can’t
design magazines for the latest trends and
accessories have made an impression on
resist.
fresh ideas.
even the most jaded designers.
COME OUT your family.your future. You didn’t choose breast cancer. It chose you. Being diagnosed with breast cancer forces you to make a lot of choices. For many women that includes having to choose between getting proper medical treatment or putting food on the table. We are the Pretty In Pink Foundation and we’ve made it our mission to ensure that no woman has to choose between her family or her future. Visit us online at www.prettyinpinkfoundation.org or call (919)532-0532.
May/June 2013
7
Practice Marketing
The Power of Internal Marketing 3 Ways to Grow Your Practice from Within By Amanda Kanaan
Although the word “marketing” may evoke
tices can take advantage of this e-patient
visions of print ads and television spots,
revolution. Use social media to stay top
when it comes to growing your practice
of mind with patients by posting links to
don’t forget your most powerful resource of
educational articles, helpful health tips and
all – current patients (i.e. walking and talk-
practice news. E-newsletters can be used in
ing billboards).
the same way. The point is to find ways to keep your patients connected beyond the
The goal of external marketing (such as
waiting room.
advertising) is to get patients to your door,
Amanda Kanaan is the president of WhiteCoat Designs – a Raleighbased medical marketing agency providing doctors with online marketing services as medical website design, search engine optimization (SEO), social media management, blog writing, graphic design, referring physician outreach and more. To contact Ms. Kanaan or to learn more about WhiteCoat Designs, visit www.whitecoat-designs.com.
however it is internal marketing that not only
2. Give Patients a Reason to Come
pulls them through the door but keeps them
Back. Communication tools like social me-
knocking time and again. Internal marketing
dia and e-newsletters are also a great way to
is a strategy that focuses on maximizing pa-
spread the word about new or existing ser-
to the color of your walls, it’s all part of the
tient retention through consistent communi-
vices within your practice. When it comes to
patient experience.
cation and, of course, good patient care.
marketing, if you’re not saying it, then you’re not doing it. That means, if you aren’t telling
Your staff needs to understand that they are
Since acquiring new patients is much more
patients about your other services then they
not just part of the administrative or clinical
costly than retaining current ones, it’s im-
probably don’t know they even exist.
departments, but they are also an essential part of marketing. I’ve seen far too many
portant to treat your patients as valuable customers. Here are three ways to grow
Sometimes patients need a service but don’t
great doctors lose patients due to poor staff-
your practice from within.
realize your practice performs it (such as
ing choices.
mole removals at a family practice), and 1. Stay Top of Mind. You’ve probably
sometimes you offer a service that patients
Your patients can be one of the best sourc-
heard the saying “out of sight, out of mind.”
don’t know they need (such as NovaSure
es of ideas to make your practice better.
Staying top of mind with patients is the best
at an OB/GYN practice). This is when you
Whether the ideas come from patient sur-
way to keep them (a) thinking about you so
have to put on your marketing hat and take
veys, your social media page or even online
there’s a greater chance they’ll come in for
the opportunity to upsell patients on other
review sites, take the feedback to heart and
more than the once-a-year visit and/or (b)
services you offer.
be open to change.
You already have a captive audience in your
Customer service is the new public rela-
current patients so take the opportunity to
tions. That means that by responding to
For good or for bad, we’ve entered an age
better communicate your services. Patients
complaints online with practical solutions,
in medicine where patients will Google just
need to hear a message several times before
patients will be far more impressed that you
about anything. In fact, 59 percent of adults
they commit it to memory so don’t make the
took action than the fact that the complaint
in the United States searched online for
mistake of sharing your message only once.
happened in the first place.
ing to a 2012 study by Pew Research Center.
3. Make it a Positive Experience for
A good marketing strategy starts from the
Because patients are so digitally savvy (also
Patients. OK, so you probably knew this
inside out. By incorporating the three ap-
known as e-patients), this presents a unique
one was coming… the patient experience.
proaches above, you’ll create an effective
opportunity for doctors to now communi-
It’s obviously a waste of money to imple-
internal marketing strategy that will enhance
cate with patients in a way that’s convenient,
ment an internal marketing plan, if you have
the ROI (return on investment) on your ex-
cost-effective and timely.
no hope of retaining patients because their
ternal marketing campaigns, thereby mak-
experience at your office was negative.
ing the most impact on the growth of your
From the way your staff answers the phone
practice.
talking about you so they’re more likely to make a referral.
health information in the past year, accord-
Social media is one example of how prac-
8
The Triad Physician
Men’s Health
Statistics Mean Nothing to the Patient On the Wrong End of Them By Edward N. Rampersaud Jr., M.D.
My father, a family physician, called me
instead, to whom treatment is offered.
Dr. Edward Rampersaud is a urologic oncologist and assistant professor of surgery for the Section of Urologic Oncology at the Duke Cancer Institute. He earned his medical degree from Duke University, where he also completed his urology residency and research fellowship. He then completed a Society of Urologic Oncology fellowship at the Institute of Urologic Oncology at University of California, Los Angles. His clinical and research interests focus on kidney cancer and other malignancies of the upper retroperitoneum. For more information on Dr. Rampersaud visit www.dukehealth.org/physicians/edward-nrampersaud-jr. He can be reached at (919) 681-8760 or edward.rampersaud@duke.edu. To schedule a patient appointment, call (919) 668-8108.
from New York one year ago to ask, “So we shouldn’t get PSAs anymore?” The
Kidney cancer has been the focal point of
news was breaking in May 2012 that the
my clinical and research efforts for several
United States Preventative Task Force
years now. I perform complex partial and
(USPTF) had chosen the week of the
radical nephrectomies; and the topic of
American Urological Association (AUA)
competing risks and over-treatment has
national meeting to announce that they
begun to touch even kidney cancer, the
would be assigning Grade D recommen-
most lethal of genitourinary malignancies.
dations to population-based PSA screening. This occurred on the backs of two
As the number of partial and radical ne-
randomized trials, of debatable design,
phrectomies has risen during the last 20
attempting to measure the impact of PSA
years, the annual death rate for kidney
screening.
cancer has not appreciably diminished. While this is certainly a multifactorial
Still, as the AUA Guidelines Panel mud-
event well beyond the scope of this edi-
dled through the data to construct its own
torial, it leads us to question the natural
set of guidelines , I cannot help but won-
history of small renal masses (SRMs), as
der why so much of the focus has been
we do not fully understand their biology.
1
on detection rather than treatment. Why would we not want to know more clinical
With the increasing prevalence of cross-
information upon which to base an even
sectional imaging obtained for any num-
more-informed decision?
ber of reasons comes the diagnosis of the incidentally discovered SRM. In the
While it is becoming clearer to me that we
last couple of years, centers have begun
have likely been over-treating men with
publishing their experiences of patients
low-risk prostate cancer, it is not at all evi-
with SRMs (usually less than 4 centime-
dent that men with intermediate or high-
ters in diameter) that have been placed
risk prostate cancer are not better served
on active-surveillance regimens. I, also,
by its detection and aggressive treatment.
believe that not every SRM needs to be
We cannot ignore the fact that remains
treated and have instituted a formal active-
– prostate cancer is still the second lead-
surveillance program for the appropriate
ing cause of cancer-related death in men
patients.
The phrase “art and science of medicine” describes the integration of two folds of a profession that at its skin appear to be distinct and separate, but actually meld together into one. Fallibility applies to both evidence and anecdotal experience. However, we must use the available information – our experiences and abilities and the uniqueness of each individual patient – all combined to make the best and most-informed decision possible. Guidelines and best-practice statements are well-intended and important; but we should never forget about common sense,
each year. Nothing is worse than objectifying a paThe rate of death from prostate cancer has
tient by quoting a statistic – only to find
decreased by 20-30 percent in the PSA era,
out later that very patient is part of the mi-
and there are many possible explanations
nority contingent you originally described
for this phenomenon. As we continue to
to them. Even if the chance of the “bad”
observe, most men die with prostate can-
thing were 1 percent, for the patient to
cer, not of it. Perhaps the focus should not
whom it occurred, the chances were 100
be about narrowing the band of patients
percent after-the-fact.
intuition and the wisdom gained through actual experience that truly make us doctors and advocates of individual people. Reference
www.auanet.org/education/guidelines/
1
prostate-cancer-detection.cfm
on whom prostate cancer is detected, but
May/June 2013
9
Practice Management
Strategies for Meaningfully Using Your EHR By Joe Reddy
Is your electronic health record helping
tion (GPRO) for PQRS requirements. If you
you obtain the available cash incentives by
missed the Jan. 31 requirement to register,
qualifying for meaningful use?
you will have another opportunity sometime this summer through Oct. 15.
Electronic health record (EHR) dissatisfaction is on the rise even with incentive
The PQRS incentive/penalty for GPRO is
payouts exceeding $12 billion. As many as
based on submission of data via registry or
39% of clinicians have buyer’s remorse and
completion of the GPRO web interface. EPs
would not recommend their EHR to a col-
reporting individually will enjoy the benefit
league.
of having PQRS “baked in” the Stage 2 MU
Joe Reddy is the owner of RevMedRx, a North Carolina-based revenuecycle management company. RevMedRx offers sophisticated, yet affordable, solutions to today’s complex practice management needs with a focus on efficiency and cash-flow optimization. Joe Reddy can be reached at joe.reddy@revmedrx. com. To learn more, visit www.revmedrx.com.
requirements that a qualified EHR should So do you accept the pain until you go
be leading you through. Therefore, you
numb or start over a little more educated?
should be able to get credit for both, with-
Moreover, the Centers for Medicare &
out two separate tracking records. There are
Medicaid Services (CMS) audits reveal
approximately 300 ambulatory MU program
that many providers struggle to document
EHR vendors. Only a few dozen of them are
meaningful use (MU)?
CMS-approved direct submitters for MU and PQRS, making it even easier to attest.
It’s hard to imagine how simple some of the challenges appear. For instance, some
Planning for Stage 2 and Beyond
EHRs don’t provide a functional audit log
We don’t know yet which EHR vendors
that allows necessary documentation for
will be certified for Stage 2. We can expect
designating attestation periods.
it to be less than those currently certified for Stage 1, largely due to the investment
Given the technology advances even in
required.
the past year, it’s important to understand what you have and the functionality that’s
We also can expect some vendors to pass
currently available. Often this discovery is
along some of those costs to you in “fees.”
achieved only by comparison in today’s
You know what I’m talking about, if you’re
market.
working with one of them now, as you get your checkbook ready for your ICD-10 up-
Understanding MU Reporting
grade
Stage 2 MU measures are comprised of core and menu objectives as they were in
In 2014, a Stage 2-certified vendor will be
Stage 1. For ambulatory-eligible profession-
required, even if you are still attempting to
als (EPs), Stage 2 requires reporting on 17
successfully attest for Stage 1. It would be
core objectives and three of the six menu
prudent to review vendors by comparison
objectives. In addition, EPs also must report
shopping before you progress much further
on one measures group or three individual
along this timeline.
measures as part of the Physician Quality Reporting System (PQRS).
By 2016, the PQRS penalties peak at 2%. The EHR penalties begin in 2015 and increase by
Beginning in 2013, two or more EPs in a
1 percent per year until 2019, maxing out at
group practice could register or self-nomi-
5%. That’s a 7% exposure in Medicare revenue
nate for the Group Practice Reporting Op-
penalties in 2019.
10
The Triad Physician
On the positive side, there’s also some incentive to get engaged sooner rather than later. In fact, it’s not too late to begin and attest Stage 1 this year and still claim a total of up to $39,000 over the next several years and avoid the first-year PQRS penalty. This is not difficult if you are with the right vendor.
For 2014 Only The Centers for Medicare & Medicaid Services recently announced that all providers, regardless of their meaningful use stage are only required to demonstrate MU for a three-month electronic health record reporting period. For Medicare providers, this three-month reporting period is fixed to the calendar quarter for eligible professionals in order to align with the PQRS. This one-time, three-month reporting period is being permitted so all providers who must upgrade to 2014-certified EHR technology have adequate time to implement their new system. Finding efficiency equals survival for clinicians as they navigate these requirements.
Stay Tuned There is some congressional discussion on Stage 2 qualification extensions. Just don’t get your hopes up for the early-adopter incentives to be extended as well.
Women’s Health
Uterine Fibroids
What can Women Do? By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
Uterine fibroids are remarkably common.
of estrogen and progesterone, or female
One study by radiologists found that by age
hormones) when she has a hysterectomy. If a
50 years, 80 percent of African-American
woman is motivated to avoid a hysterectomy,
women have fibroids and 70 percent of
then what can she do?
Caucasian women have fibroids. The minimally invasive treatments for fibroids As a clinician, I divide the problems of fibroids
include: hysteroscopic myomectomy with
into two broad categories: bulk symptoms and
MyoSure,
bleeding symptoms. The bulk symptoms are
(removal of the fibroid, not the uterus),
due to fibroids that grow to be large. Symptoms
uterine fibroid embolization (performed
may include pressure, a feeling “fullness,”
by radiologists), the new HALT procedure
back pain, urinary urgency, constipation, etc.
(radiofrequency energy administered to
The bleeding symptoms range from heavy
fibroids) and ExAblate (magnetic resonance
periods to abnormal bleeding.
imaging-focused energy to fibroids), as well
laparoscopic
myomectomy
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she cofounded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position (2007) to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
and it does not impact fertility. Elagolix is a medication under evaluation
as medications.
and available through a new study being
Despite enormous efforts to understand why women develop fibroids, our understanding
Medications for heavy periods related to
conducted at Carolina Women’s Research
is still lacking. Even so, women seem to find
fibroids include Lysteda, a medication
and Wellness Center. The oral medication,
it reassuring that they are so common, so as
approved by the United States Food and Drug
which is taken daily, essentially stops
a clinician, I start there.
Administration for cyclic heavy menstrual
bleeding by suppressing ovarian function.
bleeding (HMB). A large proportion of women The options for treatment of fibroids are
with HMB treated with Lysteda had uterine
More information about the latest treatments
growing. Certainly a hysterectomy is the
fibroids. An advantage to this medication is
for uterine fibroids and about the Women’s
classic “cure.” Importantly, a woman does
that it is nonhormonal, taken only during the
Wellness Clinic can be found online at www.
not have to remove her ovaries (source
days a woman has bleeding (up to five days),
cwrw.com.
The Institution Review Board-approved advertisement on the Elagolix study at the Women’s Wellness Clinic.
Do Heavy Periods
associated with
Uterine Fibroids
Affect You?
Uterine fibroids symptoms can affect any woman, anytime, anywhere. If you’re at least 20 years old and have heavy periods associated with uterine fibroids, you may qualify for this oral investigational medication research study. As a participant, you will receive all study-related care and investigational medication at no cost. If uterine fibroids affect your life, consider volunteering.
C a l l 919-251-9223
w w w . fi b r o i d s t r i a l . c o m Women's Wellness Clinic
May/June 2013
11
Statewide
Medical Board Contest Challenges Licensees to Polish Their Profiles The North Carolina Medical Board has
LI categories that must be reported in-
Information reported in optional licensee
launched its first-ever contest to promote
clude:
information categories must be accurate
broader licensee participation in the op-
• Basics, such as the licensee’s current
and relevant to each individual category
tional content listings offered through the
practice address and telephone number.
for which information is provided. Win-
board’s popular licensee information pages.
• Where applicable, such information as
ning entries will be determined at the sole
actions by out-of-state medical boards
discretion of the NCMB Public Affairs De-
All licensed physicians and physician as-
and other regulatory agencies, certain
partment.
sistants have licensee information (LI)
criminal convictions and information
pages, which include required and op-
about certain malpractice payments.
tional information. The NCMB reports that
How to Enter Visit www.ncmedboard.org, and click on
not all licensees are taking advantage of
The NCMB also offers licensees the op-
“Update Licensee Info Page” in the green
the opportunity to market themselves and
portunity to provide information in many
Quick Links box on the right. Log in and
their practice through optional information
optional categories, including “practice
provide content for applicable optional
categories.
philosophy,” memberships in professional
categories (practice philosophy, member-
societies, non-English languages spoken
ships, languages spoken, etc.) Verify all
Consider that, according to NCMB, the
by the licensee and/or in the office, pub-
information is accurate.
public accesses these pages up to 3,000
lic service, participation in Medicare and
times each day, most often by clicking on
Medicaid and more! This information is of
When finished, let the board know in an e-
the “Look Up a Licensee” tool, the most
great interest to current and prospective
mail to: forum@ncmedboard.org. Include
popular feature on the board’s website.
patients. In fact, according to NCMB, pa-
full name. Entrants must complete updates
tients contact the board to ask why there is
by end of business July 1.
To further incent licensees to maintain
no information in these categories.
Prizes
their NCMB website profiles, the board is challenging licensees to polish their
Contest Details
Depending on the number and quality of
optional content, and the winner will be
The North Carolina Medical Board will
entries, the NCMB’s Public Affairs Depart-
featured in an upcoming medical board
accept entries to its Licensee Information
ment will select up to 10 licensees, who
promotional campaign!
Challenge through July 1. Its goal is to
will be offered the opportunity to be fea-
encourage more licensed physicians and
tured in an upcoming NCMB public aware-
LI pages date back to the 1990s, when
physician assistants to provide optional
ness campaign. Examples of upcoming
NCMB began posting basic licensee infor-
content for their licensee information
campaigns include print media/display
mation online as part of its ongoing commit-
pages.
advertisements, radio spots and/or video
ment to public protection and transparency.
public service announcements. Winners
In 2000, the board became one of the first
Rules
medical regulators in the country to begin
Licensed physicians and physician assis-
posting public board actions on the web.
tants must:
Questions?
The most recent enhancements to online
• Have an active license,
Contact Jean Fisher Brinkley, Director,
licensee information came in 2009, when
• Practice medicine at least part time,
Public Affairs at jean.fisher@ncmedboard.
the board implemented changes to North
• Have no history of public discipline for
org or (919) 326-1109, ext. 230.
Carolina law that significantly expanded the types of information it is required to collect and report regarding its licensees.
12
The Triad Physician
at least 10 years.
also will be featured in The Forum.
News Welcome to the Area
Physicians Samuel Michael Cosmello, DO Vascular and Interventional Radiology; Radiology Wake Forest University Baptist Medical Center Winston-Salem
Amer Al-Khoudari, MD Wake Forest Baptist Medical Center Winston-Salem
Lynda Bridges Bialobrzeski, MD Emergency Medicine; Pediatric Emergency Medicine Wake Forest University Baptist Medical Center Winston-Salem
Sarah Kathryn Bolen, MD Pediatrics Wake Forest University Baptist Medical Center Winston-Salem
John-Adam Bonk, MD Emergency Medicine Moses Cone Hospital Greensboro
Rebecca Elizabeth Burkhart, MD Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Victoria Lauren Chiou, MD Gastroenterology; Hematology/ Oncology; Internal Medicine; Nephrology Wake Forest University Baptist Medical Center Winston-Salem
Jennifer Mickle Cooper, MD Pediatrics Wake Forest University Baptist Medical Center Winston-Salem
John Charles Gerancher III, MD Anesthesiology PO Box 26851 Winston-Salem
Events Vishak Johny John, MD Ophthalmology Wake Forest Baptist Health Eye Center Winston-Salem
Paul Vincent Manson, MD Pioneer Family Medical of Danbury Danbury
Steven Julian Newton, MD Family Medicine; Family Practice Cone Health Family Practice Greensboro
Nicholas Dwight Hartman, MD Emergency Medicine Wake Forest Dept of Emergency Medicine Winston-Salem
John Zeigler Hollingsworth, MD Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
What You Need to Know About Women’s Health Obstetrician-gynecologist Jill M. Wagner, M.D., F.A.C.O.G., will review guidelines for routine women’s health screenings and strategies for making the best health care decisions. Tuesday, June 18, at 6:30 p.m. Millis Regional Health Education Center, 600 North Elm St., High Point 27261 Registration is required: Call (336) 878-6888.
Michelle Dilipkumar Patel, MD Ophthalmology Wake Forest Baptist Health Winston-Salem
Leah Marie Sieren, MD General Surgery; Pediatric Surgery; Surgery WFU Dept of General Surgery Winston-Salem
Justin William Smith, MD
North Carolina’s Premier Interior Design Firm Thank You for Voting Us Best Interior Designers Two Years in a Row!
Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Linda Marie Street, MD Maternal and Fetal Medicine; Obstetrics; Obstetrics & Gynecology - Critical Care Medicine; Obstetrics and Gynecology Maternal-Fetal Medicine Department of Obstetrics and Gynecology Winston-Salem
Gerhardt Stefan Wagner, MD Psychiatry Wake Forest University Baptist Medical Center Winston-Salem
Jennifer Kay Wagstaff, MD Pathology Wake Forest University Baptist Medical Center Winston-Salem
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Commercial & Residential • Award-Winning Furnishings The Perfect Rug • Custom Window Treatments • Antiques
Jeyhan Suzan Wood, MD Plastic and Reconstructive Surgery; Plastic & Reconstructive Surgery; Plastic Surgery/Hand Surgery Wake Forest University Baptist Medical Center Winston-Salem
Magdelena Greene, MD Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Woman to Woman:
“You Dream It, We Design It!” 2575 Old Glory Rd. Clemmons • 336.778.1030 • www.junedelugasinteriors.com
The Triad Physician 2013 Editorial Calendar July Imaging Technologies Psoriasis Medical Insurance
September Atrial Fibrillation Urology Web Design
November Alzheimer’s Disease Diabetes Financial Planning
August Orthopedics Gastroenterology Medical Real Estate
October Cancer in Women COPD - Lung Health Medical Software - EMR
December Pain Management Spine Disorders Practice Management
May/June 2013
13