BY CINDY SANDERS The ﬁrst rule of marketing is to make sure you have a clear message. For the American Medical Association leader- ship, their position on the impending ICD-10 conversion could not be more straightforward … they want to see it stopped. AMA President Ardis Dee Hoven, MD, pointed to a number of issues that have members worried about the health of their practices … and ultimately their patients. Concerns range from cost of implementation and soft- ware availability to worries over disruption in pay and a siphoning of resources away from other transformative changes that improve healthcare delivery. In a Feb. 12 letter to Kathleen Sebelius, secretary for the U.S. Department of Health and Human Services (HHS), the AMA acknowledges the position they have taken is at odds with some of their industry colleagues. Yet, AMA ofﬁcials be- lieve the timing of such a massive undertaking is ill advised and could prove disastrous for physicians. SOUTH LOUISIANA EDITION YOUR PRIMARY SOURCE FOR PROFESSIONAL HEALTHCARE NEWS On Rounds Read Louisiana Medical News online at www.louisianamedicalnews.com APRIL 2014 / $5 With the Deadline Fast Approaching, AMA Continues to Campaign Against ICD-10 Implementation Dr. Danette Null Close call As an eight-year-old third grader, Danette Burnett knew that she wanted to become a doctor. “We were talking about the circulatory system and I just really found it fascinating, and wanted to learn more about the body,” she recalled. “And, I liked the idea of helping people. So, that just kind of always stuck with me.” ... page 3 Ochsner Oversight Follows National Trend In February, Ochsner Health System inked a two-year deal to manage Hancock Medical Center in Bay St. Louis, Miss., in a continuation of a national trend that has seen growing numbers of small hospitals seek outside expertise. ... page 5 Physician Spotlight PRINTED ON RECYCLED PAPER PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 (CONTINUED ON PAGE 12) (CONTINUED ON PAGE 6) Telemedicine Changes Care at Lake BY TED GRIGGS Telemedicine will soon make it possible for physicians at Our Lady of the Lake Regional Medical Center to monitor critical pediatric pa- tients while they are en route – by helicopter, plane or ambulance – from other facilities. The Lake’s Children’s Hospital developed a pediatric transport team last year to oversee the transportation of critically ill children from other in-state hospitals to the Baton Rouge facility, said David Butler, business manager for telehealth at the Lake. The team actually travels to the other hospital and escorts the patient back via ambu- lance, helicopter or plane. “We’re in the process of getting telemedi- cine and video conferencing equipment so the pediatric physicians here will be able to monitor that patient the entire time … and communicate via audio and video with the pediatric support team,” Butler said. The physicians will also be able to assess the PEDs patients before they even get into the ambu- lance or aircraft and determine whether their con- dition will allow them to be moved, Butler said. To promote your business or practice in this high proﬁle spot, contact Scott Cavitt at Louisiana Medical News. [email protected] • 337.235.5455 David Butler
By CINDy SANDERS
The fi rst rule of marketing is to make sure you have a clear message. For the American Medical Association leader-ship, their position on the impending ICD-10 conversion could not be more straightforward … they want to see it stopped.
AMA President Ardis Dee Hoven, MD, pointed to a number of issues that have members worried about the health of their practices … and ultimately their patients. Concerns range from cost of implementation and soft-ware availability to worries over disruption in pay and a siphoning of resources away from other transformative changes that improve healthcare delivery.
In a Feb. 12 letter to Kathleen Sebelius, secretary for the U.S. Department of Health and Human Services (HHS), the AMA acknowledges the position they have taken is at odds with some of their industry colleagues. Yet, AMA offi cials be-lieve the timing of such a massive undertaking is ill advised and could prove disastrous for physicians.
SOUTH LOUISIANA EDITION
yOUR PRIMARy SOURCE FOR PROFESSIONAL HEALTHCARE NEWS
make blend:Type wordOUtlinecopy and pasteselect both sets of wordshold shift key and select gradientchoose reverse front to back
text:100 Helv. Ultra comp-20 AV(one on right)-100 (between words)stroke .25 pt.
Read Louisiana Medical News online at www.louisianamedicalnews.com
APRIL 2014 / $5
With the Deadline Fast Approaching, AMA Continues to Campaign Against ICD-10 Implementation
Dr. Danette NullClose call
As an eight-year-old third grader, Danette Burnett knew that she wanted to become a doctor. “We were talking about the circulatory system and I just really found it fascinating, and wanted to learn more about the body,” she recalled. “And, I liked the idea of helping people. So, that just kind of always stuck with me.” ... page 3
Ochsner Oversight Follows National TrendIn February, Ochsner Health System inked a two-year deal to manage Hancock Medical Center in Bay St. Louis, Miss., in a continuation of a national trend that has seen growing numbers of small hospitals seek outside expertise. ... page 5
PRINTED ON RECYCLED PAPER
(CONTINUED ON PAGE 12)
(CONTINUED ON PAGE 6)
Telemedicine Changes Care at Lake
By TED GRIGGS
Telemedicine will soon make it possible for physicians at Our Lady of the Lake Regional Medical Center to monitor critical pediatric pa-tients while they are en route – by helicopter, plane or ambulance – from other facilities.
The Lake’s Children’s Hospital developed a pediatric transport team last year to oversee the transportation of critically ill children from other in-state hospitals to the Baton Rouge facility, said David Butler, business manager for telehealth at the Lake. The team actually travels to the other
hospital and escorts the patient back via ambu-lance, helicopter or plane.
“We’re in the process of getting telemedi-cine and video conferencing equipment so the pediatric physicians here will be able to monitor that patient the entire time … and communicate via audio and video with the pediatric support team,” Butler said.
The physicians will also be able to assess the PEDs patients before they even get into the ambu-lance or aircraft and determine whether their con-dition will allow them to be moved, Butler said.
To promote your business or practice in this high profi le spot, contact Scott Cavitt at Louisiana Medical News.
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Louisiana Medical News APRIL 2014 • 3
By LISA HANCHEy
As an eight-year-old third grader, Danette Burnett knew that she wanted to become a doctor. “We were talking about the circulatory system and I just really found it fascinating, and wanted to learn more about the body,” she recalled. “And, I liked the idea of helping people. So, that just kind of always stuck with me.”
The daughter of two teachers, Bur-nett grew up in the small north Louisiana town of DeRidder, La. She became the fi rst in her family to pursue medicine.After graduating from Rosepine High School, Null obtained a degree at Mc-Neese State University. Burnett then joined the Navy, which paid for her medical studies at LSU Shreveport. Af-terwards, she went to the Naval Hospital Pensacola for her family medicine resi-dency training. During those four years, she served in the Reserves. “I think it surprises people that I was in the Navy, because I’m a girly-girl,” she said. “I was not a good swimmer in college, and then ended up having to go through water sur-vival training in the Navy. It was a very good experience.”
While in Pensacola, Burnett met her husband, Robert Null, who was an active duty aviator in the Navy. For the fi rst three years of marriage, the couple was geographically separated. Danette remained in Pensacola, while Robert was stationed in San Diego, Cal., then Jack-sonville, Fla. On weekends, she would trek six hours to visit her husband on the op-posite coast.
After serving 20 years in the Navy, Robert retired. By then, the couple had two small children – Colin, born in 2006, and Tessa, born in 2008 – and decided to focus on the family. “We’d both had a couple of real close calls with both being deployed at the same time,” Danette re-called.
During that period, Robert had just fi nished a six-month deployment when Danette was called to serve in Guanta-namo Bay, Cuba. Fortunately, another department member volunteered to take her place. Then, she was summoned to Iraq while newly pregnant with Tessa. “I had just let my boss know the day before that I was pregnant,” she recounted. “The next day, he got the call that I was to go to Iraq for nine months. Because of the pregnancy, I did not go. Robert was also scheduled to be deployed to the Mediter-ranean.”
Danette decided to leave the Navy, too. The couple wanted to be closer to family, so Dr. Null started looking at resi-dency programs in Louisiana. She found one in Lake Charles Memorial Hospital.
Two weeks after Tessa was born, the Nulls relocated to Lake Charles where Danette started practicing fam-ily medicine at Memorial. Robert is an eighth-grade business teacher at S.J. Welsh Middle School. “I really like Lake Charles,” she said. “You’ve got amenities, but it’s still got a really small-town feel. And, it’s a great place to raise a family.”
Dr. Null also serves as a faculty mem-ber for LSUHSC New Orleans Family Residency program at Memorial. She now has 10 years of teaching under her belt. “I really enjoy it,” she said. “I am defi nitely always striving to be a better teacher.”
In May, she is heading to UCLA for a mini-geriatric fellowship. “I do a lot of women’s health,” she explained. “I think it’s always good to get some more updated information on taking care of the older population, and then also helping teach the residents more information.”
When not working, Null enjoys being a mom to now seven-year-old Colin and fi ve-year-old Tessa. “That’s by far my fa-vorite activity,” she gushed. “We try as a family to do activities that involve the four of us, just because time is limited. We both are den leaders for Boys Scouts because Colin is a part of that, and Tessa is in Girls Scouts.”
Besides spending time with her fam-ily, Null likes to garden, doing landscape fl ower work and growing vegetables. “I like playing in the dirt,” she said with a laugh.
Dr. Danette NullClose call
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4 • APRIL 2014 Louisiana Medical News
By CINDy SANDERS
What is the best way to get … and keep … diabetic patients actively engaged in the lifelong self-management of their condition?
The individual or institution that comes up with a definitive answer to that question will surely be remembered in the history books in the same manner as Jonas Salk. After all, diabetes is a pervasive con-dition of epidemic proportions in much of the world. According to the latest statistics from the National Institutes of Health, 25.8 million Americans have diabetes … roughly 8.3 percent of the nation’s population. Additionally, it is estimated another 79 million American adults have prediabetes, putting them at high risk for developing the condition without active intervention to stop the progression to-ward disease.
Keenly aware of the toll diabetes takes on the body, healthcare providers routinely talk to patients about the threat of comorbid conditions ranging from heart dis-ease, stroke and kidney disease to blindness and amputation. Yet, there continues to be a discon-nect from what a patient seemingly hears and un-derstands in the office and what actually tran-spires on a daily basis.
“We talk about diabetes all day long with patients, but they have to go about their business of living with the disease,” noted Elizabeth S. Halprin, MD, associate director of Adult Diabetes at Joslin Diabe-tes Center, an affiliate of Harvard Medical School.
A recent study conducted by Joslin researchers looked at obstacles present
among patients with poorly controlled diabetes. Halprin, a board certified en-docrinologist and instructor at Harvard Medical School, said the reasons for poor management vary hugely and are specific to individuals and their own personal circumstances. Are there financial issues that make office visits cost prohibitive? What about transportation or geographic barriers that make it difficult to get to an appointment? Perhaps an individual is working multiple jobs or caring for every-one else in the family with little time left over to address their own needs.
Halprin said the study also revealed some interesting perceptions about the healthcare system and providers. “They find the whole healthcare system imper-sonal,” she said of the study participants. “They think we’re not listening and that we suggest things that aren’t practical.”
To a physician, telling a patient to ‘in-crease physical activity’ seems like a highly appropriate, straightforward step toward better diabetes management. To a patient who struggles financially, a gym member-ship is out of the question and strolling through an unsafe neighborhood could be more dangerous to their health than the disease, itself.
“Diabetes is a very time consuming disease to have, but it’s also a very time consuming disease to treat,” Halprin pointed out. “The healthcare system doesn’t always permit the time for explor-ing and looking at each person’s individ-ual needs.”
To address that, Joslin is investigating the addition of care coordinators to work with high-risk patients. The coordinator becomes the point person who initiates a follow-up call after an appointment to see if the patient understood recommenda-tions and to make sure prescriptions are
being filled. The coordinator might also reach out to remind the patient when it is time for their diabetic eye or foot exam. This is the individual who is more likely to know about medication assistance pro-grams, area outlets for safe activity, and other resources to overcome obstacles.
Although the concept isn’t novel in healthcare, it is one that has been diffi-cult to fund under the current payment system. Changes in reimbursement mod-els, such as the patient-centered medical home, make it more feasible to add a care coordinator to the team approach that Halprin used at Joslin. In addition to the physician, the team includes a nurse prac-titioner, nutritionist, exercise physiologist, registered nurse, psychiatrist and diabetes educator. Through a joint project with Beth Israel Deaconess Medical Center, Joslin has launched the Diabetes Practice Liaison Program to share collaborative strategies with primary care providers and their office staff in the region.
Just as one provider doesn’t hold all the answers, it’s unlikely one approach will meet everyone’s needs.
Halprin pointed to another study among Joslin’s older patients that had en-couraging outcomes. “A highly structured education program with specific tasks and cognitive behavior strategies resulted in better A1c control, which was maintained for at least a year,” she noted of the in-tervention that worked well with older patients up to age 75. However, she con-tinued, that program didn’t show the same promise among middle-aged patients.
Race and ethnicity are also important variables in how information is received, perceived and acted upon. Joslin has ini-tiatives for Asian, African-American and Latino patients that take into account so-cial and cultural traditions. Considering
the risk of diagnosed diabetes in compari-son to non-Hispanic whites is 18 percent higher among Asian Americans, 66 per-cent higher among Latinos, and 77 per-cent higher among non-Hispanic blacks, reaching these specific populations in a meaningful way is critical.
Halprin, a member of Joslin’s La-tino Diabetes Initiative, noted there is a support group that meets regularly at the diabetes center to knit and chat. A staff psychologist joins the group to guide con-versation and answer questions.
“They bring food so that’s an oppor-tunity to discuss what is a good choice or a not-so-good choice,” Halprin said. “Nu-trition is a huge part of diabetes care, but it’s also a huge part of the Latino culture,” she noted, adding nutritionists on staff try to make suggestions that are culturally ap-pealing or that revamp traditional meals to lighten the carbohydrate load.
Additionally, education classes are conducted in Spanish and materials have been translated. Providers with the Latino program also are piloting group medical visits with four-eight participants. All of these efforts combine to make the health-care clinic less intimidating and more welcoming of natural conversation and questions about living with diabetes.
In fact, Joslin hosts a number of pro-grams in a group setting including DO IT, a four-day intensive outpatient program de-signed for those who have gotten off track with their self-management; Why WAIT, a combined weight reduction and manage-ment program with a focus on nutrition, physical activity and behavioral support; and interactive games like CarbChallenge where participants test their knowledge of carbohydrate containing foods.
“Diabetes can be a very isolating con-dition,” Halprin said. “It’s good for people to be in a group and know other people are struggling with similar issues.”
What’s good for patients is also good for providers. Halprin’s colleague, Robert Gabbay, MD, the chief medical officer for Joslin Diabetes Center, is slated to give the keynote speech at The American Journal of Managed Care annual meeting. “Patient-Centered Diabetic Care: Putting Theory into Practice” is the 2014 theme of the April 10-11 conference in Princeton, N.J.
“Our meeting will occur as the first waves of newly insured consumers are ac-cessing the healthcare system, including many who will learn for the first time they have diabetes or other cardiometabolic conditions,” said Brian Haug, president of AJMC. “This is an important time for healthcare professionals to be engaged with leaders in this field.”
By working collaboratively, utilizing diverse technologies and education offer-ings, and leveraging the theories embed-ded in new reimbursement models, the hope is patients and providers will work together to overcome the obstacles to ef-fective diabetes self-management.
Addressing Obstacles on the Road to Diabetes Control
Dr. Elizabeth S. Halprin
Louisiana Medical News APRIL 2014 • 5
By TED GRIGGS
In February, Ochsner Health System inked a two-year deal to manage Hancock Medical Center in Bay St. Louis, Miss., in a continuation of a national trend that has seen growing numbers of small hospitals seek outside expertise.
“It seems like we’re definitely not alone in this process from a national perspective,” said Michael Hulefeld, chief operating officer of Ochsner. “I think there are ways where different organizations can inte-grate where you get the best of what we can bring … and likewise couple that with what an orga-nization is already doing and that they’re successful in.”
The management contract is part of a fairly significant national trend, Hulefeld said. Hancock had for many years been managed by Tennessee-based Quorum Health Resources, but the hospital wanted a change.
Paul Salles, chief executive officer of the Louisiana Hospital Association, said the trend the industry is seeing is being driven by the changes in the healthcare in-dustry, such as the shift from fee-for-service to a system that has begun rewarding pro-viders for quality outcomes.
“I think standalone facilities are re-
alizing that with the new complexities, it helps to have a home office and access to resources and expertise, all those kinds of things that just sort of help them navigate through all the different changes that are occurring,” Salles said.
Salles said he does not know exactly how many Louisiana hospitals have man-agement arrangements.
“They’re fairly prevalent …. I think you’re starting to see more of it,” Salles said.
Quorum probably manages 10 hos-pitals in the state, and Willis-Knighton Health System in Shreveport manages a number of smaller facilities in the area, he said.
Salles said management arrangements like the one between Ochsner and Han-cock are just one part of the hospital indus-try’s effort to cope with a rapidly changing and complex operating environment.
The hospital industry is also in the midst of a period of consolidation.
A January article in the New England Journal of Medicine says the Affordable Care Act has unleashed “a merger frenzy.”
Hospitals are racing to solidify their market positions, improve efficiency and create the new organizational structures needed to manage population health, the article says. From 2005 to 2007, prior to the Great Recession, 50 to 60 hospitals were sold each year. In 2012, there were 105.
In 2013, regulatory agencies stepped in to block two hospital systems from ac-quiring competitors to prevent marketplace monopolies, the Journal says. Regulators have also opposed hospitals buying com-peting physicians practices to amass mar-ket share.
It’s unclear when the consolidation wave will end or what the industry will look like afterward.
Hulefeld said although some compa-nies have used management agreements to evaluate potential acquisitions, that’s not the case with Ochsner’s relationship with Hancock.
“We’re just the new management company there. Ochsner is not looking to acquire Hancock, and I don’t think they want to be acquired,” Hulefeld said. “This is a community asset and it’s been that way for a long, long time. It’s a great commu-nity that is very committed to seeing that hospital be successful.”
Ochsner’s other management agree-ment is with Leonard J. Chabert Medical Center in Houma. Ochsner and Terre-bonne General Medical Center are man-aging the LSU hospital.
Hulefeld said the services Ochsner provides at Hancock and Chabert Medical are structured differently, based upon the services that each hospital requires.
For instance, at Chabert, Ochsner is providing full oversight, including billing, purchasing and contracting. At Hancock,
Ochsner is providing a blended services ar-rangement.
Salles said management firms such as Quorum typically provide their hospital cli-ents with the upper end of the “C Suite,” or the most senior executives. Management companies typically bring their clients ex-pertise and efficiencies in areas such as pur-chasing, information technology and back office support.
Health systems such as Ochsner and Willis-Knighton also offer strategic advan-tages that may include access to physicians and specialists that a community hospital may lack, Salles said.
Meanwhile, Hulefeld said Ochsner isn’t looking at hospital management con-tracts as a major source of revenue, but the health system is open to working with other hospitals.
“If organizations are interested in working with Ochsner and maintaining their independence, as well as aligning with us, it’s an option,” Hulefeld said. “That’s basically our view on it.”
The advantages a management agree-ment can bring depend on each situation and aren’t limited to the financial, Hulefeld said. While one organization may want to take advantage of Ochsner Health System’s buying power, another may need help with quality improvement.
As with Chabert and Hancock, Och-sner’s management agreements are not “one size fits all,” Hulefeld said.
Ochsner Oversight Follows National Trend
6 • APRIL 2014 Louisiana Medical News
“The challenge here is disruption — it’s a disruptive process that delivers no direct benefit to patient care,” Hoven as-serted.
Many Codes Equals Much Room for Error
ICD-10 — the International Clas-sification of Diseases, 10th Edition — was endorsed by the World Health Organiza-tion (WHO) in May 1990 and put into use by member states beginning in 1994. It is the tool used to capture mortality and morbidity data, track disease outbreaks, highlight research needs, and provide a general snapshot of health among nations and populations.
There are two parts to the system in the United States. Clinical Modification (CM) is used for diagnosis coding in all healthcare settings. The Procedure Coding System (PCS) is for inpatient settings only. According to the Centers for Medicare and Medicaid Services (CMS), anyone covered by HIPAA… not just those who submit Medicare and Medicaid claims … must convert to ICD-10 by the Oct. 1, 2014 deadline.
“You’ve got to have an ICD-10 code
for the disease signs and symptoms, abnormal findings, complaints, circumstances and ex-ternal causes of injury or disease,” noted Hoven. “The problem is the granularity of the ICD-10 codes,” she continued.
Hoven said ICD-9-CM encompassed between 13,000 to 14,000 codes compared to ICD-10’s 68,000 options. “It’s about a five-fold in-crease,” she pointed out.
She was quick to add the inflated number of codes in ICD-10 wasn’t set by the WHO but instead is a product of U.S. modifications to the system. In addition to the CM codes, the PCS portion has 72,000 codes. Other countries have significantly fewer options. Canada, Germany and Australia all have less than 20,000 codes in their ICD-10 set, and Canada uses ICD-10 for inpatients only.
“There’s something like nine codes for parrot bites,” Hoven said of the U.S. system. The vast number of choices, she fears, makes the potential for error enor-mous.
Financial ConcernsSince ICD-10 accuracy is tied to re-
imbursement, physicians across the coun-try are worried about the financial stability of their practices if payments are denied, delayed or otherwise disrupted.
“If it’s not correct, Medicare won’t pay you … no one will pay you,” Hoven noted. She added patients might be the ones who ultimately pay the highest price in terms of access to care if some prac-tices simply cannot weather the financial storm.
“This is why the American Medical Association has been so adamant in trying to get ICD-10 repealed.”
Not getting paid is a very real con-cern. Hoven pointed to the results of a pilot study released last year by the Health-care Information & Management Systems Society (HIMSS) and the Workgroup for Electronic Data Exchange (WEDI) that showed experienced coders had an av-erage accuracy rate of about 63 percent when converting diagnoses to the ICD-10 coding system.
Conducted in 12 waves, each test series consisted of a number of different cases. While 63 percent accuracy was the overall result, individual figures varied widely within each wave. For example, in wave 6, ‘acute bronchiolitis due to RSV’ was accurately coded only 38 percent of the time. On the plus side, coding for “de-viated nasal septum” had a 100 percent accuracy rating in wave 7.
Another financial issue recently came to light when the AMA initiated an up-dated cost study, which found the price tag for ICD-10 implementation was dra-matically higher than previous estimates.
“We were basically operating on 2008 figures, and when we saw these new num-bers, it was even worse,” Hoven said. In fact, the 2014 figures found that in some cases implementation costs would be
nearly three times what had been predicted six years earlier. Nachimson Advisors con-ducted both the original 2008 study and updated 2014 version.
In 2008, the average predicted cost to implement ICD-10 was:
• $83,290 for a small practice,• $285,195 for a medium practice,
and• $2.7 million for a large practice.The new cost estimates feature a
range for each practice size based on vari-able factors including specialty, vendor and software. The updated study predicted implementation costs would be:
• $56,639-$226,105 for a small prac-tice,
• $213,364-$824,735 for a medium practice, and
• $2 million to just over $8 million for a large practice.
Two-thirds of physician practices are projected to fall into the upper ranges of the current cost estimates, which include training, assessment and testing, produc-tivity loss, process remediation, payment disruption and vendor/software upgrades. Data also has shown vendors are lagging behind in software development, making it difficult for practices to install and conduct appropriate pre-launch testing and to insti-tute workflow changes if needed.
“The markedly higher implementa-tion costs for ICD-10 place a crushing bur-den on physicians, straining vital resources needed to invest in new healthcare deliv-ery models and well-developed technology that promotes care coordination with real value to patients,” Hoven said.
Balancing the Pluses and MinusesICD-10 certainly has many propo-
nents who point to the benefit of having increased information through the detailed coding system to enhance data analysis, public health surveillance and research initiatives.
It isn’t an argument that sits partic-ularly well with Hoven. “But at the end of the day is it going to improve patient care?” she questioned. “The answer is no.”
Those in favor of ICD-10 insist that’s exactly what the new system will do by providing greater opportunity for evidence-based practice and clinical de-cision support. The argument has even been made that the switch ultimately will lessen the burden on providers because they won’t be required to provide as much detailed clinical documentation since the codes are already so specific.
Hoven stressed physicians are strongly supportive of changing the way healthcare is delivered in terms of implementing evi-dence-based protocols, working collabora-tively and adopting new models like the patient-centered medical home. However, according to Hoven, too many new admin-istrative and regulatory requirements that do little to improve outcomes have been thrust upon physicians to a point where it has become overwhelming.
“Over the last seven to eight years, the changes have been tumultuous in prac-tices.” Hoven said.
On the way to implementing changes that improve patient care, she noted phy-sicians have been met time and again with administrative and financial hurdles mandated by CMS including new require-ments for the physician quality reporting system (PQRS), value-based payment modifier program, and meaningful use.
Despite a national call for adminis-trative simplification, Hoven pointed out, “Nothing seems to get simplified. It gets more complicated. The problem when you start dealing with rules at the federal level is it further complicates everything. It doesn’t improve healthcare, and it doesn’t improve health outcomes.”
What AMA Hopes to AchieveIn February, AMA launched a #Stop-
ICD-10 Twitter campaign in support of the organization’s continuing effort to urge HHS to make good on its commitment to improve the regulatory climate for physi-cians. However, after a number of delays, Hoven knows CMS officials have been ad-amant the ICD-10 implementation dead-line will not move again. Oct. 1 is coming … ready or not.
Hoven said she was delighted by the announcement in mid-February that CMS would conduct end-to-end testing for select providers. AMA, along with other industry groups including the Medical Group Man-agement Association, have pushed hard for such testing. Hoven said the AMA be-lieves end-to-end testing is essential to en-suring there won’t be massive disruptions in claims and payment processing. She noted it was critical that practices of differ-ent sizes and specialties be included in the test and called upon CMS to start as soon as possible considering the short window between now and Oct. 1.
“If we see this end-to-end testing is a disaster, our hope is that they will, in fact, delay implementation until a) they can fig-ure out how to fix it, or b) replace it with something else that is more workable,” she said.
Hoven added if ICD-10 goes into ef-fect as planned, she would advocate for policy changes to protect physician prac-tices such as a two-year implementation period where there would not be payment denials around coding issues.
The Bottom Line
“ICD-10 is an unfunded mandate,” Hoven reiterated, adding it’s also one that comes with a high price tag at a time when physicians already are struggling to stay on top of other costly federal mandates.
“Adopting ICD-10, while it may pro-vide benefits to others in the healthcare system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implement-ing delivery reforms and health informa-tion technology,” she concluded.
And One Final NoteWhile the debate rages on over ICD-
10, it should be noted work on developing ICD-11 has already begun and is expected to be ready for WHO approval in 2017.
With the Deadline Fast Approaching, AMA Continues, continued from page 1
Dr. Ardis Dee Hoven
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Louisiana Medical News APRIL 2014 • 7
By LyNNE JETER
Two southern orthopedic clinics will pay a combined $1.85 million to resolve state and federal False Claims Act allega-tions.
According to the Department of Jus-tice, Knoxville, Tenn.-based Tennessee Orthopaedic Clinics PC will pay $1.3 million, and Kingsport, Tenn.-based Ap-palachian Orthopaedic Clinics P.C., will pay $550,000, for knowingly billing state and federal healthcare programs for reim-ported osteoarthritis medications, known as viscosupplements.
Viscosupplements – Synvisc and Or-thovisc – are FDA-approved injections for the treatment of osteoarthritis pain in the knee. Medicare, Med-icaid and other federal healthcare programs re-imburse Viscosupple-ments at a set rate, based on the average sales price of the domestic product.
The government contended the clinics knowingly purchased deeply discounted vis-cosupplements reimported from foreign countries, and billed them to state and federal healthcare programs for profit from the reimbursement system, when those programs don’t reimburse reim-ported viscosupplements. Allegedly, the reimported product included labeling in foreign languages and in English for ad-ditional uses not approved in the United States. Because the product was reim-ported, the government alleged there was no manufacturer assurance that it hadn’t been tampered with or stored appropri-ately.
The settlement was announced in January.
“While we’re all familiar with fraud-ulent billing cases resulting in significant financial penalties and even prison time, these claims were different,” said Michael J. Sacopulos, JD, CEO of Medical Risk Institute (MRI). “The orthopedic clinics in Tennessee and Virginia ran afoul of the Federal False Claims Act when they ‘re-imported’ Viscosupplements.”
Sacopulos pointed out there was no allegation these substances were improp-erly used. “However, because the drugs came from distributors outside the United States, at a significantly lower price than they were able to be obtained stateside, the Department of Justice brought a False Claims Act case,” he said.
William C. Killian, U.S. Attorney for the Eastern District of Tennessee, called the scheme “yet another example of illegal actions by healthcare providers to profit from drugs imported into the United States.”
“Medicare and FDA requirements are designed to prevent potential harm to patients,” he added. “Noncompliance with the law to increase profit at the risk of patients will be pursued by the Depart-ment of Justice.”
This sentiment was seconded by Der-rick Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector Gen-eral in Atlanta, who emphasized that attempts to increase profits by circumvent-ing the law “won’t be tolerated.”
“Healthcare providers buying cut rate, cheap drugs from foreign sources will end up paying a steep price,” he cau-tioned.
The allegations resolved by the settle-ment were first raised in a lawsuit filed against the clinics under the qui tam, or whistleblower, provisions of the False Claims Act by Douglas Estey, a physi-cian’s assistant who was occasionally paid by Genzyme Corp. to speak to medical providers about the use of Synvisc. The act allows private citizens with knowledge of fraudulent activity to bring civil actions on behalf of the government and to share in any recovery.
“Even though it was an approved drug, administered in an approved man-ner, to an appropriate patient, the fact that the drug’s providence couldn’t be assured made its use illegal,” noted Sacopulos.
“Ultimately, the whistleblower claim resulted in a payment to (Estey) of
$323,750.” Since January 2009, the Justice De-
partment has recovered more than $17 billion through False Claims Act cases, with more than $12 billion of that amount recovered in cases involving fraud against federal healthcare programs,” he said.
Stuart F. Delery, assistant Attorney General for the Justice Department’s Civil Division, cautioned healthcare providers: “The department is committed … to tak-ing action against companies that take chances with the health of consumers so as to improve their own bottom lines.”
Sacopulos said takeaway points from the case are:
“The federal government has incen-tivized individuals to bring false claims to their attention by effectively paying a bounty for this information.
While it might be clever to do busi-
ness in the import low-cost inventory, it’s illegal to do so with pharmaceutical prod-ucts in the healthcare industry.
The Office of Inspector General is stepping up its investigation and prosecu-tion of false claims against healthcare pro-viders. Medical providers of all sizes need to have a Coding and Billing Compliance Plan.”
The claims settled by these agree-ments are allegations only, according to the Department of Justice. No determi-nations of liability have been made in the case, United States ex rel. Estey v. Tennessee Or-thopaedic Clinics P.C., Appalachian Orthopaedic Associates P.C. and Appalachian Orthopaedic Partners LLC, Docket No. 3:12-cv-85 Varlan/Guyton.
False Claims AlertOrthopedic clinics to pay nearly $2 million to settle allegations of billing Medicare for reimported products
Michael J. Sacopulos
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8 • APRIL 2014 Louisiana Medical News
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By the time you read this, The 2014 Regular Session of the Louisiana Legislature will be in full swing. The session com-menced on March 10th and will adjourn sine die on Monday June 2, 2014. To view a bill go towww.legis.la.gov
Below is a listing of pre-filed bills related to health-care.
HB 62, PughProvides relative to pharmacy re-cord audits 1/23/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 63, LegerRevises terminology referring to persons with disabilities and other persons with exceptionalities 1/23/2014
House Tentatively referred to com-mittee on Health & Welfare
HB 66, MontoucetRequires state-affiliated physi-cians to serve on the State Medical Disability Board upon request of the Firefighters’ Retirement System 1/23/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 68, BurnsProvides that certain appeals and hearings formerly conducted by the bureau of appeals of the Dept. of Health and Hospitals shall be conducted by the division of ad-ministrative law 1/23/2014 House Tentatively referred to com-mittee on House & Govern-mental Affairs
HB 103, FoilIncreases penalties for distribution of narcotic Schedule I Controlled Dangerous Substances 2/6/2014 House Tentatively referred to com-mittee on Criminal Justice
HB 109, ConnickProvides relative to hospital service districts in Jefferson Parish 2/6/2014 House Tentatively referred to com-mittee on Municipal, Paro-chial & Cultural Affairs
HB 110, ConnickRequires voter approval of the lease of hospitals in Jefferson Par-ish hospital service districts unless all are leased to a single lessee 2/6/2014 House Tentatively referred to com-mittee on Municipal, Paro-
chial & Cultural Affairs
HB 157, PearsonRequires all newborns to be screened for adrenoleukodystrophy 2/13/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 168, HoffmannProhibits outdoor smoking within 25 feet of certain exterior locations of state office buildings 2/13/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 174, BrossettProvides for the expansion of Medicaid eligibility 2/17/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 185, HavardProvides relative to home- and community-based long-term care services provided by direct service workers 2/17/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 204, BurnsProvides for signed donor consent forms to be executed by prospective donors in connection with execut-ing an anatomical gift through the office of motor vehicles 2/18/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 240, SmithRequires the state to provide to a legal resident employed for the previous calendar year for at least 1,000 hours and whose income is below 100% of the federal poverty level the opportunity to participate in a state program providing health insurance with essential benefits 2/20/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 245, DixonAmends provisions of the Dental Practice Act relative to penalties 2/20/2014 House
Tentatively referred to com-mittee on Health & Welfare
HB 251, TalbotProvides for transparency in prices of hospital procedures, treatments, and other health care services 2/20/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 261, DixonCauses eligibility standards for the La. Medicaid Program to conform to those established by the ACA and creates the La. Health Care Independence Program 2/20/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 275, GreeneProvides with respect to the sub-poenaing of prescription monitor-ing information 2/21/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 290, SmithDirects the Dept. of Health and Hospitals to offer health insur-ance with essential health benefits to every legal resident of La. whose income is at or below 138 percent of the federal poverty level, and to allow the legislature to determine whether to continue the program when federal funding falls below 90 percent of the total program funding 2/24/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 294, BishopProvides relative to preparation of cane syrup in the traditional man-ner for public consumption 2/24/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 305, HoffmannProhibits providers of elective abortions and their affiliates from delivering any instruction or mate-rials in schools 2/24/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 331, LopintoAuthorizes licensed practical nurses to administer chemical tests for intoxication 2/24/2014 House Tentatively referred to com-mittee on Criminal Justice
HB 332, LopintoAmends criminal penalties for certain offense involving Schedule I narcotic substances 2/24/2014 House Tentatively referred to com-mittee on Criminal Justice
HB 335, RichardProvides relative to enforcement of the Patient Protection and Afford-able Care Act of 2010 2/24/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 336, SimonProvides relative to the right to treatment for a person with a ter-minal condition 2/24/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 348, BadonProhibits termination of life-sustaining procedures for pregnant women 2/25/2014 House Prefiled in the House
HB 350, BishopAdds conditions and protections relative to use of patient health care data to the La. Health Care Consumers’ Right to Know law 2/25/2014 House Prefiled in the House
HB 388, JacksonProvides for requirements of physi-cians who perform abortions 2/25/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 396, WillmottProvides relative to the member-ship of the Nursing Supply and Demand Council 2/26/2014 House Tentatively referred to com-mittee on Education
Healthcare Bills are Pre-filed for the New Legislative Session
Legislative AffairsBY CINDY BISHOP
(CONTINUED ON PAGE 9)
Louisiana Medical News APRIL 2014 • 9
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HB 399, ArmesProvides relative to the prevention of workplace violence in healthcare facilities 2/26/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 403, BurfordProvides for certificates of stillbirth and hospital policies concerning disposition of fetal remains 2/26/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 427, BadonRequires a hospital to provide in-formation regarding organ or tissue donation 2/26/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 475, JohnsonRepeals provisions relative to den-tal referral plans 2/26/2014 House Tentatively referred to com-mittee on Insurance
HB 487, WilliamsProvides relative to criminal back-ground checks of ambulance per-sonnel 2/26/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 506, GreeneProvides with respect to notice requirements for qualified health plan issuers on the health insur-ance exchange 2/27/2014 House Tentatively referred to com-mittee on Insurance
HB 513, HenryRequires the Department of Health and Hospitals to provide information concerning velocar-diofacial syndrome and 22q11.2 deletion syndrome 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 536, SmithProvides for the Louisiana Health Care Independence Act 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 552, GreeneRequires recognition of assign-ment of health insurance benefits to healthcare providers
2/27/2014 House Tentatively referred to com-mittee on Insurance
HB 571, StokesProvides relative to contracts for managed long term supports and services within the Medicaid pro-gram 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 601, AbramsonProhibits a provider of healthcare services from refusing to submit a claim to a healthcare insurance is-suer under certain circumstances 2/27/2014 House Tentatively referred to com-mittee on Insurance
HB 610, AbramsonProvides relative to licensed radio-logic technologists 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 630, AndersProvides relative to the practice of optometry and the regulation of such profession 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 634, BishopEstablishes the licensed profession of art therapist 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 635, BroadwaterProvides relative to fiscal/em-ployer agents for direct service workers 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 663, RobideauxProvides relative to the Louisiana Tax Delinquency Amnesty Act of 2013 2/27/2014 House Tentatively referred to com-mittee on Ways and Means
HB 667, SimonReorganizes and recodifies the Miscellaneous Health Provisions chapter of Title 40 of the La. Re-vised Statutes 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 668, SimonProvides for electronic visit verifi-cation for long-term care services delivered in home- and commu-nity-based settings 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 669, SimonProvides relative to healthcare cost and quality information 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 672, WhitneyProvides for a limited exemption to state licensure requirements for visiting physicians 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 674, WilliamsAllows the use of a mode of trans-portation other than an ambulance for a nonemergency situation 2/27/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 688, BishopProvides requirements relative to primary care case management within the Medicaid managed care program 2/28/2014 House Prefiled in the House
HB 691, BroadwaterProvides relative to athletic train-ers 2/28/2014 House Prefiled in the House
HB 711, GreeneRequire health plans to collect co-insurance and deductibles 2/28/2014 House Prefiled in the House
HB 719, HollisProvides for a three year mora-torium on implementation or en-forcement of the Affordable Care Act 2/28/2014 House Prefiled in the House
HB 720, HonoreAuthorizes the use of medical marijuana in Louisiana 2/28/2014 House Prefiled in the House
HB 727, IveyRequires provision of psycho-
logical health information prior to abortion 2/28/2014 House Prefiled in the House
HB 736, JamesProvides relative to the Louisiana Commission on HIV, AIDS, and Hepatitis C 2/28/2014 House Prefiled in the House
HB 746, MorenoProhibits the use of tanning equip-ment by a minor 2/28/2014 House Prefiled in the House
HB 754, MorenoAuthorizes first responders to carry naloxone 2/28/2014 House Prefiled in the House
HB 755, MorenoAuthorizes the administration of naloxone by a third party 2/28/2014 House Prefiled in the House
HB 758, NortonCreates the Bullying Awareness and Treatment Task Force 2/28/2014 House Prefiled in the House
HB 759, NortonRequires that La. Medicaid eligi-bility standards conform to those established by the Affordable Care Act 2/28/2014 House Prefiled in the House
HB 764, PearsonProvides for the licensing and regulation of health insurance navigators and similar individu-als and entities 2/28/2014 House Prefiled in the House
HB 796, CromerRelative to the Louisiana Health Care Commission 2/28/2014 House Prefiled in the House
HB 802, BarrowEstablishes a task force on toxic mold 2/28/2014
House Prefiled in the House
HB 827, WoodruffRequires food service establish-ment inspection reports to be made publicly available 2/28/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 828, WoodruffRequires disclosure and labeling of food products derived from cloned animals 2/28/2014 House Tentatively referred to com-mittee on Health & WelfareHB 833, FoilCreates the ABLE Account sav-ings program for persons with sig-nificant disabilities 2/28/2014 House Prefiled in the House
HB 877, HollisExempts Louisiana’s citizens from the mandates in the Afford-able Care Act 2/28/2014 House Prefiled in the House
Legislative Affairs, continued
(CONTINUED ON PAGE 10)
10 • APRIL 2014 Louisiana Medical News
Physicians’ health Foundation oF louisiana
Providing ass istance with the ident i f icat ion, t reatment, and monitoring of physicians who suffer from a physical or mental condition, in order to promote patient safety and to ensure the continued availabil ity of sk il led physicians
HB 889, HollisEstablishes a fund to educate Louisiana citizens on ways to opt out of the Affordable Care Act 2/28/2014 House Prefiled in the House
HB 891, StokesAuthorizes access to investiga-tional treatments for termi-nally ill patients 2/28/2014 House Prefiled in the House
HB 895, FanninProvides relative to balance billing 2/28/2014 House Prefiled in the HouseHB 903, SimonProvides for the Louisiana Tele-health Access Act 2/28/2014 House Prefiled in the House
HB 921, SchexnayderProvides relative to access to cer-tain birth records 2/28/2014 House Prefiled in the House
HB 952, WhitneyProvides for drug testing of persons who receive or apply for cash as-sistance or unemployment benefits 2/28/2014 House Prefiled in the House
HB 983, BrossettRequires reporting regarding cer-tain employers 2/28/2014 House Tentatively referred to com-mittee on Health & Welfare
HB 1003, OrtegoProvides relative to telemedicine 2/28/2014 House Tentatively referred to com-mittee on Health & Welfare
HCR 1, EdwardsAmends administrative rules to cause La. Medicaid eligibility standards to conform to those es-tablished in the Affordable Care Act 2/6/2014 House Tentatively referred to com-mittee on Health & Welfare
HCR 4, OrtegoRepeals provision of the sanitary code relative to solar water heating systems 2/28/2014 House Tentatively referred to com-mittee on Health & Welfare
SB 57, BroomeMandates inclusion of lymph-edema treatment as an option in health insurance coverage 2/14/2014 Senate Tentatively referred to com-mittee on Insurance
SB 77, NeversConstitutional amendment to require the state to provide the opportunity to a legal resident, employed for the previous calen-dar year for at least one thousand hours, and whose income is below one hundred percent of the federal poverty level to participate in a state program that provides health insurance with essential benefits 2/18/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 113, BuffingtonProvides relative to the Medical
Assistance Program 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 115, BuffingtonAmends the Sanitary Code to per-mit, at the discretion of the opera-tor of a retail food establishment, pet dogs in designated outdoor dining areas of a retail food estab-lishment 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 120, BroomeProvides for expansion of Med-icaid coverage to include lymph-edema treatment 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 137, BuffingtonProvides relative to the practice of medicine 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 165, MurrayProvides relative to prescription drug specialty tiers 2/25/2014 Senate Tentatively referred to com-mittee on Insurance
SB 178, MorrishProvides with respect to health care sharing ministries 2/25/2014 Senate Tentatively referred to com-mittee on Insurance
SB 182, MillsProvides relative to health insur-ance policies providing prescrip-tion drug coverage 2/25/2014 Senate Tentatively referred to com-mittee on Insurance
SB 185, MillsProvides for an emergency certifi-cate 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 188, MorrishProvides with respect to the state Sanitary Code 2/25/2014 Senate Tentatively referred to com-mittee on Health & WelfareSB 194, MillsProvides for mental health coun-selors
2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 195, MillsProvides for the administration of medication at schools by a school nurse 2/25/2014 Senate Tentatively referred to com-mittee on Education
SB 196, MillsProvides for health care services providers 2/25/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 258, JohnsProvides relative to the Sanitary Code 2/26/2014 Senate Tentatively referred to com-mittee on Health & WelfareSB 259, JohnsProvides relative to Louisiana health care consumers’ right to know 2/26/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 309, BroomeProvides for screening of pregnant women for HIV and syphilis in the third trimester of pregnancy 2/27/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 341, DonahueProvides for certain limitations relative to actions or rules requir-ing modification of certain existing community water systems 2/27/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 349, MorrellProvides relative to Medicaid managed long term care support and services 2/27/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 400, MillsProvides relative to Medicaid re-covery audit contractors 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 401, MillsProvides for third party contracts with pharmacies 2/28/2014
Senate Tentatively referred to com-mittee on Health & Welfare
SB 403, MillsProvides relative to third party payments of health insurance pre-miums of individuals with HIV/AIDS 2/28/2014 Senate Tentatively referred to com-mittee on Insurance
SB 404, WalsworthProvides exemption from licens-ing for medical personnel travel-ing with out-of-state sports teams while in Louisiana 2/28/2014 Senate Tentatively referred to com-mittee on Commerce
SB 410, MillsProvides for the transparency of Maximum Allowable Cost Lists for prescription drugs 2/28/2014 Senate Tentatively referred to com-mittee on Insurance
SB 421, CortezProvides that DHH shall set standards limiting certain con-taminants in water from commu-nity water systems 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 427, BuffingtonProvides relative to the Louisiana State Board of Medical Examin-ers 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 428, BuffingtonProvides relative to the prac-tice of optometry and the regulation of such profession 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 429, BuffingtonProvides relative to the Health Education Authority of Louisiana 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 486, PeacockProvides with respect to drinking fountains at places of business 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
Legislative Affairs, continued
(CONTINUED ON PAGE 11)
Louisiana Medical News APRIL 2014 • 11
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SB 487, MillsProvides for certain requirements regarding a Medicaid managed care program 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 488, HeitmeierProvides relative to Medicaid 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 489, HeitmeierProvides relative to the diabetes annual action plan 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 490, HeitmeierProvides relative to balance billing by and reimbursement of noncon-tracted facility-based physicians for covered health care services rendered in an in-network health care facility 2/28/2014 Senate Tentatively referred to com-mittee on Insurance
SB 491, HeitmeierProvides relative to the Louisiana Smokefree Air Act 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 492, HeitmeierProvides for smoking and tobacco products 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 493, HeitmeierProvides for prohibitions within a Medicaid managed care program 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 495, HeitmeierProvides for a public benefi t as-sessment by the Department of Health and Hospitals 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 496, HeitmeierProvides for limits on certain pre-scriptions 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 497, HeitmeierProvides for the payment of health care services 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 498, HeitmeierProvides for personal care assis-tance services 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare SB 499, HeitmeierProvides for authorized procedures provided by direct service workers 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 501, HeitmeierProvides for telemedicine 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 503, HeitmeierProvides for the Department of Health and Hospitals to create an upper payment limit mechanism for ambulatory surgical centers 2/28/2014 Senate Tentatively referred to com-mittee on Health & WelfareSB 505, HeitmeierProvides for an automatic suspen-sion of a physician’s license 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 513, HeitmeierProvides for the Louisiana Obe-sity Prevention and Management Commission 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 514, HeitmeierProhibits smoking near public and private elementary and secondary school property 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 516, Buffi ngtonProvides for direct primary care 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 521, WardProvides relative to commercial surrogacy 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 534, HeitmeierProvides relative to Medicaid 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 539, NeversProvides relative to suicide assess-ment, intervention, treatment, and management training for certain professions 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 541, MillsProvides for the use of marijuana for medicinal purposes 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
SB 545, MillsProvides relative to third party initiated medication substitutions 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare SCR 1, MillsAmends the communicable dis-eases reporting rules. 2/28/2014 Senate Tentatively referred to com-mittee on Health & Welfare
Real-time monitoring of critical PEDs patients is just one of the ways that telemedicine is transforming healthcare at the Lake.
The hospital also utilizes telemedicine technology to monitor ICU patients, not just at the Lake but at St. Elizabeth’s Hos-pital in Gonzales, Butler said. The Lake will be adding the “mobile virtual criti-cal care program” service at Our Lady of Lourdes Regional Medical Center in La-fayette.
The Lake is part of the Franciscan Missionaries of Our Lady Health System, as are St. Elizabeth’s and Our Lady of Lourdes.
Physicians stationed in a central lo-cation known as “the bunker” monitor about 48 critical-care patients at the Lake, as well as the patients at other facilities, Butler said.
The system’s software allows the hos-pital to set the parameters for intervention. If the patient’s condition changes and he or she reaches the parameter, the system sends out an alert.
The physicians then contact the nurses’ station and let them know some-thing needs to be taken care of, Butler said. Mobile virtual critical care means someone is monitoring the patients’ vital signs 24 hours a day so the providers can react instantly rather than waiting even the few minutes between the ICU nurses’ regularly scheduled checks.
Kelly Zimmerman, a spokeswoman for the Lake, said the ICUs have very low patient-to-nurse ratios, a design that places the nurses just outside the patient rooms, and a schedule that calls for fre-quent checks.
The mobile virtual critical care pro-gram adds an extra layer of monitoring that really tends to improve outcomes since there’s that much quicker reaction time, which is especially important for ICU patients, Zimmerman said.
“This program is especially good for some of your rural hospitals that don’t have critical care units or can’t afford to staff them,” Butler said. “So having some-one be able to monitor those patients, in their hospitals, is a good thing for them. And it’s also a good thing for the patient because the patient gets to stay in the hos-pital within his or her community.”
The Lake has discussed modifying the system so that it will alert physicians on their iPhones or iPads, but the hospital has not yet decided whether to do that yet, Butler said.
The Lake has also equipped as many as a half a dozen of its rooms for video conferencing, and one of the technology’s biggest benefi ciaries has been the Gradu-ate Medical Education program.
The Lake’s resident programs, which include otolaryngology, pediatrics, and psychiatric rotations, use video confer-encing to do grand rounds, Butler said. The Lake has used video conferencing to connect its residents with physicians in New Orleans, Lafayette, Ohio and even Mexico.
Before video conferencing, residents had to drive from whatever city they were in, Baton Rouge, Lafayette or New Or-leans, to wherever the ground rounds were being held, Butler said. The drive time meant rounds could take up an entire day.
Video conferencing saves time while exposing residents to more hospitals, he
said.Meanwhile, the Lake’s Telestroke
Medicine Program remains the hospital’s largest telemedicine program. The Lake is working with fi ve rural hospitals in the program, using video conferencing tech-nology to remotely treat stroke patients. Three of the facilities are FMOL proper-ties: St. Elizabeth, Our Lady of the Lake Livingston, and St. Francis Medical Cen-ter in Monroe. The others, Lane Regional Medical Center in Zachary and West Fe-liciana Parish Hospital in St. Francisville, are not.
In 2013, the program received the American Heart Association and Ameri-can Stroke Association’s highest level of recognition: the Get with the Guidelines Stroke Gold Plus Quality Achievement Award. In addition to meeting seven best-practice stroke achievement measures, the Lake exceeded the award benchmarks and had better than 80 percent compli-ance in fi ve additional quality measures including aggressive use of treatments and medication aimed at reducing death and disability, preventing recurrent stroke, and improving the lives of stroke patients.
Telemedicine Changes Care at Lake, continued from page 1
May – Women’s Health– HIT
June – Rural Health– Practice Management
July – Pediatrics– Health Exchanges
August – Orthopedics/Sports Medicine– Physician/Hospital Alliance
September– Oncolocy– Medicare/Medicaid
October – Senior Health– Reimbursement
November– Radiology/Imaging– Health Education
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Louisiana Medical News APRIL 2014 • 13
In the News
EDWIN G. PREIS, JR.L. LANE ROYROBERT M. KALLAMFRANK A. PICCOLOJOHN M. RIBARITSCATHERINE M. LANDRYJAMES A. LOCHRIDGE, JR.CHARLES J. BOUDREAUX, JR.DAVID L. PYBUSDAVID M. FLOTTELEAH NUNN ENGELHARDTEDWARD F. KOHNKE IVJENNIFER A. WELLSJONATHAN L. WOODSM. BENJAMIN ALEXANDERKEVIN T. DOSSETTKENNETH H. TRIBUCHCARL J. HEBERTMARJORIE C. NICOLMATTHEW S. GREENEZRA L. FINKLEJEAN ANN BILLEAUDJOHN F. COLOWICHKRISTOPHER STOCKBERGERJOHN L. ROBERT, IIIWILLIAM W. FITZGERALDCAROLINE T. WEBBMANDY A. SIMONNATHANIEL C. PITONIAKNICOLE M. BOWENANDREW B. BROWNTHOMAS H. PRINCERACHAL D. CHANCECRAIG R. BORDELON, IIJARED O. BRINLEEKELLYE E. ROSENZWEIG
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2014 Angel Award Nominees Sought by Blue Cross Foundation
BATON ROUGE- Nominations for the Angel Award, which recognizes and rewards exceptional volunteer work for the benefi t of Louisiana children, have been opened by the Blue Cross and Blue Shield of Louisiana Foundation. Now in its 20thyear, the Angel Award will honor eight individuals. Deadline for nominations is April 4, 2014.
Each winner will name a 501(c)(3) or-ganization to receive a grant of $20,000. In the two decades since its inception in 1995, more than 150 individuals from all across the state have been chosen for the honor. With this year’s grants, the total going to support organizations en-riching and improving life for Louisiana children will top $1.8 million.
There is no age limit, upper or lower, imposed on potential nominees. They have run the gamut from students to retirees, with a wide range of voca-tions in between. They were all chosen for the time and effort they spent away from or in addition to their studies, their jobs or their retirement activities to be an “Angel.”
An online nomination form and more details on the program are avail-able at the Blue Cross website, www.bcbsla.com/angelaward.
Nomination packets are also avail-able by calling toll-free 1-888-219-BLUE (1-888-219-2583) or emailing [email protected]. Nominators are encouraged to send supplemental in-formation in support of the nomination, including testimonial letters, brochures, news articles, photos and videos. (Please note: These materials cannot be returned.)
Individuals who themselves have been honored as “Angels” make up the committee that will decide this year’s winners. The following are the criteria they consider and nominators are asked to carefully consider this list:
• NEED: Did the nominee contrib-ute a needed service to Louisiana chil-dren?
• ACTION: Was the nominee ac-tive, not just a fi gurehead?
• INITIATIVE: Did the nominee initi-ate new programs or activities and use new methods to solve problems?
• ACHIEVEMENT: Has the nominee accomplished desired results?
• IMPACT: Has the activity or ser-vice provided by the nominee pro-duced positive changes and provided examples for other groups?
• TIME: Was the amount of time devoted to the activity or service signifi -cant?
• CHALLENGE: Did the nominee have to overcome any unusual chal-lenges, such as limited resources or public misperception of the problem?
A nominee may be recognized for work performed individually or through churches, schools or civic organizations,
but a group cannot be nominated. The volunteer work must have been per-formed in the state of Louisiana with Louisiana children as the primary ben-efi ciaries. The volunteer effort can be focused on enhancing any aspect of a child’s life, including physical, emotion-al, creative and spiritual. Individuals who are paid for their services are eligible, but their efforts must be considered to go above and beyond their job descrip-tions. Work done on work-release time and/or for student course credit may also be considered. Individuals may not be nominated posthumously.
The Blue Cross and Blue Shield of Louisiana Foundation will award grants to the honorees’ chosen charities that qualify as Louisiana-based nonprofi t charitable organizations with tax-ex-empt status under section 501(c)(3) of the Internal Revenue Code.
Our Lady of the Lake College Announces New President
BATON ROUGE – Our Lady of the Lake College has an-nounced Tina S. Holland, PhD, as the new Presi-dent of the private Cath-olic institution. Holland will lead the four-year college which provides a strong foundation in health sciences, nursing and liberal arts programs.
Holland will join Our Lady of the Lake College from Holy Cross Col-lege in Notre Dame, Indiana where she serves as the Executive Vice President and Provost and also held the roles of Vice President for Student Affairs, Mathematics Professor, and the Direc-tor of the Conditional Acceptance Pro-gram. She will assume her position on April 22.
Our Lady of the Lake College is a subsidiary of Our Lady of the Lake Re-gional Medical Center and is sponsored by the Franciscan Missionaries of Our Lady Health System. Sr. Kathleen Cain, Provincial of the Franciscan Missionaries of Our Lady shared, “Dr. Tina Holland is everything we envisioned when we be-gan this important national search. Her qualifi cations bring a depth of experi-ence in higher education administration from a faith based organization that fi ts with our culture and will serve Our Lady of the Lake College well during an excit-ing time of growth.”
The search committee was headed by Judge Luke LaVergne of Baton Rouge who stated, “Dr. Holland is an eminent teacher who demonstrates a profound faith in the power of education to change lives and add value to commu-nities. She recognizes the demand for a well-prepared healthcare workforce and the important role Our Lady of the Lake College has to train future healthcare professionals. Her experience will ensure the College continues advancements in higher education while remaining en-gaged with the community.”
Dr. Holland earned her PhD in Higher Education from Indiana State University and received her MA in Inter-national Relations from the University of San Diego. Before attending graduate school she graduated from the United States Naval Academy and served as an offi cer in the United States Marine Corps. Holland and her husband, Peter, will be coming to Our Lady of the Lake College from northern Indiana, where they raised their four children.
“Our Lady of the Lake College has a solid strategic plan and is work-ing closely with Our Lady of the Lake and all of its partners and subsidiaries. Dr. Holland is a servant leader who will continue to guide us forward and help
us achieve our plan and continue to be a premier academic institution,” said Charlie Freeburgh, Our Lady of the Lake College Board of Trustees Chair.
Broussard to Serve on American Nurses Foundation Grant Review Committee
LAFAYETTE- Dr. Lisa Broussard has been chosen as an American Nurses Foundation grant reviewer and will serve a three-year term on the Nursing Researcher Grants Review Committee for the American Nurses Foundation. In 2014, ANF will award $225,000 in research grants to beginner and expe-rienced nurse researchers, with a focus on nurse leadership and empowerment of nurses to become change agents in the transformation of the health care system.
The ANF Nursing Research Grants Program was founded 59 years ago to encourage the research career develop-ment of nurses. This program continues to grow with contributions for nursing research, from organizations and indi-viduals. These donations support scien-tifi c research for advancing the practice of nursing, promoting health and pre-venting disease.
Dr. Broussard currently serves as Department Head and Associate to the Dean, Department of Nursing at the University of Louisiana at Lafayette where she began her career as a nurse educator in 1992. She serves on a myr-iad of university as well as community committees and task forces, and is the recipient of several professional awards. Her activities include memberships in various nursing organizations, and she is the current President of Sigma Theta Tau, Delta Eta Chapter. Her scholarly works are numerous and varied includ-ing research projects, publications, and podium presentations.
Dr. Tina S. Holland
14 • APRIL 2014 Louisiana Medical News
New CEO of Imperial Health System Announced
LAKE CHARLES- Keith Broach, MBA, FACHE, has been named Chief Executive Offi cer of the Imperial Health System in Lake Charles. Broach, an Alabama native, has over 30 years of experience in the hospital administra-tion and healthcare ser-vices management fi elds.
Broach most recently served as President and CEO of Ferrell Hospital in Eldorado, Illinois. He earned an MBA from Aspen University and a Bachelor of Science degree from Auburn University in Auburn, Alabama. Keith has received many national awards and special rec-ognitions throughout his career includ-ing: the 2007 National Health Care Leader of the Year, three-time Nation’s Top Hospital for Patient Satisfaction winner and recipient of the Full Doc-toral Scholarship Award for Healthcare Administration.
Nelson Named Vice-Chair Of National POLST Paradigm Task Force
BATON ROUGE, La. – March 6, 2014 – Susan Nelson, MD, Chair of the LaPOST Coalition, a statewide network of health care professionals, has been named Vice-Chair of the National Phy-sician Orders for Life Sustaining Treat-ment (POLST) Paradigm Task Force (NPPTF) and its Executive Committee.
According to Amy Vandenbroucke, Executive Director of the National
POLST Paradigm, the purpose of the NPPTF is to advance education and science related to POLST and end-of-life planning. The NPPTF is dedicated to overseeing the success of the POLST Paradigm in every state and to estab-lishing clear tenets of the POLST Para-digm. As Vice-Chair, Nelson will serve as a key leader in shaping the direction of the National POLST Paradigm, she said.
As Chair of the LaPOST Coalition, Nelson has worked tirelessly to in-crease awareness and provide educa-tion about the Louisiana Physician Or-ders for Scope of Treatment (LaPOST) document. Designed to improve the quality of end-of-life care, the LaPOST form is based on effective communica-tion of the wishes of patients with seri-ous, advanced illnesses, a promise by health care professionals to honor these wishes and documentation of the corre-sponding medical orders on a brightly colored form.
In addition to her role as Chair of the LaPOST Coalition, Nelson is board-certifi ed in internal medicine, geriatrics and hospice and palliative medicine and serves as Medical Director of Senior Services and PACE Baton Rouge, Fran-ciscan Missionaries of Our Lady Health System and St. Joseph Hospice. She is a fellow of the American College of Phy-sicians and the American Academy of Hospice and Palliative Medicine as well as an advocate for senior health. She
works with the Louisiana State Medical Society Council on Public Health and the Louisiana Department of Health and Hospitals (DHH), and she serves on the Board of Directors for the Louisiana Health Care Quality Forum.
NEW ORLEANS – Following an extensive nationwide search, Ochsner Baton Rouge has hired Scott Mabry as Chief Op-erating Offi cer – Ochsner Baton Rouge Clinic Op-erations, effective March 10, 2014.
A Baton Rouge na-tive, Mabry joins Ochsner with 12 years of health-care management experience. He most recently served as the Senior Director of Physician Services at LifePoint Hospi-tals in Brentwood, Tennessee, where he had responsibilities for more than 120 providers, supporting 12 hospitals in 8 states.
Prior to joining LifePoint Hospitals, Mabry held leadership positions at Im-pel Management Services in Richland Hills, Texas, Methodist Health System in Dallas, Texas and University of Texas Medical Branch in Galveston, Texas. He earned a Bachelor of Science from Loui-siana State University in Shreveport, Louisiana and a Master of Science in Healthcare Administration from Trinity University in San Antonio, Texas.
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We all know chronic illness is destroying lives. And crippling the healthcare system. That’s why Blue Cross has created Quality Blue Primary Care, a program that rewards doctors for getting better health results for our Blue Cross members. Especially those with chronic health issues.
Our Quality Blue Primary Care program offers primary care practices in our network access to technology, tools and services to help them focus on what they do best: treating patients. Plus, providers and clinics enrolled in the program are paid a monthly care management fee—on top of their usual fee-for-service amount.
Patients benefit. Providers benefit. And together, we create a healthier, more affordable healthcare system for all of us.
For more information on Quality Blue Primary Care:Call 800.376.7765Email [email protected] Visit www.bcbsla.com/qbpc
Dr. David CarmoucheExecutive Vice President of External Operations & Chief Medical Officer
Blue Cross and Blue Shield of Louisiana
We invite our network primary care doctors in Family Medicine, Internal Medicine or General Practice to learn more about Quality Blue Primary Care.
Introducing A New Introducing A New Primary Care Program Primary Care Program
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01MK5620 02/14 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.
Regional Now Offering Breakthrough Heart Procedure
LAFAYETTE – Regional Medical Center of Acadiana is the fi rst hospital in the state to implant the new Boston Scientifi c S-ICD® System, the world’s fi rst and only commercially available subcutaneous implantable defi brillator for the treatment of patients at risk for sudden cardiac arrest.
The S-ICD System is designed to provide the same protection from SCA as trans venous implantable cardiovert-er defi brillators (ICDs); however the S-ICD System sits entirely just below the skin without the need for thin, insulated wires – known as electrodes or ‘leads’ – to be placed into the heart itself. This leaves the heart and blood vessels un-touched, offering physicians and pa-tients an alternative treatment to trans venous ICDs.
“The new S-ICD System provides implanting physicians with a new break-through treatment option for patients at risk of sudden cardiac ar-rest,” said Dr. Raghotham Patlola, interventional cardiologist with Cardio-vascular Institute of the South on the Regional Medical Center campus. “The system’s innovative design is an important new alternative that provides patients with a new treatment option that elimi-nates the need for trans venous leads.”
Sudden cardiac arrest is an abrupt loss of heart function. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricu-lar tachycardia or ventricular fi brillation. Recent estimates show that approxi-mately 850,000 people in the United States are at risk of sudden cardiac ar-rest and indicated for an ICD device, but remain unprotected.
The S-ICD System has two main components: (1) the pulse generator, which powers the system, monitors heart activity and delivers a shock if needed, and (2) the electrode, which enables the device to sense the cardiac rhythm and deliver shocks when neces-sary. Both components are implanted just under the skin — the generator at the side of the chest, and the electrode beside the breastbone.
Unlike trans venous ICDs, the heart and blood vessels remain untouched. Implantation with the S-ICD System is straightforward using anatomical land-marks, without the need for fl uoroscopy (an X-ray procedure that makes it pos-sible to see internal organs in motion). Fluoroscopy is required for implanting the leads attached to trans venous ICD systems.
The S-ICD System is intended to provide defi brillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, inces-sant ventricular tachycardia or sponta-
neous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing.
The S-ICD System received CE Mark in 2009 and is commercially avail-able in many countries in Europe as well as New Zealand. To date, more than 1,400 devices have been implanted in patients around the world.
Dr. Raghotham Patlola
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