Louisiana Medical News June 2015

SOUTH LOUISIANA EDITION

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JUNE 2015 / $5

Dr. Dani BidrosExploring What We Don’t Know

At age 9, Dani Bidros moved to Lafayette, La. from Syria with his family. Growing up, his role model was older brother, Rafi , who became a plastic surgeon. The younger Bidros followed in his footsteps on an almost identical path, diverting just a bit to become a brain surgeon. “It was great to have an older sibling to follow,” he confi ded ... page 3

Rural Hospitals Find ACO Help Two Louisiana hospitals are among more than 200 U.S. health systems that applied for $114 million in federal funds to help set up rural Accountable Care Organizations ... page 5

Physician Spotlight

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To promote your business or practice in this high profi le spot, contact Scott Cavitt at Louisiana Medical News.

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The Competing P’s: Provision & PaymentChanging reimbursement for new models of care

By CINDy SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to fi gure out how to pay for it.

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


By TED GRIGGS

A Louisiana Health Care Quality Forum and Aledade Inc. partnership has formed a new Accountable Care Organi-zation made up of independent primary care providers in small and mid-sized cities.

The partners will begin with just 10 to 12 practices, focusing on those that have the technology infrastruc-ture in place to capture clinical data and a large enough population of fee-for-service Medicare patients, said Dr. Farzad Mostashari, Aledade CEO. The Quality Forum and Aledade will help the practices put the data to use, helping doctors improve prevention and care coor-dination for their patients.

“If you have 500 patients, that’s too small for a contract with Medicare or a health plan,” Mostashari said. “The idea is to pool

patients from 10 or 12 practices and manage them together.”

At 10,000 patients, an ACO can manage risk over that population. Medicare has estimated it will pay $100 million next year on care for 10,000 patients.

“If we can together, as an ACO, reduce that by 10

percent, that’s $10 million that gets split between ACO

and Medicare,” Mostashari said.The incentives are made possible by

the Medicare Shared Savings Program, which rewards ACOs for slowing the growth in healthcare costs and meeting quality standards.

Travis Broome, healthcare policy lead for Aledade, said the ACO is focusing on Medicare fi rst. Large numbers of those patients have chronic conditions and there is an opportunity to keep those

Quality Forum, Aledade Form New ACO

PATIENT CARE MODELS

PATIENT CARE MODELS

2 • JUNE 2015 Louisiana Medical News

Louisiana Medical News JUNE 2015 • 3

By LISA HANCHEy

At age 9, Dani Bidros moved to Lafayette, La. from Syria with his family. Growing up, his role model was older brother, Rafi , who became a plastic surgeon. The younger Bi-dros followed in his footsteps on an almost identical path, diverting just a bit to become a brain surgeon. “It was great to have an older sibling to follow,” he confi ded.

As a high schooler, Bidros ex-celled in biology and sciences. Like his brother before him, Bidros at-tended the University of Louisiana at Lafayette (USL at the time his brother went), then LSU medical school in New Orleans. But, instead of pursuing plastic surgery, Bidros decided to concentrate on the brain. “With the human brain, there is so much that we know, but there’s so much that we don’t know,” he ex-plained. “And, I always knew I’d do something surgical where I’d be working with my hands. Neurosurgery blended the two. The complexity of the work itself and the gratifi cation of helping people, whether it was a brain or a spine issue, was just amazing.”

Two months after starting his resi-dency, Hurricane Katrina hit New Or-leans. During the ensuing week, Bidros

cared for his patients at Charity Hospital. Then, he and his fellow residents tempo-rarily relocated to Baton Rouge for a few months. After returning to New Orleans in an attempt to rebuild the program, Bi-dros was recruited by the chairman at the renowned Cleveland Clinic to complete his residency and fellowship in neurosur-gery.

In Cleveland, Bidros learned from the very best about all types of neurosurger-ies. “It was such a big facility and tertiary referral center, so we got to treat the most complex neurosurgical problems,” he re-called. “People were being fl own in from

all over the state, the country – the world – to be treated. It was a great opportunity and great training.”

Cleveland turned out to be a good move in another way – Bidros met his future wife, Maria, an oph-thalmology resident, at the clinic. Several months later, the two mar-ried. While completing their resi-dencies, the couple had two sons – Daniel in 2008, and Jacob in 2011.

After completing their studies, the young docs moved to Maria’s home state, New Jersey, where Bi-dros landed a job at Princeton Uni-versity. While living in the Garden State, they had another son, Sam-uel. “My wife is superwoman,” he confessed. “She defi nitely did the bulk of the work at home at that point.”

Eventually, the couple became weary of the frigid winters and longed for a warmer climate. Bidros had the opportunity to move back

home when Dr. Stephen Goldware, a re-tiring neurosurgeon, contacted him about joining his practice. In August 2013, the Bidros family moved to Lafayette. “I made the full circle coming back,” he said.

Bidros joined Goldware’s practice, Lafayette Brain and Spine, in the profes-sional offi ce building at Lafayette Gen-eral Medical Center. Four months later, Goldware retired, and Bidros took over the practice. He currently practices neu-rosurgery at LGMC and Our Lady of Lourdes Regional Medical Center. “I love it,” he said. “It’s everything I wanted to do. Everybody has been wonderful, from

the medical community to the patients.”Bidros performs general neurosurgery, treating brain, spine and peripheral nerve disease. The majority of his practice in-volves the spine, including degenerative cervical, lumbar and thoracic disease, neck and back pain and trauma. He also treats brain tumors, aneurysms, pain syndromes, traumatic brain injuries and peripheral nerve conditions. His subspecialties in-clude spine oncology and brain oncology, for which he treats tumors both surgically and nonsurgically with CyberKnife and radiosurgery.

Off-duty, Dani and Maria enjoy spending time with their three boys. “Sports activities, going to birthday par-ties, or just being at home with our kids is what we enjoy, fi rst and foremost,” he said. “We also enjoy traveling with our kids to visit family in California and New York.”

Bidros confesses that he is also a “sports fanatic,” particularly when it comes to tennis, soccer and NFL football. “I’m a huge Saints fan,” he said. “When I was in Cleveland and New Jersey, Cleve-land was my team. And, I’ve been to sev-eral soccer games in Europe.”

As for his practice, Bidros says that he gets the most fulfi llment from getting to know his patients and their families. “When my patients come in, it’s great to get to know them, and make them feel at home,” he explained. “Neurological disease in general can be stressful for a patient, so you want them to feel com-fortable. It’s also important to involve the families. So, we defi nitely make sure that the family is around to help with the treat-ment and the decision-making.”

Physician Spotlight

Dr. Dani BidrosExploring What We Don’t Know

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people healthier.For example, say a

patient gets discharged from the hospital. Every-one knows that the first week afterward is a high-risk period, Mostashari said. The patients are el-derly and may be weak. Their whole routine with medications may have been changed. The result is that within 30 days of being dis-charged, one out of seven seniors ends up back in the hospital.

The risk is much lower for patients who see their primary care doctor within seven days of being discharged from a hos-pital, Mostashari said. The problem is that lots of times the primary care doctors aren’t notified that their patients have been ad-mitted or discharged.

That’s where the ACO comes in. Ana-lytics can help practices prioritize the pa-tients most at risk and identify frequent fliers and their health issues. Cloud-based tools help practices follow up with patients, track who has been contacted and the outcome of that call. The ACO will also help coach physicians in the key component of manag-ing a population’s health: knowing where the patients are, being able to reach them, and bringing them in so they can be helped.

“Patients are going to feel like their primary care practice knows more about what’s going on with them and is more available and accessible to them when (pa-tients) are going through difficult periods,” Mostashari said.

Broome said the ACO will use analyt-ics and data, from the practices and other sources like the Louisiana Health Informa-tion Exchange to figure out which patients aren’t coming to the clinic but should be.

With the claims data and analytics tools, the ACO can help practices build a holistic view of patients, he added.

The Quality Forum has been a force

in reshaping health and healthcare in Loui-siana. Among other things, the nonprofit established a Regional Extension Center to help providers adopt EHRs and reach the “meaningful use” standard.

Quality Forum CEO Cindy Munn said the nonprofit supports the transition from a volume-based health system to one based on value and quality.

Maryland-based Aledade was co-founded in 2014 by Mostashari, former National Coordinator for Health Information Technology. The com-pany has ACOs in New York, Delaware, Mary-land and Arkansas.

Mostashari said the Quality Forum, with its strong connections to Louisiana physicians, made it a natural choice for a partnership.

Meanwhile, patients in the practices that join the ACO shouldn’t feel anything has changed in the relationships with their primary care physi-cian, Mostashari said.

Here’s what will change. If a patient isn’t feeling well, he or she should be able to get a same-day of-fice visit. If a patient has to go to the hos-pital, someone from the ACO will contact the ER doctor and talk to him or her. If the patient is discharged from the hospital, someone’s going to reach out to him or her. If a patient needs specialty care, his or her primary care physician will help them navi-gate all the specialists and all the different information that entails.

“Our goal, really, is to make these seniors feel like they’re getting concierge medicine for free,” Mostashari said. “And we believe that’s going to save the system money and save lives.”

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PATIENT CARE MODELS

Nashville-based Sheidy said the Cen-ters for Medicare and Medicaid Services have stated their plans to significantly in-crease value-based payments to providers over the next few years. In a fact sheet re-leased in late January, CMS noted improv-ing quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than vol-ume and duplication. To that end, the De-partment of Health and Human Services has adopted a framework of four categories of payment:

• category1:fee-for-service with no link of payment to quality,

• category2: fee-for-service with a link of payment to quality,

• category 3: alternative payment models built on fee-for-service archi-tecture, and

• category4:population-based pay-ment.

Value-based purchasing includes pay-ments in categories two through four. The stated goal is to have 30 percent of Medi-care payments in alternative payment mod-els (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 per-cent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

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

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

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presiden-tial election.

The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant num-ber of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he

said, noting teachers, labor unions and public officials often have strong health-care benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the popula-tion through employer-provided benefits.”

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

“The government … through state-ments around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Afford-able Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the pay-ment mechanism. On the commercial side, we’re looking at the Cadillac tax and how

to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

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

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

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

The Competing P’s: Provision & Payment, continued from page 1

TravisBroome

Quality Forum, continued from page 1

Dr.FarzadMostashari

CindyMunn


By TED GRIGGS

Two Louisiana hospitals are among more than 200 U.S. health systems that applied for $114 million in federal funds to help set up rural Accountable Care Or-ganizations.

Lynn Barr, CEO of National Rural ACO, which is overseeing the grant pro-gram, said she could not disclose the names of those hospitals. But she added that it’s crucial that rural providers move to payment models based on population health.

Until recently, rural hospitals, health clinics and federally qualified health centers couldn’t take part in Medicare’s cost-and-quality incentive programs, she said. Excluding rural providers created a real disparity between rural patients and the rest of the country.

The entire U.S. health system is work-ing on ways to reduce waste, fraud and abuse, to cut the number of unnecessary hospital visits and to improve outcomes for patients with chronic diseases – except in rural areas, Barr said.

“I think that’s a very serious situa-tion,” she said.

The National Rural ACO was formed in 2013 to help change that. The CEOs of nine rural health systems got together to simplify the process of moving from fee-for-service models to those emphasizing population health management.

By focusing on care coordination, data and evidence-based medicine, the group was able to reduce the expense of forming an ACO, Barr said.

That was important because while federal estimates place those costs at $4.2 million over the first three years, the CMS grants provide between $1.5 million and $2.5 million over that time. The NRACO model allows rural hospitals to form ACOs without exceeding the grant amounts.

Hospitals that participate in NRACO and the Medicare Shared Savings Program will incur out-of-pocket costs of around $1,000, Barr said.

“A lot of this is because we’re rural. We rely on rural health systems to grit their teeth, put on another hat, work a little harder, and not just hire a bunch of people to do this,” Barr said.

The deadline to apply for the grants was May 1. The funding is for the 2016 Medicare Shared Savings Program year.

Barr said the NRACO model offers rural providers another major advantage: it helps them aggregate enough Medicare lives to meet the minimum requirements

for a CMS grant.In order for CMS to approve a pro-

vider’s grant, the ACO must include 5,000 Medicare patients, Barr said. Since Medi-care patients account for 10 percent to 15 percent of the population, to qualify by it-self, a single health system would have to serve between 75,000 and 100,000 people.

“That’s not rural,” Barr said. “So the only way we can make it work is to bring them together.”

The first ACO that Barr’s group created included hospitals in California, Michigan and Indiana, she said. Those states have nothing to do with each other, but that’s where the hospitals were.

The ACO is really a governance structure, she said.

The Louisiana ACO applicants will have to combine with providers in other states to reach 5,000 Medicare lives. But Barr’s not sure which state or territory – Guam had one applicant – will be aggre-gated with Louisiana.

The number of applicants varied by state. In Mississippi, 11 hospitals applied, enough to form two ACOs. In North Car-olina, only two hospitals applied.

Barr said like most quality programs, the ACOs are not expected to generate savings initially.

A big part of managing population health is reaching out to patients and

bringing them in for visits. The initial part of the process is time-consuming and ex-pensive. It requires a lot of one-on-one contacts with patients, helping them to navigate the healthcare system and to bet-ter manage their diseases.

“It’s only over time that you really es-tablish these processes and procedures and the costs start to go down,” Barr said. “And that’s why it’s so important for us to get the costs of this program paid for by CMS.”

Under Medicare’s Shared Savings Program, ACOs are rewarded for slowing the increase in healthcare costs and meet-ing quality standards. Medicare estimates that annual costs for one member are around $10,000.

On average, the Shared Savings Pro-gram pays $100 per Medicare patient per year for the first three years. Whatever ACO Investment Model funds the ACO gets in advance would be deducted from those payments. NRACO receives 10 per-cent of the balance, and clinicians a mini-mum of 20 percent.

Barr said it’s unlikely that savings will be greater than costs during the first three years of the ACO’s existence.

Taking a rural hospital that’s never managed care and thinking the facility is going to make money on shared savings in one, two or even three years is unrealistic, Barr said.

Rural Hospitals Find ACO HelpPATIENT CARE MODELS

LynnBarr


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By JOHN PAUL NETTLES

The growth of capitation may repre-sent a juncture for the healthcare industry. If the new funding structure rises as an-ticipated, a host of fundamental changes will emerge in the industry, including in-frastructure shifts and new care tactics. This may result in a series of new business challenges and opportunities.

Capitation is population-based healthcare. While most other funding models involve reimbursements for ser-

vices administered, capitation distributes lump sums for entire patient segments (diabetics, children, etc.). The payments are the same whether or not the popula-tions actually use the services. For provid-ers, the main difference is that they are incentivized for effi ciency, rather than for maximizing service output.

Capitation is not new, having expe-rienced a fad-like boom and bust in the 1990s. Rising healthcare costs were a contributor to the lack of success. The discernable failure of capitation during

this time has lead to skepticism that it will work now.

However, proponents argue that modern technological and process devel-opments in healthcare will make capita-tion a success. Further, policy makers and payers are still eager for opportunities to control rising healthcare costs and see capitation as a possible solution.

As such, capitation seems to be on the rise, and some planners think that capita-tion may be the future of healthcare. Ac-cording to a 2014 survey of 39 health

plans conducted by Catalyst for Payment Reform, most healthcare providers ex-pressed positivity about their capitated payment arrangements (Further, associ-ate managing director for rating agency Moody’s Investor Service Lisa Goldstein said that she expects capitation in hos-pitals to grow, in a 2014 interview with Modern Healthcare.

The AMA has not entirely embraced this new trend, but has expressed some-thing between acceptance and support.

“Engaging in capitation arrange-ments can be challenging,” according to the AMA’s published stance on capita-tion. “However, some physician practices have been successfully participating in capitated contracts for many years. Under the right conditions, physicians can make capitation work.”

Large-scale changes are emerging where capitation has come into play. One area of change is in infrastructure. Since capitation incentivizes effi ciency over service volume, hospitals are not as motivated to keep their facilities buzzing with people. Instead, capital expenditures are focusing more on streamlined, cost-ef-fi cient hospital campuses with integrated infrastructures, such as by having differ-ent departments closer together.

Another way that capitation is chang-ing the industry is by motivating the es-tablishment of “care centers.” Physically, these business units are like the call cen-ters used for administrative functions like billing. However, the main function of the centers is to eliminate unnecessary hospi-tal visits, such as by providing medical in-formation. The care centers also reduce sources of ineffi ciency, such as patient no-shows.

So far, capitation growth has been moderate, but time will tell if the payment structure explodes or sputters out. But if capitation catches on, it is likely that a series of sweeping changes will affect the industry. Business planners should remain watchful of these new trends and react accordingly.

John Paul Nettles is a business consultant and expert in health and human services technology, especially in call centers. He works with partners at GeauxPoint Business and Technology Consulting, a collaboration that advises clients on innovative business solutions. He can be reached at [email protected].

Capitation-Related Changes Emerging


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Legislative AffairsBY CINDY BISHOP, AND EARL MICHAEL WILLIS

A Report on Health Care Legislation Below is a report of the 112 health care

related bills that are moving through the 2015 Regular Session of the Louisiana Leg-islature. It is a well-known fact that we are facing a $1.6 Billion budget deficit. From all accounts, the revenue measures, either through tax increases or cuts to tax credits, or anything in between, will not be final-ized until close to the end of the legislative session.

Lawmakers will adjourn sine die on Thursday June 11, 2015. If you are inter-ested in healthcare policy, please stay tuned. In other words, things will go down to the wire. Health Care Information Services publishes an information packed newslet-ter once a week during session. Subscrip-tions are $200 for the entire calendar year. For an order form, send an email to Sarah Heath at [email protected]

Last Action Taken as of May 2, 2015

HB6,HonoreAuthorizes the use of medical mari-

juana in Louisiana. 4/13/2015 House -Referred to committee

on Health & Welfare

HB77,RitchieLevies an additional tax on cigarettes. 4/13/2015 House -Referred to committee

on Ways and Means

HB83,JeffersonProvides for continuance of nutrition

assistance for certain retirees. 4/13/2015 House -Referred to committee

on Health & Welfare HB158,HoffmannProvides relative to promotion of

smoking cessation programs and services.4/30/2015 House -Finally passed by vote

of 87 to 0

HB159,HoffmannAdds a fee at license renewal for phar-

macists and pharmacies and dedicates proceeds to certain pharmacy education programs.

4/30/2015 Senate -Received in the Senate

HB165,AndersProvides relative to fees collected by

the Louisiana State Board of Medical Ex-aminers.

4/28/2015 House -Returned to the calen-dar subject to call

HB177,WhitneyProvides relative to roles of human

services authorities and districts in imple-mentation of the Developmental Disability Law.

4/29/2015 Senate -Referred to committee on Health & Welfare

HB186,MontoucetRequires that mammography and ultra-

sound reports provide information regarding supplemental breast cancer screening.

4/30/2015 House -Finally passed by vote of 88 to 0

HB194,MorenoProvides relative to the examination,

treatment, and billing of victims of a sexu-ally-oriented crime.

4/13/2015 House -Referred to committee on Judiciary

HB210,MorenoAuthorizes the prescribing or dispens-

ing of naloxone to third parties.4/29/2015 Senate -Referred to committee

on Health & Welfare

HB247,HuvalProvides relative to the disciplin-

ary proceedings of the Louisiana Physical Therapy Board.

4/28/2015 House Scheduled for Floor De-bate on 5/4/2015

HB252,MontoucetLevies an additional tax on certain to-

bacco products and levies a tax on vapor products and electronic cigarettes.

4/13/2015 House -Referred to committee on Ways and Means

HB257,SeabaughProvides relative to healthcare pro-

vider credentialing. 4/30/2015 House - Scheduled for Floor

Debate on 5/6/2015

HB260,Williams,A.Establishes the Sickle Cell Patient

Navigator Program. 4/13/2015 House -Referred to committee

on Health & Welfare

HB270,ArmesProvides relative to filing of Medicaid

claims. 4/30/2015 House -Scheduled for Floor De-

bate on 5/6/2015

HB304,HallProvides relative to sharing of pre-

scription monitoring program information with equivalent programs of other states.

4/28/2015 House -Scheduled for Floor De-bate on 5/4/2015

HB307,JacksonProvides relative to coverage and pay-

ment for services rendered to a person ad-mitted under an emergency certificate

4/13/2015 House -Referred to committee on Health & Welfare

HB329,ArmesRequires the state Office of Group

Benefits to cover bariatric surgery tech-niques for the treatment of morbid obesity.

4/27/2015 House -Recommitted to com-mittee on Appropriations

HB335,Burns,H.Adds registered dietitians under the

medical malpractice act. 4/30/2015 House-Sheduled for Floor De-

bate on 5/5/2015

HB370,BroadwaterEstablishes the Group Benefits Actuar-

ial Committee and requires an annual ac-tuary study on the premium rate structure and approval by the panel of recommended changes to the premium rates charged for members of the Office of Group Benefits.

4/13/2015 House -Referred to committee on Appropriations

HB375,HarrisExemption for certain ophthalmic

drugs administered in a physician›s office. 4/13/2015 House -Referred to committee

on Ways and Means

HB381,JacksonExempts certain providers from licen-

sure as behavioral health services providers. 4/29/2015 Senate -Referred to committee

on Health & Welfare

HB397,PopeProvides relative to prescription re-

fills. 4/29/2015 Senate -Referred to committee on Health & Welfare

HB416,BarrowProvides relative to advanced practice

registered nurses 4/13/2015 House -Referred to committee

on Health & Welfare

HB436,Johnson,R.Provides for insurance reimbursement

of certain provider fees paid by pharmacies. 4/13/2015 House -Referred to committee

on Health & Welfare

HB440,LeBasProhibits certain fees relative to the ad-

judication of pharmacy benefit claims. 4/30/2015 House -Engrossed, recommitted

to committee on Appropriations

HB450,SchexnayderCreates the Home Health Agency

Trust Fund and provides for the deposit of fines and penalties levied against home health agencies into the fund.

4/27/2015 House -Engrossed, recommitted to committee on Appropriations



HB461,SimonProvides relative to the regulation of

telemedicine and telehealth services. 4/13/2015 House -Referred to committee

on Health & Welfare

HB486,Johnson,R.Provides relative to collaborative prac-

tice agreements between advanced practice registered nurses and physicians.


HB494,WillmottRequires ambulance services to estab-

lish protocols for transporting patients with cardiac and stroke emergencies.


HB498,TalbotProvides for transparency in health

services pricing and health care quality measures.


HB517,EdwardsProvides for expansion of Medicaid

eligibility in conformance with standards provided in federal law.


HB560,NortonRequires that La. Medicaid eligibility

standards conform to those established by the Affordable Care Act.

4/29/2015 House -Involuntarily deferred

HB568,ThierryProvides relative to the licensing and

regulation of pharmacists.4/13/2015 House -Referred to committee

on Health & Welfare

HB573,HazelProvides for the investigation and ad-

judication of violations by the Louisiana

State Board of Medical Examiners. 4/13/2015 House -Referred to committee

on Health & Welfare

HB602,Johnson,R.Provides relative to collection of coin-

surance and deductibles. 4/13/2015 House -Referred to committee

on Insurance

HB652,HunterRequires the Dept. of Health and Hos-

pitals to implement an equitable system of Medicaid reimbursement among certain hospitals.


HB683,KleckleyRequires the Department of Health

and Hospitals to determine a methodology for reimbursement related to uncompen-sated care costs in Calcasieu Parish.


HB701,WhitneyProhibits abortion based on sex selec-

tion. 4/13/2015 House -Referred to committee on Health & Welfare

HB702,ThierryRequires health insurance issuers to

cover contested healthcare services, includ-ing prescription drugs, during the appeal or review process.

4/13/2015 House -Referred to committee on Insurance

HCR4,SimonExpresses the intent of the legislature

regarding the standard of care prescribed by law for the practice of telemedicine.

4/28/2015 House-Scheduled for Floor De-bate on 5/5/2015

HCR10,BurfordSuspends rules of the La. Board of

Pharmacy that invalidate prescriptions with

computer generated electronic signatures. 4/13/2015 House -Referred to committee

on Health & Welfare

SB10,PetersonConstitutional amendment to direct

DHH to offer health insurance with essen-tial health benefits to every legal resident of Louisiana whose income is at or below 138% of the federal poverty level.


SB39,MillsProvides for the Louisiana Board of

Drug and Device Distributors.4/30/2015 House -Referred to committee

on Health & Welfare

SB40,NeversRequires the Department of Health

and Hospitals provide health care cover-age with essential health benefits to every legal Louisiana resident whose household income is at or below 138% of the federal poverty level.


SB68,BuffingtonExtends moratorium on additional

beds for nursing facilities. 4/30/2015 House -Referred to committee

on Health & Welfare

SB113,GallotProvides relative to membership of

the State Board of Examiners of Psycholo-gists, qualifications of certain licensees, and maintenance of board documents and re-cords.

4/13/2015 Senate -Referred to committee on Commerce

SB115,MillsProvides with respect to the practice of

physician assistants 4/30/2015 Senate -Engrossed, passed to

3rd reading

SB143,MillsProvides relative to prescribed mari-

juana for therapeutic uses and the devel-opment of rules and regulations by the Louisiana Board of Pharmacy and the Louisiana State Board of Medical Exam-iners.

4/30/2015 Senate -Engrossed, passed to 3rd reading

SB158,HeitmeierRequires the reporting of malpractice

claims paid by insurers or self- insurers on behalf of certain health care providers in an annual report to the Senate and House committees on health and welfare.

4/30/2015 Senate -Engrossed, passed to 3rd reading

SB163,MillsProvides relative to Medicaid man-

aged care. 4/13/2015 Senate -Referred to committee

on Health & Welfare

SB197,ChabertProvides for funding of state hospitals

operated by the Board of Supervisors of Louisiana State University and Agricul-tural and Mechanical College.


SCR17,MillsDirects the Department of Health and

Hospitals to evaluate and report on the health benefits and costs of adding Krabbe disease to the list of madatory screenings performed on newborns under certain cir-cumstances.


SCR18,WhiteAuthorizes and directs the Louisiana

Emergency Response Network (LERN) to organize and facilitate a working group of healthcare providers who deal with victims of trauma to develop recommendations for a Level III Trauma Center in Northeast Louisiana.


SCR34,HeitmeierRequests the Department of Health

and Hospitals, the Department of Educa-tion, the Medicaid managed care plans, and representatives of the Whole Child Ini-tiative to work together to develop a plan to implement the Whole School, Whole Community, Whole Child model devel-oped by the United States Centers for Dis-ease Control and Prevention.


A Report on Health Care Legislation, continued from page 7

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By JULIE PARKER

The most infl uential demographic group – millennials, ages 21-32, empow-ered by advances in technology – is turn-ing America’s healthcare landscape upside down.

In a recently released survey com-missioned by PNC Healthcare, more than 5,000 participants nationwide ex-plored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most signifi cant finding: online shopping for doctors, web-based diagnostic tools and research about treatment options have a role in healthcare decisions for millennials, re-placing the single-source, primary care phy-sician (PCP) favored by older generations. “As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more effi cient ways to make healthcare payments via digital channels that are consistent with their ex-periences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment ex-pectations by progressing further along the technology continuum, especially con-sidering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility. Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fast-paced, technology-driven generation.” Growing trends among the millennials that are driving change in healthcare include:

SpeedydeliveryWhen it comes to the drive-thru

generation, millennials prefer retail (34 percent) and acute care clinics (25 per-cent) double that of boomers (17 and 14 percent, respectively) and seniors (15 and 11 percent, respectively). On the fl ip side, seniors (85 percent) and boomers (80 per-cent) visited their PCP signifi cantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clin-ics over the last four years have grown dramatically. “Quick Care” availabil-ity has been recognized as a top priority by many healthcare organizations, and even large retailers and several phar-

macy chains. Millennials expressed con-cern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

Word-of-mouthmarketingNearly 50 percent of millennials and

Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 per-cent of baby boomers and 28 percent for

seniors. “The timely management of so-

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

Kick the tires online beforebuying

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

Goodfaith,upfrontestimatesOne of fi ve people surveyed by PNC

listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more in-clined (41 percent) to request and receive estimates before undergoing treatment. Only 18 percent of seniors and 21 percent of boomers reported asking for or receiv-ing information on costs upfront. Unfortu-

nately, 34 percent noted the fi nal bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

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

Kickingcaredowntheroad.All age groups agreed that medical

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

“What we’ve found locally,” added Print, “is that with many patients neglect-ing their care due to costs, practices are addressing this issues by offering free/low cost healthcare clinics, healthcare educa-tion, and automated patient payment pro-grams.”

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

Five Ways Millennials Have Shaken Up HealthcareThey prefer alternative to single-source, PCP favored by older generations

By JULIE PARKER

The most infl uential demographic group – millennials, ages 21-32, empow-ered by advances in technology – is turn-ing America’s healthcare landscape upside

In a recently released survey com-missioned by PNC Healthcare, more than 5,000 participants nationwide ex-plored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most signifi cant finding: online shopping for doctors, web-based diagnostic tools and research about treatment options have a role in


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New Medical Director to Lead BR General’s Mid City Behavioral Health Program

BATON ROUGE – Venugopal Vatsa-vayi, MD, has been named Medical Direc-tor for Baton Rouge Gen-eral’s Inpatient Geriatric Psychiatric Unit and Out-patient Behavioral Well-ness Center at the Mid City campus. Dr. Vatsavayi will lead BRG’s multi-dis-ciplinary clinical team of behavioral health experts with Associate Medical Di-rector Terry LeBourgeois, MD.

One of the region’s leading physicians pro-viding Electroconvulsive Therapy (ECT), Dr. Vatsa-vayi oversees ECT therapy at BRG Mid City, which is the only program of its kind in Greater Baton Rouge. A member of BRG’s medical staff since 2011, Dr. Vatsa-vayi completed his residency at Cleveland Clinic Foundation and is certifi ed by the American Board of Psychiatry and Neurol-ogy. Specializing in psychiatry for more than 15 years, Dr. Vatsavayi will also con-tinue to provide outpatient clinic services at his new Mid City clinic location at3401 North Blvd., Suite 100.

ECT therapy often works when other treatments are unsuccessful and can ben-efi t pregnant women, seniors, patients with limited tolerance to psychiatric medi-cations, and patients who are at a high risk of suicide. Depression is one of the most common mental disorders in the U.S. It affects more than 6.5 million Americans aged 65 years or older, and is estimated to affect about 10% of pregnant women in the U.S. In patients with major depression, ECT has been shown to have a 70-90% re-mission rate.*

“Our focus remains on providing high quality mental health services for

our community with special attention to the mental health needs of seniors and adult patients,” said Dr. Vatsavayi. “We are proud to provide our area’s only ECT therapy program, which is shown to be one of the most effective and safe acute treatment options for major depression.”

Mary Bird Perkins – OLOL Cancer Center Receives Outstanding Achievement Award

BATON ROUGE- Mary Bird Perkins – Our Lady of the Lake Cancer Center (Cancer Center) was recently presented with the 2014 Outstanding Achievement Award by the Commission on Cancer (CoC) of the American College of Sur-geons (ACoS). The Cancer Center, Loui-siana’s only facility to receive this recog-nition, has received the award for two consecutive (three-year) survey cycles, the fi rst time in 2011. In addition, the Cancer Center is one of a select group of only 75 U.S. healthcare facilities with accredited cancer programs to receive this national honor for surveys performed last year. The award acknowledges cancer programs that achieve excellence in providing qual-ity care to cancer patients.

“We are extremely proud of the Can-cer Center’s physicians and team mem-bers for achieving such an esteemed rec-ognition. We always aspire to a higher lev-el of care for patients and the Outstand-ing Achievement Award validates our ability to sustain clinical excellence and overall patient experience,” said Linda Lee, Cancer Center administrator. “As the Gulf South destination for cancer care, we provide innovative and comprehensive services so that patients throughout the southeast can remain closer to home and access exceptional care throughout their cancer journey.”

The purpose of the Outstanding Achievement Award is to raise aware-ness of the importance of providing qual-ity cancer care at healthcare institutions throughout the U.S. In addition, it is in-tended to:

• Educate cancer patients on avail-able quality-care options.

• Motivate other cancer programs to work toward improving their level of care.

• Facilitate dialogue between award recipients and healthcare profes-sionals at other cancer facilities for the purpose of sharing best prac-tices.

• Encourage honorees to serve as quality-care resources to other can-cer programs.

The Cancer Center was evaluated on 34 program standards categorized within one of the four cancer program activity ar-eas: cancer committee leadership, cancer data management, clinical services and quality improvement. The Cancer Center was further evaluated on seven commen-dation standards.

Dr. Venugopal Vatsavayi

Dr. Terry LeBourgeois

LUNG CANCER IS THE DEADLIEST CANCER IN THE

WORLD.

WE CAN CHANGE THAT.

The American Lung Association is leading the fight against the deadliest cancer there is—lung cancer.

Join the fight by giving a gift to the American Lung Association today.

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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

888-743-5747 www.phfl.org

Our Lady of the Lake Announces Specialists at New Neurology Clinic

BATON ROUGE– Our Lady of the Lake Physician Group is pleased to wel-come Joseph A. Acosta, MD and Kevin J. Calle-rame, MD as specialists to its new Neurology Clinic at 5247 Didesse Drive in Ba-ton Rouge.

The Neurology Clinic provides the highest qual-ity care related to the di-agnosis and treatment of disorders of the brain and nervous system, including seizures, stroke, carpal tun-nel syndrome, nerve disor-ders, Parkinson’s disease, dementia and nerve pain.

Dr. Acosta specializes in general neu-rology, clinical neurophysiology and is trained in neurovascular ultrasound with a special interest in the treatment of stroke. He received his medical degree from the University of Texas Medical Branch in Galveston, Texas in 1989. Following his internship in internal medicine, Dr. Acosta completed a residency in neurol-ogy at Hahnemann University Hospital in Philadelphia, Pennsylvania, where he also served as chief resident of the program from 1992 to 1993. After his residency, he was fellowship trained in neurovascu-lar disease and stroke at the University of Maryland Medical Center in Baltimore, Maryland from 1993 to 1995.

Dr. Callerame is Board Certifi ed in neurology, clinical neurophysiology and sleep medicine. He has a special interest in epilepsy, sleep disorders, EMG and the use of botox in neurological indications. He received his undergraduate degree in biomedical engineering, a master’s de-gree in public health, and medical degree from Tulane University in New Orleans, Louisiana. Dr. Callerame completed a residency in neurology at Wilford Hall United States Air Force Medical Center in San Antonio, Texas, followed by a Fellow-ship in epilepsy at the University of Miami in Florida. He completed his term with the United States Air Force at Wilford Hall Air Force Medical Center where he served as head of EEG and clinical neurophysiology.

The addition of the Neurology Clinic

adds to Our Lady of the Lake’s compre-hensive offerings in neurological care. The Lake performs more neurosurgery procedures than any other hospital in the state, including innovative techniques for spine surgery. It is also the only acute care hospital in the Baton Rouge area with 24/7 trauma care, including neurosurgical and neurological coverage.

In the News

Dr. Joseph A. Acosta

Dr. Kevin J. Callerame

H E R S O U T H . C O M

L O V E ?N E E D A G I F T S H E W I L L

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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