Louisiana Medical News March 2014

By BARBARA MCCONNELL

Karen DeSalvo, MD, MPH, MSc, was appointed by President Obama to head the Offi ce of National Coordinator (ONC) for Health Information Technology, tak-ing over the National Coordinator position in January 2014 with the enthusias-tic support of Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS).

In an internal staff announcement in December Sebelius stated, “Dr. DeSalvo has been at the forefront of efforts to modernize the New Orleans healthcare sys-tem,” and added that her, “hands-on experience with health delivery system reform and health IT and its potential to improve healthcare and public health will be invaluable assets to the ONC and the Department.”

With an almost $29 billion budget, and operating out of the offi ce of the Secre-tary of HHS, the ONC is implementing a national electronic health record (EHR) and information exchange system for physicians and hospitals.

The American Recovery and Reinvestment Act of 2009 (ARRA) aka “The Stimulus Package” was created to respond to recession and save and create jobs, provide tax relief, as well as to invest in education, infrastructure, health and energy.

From ARRA came HITECH, or the Health Information Technology for

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Louisiana Physician Tapped for National Health PostDr. Karen DeSalvo named head of the Offi ce of National Coordinator for Health IT

Dr. Bill Dedo Renaissance Man

Son of renowned otolaryngologist Herb Dedo, Dr. Bill Dedo inherited a knack for inventing medical tools. During his practice as an anesthesiologist, he observed that his colleagues had trouble fi tting adult patients with snoring surgery equipment ... page 2

Network May Radically Change Clinical ResearchLouisiana Public Health Institute, Pennington Biomedical Research Center, and Tulane University are part of a newly formed research network that could radically change the way clinical research is done ... page 3

Physician Spotlight

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Medical Society President Addresses Challenges

By TED GRIGGS

The two greatest challenges the Louisiana State Medical Society faces in 2014 are the ero-sion of the physician-patient relationship and the barriers in providing adequate access to quality healthcare, newly installed President Dr. Roberto E. Quintal said.

In the past, a patient saw his or her physicians until one of the two of them died or retired, Quin-tal said. There was a personal relationship and that relationship played a key role in continuity of care.

“I am an older physician so I have patients I

have taken care of for more than 20 years. I know everything about their family,” Quintal said. “I know when their granddaughter got married. I can tell when they walk in if they’re physically well or if they’re not feeling well because I’ve been taking care of them for so many years.”

But changes wrought by the Affordable Care Act could force some people to change their insur-ance carriers, further eroding the physician-patient relationship.

All too frequently, a patient who has regularly seen the same physician, sometimes for many years,

2 • MARCH 2014 Louisiana Medical News

By LISA HANCHEY

Son of renowned otolaryn-gologist Herb Dedo, Dr. Bill Dedo inherited a knack for inventing medical tools. During his practice as an anesthesiologist, he observed that his colleagues had trouble fi t-ting adult patients with snoring sur-gery equipment. So, he developed a crafty metal instrument, the Dedo Extension (named after Herb), welding the prototype himself. The device became so popular with area physicians that the word spread quickly throughout the medical community. Today, the Dedo Ex-tension, manufactured by Dedo’s company, CANT (initials of sons Christopher and Nicholas with a rose sketch added for daughter Jen-nifer Rose), is distributed in all 50 states and to countries as far away as Portugal and Abu Dhabi.

Invention is one of Dedo’s many talents. From his father, he learned the art of playing bagpipes. As an adult, he took up the instru-ment again, mastering the tricky technique. He currently plays gigs with the Baton Rouge bagpipe band, Baton Rouge Pipes and Drums. But, that’s not the only in-strument he plays – he also strums the banjo. And, he does woodworking, sails a catamaran, bee keeps, collects an-tique cars and fl ies model airplanes.

In addition to these passions, Dedo dabbles in nature photography. One of his favorite sites for snapping pics is at the pond fronting his home. There, several

families of wood ducks nest among four boxes equipped with cameras. When the ducklings hatch, he covertly captures their fi rst fl ights out of the tiny holes. His other preferred shooting spot – for cameras as well as guns – is his hunting camp in nearby Delcambre, La.

At his camp, Dedo indulges in another hobby – crawfi sh farming. He has a pond on the property with traps baited for the coveted crusta-cean. But, he does it purely for fun, hosting boils for only family and close friends.

The San Francisco-bred Dedo never dreamed that he’d end up in South Louisiana. His father was an ENT physician and researcher at UC San Francisco and inventor of several medical devices. Two uncles – an ENT with a specialty in plastic sur-gery and an orthopedic surgeon – also served as mentors for the young Dedo. “My father was in a very unique time in medicine for ear, nose and throat, where a lot of changes were happen-ing and technology was becoming available.” Dedo explained. “He had done a lot of research in ear, nose and throat, and was then able to capitalize on it, and then come up with the in-struments to further the fi eld of ENT. It was obviously a positive spin, and it was a very good career when my Dad was doing it.”

His family’s positive experi-ences infl uenced Dedo to pursue medicine. For his education, he at-tended the University of California, Berkeley and UC Riverside. He then traveled south to Baylor Col-

lege of Medicine in Houston. His train-ing after medical school began with a one year surgical internship. Then, he trekked to Denver for his anesthesiology residency training. “A medical school classmate and I had studied together a lot, and we both started realizing the benefi ts that we saw

in anesthesia,” he explained. “It was one of those things that just becomes clear to you.”

During his internship in Houston, he met Lafayette native Yvonne Laborde, a nurse who worked in the ICU at St Luke’s Hospital and Texas Heart Insti-tute. After dating long distance, the two married when Dedo fi nished his training in Denver. Laborde also hails from a fam-ily of physicians – her father, Elmo, was a general surgeon; brother Kenneth also became a general surgeon, and sibling Jeff is a radiologist.

While training in Denver, Dedo re-turned to Houston for six months to study cardiovascular anesthesia. He made such an impression that he was offered a job after he graduated. Upon completing his studies in Denver, he began working at Baylor in the cardiovascular section. “I was actually around Dr. Michael De-bakey,” he recalled. “That was the section that did heart transplants, heart surgery and aneurysm surgery.”

After a year at Baylor, Dedo moved to St. Luke’s in Houston for a few years. He then surprised Yvonne by accepting a job in her hometown. Prior to their marriage, he had spent only 14 days in Lafayette. “I had gotten to spend time at Lourdes Hospital and Lafayette General, and real-ized that at the time, both of them were very up-to-date,” he recounted. “Being in Houston, you always had the notion that you were in the big medical center that knew it all. But, what I saw here was that the medical centers were very up-to-date, but also were very accommodating and had more of that personal touch than the Texas Medical Center.”

Dedo practices with Professional An-esthesia Services at Our Lady of Lourdes Regional Medical Center and the Heart Hospital of Lafayette. He and Yvonne have three children – Christopher, a freshman at LSU; Nicholas, a junior at St. Thomas More High School, and Jen-nifer, an eighth grader at Cathedral Car-mel School.

The California-born doc has adapted well to living in south Louisiana. “Yvonne’s brothers have now concluded that I am probably more Cajun than they were,” he said with a laugh.

Physician Spotlight

Dr. Bill Dedo Renaissance Man

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By TED GRIGGS

Louisiana Public Health Institute, Pennington Biomedical Research Center, and Tulane University are part of a newly formed research network that could radi-cally change the way clinical research is done, speeding treatment advances to pa-tients and physicians.

The Louisiana Clinical Data Re-search Network is one of 29 networks that received $93.5 million – LCDRN’s share was roughly $7 million – in funding from the Patient-Centered Outcomes Research Institute. The LCDRN will develop and expand a health data network that will be part of PCORnet: the National Patient-Centered National Clinical Research Net-work.

The national research network will allow the regional networks to pool re-sources and compare different treatment and management alternatives for obesity, diabetes and other conditions, said Anjum Khurshid, PhD, principal investigator and director of health systems at LPHI. The national network will also help collabora-tors write up evidence in a way that can be easily and quickly implemented.

One of the goals nationally is to bring in patients, through an advisory board, and physicians who manage these con-

ditions into the research group, Khurshid said. Traditionally those phy-sicians have not been involved in clinical re-search, he said. Clini-cians don’t have time to do research in addition to handling their prac-tices or even to read all of the research because there’s so much of it coming down.

Constructing the research group this way provides more patient input and in-volvement in generating research ques-tions, Khurshid said. So people can come in and ask questions that they think are important, questions that might not have been important to a clinical researcher looking for publication in a journal or se-curing a grant.

The network may also drastically re-duce the time research findings take to get to physicians and their patients.

In traditional research, a clinical trial may take three to four years or longer, depending on what is being researched, Khurshid said. Then the results are de-veloped, presented at professional con-ferences and sent to journals, where publication takes an average of 12 to 18 months.

“So the full cycle from the point where you ask the question to the point where you get the answer is anywhere from seven to 10 years,” Khurshid said.

“And that’s just too late for impacting out-comes. As patient and as a state, we can’t really wait for that (cycle) to get the an-swers.”

The goal for the clinical research net-works is to be able to translate the results of any research within 12 months, and even shorter periods of time, Khurshid said.

“We are trying to, really, transform the way clinical research is conducted in this country. And that is a big task,” Khur-shid said.

Most people agree that the healthcare delivery system has to change so that it fo-cuses more on outcomes and patients than providers and reimbursements. The coun-try is moving from a fee-for-service model to a fee-for-value system.

In a similar way, the clinical research networks are trying to move away from a supply-driven model, where research is sometimes done for the purpose of secur-ing funding, Khurshid said. In that model, the research is done and then the investi-gators say whoever wants to may use it.

Khurshid and others are pushing for a demand-driven research model, where charge is led by patients, their families and the clinicians who provide care, manage conditions, and are responsible for im-proving health outcomes.

“They are the ones asking for an-swers, and it is our responsibility as a re-search network to provide those answers to them,” Khurshid said.

Part of formulating the networks’ infrastructure will be forming patient boards that will be actively involved. Those boards can make sure the questions researchers are asked are relevant to pa-tients, their families and the doctors who take care of them.

The first phase of funding will be used to develop the infrastructure that allows the LCDRN to do its work, Khurshid said. Building the infrastructure involves ensur-ing the large amounts of patient data that will be used remain secure and confiden-tial.

The network also has to develop the infrastructure for how researchers in the different institutions collaborate and figure out the best way to engage patients and clinicians.

And the network has to do all that by mid-2015.

Khurshid hopes the network will even be able to test the system by then, a task he described as “an ambitious target.”

Still, he said, the LCDRN may be the only research network focused entirely in one state.

“We see that as a huge opportunity for our state,” Khurshid said.

Those efforts will be aided by the tre-mendous investments Louisiana has made in health information technology, and a history of collaboration among researchers in the state’s academic centers and health systems, he said.

Network May Radically Change Clinical Research

Dr. Anjum Khurshid


By CINDY SANDERS

Everyone wants to build a better mousetrap … but building it over and over again isn’t very efficient. Finding a way to keep the ‘mousetrap’ infrastructure in place while adding new features based on a collective body of knowledge is fun-

damentally the basis of the new National Institutes of Health Stroke Trials Network.

Funded and managed by the Na-tional Institute of Neurological Disorders and Stroke (NINDS), NIH StrokeNet is focused on the three prongs of stroke research — prevention, treatment and recovery. The new structure utilizes a net-

work of academic medical centers across the country working with nearby satel-lite facilities to coordinate and streamline stroke research by centralizing approval and review, while creating a comprehen-sive data-sharing system. The network also is expected to lessen the time required to set up clinical trials since the infrastructure

will already be in place, thereby making research more efficient and less costly.

Scott Janis, PhD, program director in the Office of Clinical Research at NINDS and the scientific director for NIH Stro-keNet, explained, “We identified 25 geo-graphically distributed regional centers and identified over 200 hospitals that will be part of the network. Many are primary stroke centers, but many are community hospitals aligned with the regional stroke participant.”

The 25 lead sites were chosen based on a demonstration of past experience in stroke research and recruitment, in-cluding the ability to enroll underrepre-sented populations. Each center has been granted five-year funding with $200,000 in research costs and $50,000 for training stroke clinical researchers per year over the first three years. The completion of milestones will drive additional funding. The University of Cincinnati has been named the national clinical coordinating center.

With the new structure in place, Janis said it should be possible to more rapidly add studies to the pipeline. NIH Stro-keNet also creates a central institutional review board and has a built-in master trial agreement to further expedite launch-ing new trials.

Janis also noted the network calls on a truly intraprofessional team of providers and researchers — from first responders and emergency room physicians to the specialists caring for patients acutely all the way through to ambulatory rehabili-tative therapists. By having a coordinated team across the continuum of care, includ-ing pediatric specialists in the 25 regional centers, the hope is that stroke patients will be rapidly identified and more easily fol-lowed throughout their journey.

“This network fosters communication in a collaborative way,” he said. “We can’t control when someone has a stroke, but we can control our ability to identify them for a potential study.”

Previously, the model for stroke clini-cal trials happened in a stand-alone man-ner. A large team, often over multiple centers across the country, had to be as-sembled, and the infrastructure set up for each trial. Then, once completed, the en-tire team had to be disassembled only to start the process all over again for the next study. The cumbersome method led to de-lays in patient recruitment and repeated costs to initialize new projects. Sometimes those delays caused a stroke trial to go much longer than initially anticipated, costing millions of dollars more than the original estimate.

“That effort in building and tearing down, building and tearing down, doesn’t efficiently allow us to ask the questions to move the science forward,” Janis said.

A New View on Clinical Stroke ResearchNIH Hopes to Revolutionize Process through National Network

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By LYNNE JETER

Editor’s note: The Medi-cal News series, “Preparing for ICD-10 Conversion,” began last month with “8 Steps” for physicians to take now. This month, implementing the “4 Ts” is the focus recommendation to fa-cilitate a smooth transition.

Even though ICD-10 conversion has been anticipated for many years industry-wide, most physician practices haven’t had the resources or the inclination to start preparing before now.

It’s not too late to bring those prac-tices up to speed, said Jennifer O’Brien, MSOD, a practice management consul-tant with KarenZupko & Associates Inc.

“Time is of the essence, however,” she said. “Physician practices need to under-stand the enormity of this mandated tran-sition that will affect their bottom line.”

O’Brien recommends applying the “4 Ts.”

Team: Establish a work group for ICD-10 conversion.

“The group should be a cross sec-tion of the practice, including at least one

physician, biller, and clinical assistant, and representatives from other functions in the practice that have diagnosis coding as part of their work, such as a surgery scheduler or ancillary service provider,” said O’Brien. “The practice manager or administrator, someone who has an un-derstanding of the whole practice, should also be included. This will require true teamwork. No one person should be shouldering the bulk of the conversion for two reasons: it’s too much and it’s too risky. If one person is doing almost every-thing and wins the lottery in July, the con-version will fall apart.”

Place a year-at-a-glance calendar in a common staff area so all employees may see the deadlines and target dates, sug-gested O’Brien.

“The group will need to meet regularly,” she said. “Someone

should create and be the keeper of a work plan

that lists tasks, dates and who’s responsible. We recommend keep-ing a single work plan

so that everyone can see the progress, looming

dates, and the specifi cs of the shared responsibility.”

Testing: Communicate with your EMR, Practice Management Software (PMS) vendor, clearinghouse and biggest payors concerning if, when and how testing of claims with ICD-10 will be done.

“Medicare has announced that test-ing will occur the week of March 3-7. A couple of fi scal intermediaries are requir-ing providers to register to participate in the testing. At this point, there’s no indica-tion of another testing period, so if prac-tices or clearinghouses miss that testing, there may not be another opportunity before October 1. That’s just Medicare; communicate with other big payors to fi nd out about their testing. ”

Training: Make time for training sessions, both self- and instructor-led.

Self-training exercises are available to all physicians, such as running a re-port of the 25 to 75 most frequently used ICD-9 codes and then crosswalking those to ICD-10.

“I have a client who’s pregnant with her fi rst, and due in April,” said O’Brien. “She’s already started on this process to teach herself how she’ll need to code and document differently and is planning on implementing necessary changes before she goes on maternity leave, so that when she returns in the summer, she’s not hav-ing to learn and prepare for ICD-10, in addition to adjusting to her new work-life balance.”

Specialty societies, state medical soci-eties, hospitals, software vendors and con-sulting fi rms also provide ICD-10 training sessions for physicians and staff.

“Sign up for those sessions, go to them, listen and learn,” he said. “For most physicians, the dread associated with at-tending coding training is akin to that of having a root canal. It’s not going to be fun; it may be barely tolerable. Thing is, it’s not optional. In the past, when phy-sicians considered coding training, it’s

Preparing for ICD-10 Conversion Part 2Practice management consultant shares the ‘4 Ts’ for physicians to consider

By LYNNE JETER

Medi- series, “Preparing

implementing the “4 Ts” is the focus recommendation to fa-

Even though ICD-10 conversion has

“The group will need to meet regularly,” she said. “Someone

should create and be the keeper of a work plan

that lists tasks, dates

ing a single work plan so that everyone can

see the progress, looming dates, and the specifi cs of the

shared responsibility.”

“Medicare has announced that testing will occur the week of

March 3-7. A couple of fi scal intermediaries are requiring providers to register to participate in the testing. At this

point, there’s no indication of another testing period, so if practices or clearinghouses miss that testing, there may not

be another opportunity before October 1.”– Jennifer O’Brien, MSOD, Practice Management

Consultant, KarenZupko & Associates Inc.



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By LYNNE JETER

Controversy has swirled about a re-cent New York Times article stating that “some healthcare executives say predic-tions of a fi asco next Oct. 1 will prove as erroneous as those that said civilization would collapse on Jan. 1, 2000 ... the so-called Y2K issue.”

“It’s not going to be a shock to the industry to confront this,” Christopher G. Chute, professor of biomedical infor-matics at the Mayo Clinic, told the NYT. “We’ve literally had seven or eight years to anticipate it.”

Underestimating the conversion to ICD-10 is dangerous, say practice man-agement experts.

“When you’re in a roomful of pay-ors hearing them talk about how they’re worried, it scares me,” said Shelly Bangert, di-rector of revenue cycle management for Haw-thorn Physician Ser-vices Corporation, one of the nation’s leading healthcare revenue cycle management compa-nies. “Bigger payers are still expecting hiccups, and they’ve been working on this conversion for several years. We want to make sure practices are prepared.”

The cost of preparing the new system by the original implementation date of Oct. 1, 2013, has already been fi nancially draining for some providers, who had sunk hundreds of thousands of dollars into meeting that deadline.

“Some hospitals had teams ready to go, consultants in place,” said Bangert. “Then when the start date was postponed a year, everything was put on hold and money was lost. The payors were saying

the same thing, but they were losing mil-lions trying to convert dozens of systems – antiquated, those inherited from buyouts, and new and upcoming systems – into one that would work with ICD-10 codes.”

Practice management consultants also expressed concern about the Ameri-can Medical Association’s recent ICD-10 readiness survey that ended Jan. 31, say-ing it’s irresponsible of the national group to take such a step nine months out, and will only put physicians in a greater state of denial and therefore less prepared for the new conversion date.

“Some will run smoothly,” said Bangert. “Others will be total catastro-phes. When you have a payor who’s just as worried about underpaying as overpay-ing, and reconciling and going through millions of provider contracts manually to make sure they’re all updated is over-whelming. That worries me. It won’t be a piece of cake. Some practices may go out of business as a result.”

Risk Assessment Hospital informatics folks and ad-

ministrators may have done a thorough job of preparing on behalf of the hospital but the situation physician practices face is different, said Jennifer O’Brien, MSOD, a consultant with KarenZupko & Associates Inc., a Chicago-based fi rm that has been specializing in physician practice manage-ment for 29 years.

“If everything isn’t perfectly in place for the conversion to ICD-10, it’s not re-duced reimbursement rates (that) practices are facing; it’s zero reimbursement,” said O’Brien. “Reimbursement rates for phy-sician services aren’t directly attached to diagnosis codes, but rather to CPT codes. Diagnosis codes provide the justifi cation for those CPT codes. It’s an all-or-nothing thing. We’re not talking about a risk of re-

duced reimbursement on a claim-by-claim basis; the risk is zero reimbursement be-cause the ICD-10 code isn’t accurate and specifi c to justify the CPT code.”

Decidedly, overall reimbursement fl ow will be slower, said O’Brien.

“Hospitals and larger healthcare or-ganizations have larger IT and adminis-trative support structures, profi t margins, cash fl ow, established credit lines and lon-ger revenue cycles than physician prac-tices,” she said. “If a physician practice averages 45 days (from the date of service) in accounts receivable (before payment) and a hospital averages 105, the practice is going to feel it in the reimbursement by November 15, 2014, whereas the hospital payment cycle doesn’t have it receiving payments for early October services until later.”

Unfortunately, most practices haven’t been preparing well enough for the con-version date.

“One large, Midwestern specialty

practice client of ours has been prepar-ing for the transition since 2011,” said O’Brien. “They’ve been doing bilingual coding (both ICD-9 and ICD-10 for some time) and still, they’ve bolstered their line of credit to cover six months of operating expenses and minimal physician salaries in anticipation of October 1, 2014.”

Regardless of physicians’ prepara-tion for ICD-10 conversion, or lack of, the looming Oct. 1 coding change date will signal one of the most signifi cant chal-lenges the medical industry has faced, said Bangert.

“Likening it to Y2K is a risky over simplifi cation” said O’Brien. “Y2K ap-plied to two digits in the year fi elds of four digits, and while it had global implications in every industry and system, it was that contained. In other words, there was some analysis, hypothesis and possibly software changes to prepare, but that along with crossed fi ngers could be, and in fact was, enough. Not the case with ICD-10.”

Predicting the ICD-10 Conversion OutcomeSome pundits liken it to Y2K issue; others call underestimating change ‘dangerous’

Shelly Bangert

been for the opportunity to improve their existing CPT and ICD-9 coding, which they’ve been doing for decades. They al-ready have a base fund of knowledge and experience with those two coding systems. This is completely new to everyone. Basic training on how to use the system – look up, differentiate, assign and document codes – is essential for every physician. Everyone is starting at a base of zero.”

Tools: Identify all practice tools, processes and systems that use diagnosis codes.

“They’ll all need to be converted to ICD-10, and folks will need to be intro-duced to and trained in their use,” said

O’Brien. “At one of the early meetings, have your work team brainstorm to cre-ate a list of all affected tools, processes and systems. For example, if the practice con-tracts with an outside lab, which includes diagnosis codes in its orders form, the lab will likely issue a new form. Creating the list is just to understand the scope and del-egate specifi c assignments so that every-thing can get done by October 1.”

The following list may facilitate tool identifi cation:

Billing system

Charge tickets

Claims/clearinghouse

Clinical trials/studies

Eligibility

EMR discreet data templates ASC

Encounter forms

Orders (imaging, lab, therapy)

Payment posting

Patient information/history

Prior authorization

Referrals (incoming, outgoing)

Registration

Scheduling

Subcontracted services

Surgery scheduling

Tumor/disease registry

Voice recognition templates

Preparing for ICD-10, continued from page 5


By CINDY SANDERS

The recession took a heavy toll on healthcare construction projects across the nation. However, as the economy has begun to improve, projects are beginning to move forward again.

Experts in healthcare real estate devel-opment and evidence-based design recently shared their insights with Medical News re-garding the current state of healthcare con-struction projects in the ambulatory setting.

Real Estate DevelopmentAfter seeing a number of plans put on

hold over the last few years, Bond Oman, chief executive officer of OGA, a national full-service real estate development and project management firm based in Nash-ville, said there has been an increase in activity lately. While dialysis projects have remained fairly steady throughout, he said, the improved financial environment has resulted in an uptick in ambulatory sur-gery centers, urgent care centers and behavioral health facilities, among other sectors.

Oman said OGA presently has 21 projects in various stages of pro-duction. That is about a 30 percent increase over what the company was doing during the recession and quickly approaching pre-recession numbers, ac-cording to Oman. The company’s current portfolio includes work crossing the United States from California to Texas, Ohio to Florida.

One trend Oman said he is seeing nationwide is an emphasis on building smarter. He noted clients are trying to be more efficient by using basic green design to lower ongoing costs and keeping the build-ing footprint as tight as possible.

“With the health systems we are work-ing with, we haven’t done a total gold or silver building,” he said, referring to Lead-ership in Energy and Environmental Design (LEED) status. However, Oman added, many employ green design when it comes to choosing lighting, insulation, windows, paint, and other elements that increase en-ergy efficiency. In most cases, developers are still trying to strike a balance between the cost of adding green elements and the payoff in reduced monthly costs.

As a whole, Oman said he thinks fa-cilities are being built a little smaller on the front end but with room for growth. “We are designing a large number of our build-ings for expansion,” he noted. Rather than creating facilities with shell space to be fin-ished off later, Oman said he is really see-ing more facilities completely finished but designed from the outset with the ability to blow out a wall for future outward expan-sion.

What might be surprising to some is how quickly pricing has rebounded. Oman noted those considering developing health-care properties aren’t going to find any real deals. “The cost of doing business is get-ting back to where it was pre-recession,” he noted. “I’d say we’re definitely going to see an increase in cost because the economy is doing better … not doing great but defi-nitely doing a little better each year.”

Oman noted landowners who survived the recession are holding firm on real es-tate prices. Many municipalities that dialed back or waived impact fees to try to entice developers a few years ago have reinstated, and in many cases increased, those fees. He said prices are also inching up for mechani-cal, electrical and plumbing.

In general, Oman said healthcare de-velopment doesn’t tend to be speculative in nature. “It’s a different animal than a lot of the other real estate sectors,” he said, noting a demonstrated patient base and service need must be present before most in the medical industry will consider build-

ing. He added that while some markets — including Dallas, Denver, Houston and Nashville — are “on fire” right now, there is still a feeling of cautiousness across most of the nation. Still, projects that were halted a few years ago are beginning to get the green light again.

An Evidence-Based Design Aesthetic

Where facilities are sprouting up, more and more of them are relying on research to inform design decisions.

Ellen Taylor, AIA, MBA, EDAC, an architect for more than 25 years, began vol-unteering with the Center for Health Design (CHD) before she began work-ing with the organization in 2008. As director of research, the New York-based Taylor helps spread the word about the best available information and latest credible research to help those creating healing spaces.

“The Center for Health Design is a nonprofit based in California that looks at how the built environment can affect health outcomes … whether for the patient or staff,” she noted, adding CHD accom-plishes this goal through research, educa-tion and advocacy.

While elements of evidence-based de-sign (EBD) have intuitively been incorpo-rated in healing spaces for centuries, the

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Economic and Clinical Health Act, and the ONC, (originally mandated in 2004) is part of HITECH.

DeSalvo, no stranger to the ONC, has an extensive history of activities in health information technology (HIT).

In the late 1990‘s, DeSalvo fi rst re-alized the importance of EHR when she was on the faculty and was associate chief of the medical service for the Tulane Uni-versity School of Medicine. One of the tasks she picked up was membership on the medical records committee at Char-ity Hospital, while they were looking at the opportunity to move to an electronic health record.

They started with an electronic scheduling system for the medicine clinic because their patients’ access to care was so critical that a timely appointment could make a big difference.

“With the use of electronic schedul-ing, the clinic went from a patient wait time of 12 months – to two weeks,” she stated.

After Hurricane Katrina in 2005, De-Salvo helped develop projects to increase access to care by creating the patient-cen-tered medical home (PCMH) model for low income, uninsured and at-risk popu-lations in the New Orleans area, and to increase the number of primary care pro-viders, who had basically been forced to move from the area.

In 2006 she participated in the Loui-siana Health Care Redesign Collabora-

tive, which was comprised of more than 40 healthcare and consumer entities after Katrina and Rita devastated the Louisi-ana and Gulf Coast.

Out of that group came the Louisi-ana Health Care Quality Forum in Baton Rouge, of which she was a founding member and board president. The Qual-ity Forum oversees two organizations that are also funded by the ONC; the LaHIT Resource Center, one of more than 60 Regional Extension Centers (REC) na-tionwide that assist providers with EHR changeover from paper records; and, LaHIE, a secure health information ex-change of medical records between pro-viders.

Dr. Anjum Khurshid, who came to New Orleans in early 2011 to be a direc-tor of health systems development at the

Louisiana Public Health Institute (LPHI), worked closely with Dr. DeSalvo on an LPHI project funded by the ONC; the Crescent City Beacon Community, which is funded by the ONC to further HIT and care coordination.

Khurshid said DeSalvo “brings her own capabilities and experience and ex-pertise which are pretty outstanding as a primary care physician, public health professional, an academic and researcher. She brings a lot of things to the table in terms of her understanding of the real world challenges of delivering healthcare.

“I think Dr. DeSalvo has been able to see fi rsthand and experience the pain and agony of patients when they don’t have access to care. She has also experi-enced the problems that occur when we don’t have the high-end option of elec-tronic records, so that patients’ informa-tion is not readily available to physicians or to the patients themselves to improve their health outcomes. And she has seen with the experience of the Beacon pro-gram how that same technology can really help create a better system of care.”

As the New Orleans health commis-sioner and senior health policy advisor to Mayor Mitchell Landieu from 2011-2013, DeSalvo worked on the newest hospital in the city, New Orleans East Hospital, which will be paperless under her guid-ance and is scheduled to open May 2014.

Before joining the Landrieu admin-istration, she was professor of medicine and vice dean for community affairs and health policy at Tulane University School of Medicine.

In an interview with Louisiana Medi-

cal News when questioned about health providers’ acceptance of EHR, she said, “I want to give a shout out to the Louisi-ana State Medical Society for their work on the advancement of EHR in the state.”

She said that four out of ten providers are using some form of electronic records now.

And as to the EHR incentives pro-gram, “We have an opportunity to le-verage the ‘meaningful use’ payment to encourage the adoption of EHR using the fi nancial resources of Medicare, and the Medicaid programs at the state level are able to do that all the way until the year 2021. That helps the doctors and hospi-tals to get EHR into the clinical environ-ment.”

Rewards to providers can amount to $44,000 over 5 years for Medicare and $63,750 over six years under Medicaid for the adoption of HIT and use in a way to affect care.

She continued, “The challenge ahead is how to see that the systems are interop-erable, and we can use health information technology to save lives, and to improve the value of care for everybody includ-ing the taxpayers. The fi rst decade of the ONC has been very productive, and it is hoped the next decade will be full of value and progress, though we have a lot of work to do forging toward a paperless system.”

DeSalvo has an MD from the Tulane University School of Medicine, a master’s in public health from Tulane University School of Public Health, and a master’s degree in clinical epidemiology from the Harvard School of Public Health.

Louisiana Physician Tapped for National Health Post, continued from page 1

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www.healthcare-informatics.com

www.healthit.gov

www.healthit.gov/buzz-blog

www.cms.gov (EHR incentives)

www.fi ercehealthit.com

www.modernhealthcare.com

Drug research to control stroke risk fac-tors has improved to the point that Janis said sometimes the medicine had moved on by the time a stroke trial that had un-dergone delays managed to wind down. “You really want to get to answers more rapidly,” he noted.

Janis said the tipping point to change the way stroke research occurred across the country came about in a couple of dif-ferent ways. First, stroke experts identifi ed key research priorities during a NINDS strategic planning meeting two years ago and stressed the need for an orchestrated effort. Second, Janis said NINDS already had honed their ability to manage a co-ordinated effort through SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke).

“The idea behind the network is to take what we already know how to do and do it in a more effi cient way,” Janis said.

NINDS has a long history of oversee-ing successful stroke clinical trials, includ-ing the fi rst treatment for acute stroke, announced in 1995. Although sometimes slow, research translated from bench to bedside still has been so successful that mortality rates from stroke have declined

signifi cantly over the past decade. While still a leading cause of disability, stroke re-cently moved from the third leading cause of death in the United States to the fourth.

Janis noted funding still would be available to researchers outside the network when appropriate. However, he added, the goal would be to collaborate with the net-work and to coordinate trials through the new mechanisms now in place.

“We want to be able to use this in-frastructure we’re investing in to be our frontline sites for stroke trials,” he stated.

In the Southeast, lead research sites include Emory University School of Medicine in Atlanta, Medical University of South Carolina in Charleston, Miller School of Medicine at the University of Miami, and Vanderbilt University Medi-cal Center in Nashville. Providers and researchers can learn more about the net-work and clinical trials through the new website at nihstrokenet.org.

A New View on Clinical Stroke Research, continued from page 4

To Learn More:Go online to NIHStrokeNet.org


By LYNNE JETER

Despite staunch opposition from vari-ous circles, Community Health Systems (NYSE: CHS) easily sealed its $3.9 billion acquisition of Naples, Fla.-based Health Management Associates (NYSE: HMA) three days shy of the 6-month engage-ment.

On Jan. 27, trading of HMA stock ceased at $10.50 per share, with HMA stockholders also receiving .06942 shares of CHS stock for every HMA stock.

Among concerned parties, the Amer-ican Federation of Teachers (AFT) had criticized the CHS-HMA transaction, saying the deal has “apparent confl icts of interest” and “also has complications” related to Department of Justice (DOJ) investigations at both for-profi t hospital operators. One probe: alleged Medicare fraud related to admissions practices. The AFT’s interest emerged from its role in managing $1 trillion in public pension plans, with a portfolio including $68 mil-lion and $34 million, respectively, in CHS and HMA stock.

Nurses also expressed worries. On the morning HMA shareholders voted on the pending deal needing 70 percent approval, RNs challenged the CHS buy-out of HMA, saying the massive hospital monopoly of 206 mostly rural-based hos-pitals in 44 states would threaten patient access and quality of care. RNs from West Virginia, Ohio, California, Pennsylvania and Florida represented National Nurses United (NNU), the nation’s largest nurses’ union, at a press conference before the shareholders meeting at HMA headquar-ters in Naples. Months earlier, NNU had fi led a formal complaint with the Federal Trade Commission (FTC), noting “vigi-lant antitrust oversight is essential to pre-vent the predictable ills of an irreversible market consolidation” that would threaten patients and the public interest.

The Argument “The deliberate practice of setting

these disgracefully high charges, especially in communities where patients and families have nowhere else to go for hospital care, CHS and HMA are exposing countless numbers of people to fi nancial ruin – or discouraging them from seeking care when they need it due to the cost,” said NNU co-president Jean Ross, RN, pointing out that CHS-affi liated hospitals are the sole provider of healthcare services in more than 55 percent of markets served, and are regarded among the nation’s priciest hospi-tals. “This is exactly why the merger, which would give these irresponsible hospital ex-ecutives even more monopoly clout, should be stopped.”

HMA shareholders weren’t swayed; the pending deal garnered 98 percent ap-proval.

The FTC approved the acquisition after the Franklin, Tenn.-based company agreed to divest two acute care facilities: Riverview Regional Medical Center, a 281-bed hospital in Gadsden, Ala., and Carolina Pines Regional Medical Center, a 116-bed hospital in Hartsville, SC.

“This transaction provides us with increased scale and broader geographic reach as we work to create strong health-care networks across the nation,” said CHS CEO Wayne T. Smith. “Our larger organization is well positioned to address the changing dynamics in our industry and dedicated to providing quality care for mil-lions of patients and all the communities we serve.”

HMA AftermathJust before the marriage between

companies became official, the DOJ shifted its primary focus on HMA to for-mer HMA CEO Gary Newsome, who re-tired from the company last year to preside over a South American mission program for the Church of Jesus Christ of Latter-Day Saints.

The government alleges that New-some led the charge to pressure emergency department physicians and hospital ad-ministrators to increase the volume of in-patient admissions, “regardless of medical necessity.” Also feeling the investigation’s ripple effect: The University of Florida Health, a joint venture with HMA in three hospitals, and Primary Care Associates, a physician practice in Port Charlotte, Fla.

“Unlawful financial relationships between hospitals and physicians solely to increase referrals are, unfortunately, a common practice that corrupts the health-care system,” said Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida. “The system also suffers a direct fi nancial hit when hospitals fraudulently increase admissions where they’re not in-dicated, solely to benefi t hospitals’ bottom line. We won’t relent in our efforts to com-bat these kinds of fraudulent schemes and recover funds for the Medicare program.”

Supersizing CHSHMA acquisition complete, nation’s largest chain of hospitals scoops forward

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suddenly has to find a new doctor. The rea-son? The patient’s employer has changed insurance companies or the insurance car-rier has changed its panels, Quintal said. The physician the patient has seen is no longer covered.

“And that is bad for the patient and that is bad for medicine,” Quintal said. “The continuity of care is extremely impor-tant.”

Establishing a relationship between a patient and a physician and maintaining that relationship over time is extremely important in the practice of medicine. The physician-patient relationship is being affected by the influence of several external agents.

One of those agents is insurance com-panies’ influence.

“Insurance companies are in many ways dictating how and when to practice medicine,” Quintal said.

Another factor that may further erode the physician-patient relationship involves an unintended consequence of the Afford-able Care Act’s rollout.

Under the legislation, patients have until March 31 to pay the premiums for their newly acquired insurance coverage, Quintal said. The problem arises if a patient chooses not to pay his or her premium.

A doctor may provide care for that patient, and submit a bill only to discover later that he won’t be reimbursed because the patient didn’t pay the premium.

There should be a way by which the insurance company lets the doctor’s office know that a patient is in that 90-day win-dow, Quintal said. The doctor then has the choice to take care of these patients or to ask for alternative ways to take care of them.

Even if that choice is available, the physician is still left between a rock and a hard place, Quintal said.

“You either are the bad guy and say, ‘No, I’m not going to take a patient,’ or you are the good guy and take the patient and you have no idea if and when you’re going to be paid,” Quintal said.

It’s unclear how many patients will be affected or which doctors will see more of an impact because the problems haven’t arisen yet, Quintal said. But it is an issue.

Quintal earned his medical degree from the Universidad de Yucatan in 1975. His residency was at the Tulane University Affiliated Hospitals from 1978-1982 in in-ternal medicine. He also won a cardiology fellowship at Tulane. He is board-certified in internal medicine, cardiovascular dis-eases, and interventional cardiology.

Quintal was elected president of the Orleans Parish Medical Society in 2006, fol-lowing Hurricane Katrina. He was deeply in-volved with the reorganization of the society, as well as in the efforts to bring back medicine to Orleans Parish. He is currently the Rajen-

dra Dhurandhar Professor of Cardiology at LSU Medical School in New Orleans.

Today Louisiana, like other parts of the country, needs help addressing the shortage of physicians, especially primary care physicians and especially in rural areas, Quintal said.

The national shortage persists even though medical schools have increased the size of their classes and are producing more doctors, Quintal said. The problem is that these new doctors don’t have enough places to train as residents because the federal gov-ernment continues to cut graduate medical education funding so fewer residency spots are available.

“That is somewhat schizophrenic,” Quintal said. “There is a care disconnect,

and that needs to be addressed.”The federal government’s proposed

2014 fiscal budget would cut GME fund-ing by $11 billion, or roughly 10 percent of Medicare’s total contribution to GME. Meanwhile, a record 528 medical gradu-ates went unmatched in 2013, while the total number of applicants rose by 1,000 to a record 26,392.

“We cannot be reducing the number of spots available to newly graduated and newly minted physicians where they can train,” Quintal said. “We need more doc-tors, especially in primary care.”

The solution is to develop programs to encourage physicians to go into primary care and to reward them for doing so, he said.

Medical Society President Addresses Challenges, continued from page 1

formalized concept is relatively new. Taylor said a landmark 1984 study by Roger Ul-rich, PhD — which found surgical patients with a view of nature had a reduced length of stay, required reduced levels of narcotics and had fewer complications — really cap-tured people’s attention and launched the EBD movement. Since 2009, CHD has of-fered the Evidence-Based Design Accredita-tion (EDAC) to those who have proven their expertise in the field.

Although launched in the acute setting, Taylor said an increased awareness of how design impacts outcomes and a focus in the Affordable Care Act on engaging patients and keeping them out of the hospital have combined to create a recognition that EDB has an important role in outpatient settings, as well.

Another major trend for ambulatory spaces, she said, is the notion of flexibility and adaptability. It isn’t uncommon for one specialty to utilize a space two days a week with another specialty using it the rest of the time. “There’s this real need to be nimble,” Taylor said. “You can’t have a room that’s just designed for one purpose.”

Taylor added the concept of the pa-tient-centered medical home has really had an impact on facility design, as well. It is in-creasingly common to see outpatient clinics and facilities, particularly community health centers, include larger multipurpose rooms that could be used for a support group, to teach a health class or to hold neighborhood meetings.

When working on safety net facility design in California, Taylor noted a center added a walking trail behind the facility so that a physician could prescribe ‘four loops’ to a patient in need of physical activity. To make it truly useful, a playground was in-stalled in the center of the trail so parents could easily keep an eye on children, who coincidentally were also engaging in fun, physical activity playing outside. Similarly, some facilities have begun hosting a farmer’s market or have created a community garden and offer cooking classes to demonstrate the benefits of making simple, nutritious meals.

Along the same vein, Taylor said it is becoming increasingly common for out-patient settings to be embedded in retail locations. Vanderbilt One Hundred Oaks

in Nashville is an example of having mixed health and retail venues under one roof. Storefronts featuring supplies a patient needs to support a prescribed treatment sit next to national retailers featuring clothing or home goods. “It’s that concept of the one-stop-shop … if you can make it easier, you’ll have better compliance,” Taylor said.

The Mayo Clinic, she continued, offers another example of innovative, flexible de-sign. “They started realizing not everyone needed to disrobe for every appointment with physicians,” Taylor said. To address this, ‘Jack and Jill’ rooms were created — two offices with an exam room in between them. One patient could meet with his phy-sician in the office, while another patient was using the exam room … or a patient might begin in the physician’s office and then move to the exam room to complete the appointment. “You have a more effi-cient flow,” Taylor pointed out. “You are freeing up that valuable exam space.”

In addition to efficiency, however, Ad-elante Healthcare in Arizona is also study-ing whether or not the setup might also reduce stress levels and lead to increased patient satisfaction. Is it easier to pay atten-tion and be more engaged in a conversation with a physician when fully clothed in an office compared to sitting on an exam table in a cold room while wearing a thin gown? Does the setting change patient behavior? Does the setup change outcomes? Finding quantifiable answers to those types of ques-tions is key to EBD.

Adelante is also studying other design tweaks that might shift the traditional power concept between physician and patient. Something as simple as having patients and physicians sit side-by-side and share a com-puter screen while discussing treatment op-tions or giving a patient the ability to choose what they wish to view on a video monitor while waiting to see a provider can shift the perception of power. “That’s creating much more equality in care,” Taylor said. “There is a cultural awareness that needs to happen from a physician side, but then the design needs to accommodate that, as well.”

Taylor concluded, “Ultimately what we hope is that the design of the built envi-ronment is one tool in the toolkit to improve outcomes and improve health overall.”

Developing & Designing, continued from page 7


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On April 8, 2014, Microsoft is ending security updates and patches for Windows XP. Just having a Windows XP computer on your network will be an automatic HIPAA violation— which makes you non-compliant with Meaningful Use— and will be a time bomb that could easily cause a re-portable and expensive breach of protected patient information. HIPAA fines and loss of Meaningful Use money can far outweigh the expense of replacing your old operating system.

The HIPAA Security Rule specifically requires that you protect patient information with system patches and updates, which will not exist for Windows XP after April 8th. Here are some ideas provided by 4MedAp-proved’s healthcare IT experts that will help you make the right decisions.

You need to take replacing Windows XP seriously and act quickly. The deadline not only affects health care, but businesses and government agencies. This is likely to result in a shortage of equipment and delays getting replacement systems installed. It may take weeks or months to order equipment and get it installed, after you have gone through your purchasing process.

Getting rid of Windows XP often means replacing both software (XP) and hardware (the computer itself). Consider re-placing older desktops with newer laptops, micro PC’s that mount to the backs of moni-tors, all-in-one computers, thin clients with-out hard drives, or tablets. Look at the new ways to purchase or ‘rent’ software like word processing, spreadsheets, presentations, on-line backups, and file sharing. Rather than installing and supporting expensive software programs on every device, you can pay low monthly fees for the latest software through the Cloud, where everything is accessed through the Internet.

Replacing Windows XP lets you com-ply with both the HIPAA and Meaningful Use requirements that you secure patient data. Whatever computers you decide to buy must include business-class operating systems that include features to secure ac-cess and protect data. ‘Home’ operating sys-tems do not have security features that can protect patient data. You must have a pro-fessional version of Windows that includes security features and can join a domain. Don’t be delusional and think that all of your protected patient data is in your EHR system. It may be all over your office on in-dividual PCs. Data should not be stored on

individual PC’s because it makes it harder to comply with HIPAA and to secure and back up everything. Have a professional IT specialist set up your network so data is al-ways stored on a secure server that is backed up offsite. A network set up with a server as a domain controller will also enable you to comply with HIPAA’s requirements for se-cure access and retaining access logs for six years.

Some of your Windows XP comput-ers may be managing diagnostic or special purpose devices, and are not managed as part of your office network. Don’t let these hide from you as you replace your office sys-tems. They all need to go. Many diagnostics tools from imaging to dental to ophthalmo-logic devices have dedicated Windows XP computers that came with the device and are supported by that vendor. Talk to the vendor now. Hospitals may have Windows XP computers connected to point-of-sale systems in Admissions, the billing office, caf-eterias, and gift shops.

Encryption was not in Windows XP but is now included in some business-class ver-sions of Windows. It can also be purchased separately from vendors like WinMagic, Symantec, and McAfee/Intel Security. En-cryption should be installed on every com-puter that stores any patient data, including servers, desktops, laptops, and portable de-vices. Encryption not only protects data at a high level than passwords, it exempts you from reporting a lost or stolen device. Con-sidering the recent $ 1.5 million fine for a lost laptop, $ 1.7 million fine for a lost hard drive, and $ 150,000 fine for a lot thumb drive, encryption is your cheapest insurance against a reportable data breach.

Refer yourself to a specialist. Talk to an IT professional to determine what will work best for you. Be sure you only consider vendors that will sign HIPAA Business As-sociate Agreements and validate to you that they comply with HIPAA. (Any breach they cause may ultimately be your responsibility.) The HIPAA and Meaningful Use require-ments regarding patient data protection require business-class solutions installed by qualified IT professionals. Devices that in-clude security features must be properly in-stalled, configured, and actively maintained.

This is an abridged version of an article origi-nally published in 4Medapproved’s HIT Security Column. It is republished here with permission of the authors.

Time’s Up. Get Rid of Windows XP.


By CINDY BISHOP

The Louisiana Health Care Com-mission met on Friday February 7, at the Department of Insurance in Baton Rouge. Donna Fraiche, Chair of the Commission, introduced the following new commission members including:

• Robelynn Abadie, NAIFA Louisiana;• Korey Harvey, Louisiana Department of Insurance; • Brenda Hatfi eld, AARP Louisiana - volunteer representative;• Andrew Muhl, AARP Louisiana;• Korey Patty, Louisiana Independent Pharmacist Association;• Jennifer Valois, Louisiana Association of Justice.Tommy Teague, Vice President of

Network Development and Provider Re-lations, Louisiana Health Cooperative, gave an update on the Affordable Care Act (ACA). He said the exchange is now

working. However, it is not working per-fectly. He said that in Louisiana, the LHC has enrolled 6,000 members - some small group but mostly individuals. The dead-line to enroll members, with subsidies, through the exchange is March 2014.

Mike Bertaut, Senior Economist and Exchange Coordinator for Blue Cross Blue Shield of Louisiana said that he spends a lot of time studying the Afford-able Care Act from the carrier perspec-tive. Blue Cross Blue Shield of Louisiana is cautiously optimistic that they will hit their target (of enrollees) by November 2014. He stated that there is an enormous amount of fl ux with the ACA. “Until you make your fi rst payment you’re not in the system” he added. He said that one of the things that is constraining membership is that there is no payment redirect and there is a terrifying lack of knowledge in the marketplace. He acknowledges that he does a lot of presentations. He said last year he gave 162 presentations. “There are a lot of people who think the coverage

is free. We (BCBS) try as much as possible to push these people through the (licensed insurance) agent channels.” He said that the people, who enroll through an agent, have a higher percentage of (premium) payment.

Korey Harvey gave an update on the Louisiana Department of Insurance per-spective.

He told the Commission that of the number of ACA enrollees through De-cember 31, 2013, 55 percent are women. He said that when HHS cites fi gures of how many people have selected a plan, that fi gure does not refl ect how many of the enrollees have not paid a premium.

Korey Harvey, Deputy Commis-sioner, Offi ce of Health Insurance, Loui-siana Department of Insurance said that the Kaiser Family Foundation recently reported that 25 percent of enrollees are young and invincible, which is the worst case scenario because it could lead to the cost being 2.5 times higher than the premium dollars. CBO lowered their es-timates of the number of people expected to enroll to 5 million in the fi rst year. The estimate was 14 million. He said that in Louisiana, 17,548 selected a plan in Loui-siana.

He stated that the non-discrimination provisions of the Affordable Care Act will be delayed for another year. HHS is re-viewing rates right now but Department of Insurance will take over that function soon. The Department of Insurance will sponsor legislation during the 2014 Regu-lar Session of the Louisiana Legislature to give them authority.

Donna Mayeaux said that she’s re-quested a list from the Department of In-surance of the licensed insurance agents in Louisiana who have gone through the training for enrolling people through the Affordable Care Act. She voiced concern about the insurance industry sending mixed messages about this product. On one hand, she said that they are offering the product, but on the other hand they are speaking about how problematic the ACA has been. “What young person is going to buy something that insurance companies say is not good?”

Tommy Teague said that he would love to see the young invincible buy the product. He said that LHC does not take a stance on the politics of the Affordable Care Act.

Mike Bertaut said that in June 2010, the CEO of Blue Cross Blue Shield of Louisiana gathered all their leadership and said that irrespective of their personal opinions about the ACA they are com-mitted and have spent millions on ads on TV and marketing of the Affordable Care Act. “The commitment is there but there

is an enormous amount of public noise on the Act....It is divisive issue and there is no magic wand to change that.”

Mr. Bertaut said that BCBS has a web based program called I-link Blue that allows healthcare providers to see whether a patient is enrolled in the exchange. The Louisiana Health Cooperative has the same function on their website for health-care providers.

Kristen Kieren, Department of In-surance, gave an update on the Access to Care Brochure Subcommittee. She dis-tributed copies of the new brochures and asked for suggestions on where to distrib-ute them.

Chairman Fraiche discussed the de-velopment of an ACA workgroup. She said that we need a workgroup to make sure that we are adhering to our responsi-bility in regard to the ACA.

The Louisiana Health Care Commis-sion did a poll of the Commission mem-bers.

The next meeting of the Louisiana Health Care Commission is slated for May 2, 2014.

The 2014 Regular Session of the Lou-isiana Legislature begins on March 10, 2014 and will run through June 2, 2014. Because 2014 is an even-numbered year, the session will last for 85 days and is a general session, as opposed to a fi scal only session. If you would like to receive weekly updates on healthcare policy measures, you may want to consider subscribing to Health Care Information Services

Health Care Information Services is a newsletter published by the Checkmate team. It is published year-round; however HCIS subscribers receive a large number of reports when the Legislature is in ses-sion. Prior to the commencement of each legislative session, subscribers receive a comprehensive list of all healthcare related bills fi led for consideration. On a year-round basis, subscribers receive up-to-date coverage of meetings, legislation, and regulatory efforts that affect the healthcare industry. For a subscription form, email [email protected]

Louisiana Health Care Commission Updates Progress of ACA in State

Legislative Affairs content is provided by Checkmate Strategies, publisher of Health Care Information Services. All content © Checkmate Strategies and Louisiana Medical News, LLC. For more information, readers may contact Cindy Bishop at 225.923.1599 or P.O. Box 80053,

BR, LA 70598, or send email to [email protected]. Our website is

www.checkmate-strategies.com

Legislative AffairsBY CINDY BISHOP

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In the News

Study Reveals Economic Impact Of LSUHSC On Metro New Orleans

NEW ORLEANS- LSU Health Sci-ences Center New Orleans generated $888 million in sales, more than $390 mil-lion in earnings, and more than 6,900 jobs (direct and indirect) in the New Orleans Metropolitan Statistical Area (MSA) in 2013. The fi gures, part of the 2013 LSU Economic Impact Study: Estimating the Economic Impact of LSU on Louisiana, were presented by Dr. F. King Alexander, President and Chancellor of Louisiana State University, to the LSU Board of Su-pervisors.

“LSU Health Sciences Center New Orleans has people and programs that span the state, with signifi cant concen-trations in Baton Rouge and Lafayette as well as New Orleans,” said Dr. Larry Hollier, LSUHSC Chancellor. “A powerful economic engine, LSU Health Sciences Center New Orleans not only makes sig-nifi cant contributions to our state’s eco-nomic health, but also to the health and well-being of its citizens and the quality of life in their communities.”

It is the fi rst study of the combined impact of the nine LSU campuses on the state, as well as on their regional econo-mies. The study was conducted by LSU’s E. J. Ourso College of Business, led by Stephen Barnes, PhD, Assistant Professor of Economics and Associate Director of the LSU Division of Economic Develop-ment, along with Dek Terrell, PhD, Free-port-McMoRan Endowed Chair of Eco-nomics, Professor, and Executive Director of the Division of Economic Develop-ment. It determined that during the 2013 fi scal year, LSU supported nearly $3.9 billion in Louisiana sales, $1.5 billion in new statewide earnings and an estimat-ed 36,757 direct and indirect annualized jobs. For every operating and capital dol-lar provided by the state, LSU supported $5.08 of economic activity.

LSU Health Sciences Center New Orleans is a major employer. More than 2,000, or 15.2 percent, of full-time LSU System workers are employed in the New Orleans MSA, an eight-parish region in-cluding Jefferson, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John the Baptist and St. Tammany par-ishes. With its schools of medicine, den-tistry, nursing, allied health professions,

public health, and graduate studies, LSU Health Sciences Center New Orleans is Louisiana’s fl agship university educating health professionals. Impacts for the re-gion were generated by measuring the impact of the university spending and student spending associated with LSU Health Sciences Center.

“LSU already has a broad and posi-tive impact in Greater New Orleans, supporting over 2,000 full-time jobs and driving nearly $900 million in economic impact,” said Michael Hecht, President & CEO of Greater New Orleans, Inc. “Go-ing forward, however, this impact will grow even further, as the new University Medical Center comes online and be-gins to drive destination healthcare and research commercialization. LSU is a cor-nerstone economic and intellectual part-ner in Greater New Orleans.”

The total impact of LSU Health Sci-ences Center New Orleans exceeds the economic impact, however. It includes the benefi t of educating and training a pool of health care professionals to prac-tice in the state, providing LSUHSC facul-ty, residents and fellows to staff Louisiana hospitals and clinics, and conducting bio-sciences research that translates to treat-ment advances, improved outcomes, and higher quality of life for the people of Louisiana, the United States, and the world. A major health resource, LSU Health Sciences Center New Orleans supports the recruitment and retention of other jobs and companies to the region ensuring the availability of high quality health care.

“While the economic impact of LSU employment is signifi cant and important to our region, the potential economic effect of spin off activities resulting from research at LSU is as benefi cial to our re-gion’s economy,” added Paul H. Flower, Chairman, Business Council of New Or-leans and the River Region.

“The LSU Health Sciences Center clearly is one of Downtown’s biggest economic generators,” said Kurt Weigle, President & CEO of the Downtown De-velopment District. “The numbers speak for themselves, but in simple terms, the Health Sciences Center drives demand for Downtown housing, retail, restau-rants, and many other services that are enjoyed by everyone Downtown.”

January

– Public Health

– Financial/Tax Planning

February

– Cardiology

– Mergers & Acquisitions

March

– Stroke

– Healthcare Design/Construction

April

– Diabetes/Wound Care

– ICD-10

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

December

– Post Acute Care

– Audits/Compliance

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2014 Editorial Calendar




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In the News

Lakeview Regional Physician Performs Northshore’s First Single-Site Robotic Surgery

COVINGTON - Gary Agena, a sur-geon specializing in gynecology and obstetrics, successfully performed a single site (single incision) robotic hys-terectomy at Lakeview Regional in December. Dr. Agena used Lakeview Regional Medical Center’s recently in-stalled daVinci Si surgical system for this procedure.

The da Vinci® Surgical System uses breakthrough technology to offer a minimally invasive alternative for many complex surgical procedures. With sin-gle-site instrumentation, procedures are passed through just one port inserted through the patient’s navel. Thisallows all the instruments for surgery, includ-ing a three-dimensional camera and two surgical instruments, to pass through a single, tiny incision. The more slender instruments, along with the precisely translated movements of the surgeon through robotic technology, enhance the surgeon’s dexterity and make the surgery even less invasive for the pa-tient. In addition to smaller incisions, the da Vinci®robot also provides bene-fi ts to the patient such as less pain, fewer side effects, a reduced risk of infection, a shorter hospital stay and a quicker re-turn to normal activities.

LHC Group to acquire Deaconess HomeCare

LAFAYETTE– LHC Group Inc. (NAS-DAQ: LHCG), a national provider of home health, hospice and comprehen-sive post-acute healthcare services, an-nounced that it has signed a defi nitive stock purchase agreement with Bio-Scrip®, Inc. (NASDAQ: BIOS) to pur-chase two of its operating subsidiaries, doing business as Deaconess HomeC-are and Elk Valley Health Services, for $60 million.

The combined service area of Dea-coness HomeCare and Elk Valley Health Services, collectively one of the nation’s largest home health providers, includes 121 counties for home health, 30 coun-ties for hospice and 95 counties for community-based services in the states of Mississippi, Tennessee, Kentucky, Il-linois, and Nebraska. Annual revenues are approximately $72.6 million.

“When we founded LHC Group 20 years ago, Deaconess HomeCare al-ready had a strong reputation as one of the nation’s premier providers,” said Keith Myers, LHC Group chairman and CEO. “Joining forces with a provider of this caliber marks a great day for our company.”

“As consolidation continues to oc-cur in our industry, we look forward to more opportunities like this to join forc-

es with other high-quality providers who share our values and commitment to excellence. We welcome the healthcare professionals at Deaconess HomeCare and Elk Valley Health Services to the LHC Group family and look forward to combining our strengths and partner-ing with local clinicians to deliver high-quality health care that allows patients to safely remain in the comfort of their homes.”

Established in 1969, Deaconess HomeCare is a nationally recognized provider with a long-standing reputa-tion for providing quality care and ex-ceptional service to patients, families and communities they serve.

The transaction will add 33 locations in fi ve states, increasing LHC Group’s geographical footprint to 342 locations across 27 states. The transaction, which is expected to close by the end of the fi rst quarter of 2014, subject to custom-ary closing conditions, is anticipated to be accretive to LHC Group’s 2014 earn-ings by between $0.05 and $0.10 per di-luted share.

LaPOST Workshop Set For March

BATON ROUGE- A Louisiana Physi-cian Orders for Scope of Treatment (“La-POST”) workshop for health care profes-sionals, administrators and social work-ers will be held at 2 p.m. on March 24 at Nottingham Regional Rehab Center, 2828 Westfork Dr. in Baton Rouge.

The workshop is part of the LaPOST Coalition’s mission to empower health care professionals with information and resources to assist patients with serious, advanced illnesses in making educated decisions about end-of-life care.

The workshop will feature Susan Nel-son, MD, Chair of the LaPOST Coalition. Board certifi ed in internal medicine, ge-riatrics and hospice and palliative medi-cine, Nelson serves as medical director of Senior Services and PACE Baton Rouge, Franciscan Missionaries of Our Lady Health System and St. Joseph Hospice. She is a fellow of the American Acad-emy of Hospice and Palliative Medicine and the American College of Physicians and well as an advocate for senior health. She works with the Louisiana State Medi-cal Society Council on Public Health and the Louisiana Department of Health and Hospitals (DHH), and is a member of the Board of the Directors of the National Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Task Force.

The workshop is certifi ed for one-hour of CME credit by the American Academy of Family Physicians and one-hour of CEU credit by the Louisiana Chapter of the National Association of Social Workers and the Louisiana State Board of Examiners of Nursing Facility Administrators.

There is no cost to attend the work-shop. For information, contact Cynthia Michael via email at [email protected]. Online registration will be available on the LaPost website: http://lhcqf.org/lapost-home

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

888-743-5747 www.phfl.org


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Lake Charles Physician Receives National Recognition

LAKE CHARLES—Craig G. Mor-ton, M.D., Imperial Health Center For Orthopaedics Physical Medicine and Rehabili-tation Specialist, was re-cently recognized as the Top Physical Medicine and Rehab Specialist in Louisiana, Most Infl uen-tial Doctor in the Lake Charles Region, Top Doctor in the Lake Charles Region and Thought Leader in the Lake Charles Region by HealthTap, a medical expert network comprised of over 50,000 U.S. licensed doctors dedicated to improv-ing people’s health and well-being by providing registered users with person-alized health information and free on-line and mobile answers.

Dr. Craig Morton is originally from Lake Charles and graduated from Mc-Neese State University. He received his Medical Degree from Louisiana State University Health Science Center in Shreveport and completed a Residency in Physical Medicine and Rehabilitation at the University of Alabama in Birming-ham, with an emphasis on non-surgical spine care and intervention.

Dr. Morton is Board Certifi ed by the American Board of Physical Medicine and Rehabilitation.

Peoples Health Promotes Barbara Guerard to SVP of Health Services

METAIRIE- Peoples Health has an-nounced the promotion of Barbara Guerard to senior vice president of health ser-vices.

Guerard brings 30 years of healthcare man-agement and clinical experience to Peoples Health, having begun her career as a nurse practi-tioner. Her senior management expe-rience includes strategic planning, op-erations, policy formation and systems enhancements. Guerard also spent 18 years in clinical positions, including as senior administrator at the Harvard Community Health Plan in Boston. Prior to joining Peoples Health, Guerard was executive director and chief executive offi cer for both LSU Healthcare Network and Faculty Practice at the University of Vermont College of Medicine/Fletcher Allen Health Care. She also served as vice president of Adult Multi-Specialty Services for the University of Tennessee Faculty Practice in Memphis.

Guerard earned her doctorate in health services administration at the University of Alabama in Birmingham and her Master of Business Administra-tion from Suffolk University in Boston. She also earned her Bachelor of Science degree from Northeastern University.

Dr. Craig G. Morton

Barbara Guerard

In the News

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