SOUTH LOUISIANA EDITION YOUR PRIMARY SOURCE FOR PROFESSIONAL HEALTHCARE NEWS On Rounds Read Louisiana Medical News online at www.louisianamedicalnews.com SEPTEMBER 2014 / $5 Feds Propose Emergency Prep Rules But at What Cost? Dr. Laura Lazarus Defying gravity When it comes to an adventure, Dr. Laura Lazarus reaches new heights. After her sister treated her to a trapeze lesson, she took up the ﬂying version ... page 2 New ACO Targets Cost Curve, Quality Ochsner Health System, Ochsner Physician Partners and UnitedHealthcare of Louisiana have launched a new accountable care organization the partners hope will eventually achieve healthcare’s Holy Grail: bending the cost curve ... page 3 Physician Spotlight PRINTED ON RECYCLED PAPER PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 (CONTINUED ON PAGE 8) BY LISA HANCHEY From an early age, Timothy Harlan knew that cooking was his calling. At age 11, the Atlanta native started washing dishes in a restaurant. By 18, he had worked his way up to manager. At 22, he opened a French bistro, Le Petit Café, in Athens, Ga. A few years later, he closed the restaurant to pursue a hotel and restaurant man- agement degree, and ended up in medical school. “When I was in medical school, I recognized that physicians as well as most health- care providers across the spectrum didn’t know a lot about nutri- tion, diet, food – and weren’t necessarily terribly healthy themselves sometimes,” Harlan recalled. Now, he has combined his culinary talents with medicine – as head of The Goldring Center for Culinary Medicine at Tulane Uni- Chef MD Medicine and nutrition: delicious together (CONTINUED ON PAGE 6) BY TED GRIGGS The federal government’s proposed emergency preparedness requirements for hospitals and 16 other healthcare providers and suppliers closely fol- low those of the Joint Commission, but questions re- main about the costs to comply with the guidelines. The proposed rule contains a lot more detail about what the Centers for Medicare and Medicaid expect, said Allyn Whaley-Martin, project manager for the Louisiana Hospital Association Hospital Pre- paredness Program. But there are operational costs associated with those requirements, and those costs may not be fully reﬂected in CMS’ estimated costs of compliance. For example, one of the things under discussion is requiring hospitals to maintain a supply of water for each staff member and person in the building, basically one gallon of water per person per day. Well, that presents some operational chal- MEDICARE/MEDICAID 2014 LOUISIANA HIPAA & EHR CONFERENCE Louisiana’s Prescription for Privacy, Security and Electronic Health Records L’Auberge Casino Resort - Event Center | 777 l’Auberge Ave. Baton Rouge, LA 70820 October 20-21, 2014
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SEPTEMBER 2014 / $5
Feds Propose Emergency Prep Rules But at What Cost?
Dr. Laura LazarusDefying gravity
When it comes to an adventure, Dr. Laura Lazarus reaches new heights. After her sister treated her to a trapeze lesson, she took up the fl ying version ... page 2
New ACO Targets Cost Curve, QualityOchsner Health System, Ochsner Physician Partners and UnitedHealthcare of Louisiana have launched a new accountable care organization the partners hope will eventually achieve healthcare’s Holy Grail: bending the cost curve ... page 3
PRINTED ON RECYCLED PAPER
(CONTINUED ON PAGE 8)
By LISA HANCHEy
From an early age, Timothy Harlan knew that cooking was his calling. At age 11, the Atlanta native started washing dishes in a restaurant. By 18, he had worked his way up to manager. At 22, he opened a French bistro, Le Petit Café, in Athens, Ga. A few years later, he closed the restaurant to pursue a hotel and restaurant man-agement degree, and ended up in medical school. “When I was in medical school, I recognized that physicians as well as most health-care providers across the spectrum didn’t know a lot about nutri-tion, diet, food – and weren’t necessarily terribly healthy themselves sometimes,” Harlan recalled.
Now, he has combined his culinary talents with medicine – as head of The Goldring Center for Culinary Medicine at Tulane Uni-
Chef MDMedicine and nutrition: delicious together
(CONTINUED ON PAGE 6)
By TED GRIGGS
The federal government’s proposed emergency preparedness requirements for hospitals and 16 other healthcare providers and suppliers closely fol-low those of the Joint Commission, but questions re-main about the costs to comply with the guidelines.
The proposed rule contains a lot more detail about what the Centers for Medicare and Medicaid expect, said Allyn Whaley-Martin, project manager for the Louisiana Hospital Association Hospital Pre-paredness Program. But there are opera tional costs associated with those requirements, and those costs may not be fully refl ected in CMS’ estimated costs of compliance.
For example, one of the things under discussion is requiring hospitals to maintain a supply of water for each staff member and person in the building, basically one gallon of water per person per day.
Well, that presents some operational chal-
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2 • SEPTEMBER 2014 Louisiana Medical News
By LISA HANCHEy
When it comes to an adventure, Dr. Laura Lazarus reaches new heights. After her sister treated her to a trapeze lesson, she took up the fl ying version. But that still wasn’t enough. An avid hiker, Lazarus climbed mountains in Utah, Arizona and Colorado before summiting the ultimate peak – Mount Kilimanjaro.
In the fourth grade, the Cincinnati native knew that she wanted to become a doctor. “One of my classmate’s fa-thers, who was a heart surgeon, came in and talked to the class,” she recalled. “I thought it was the coolest thing I had ever seen. I went home and told my parents that I wanted to be a surgeon.”
After graduating with a B.S. in bio-psychology from Tufts University in Medford, Mass., she earned her medical degree at Hahnemann University School in Philadelphia. Her mentor, who had been at Tulane prior to teaching at Hahn-emann, encouraged her to apply for a residency at LSU. “When I came down to New Orleans, I liked it,” she recalled. “It ended up being the perfect fi t for me.”
During her third year, she read an ar-ticle in Self magazine about breast surgery during a plane trip in October – breast cancer awareness month. “I didn’t even know that specialty existed,” she revealed. “I thought, ‘That’s exactly what I want to do.’”
She followed her residency train-ing with a fellowship in breast surgery at Northwestern University Medical School, Lynn Sage Breast Center in Chicago. When it came time to practice, her love of New Orleans lured her back. “At the time,
I felt that it gave me the best option, be-cause I knew people at LSU, which gave me the opportunity to go into practice and learn to work on my own,” she explained. “It also allowed me to stay involved with teaching at the same time.”
After returning to the Crescent City in 2002, Lazarus practiced breast surgery at Memorial Medical Center and served as an associate professor of surgery and di-rector of the Breast Center at the Medical Center of Louisiana. In 2003, she received the Professional Recognition Award for Outstanding Physician in the Practice of Oncology from the American Cancer So-ciety, Louisiana.
That all changed when Hurricane Katrina hit in August, 2005. At the time, Lazarus was working at Baptist Hospi-
tal and Charity Hospital, both of which fl ooded in the storm. After struggling to practice in less than ideal conditions, she returned to Cincinnati that December. “I wasn’t ready to leave New Orleans, she re-called. “In fact, I was supposed to close on a house the day the city fl ooded.”
In 2006, she landed a breast surgery position at Greenwich Hospital in Con-necticut, where her accolades contin-ued. In 2008-2009, she won the Patient’s Choice Award, and was named a Top Doctor in the New York Metro area from 2012-14.
It was while practicing up North that Lazarus discovered the trapeze. As a birthday surprise, her sister, who lives in Manhattan, brought her to a class. “I loved it,” she said.
After that fi rst class in 2007, she took fl ying trapeze lessons whenever she had the chance. “It is just an amazing experi-ence,” she said.
In 2010, she reached another per-sonal goal – climbing Mount Kilimanjaro. Over four days, Lazarus and her expedi-tion made their way up the 19,341-foot mountain. “We climbed up to over 12,000 feet the fi rst day, then went up to 16,000 and back down to 14,000 on the second, then went up and back down to 14,000, just to acclimate ourselves,” she explained. “At night while you were trying to sleep, it was work just to turn over in bed.”
On day four, the troupe climbed to over 19,000 feet. Upon reaching the summit, Lazarus felt exhilarated – and exhausted. “I don’t need to go anyplace higher than Kilimanjaro – ever again,” she said with a laugh. “It was amazing what being at that high of an altitude does to you. It was like trying to get up a steep mountain with an elephant on your back.”
After the trip, Lazarus started focusing more on the trapeze, taking classes weekly, then progressing to several times a week with a small troupe. But, just as she was getting ready for her fi rst performance, she got a call from Drs. Frank J. DellaCroce and Scott Sullivan of the Center for Re-storative Breast Surgery at the St. Charles Surgical Hospital in New Orleans. “It was my dream job, and an opportunity I didn’t want to pass up,” she said.
In July, 2014, Lazarus returned to New Orleans – for good. “I am really ex-cited to be back here where I had started,” she said. “Seeing some of my patients who are in their 90s and still swimming laps every day really inspires me. I would like to keep developing relationships with patients and help them through this chal-lenge that they are facing. I want to feel that I really am making a difference in their lives.”
Dr. Laura LazarusDefying gravity
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Louisiana Medical News SEPTEMBER 2014 • 3
By TED GRIGGS
Ochsner Health System, Ochsner Physician Partners and UnitedHealth-care of Louisiana have launched a new accountable care organization the part-ners hope will eventually achieve health-care’s Holy Grail: bending the cost curve.
Coordinating care through the ACO could someday improve quality, increase patient satisfaction and reduce costs for more than 350,000 south Loui-siana residents enrolled in UnitedHealth-care’s employer-sponsored health plans. The two-year contract links a portion of Ochsner’s reimbursement to quality and cost-efficiency.
“We view this as a great starting point for us and for our partners,” said Glen J. Golemi, president and chief executive offi-cer of UnitedHealthCare Louisiana.
UHC will begin by evaluating the cost and quality of care for the pa-tients that can be attrib-uted to Ochsner. During the first year, United-HealthCare will be able to share with Ochsner data on patterns of care, physicians who are practicing evidence-based medicine, and hospital infection and readmission rates, and lengths of stay.
Once the baseline is established, UHC will move to rewarding Ochsner for quality and cost-efficiency, Golemi said.
By the time the contract is up for re-newal, UHC expects to have meaningful and measurable data showing whether pa-tient outcomes, experience and quality are improving. The data will help determine the next steps for the collaboration. United-Healthcare has a number of value-based con-tract models, Golemi said, because not every health system is ready, or willing to take on the risk for cost and quality outcomes.
Ochsner won’t be doing so initially, but the health system and its providers could eventually make that move.
Ochsner Health President and CEO Warner L. Thomas said the health system is trying to move more of its contracts with all payers to a model that rewards Ochsner for providing great qual-ity and making health-care more affordable.
Ochsner has three other contracts similar to the UnitedHealthcare ACO, he said. The con-tracts are structured a little differently – Ochsner is taking on risk under some agreements – but all of them contain incentives that reward the health system for quality and affordability.
If Ochsner doesn’t hit its quality met-rics, the health system won’t earn the addi-tional dollars available for achieving those
goals.The health system is positioning itself
so that Ochsner can assume more risk for contracts in the future, Thomas said, and make sure the health system is once again incented to do a good job controlling medi-cal costs while delivering excellent out-comes and quality.
Although getting physicians to buy into an uncertain reimbursement model derailed some earlier ACO efforts, Thomas said Ochsner’s integrated model helps ad-dress that issue.
The health system can take global pay-ments, for example.
“But I think our physicians understand that today we have to help consumers be cost-conscious,” Thomas said.
The health system has made major investments in information technology. Among other things, that means Ochsner is very clear on what tests patients have undergone and can avoid duplicate testing, Thomas said.
“If someone needs a procedure they’re going to get that but we also understand that people have to be much more cost-conscious,” Thomas said. “They’re pay-ing more out of pocket so we’re working hard to make sure we help our patients go through this process.”
The Louisiana ACO is part of a na-tional push that UnitedHealthcare is mak-ing to move away from “a completely fee-for-service system,” Golemi said, and begin systemically to change how health care is delivered in the United States.
“We have to be more focused on out-comes and quality that’s being delivered by our providers,” Golemi said. “We have to be able to allow our members, the patients, to shop just like they do for their iPhones, for their televisions, their automobiles, based on quality and cost.”
Arming consumers with that infor-mation through ACOs will greatly ben-efit members, he said. UnitedHealthcare would also like to see patients become more engaged in their healthcare.
Patients need to be just as conscious about their healthcare decisions and living healthier – following the right diet, choos-ing the right blend of exercise and taking their medication as directed – as they do when buying a smartphone, Golemi said.
“That responsibility cannot be com-pletely on the provider. The individuals have to begin to take responsibility for those things as well,” Golemi said.
More than $30 billion of United-Healthcare’s annual physician and hospital reimbursements are now tied to account-able care programs, centers of excellence and performance-based programs. The company expects to increase that to $65 billion by 2018.
“If you have that type of volume that’s being run through these types of systems that will improve care and it will reduce costs,” Golemi said.
New ACO Targets Cost Curve, Quality
Glen J. Golemi
Warner L. Thomas
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By LyNNE JETER
A decade ago, Tony Stajduhar recruited a well-experienced specialist from the Cleveland Clinic to a rural in-termountain community. The physician was looking for a place where he could raise horses and enjoy the last phase of his career. The new job fi t the bill.
“On my latest visit to the commu-nity, I was happy to see that he’s still there working full-time and is an integral part of the program and commu-nity,” said Stajduhar, president of Jackson & Coker, a national permanent physician placement fi rm, based near Atlanta.
Older physicians, overwhelmed by federal mandates com-plicating the practice of medicine and considering retirement as their only op-tion, may be much more marketable than originally considered in the post-Affordable Care Act (ACA) era.
For starters, the supply/demand curve is in their favor. According to the American Medical Association (AMA), nearly 1 million physicians practice medicine in the United States. Roughly
36 percent are 55 years or older. Of those physicians, pulmonologists and psychiatrists comprise two of the largest percentage categories.
A frightening statistic: up to 76 per-cent of pulmonologists and critical care specialists are in that age group.
“Older physicians are very mar-ketable,” said Stajduhar. “Even though clearly, nobody should be discriminating … in a perfect world, hospital admin-istrators would like to bring in doctors fresh out of residency, who could work there for 25 to 30 years. That’s utopia. In the real world, we know that when doctors complete their residency pro-grams, more than half of them leave within three years after making their fi rst (placement) decision. That’s a huge percentage! Just because they’re young doesn’t mean they’ll stay.”
On the other hand, practitioners in their fi fties, for example, who are con-sidering making a change realize it’s probably their last career move and are more motivated to make it permanent, said Stajduhar.
“Then it’s just a matter of asking: ‘how long are you willing to practice?’ Perhaps they’re 59, and say they want to work as long as their health holds out. When they’re upfront with the hir-
ing client, you have a very marketable physician.”
Surprisingly, hospital administra-tors rarely ask if qualifi ed candidates are tech-savvy, noted Stajduhar, which quells one worry among older physicians.
“It doesn’t seem to be a concern at this point,” he said. “The older recruit may move into a hospi-tal system that makes it fairly easy for them to adapt. For example, they may assign a nurse or nurse practitioner to the physician, who can plug notes into an electronic medical record (EMR) system as the physician tends to the patient.”
After the ACA kicked in, most physicians with 25 or 30 years under their belt considered retiring. Unfortu-nately, it was signed into law less than 18 months after the stock market crash of September 2008, when many physi-cians watched in dismay as their retire-ment funds withered.
“Many would’ve retired then, if they could have,” said Stajduhar. “The ACA, out of the gate, scared the heck out of older physicians. If there’s a sig-nifi cant continued uptick in the econ-omy, I wouldn’t be surprised to see the retirement rate of that age group ac-celerate over the next fi ve or six years. But then we’ll have a huge problem with specialties being in critical short-
age areas.”If that happens, older physicians
who opt not to retire sooner will be in even more demand, particularly if they’re open to moving to a different location, which melds with another emerging phy-sician employment trend: The best jobs aren’t necessarily in rural areas, defi ned as a population of 40,000 or less.
“We probably have more primary care needs in urban areas than ever be-fore,” said Stajduhar, noting the greatest demand is internal medicine. “Yet we still have many unmet needs in rural areas, especially those areas we know are very rural. Older physicians have more opportunities than perhaps they realize.”
The passage of time since the ACA took effect has also softened the atti-tudes of older physicians, adding to their marketability.
“Physicians, as a rule, have been fi ercely independent,” said Stajduhar. “They didn’t want people telling them how to practice medicine from a hospi-tal level. When it became imminently clear that we’d have a different indus-try in fi ve to 10 years, that revelation became the impetus of the dramatic change in the hiring process. Now those physicians are seeing the benefi ts of being employed by a hospital or health system, perhaps in another location. They’re in an age group where most are empty nesters, and being confi ned to a school district or a place to settle down isn’t holding them back. Only caring for aging parents may play a role in their ability to relocate.”
An employment contract for the older physician is a win-win for both parties.
“Administrators know the move is probably the doctor’s last hurrah,” he said. “That’s where they’ll retire. Then at a minimum, the client will have six or seven years from a good, experienced physician with a great track record on staff.”
Help Wanted: Older PhysiciansThe 55-and-over group is more marketable than ever
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Louisiana Medical News SEPTEMBER 2014 • 5
By LyNNE JETER
“Uncertainty prevails” was a com-mon theme in the recently released Jack-son Healthcare study on the Affordable Care Act’s (ACA) impact on physicians and practices.
“We found that a significantly larger number of physicians desire to be em-ployees (versus independent contrac-tors) in the post-ACA world,” said Sheri Sorrell, manager of market research for Jackson Healthcare, a national health-care recruitment firm based near Atlanta. “They know a salary is constant, even when reimbursements decline. Plus, they know someone else will navigate the complexities of the ACA.”
Jackson Healthcare’s “Physician Practice Trends 2014,” a national study with nearly 2,000 physicians represent-ing all 50 states and medical-surgical specialties, revealed some rapidly chang-ing statistics that are shaping physicians’ decisions to ink an employment deal with a hospital or healthcare system.
The happiness factor. Physicians whose income decreased in the last year are more likely to be age 45 to 64, own their medical practice, work more than eight hours a day, be dissatisfied with their career, and discourage young people from entering the medical field. Because of the
ACA roll-out, they say they’ve lost pa-tients, and remaining patients often delay treatments because of higher out-of-pocket costs.
The “never-known-indepen-dence” physicians. Satisfied physicians are more likely to be between the ages of 25 and 44, work eight hours a day, be em-ployed, have chosen employment for life-style reasons, and have a greater number of patients with private insurance. “Younger physicians are most likely to have never been in private practice,” noted Sorrell. “They started out employed and remain employed.”
The impact of higher deduct-ibles. As a result of higher deductibles resulting from effects of the ACA law, patients are seeking routine care less frequently and postponing certain pro-cedures. The trend attributed to 12 percent of physicians’ responses to the most prevalent effects the rollout of the ACA has had on their practices. The higher deductible has made insurance the equivalent of self-pay. “In reality,” one physician wrote, “patients don’t have insurance until they’ve met their deduct-ibles.”
The insurance cancellation as-pect. Insurance policy cancellations led to 23 percent of physicians saying they’ve lost patients since the ACA implementa-
tion; another 15 percent lost patients because their practice could no longer accept their insurance plans.
Quality of life and financial reasons are only a part of the reason why older physicians, especially primary care pro-viders (PCPs), are approaching hospitals, with the keys to their practice in hand.
“The majority of acquisitions are ini-tiated by physicians,” emphasized Sorrell. “It’s not necessarily the hospitals going after the practices. It’s the practice physi-cians knocking on the hospital door.”
Fortunately, practice acquisitions are mutually beneficial for practice physicians and hospitals and health systems, the latter of which are welcoming the opportunity to buy PCP practices as they’re forming and growing Accountable Care Organizations (ACOs).
The answer to which party has the upper hand depends on the geographic lo-cation of the practice.
“They’re hedging their bets,” added Sorrell. “They’ve done the math. They know what they need to keep up with the ACA compliance. They see it’s too much to deal with. They realize they’re better off ac-cepting a salary, putting in their eight hours a day, and going home.”
Despite the awkward position of prac-tice physicians approaching hospitals and health systems about a deal, they have a
considerable amount of leverage, espe-cially in larger metropolitan areas, Sorrell pointed out.
“They’re offering the practice on their terms,” she explained, “and can say, ‘if you don’t take it, I’m going down the street to offer it to your competitor.’”
A striking study statistic as a positive benefit to physicians of selling their prac-tice: The number of physicians taking call dropped from 77 percent in 2012 to 55 per-cent in 2014.
“Basically, it’s a result of employ-ment,” Sorrell said. “It’s interesting be-cause physicians, especially older doctors, tend to complain a little bit about the work ethic of younger folks, who want to work eight hours a day and not take call. Those same physicians are making a shift in that percentage by at least limiting on-call time in their contracts.”
Sorrell said study statistics align with broader trends seen in other Jackson Healthcare and industry research.
“We’ve been tracking the trend to-ward employment in various ways, with studies on physician practice acquisitions, why physicians decided to sell their prac-tice, or why they want to get out of private practice,” she said. “We’ve also been tak-ing a look at what happens when physicians become employed. These are trends we’ll continue to watch.”
Shifting Toward EmploymentMore PCPs are becoming hospital employees, according to ACA impact study
6 • SEPTEMBER 2014 Louisiana Medical News
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versity.The idea came from Dr. David Eisen-
berg of Harvard Medical School and Asso-ciate Professor of Nutrition at the Harvard School of Public Health, who wanted to create teaching kitchens for medical stu-dents. Dr. Benjamin Sachs, former dean of the Tulane University School of Medi-cine, heard about Eisenberg’s concept from Dr. Bob Elson, a Tulane alumnus. “Dr. Sachs came to a group of us about four years ago, and said that he wanted to build a teaching kitchen to teach medical students how to cook,” Harlan explained. “It was when we decided to put this proj-ect out in the community and that we would also teach the community how to cook that I thought it would work.”
Harlan fi rst became interested in the nutritional aspect of cooking through his late wife, Barbara, who was diabetic. “I became interested in what she needed to eat and how she needed to live,” he said. “I just became very passionate about health. I’ve always had a long-standing love af-fair with food, and so, I’ve been able mesh those two things together very well.”
After running Le Petit Café for three years, Harlan shut it down to go Emory University School of Medicine. But, the natural born chef never lost his culinary passion, working as a caterer throughout medical school and writing It’s Healthy Fare, a food manual for heart disease pa-tients. “I wrote my fi rst book when I was in medical school and, since then, I have
been writing cookbooks for lay people,” he explained.
Following medical school, Harlan practiced as an internist in Virginia for 12 years. He remarried Morgan, a Tu-lane graduate. At dinner with a group one night, he met a cardiologist who was prac-ticing in New Orleans. “I said, ‘Oh, my gosh, if I could get a job in New Orleans, I would move there tomorrow.’ She leaned across the table and said, ‘I can get you a job in New Orleans.’”
In 2006, Harlan moved to the Cres-cent City, where he splits his time between practicing internal medicine and serving
as assistant dean for clinical services at Tu-lane. He became executive director of The Goldring Center for Culinary Medicine in 2011. “This is the fi rst fully-functional teaching kitchen affi liated with a medical school in the world,” Harlan said.
This ground-breaking project is a collaboration between Tulane’s medical school and Johnson & Wales University College of Medical Arts. Chef Leah Sar-ris, a Johnson & Wales graduate, serves as program director. “She runs the show,” Harlan said.
For the last two and a half years, the center has held cooking classes for both medical students and the community in an ad-hoc kitchen on Tulane’s campus. “The core of our curriculum is actually the community programming,” Har-lan explained, “because our mission is to change and help our patients and the community understand how they can cook and eat great food that just happens to be healthy.”
Tulane’s culinary medicine center developed a 12-module series for the com-munity consisting of free hands-on cook-ing classes. For the medical school, the core curriculum was expanded into an eight-module series offered as a 24-hour elective for Tulane’s fi rst- and second-year students. “That curriculum takes the basic science that they are learning over the fi rst two years centering around nu-trition, such as metabolism, physiology, anatomy and biochemistry, and trans-lates it into the conversation that they are going to have in the examination room with their patients about food,” Harlan explained. “The idea is that we want to them to understand how to have a brief, but important, conversation about how their patients can change their diets.”
Recently, the Goldring Center intro-duced programs for pediatric and family medicine residents. A 28-day rotation is also available for third- and fourth-year students. Over the last two years, about 13 percent of medical students and 800 com-munity members have taken the culinary program. The center also offered a ran-
domized control trial for diabetics, with about 50 patients completing the study.
This month, the center moved into its brand new location at the corner of North Broad Street and Bienville as part of the ReFresh Project. Site of the former Schwegmann Bros. grocery store, the 60,000-square-foot site will also house a Whole Foods Market, a social entre-preneurial coffee shop, a charter school and other community partners. “It’s a multi-use food hub that’s been built by a non-profi t organization called Broad Community Connections in the middle of a food desert out here in New Orleans,” Harlan explained.
The 4,600-square-foot space dedi-cated to the Goldring Center consists of a teaching kitchen with professional ovens and cooking stations. With the new and improved space, staff will be able to teach 16 to 20 people hands-on cooking at a time. “It’s a full-on cooking school,” Har-lan said. “Our goal is to offer one commu-nity class every single day to New Orleans residents by the end of this coming aca-demic year.”
Since January, Tulane has licensed its curriculum to 10 medical schools, with an-other three to four in the works. “Our ul-timate goal is to teach physicians that they can be healthier themselves, how they can teach their patients how to be healthier, but also, teaching the community at the same time,” Harlan explained.
The Goldring Center also offers a continuing medical education program for practicing physicians. Over the last year, the center has taught hands-on cooking to over 250 docs. “It is like our medical stu-dent programming, but inst ead of being a three-hour class, it’s about three to four hours of CME per module,” Harlan ex-plained. “There are 12 different modules that we are offering. The response has been amazing and incredible.”
Chef MD, continued from page 1
For more information, visit culinarymedicine.org.
Louisiana Medical News SEPTEMBER 2014 • 7
The medical complex will feature a free-standing 24/7 emergency department with an anticipated yearly patient volume of 10,000 – 12,000, an adjoining full service health center providing primary care, and have capacity for one OB/GYN or certifi ed nurse midwife and two rotating spe-cialists. Other features include: 22 patient exam rooms, lab services, and radiology services including X-Ray, CAT scan, MRI, Ultrasound and Mammography.
Ochsner is perfectly positioned to provide value and effi -ciencies in the healthcare reform environment of account-able care, medical homes, budget cuts, declining reim-bursement, and increased regulation.
Ochsner Health System is a physician-led, non-profi t, academic, multi-specialty, healthcare delivery system dedi-
cated to patient care, research, and education. Our mission is to Serve, Heal, Lead, Educate, and Innovate. The system includes 10 hospitals and more than 40 health centers throughout Southeast Louisiana. Ochsner employs over 900 physicians representing all major medical specialties and subspecialties. We conduct over 575 ongoing clinical re-search trials annually. We offer a generous and comprehen-sive benefi ts package and enjoy the advantage of practicing in a favorable malpractice environment in Louisiana. Please visit our website at www.ochsner.org.
Ochsner is an equal opportunity employer and all quali-fi ed applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, disability status, protected veteran sta-tus, or any other characteristic protected by law.
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Legal Review BY NICHOLAS GACHASSIN, III,
Don’t Let Others Build a Business off of Your Practice and Place You at Risk
Physician practices are always looking for margin growth opportunities, and right-fully so given the current state of practicing medicine. Margin growth can be achieved in multiple ways, such as the expansion of your patient base or services offered, cost control/reduction, and/or economies of scale, which normally results from the com-bination of the fi rst two ways. And as big of a business that healthcare has become, there are plenty of people in the business of assisting you with achieving these goals. “Don’t worry Doc, all you have to focus on is seeing your patients, and we’ll take care of the rest. Plus, you can increase your revenue this way without having to work harder.” Almost every physician has been presented with some venture that offers the same solution- “make more and work less”. We want to be clear, this article is not addressing those vendors necessary to your practice (i.e. billing and collections, medical supplies, staffi ng, etc.), nor are we saying that every business pitch is destined for failure. Rather, we wish to briefl y sum-marize some common business terms that should raise the proverbial “red fl ag” when being pitched.
Risk Burden Your practice is your practice. Your
license is your license. No one should have the ability to add any more risk to your own practice than you. Beware of business pitches that try to expand the level of services you provide, because if deemed inappropri-ate by either a payor or LSBME (because the service is being billed under your num-ber, or performed under your supervision, respectively), then you are the one at risk, not the business vendor. Sure, you can in-clude indemnity provisions in your agree-ment for protection, but having to invoke the indemnity provision normally means the damage has already been infl icted. It is easier to protect yourself by properly evalu-ating a business proposal on the front end than chasing a remedy after the fact.
Long Term Contracts or Joint
VenturesBeware of any arrangements that re-
quire a term of one (1) year or more with-out any short-notice termination without cause provision in the contract. Also, be wary of any venture that is structured like a true joint venture, whereby your practice legal entity is a partial owner with the third party vendor in a joint venture limited li-ability company. The common reasoning you hear for long-term contracts with no quick outs or joint ventures is, “well, we are going invest a substantial amount of time and money into this venture, and we don’t want to risk our investment on a short-term relationship.” That may be true, but the
only way they can make money off of addi-tional services you provide is you, and hence there is your leverage. Long term contracts and joint ventures can have painful conse-quences should the relationship not be of any value to you and your practice, and can become a costly distraction. In other words, make sure the break-up can be handled as easily as a bad blind date rather than a long, nasty divorce.
“Percent of Revenue” Fee Like some services that provide le-
gitimate practice support (i.e. billing and collections), most third party ventures seek compensation in the form of a percentage of the revenue generated by your practice. Think about that for a minute. If they want to be your partner, then why are they trying to get their compensation before you make any money? Meaning, there is no incentive for them to ensure the profi tability of an ex-panded service if they have no reward tied to profi tability. It is possible that a vendor could make a handsome profi t because of their percent of revenue fee structure, and you lose money on providing the expanded service; a true lose-lose from your perspec-tive. If the percent of revenue fee is the only option, then you need to start asking your-self questions. Do I have enough resources to make this work? Do I have enough time to commit to this without jeopardizing my existing services and patient load? What additional expenses will I incur in expand-ing into a new service line?
Expense ReimbursementIn addition to the services provided
in exchange for whatever fee structure charged, be extremely cautious of provi-sions that require the practice to reimburse the business venturer for expenses incurred in connection with the service. This could be a devise to derive more profi t from your practice by marking up their expenses. How do you truly know what true expenses are if they are being incurred and paid by the vendor, and not directly being invoiced to the practice? Stand your ground and know that the person or company pitching the business/service can make money off of its fee structure alone, or else they would not have approached you in the fi rst place.
“We have an opinion letter
stating this structure is legal”Again, be it a payor or licensure issue
that the proposed business venture may call into question, never rely on the representa-tion that the structure has been vetted and that it is indeed legal. You absolutely must vet the structure yourself. Make sure your legal counsel analyzes the proposed venture from every regulatory perspective neces-sary. Again, you have the most to lose in
any relationship with a third party, so the theme here is defense.
In closing, the above is a non-ex-haustive list of business terms and dealings to watch out for before entering into a re-lationship with a third party proposing to increase practice revenue and/or expand your service line. While not all propositions are intended with ill-will, some can place you and your practice at risk, fi nancially and legally. Also, your time is valuable, so do not spend it hearing proposal after proposal promising more revenues and less headaches. In fact, a bad arrangement can be just the opposite. Should your interest be truly piqued by a proposal, then make sure you vet it thoroughly with your fi nancial and legal representatives.
This month’s Legal Review content is provided by Nicholas Gachassin, III, a partner in the Gachassin Law Firm. Mr. Gachassin is licensed to practice in Louisiana and Mississippi and is a member of several organizations, including the American Health Lawyers Association and the Louisiana Association of Hospital Attorneys. His area of practice is focused on assisting various types of health care providers and businesses with specifi c legal and regulatory issues applicable to the health care industry.
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8 • SEPTEMBER 2014 Louisiana Medical News
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lenges, Whaley-Martin said. The hospitals would have to find a place to store all that water and maintain it. There’s also the question of whether CMS would consider a contract with a vendor adequate to meet that regulation.
Another proposal would require hos-pitals to maintain the temperature of their buildings. For some facilities, this will mean going beyond an emergency genera-tor, Whaley-Martin said.
Some hospitals would have to add enough generator capacity to be able to support their air conditioning system for
the entire building, she said.“That is a significant increase in costs,
and that would require additional testing and support,” Whaley-Mar-tin said.
Some hospitals, particularly those in the Baton Rouge and New Orleans areas have al-ready taken the extra step of hardening their facilities, she said. The experience of losing power following a major storm –
Hurricane Gustav in Baton Rouge and Hurricane Katrina in New Orleans – led hospitals to invest in additional backup power.
Having their own generators, capable of running their air conditioning as well as the facility’s other functions, means hospi-tals don’t have to evacuate and put patients at risk in doing so, Whaley-Martin said.
But other Louisiana hospitals have not made those investments, and purchasing additional generator capacity could further strain their finances.
CMS wants to establish a uniform,
national standard for emergency prepared-ness. The federal agency examined the current Medicare requirements and found they were not comprehensive and fell short of what would be needed to make sure pro-viders and suppliers were adequately pre-pared for a disaster.
Among other things, the current rules didn’t address the need for communication to coordinate with other health systems in a city or state; risk assessment and contin-gency planning; and personnel training and testing.
The proposed rule requires providers to adopt standards in each of those areas.
CMS has estimated that the total cost of the proposed rule would be $225 mil-lion the first year. The projected annual cost in subsequent years would be around $41 million.
The average cost to each hospital? Roughly $8,000 a year, according to CMS.
The American Hospital Association says it supports hospitals, providers and suppliers planning appropriately for di-sasters, whether natural or man-made, and coordinating with federal, state and local emergency preparedness systems. The hospitals want to make sure patients’ needs are met during disasters and emer-gencies.
But CMS may have significantly un-derestimated “the burden and the cost” of complying with the proposed rule.
Hospitals and other inpatient provid-ers would be required to meet the subsis-tence needs of staff and patients, according to the AHA. Those needs include food, water and supplies, as well as the energy to maintain temperatures, emergency light-ing, fire detection and alarm systems and sewage and waste disposal.
However, since CMS considers that the “usual and customary” business prac-tice, the agency says providers won’t incur any additional cost, according to the AHA. The Hospital Association disagrees.
“So there’s greater detail for these things that are out there that I think prob-ably need some better investigation to re-ally understand what it’s going to cost the hospital and how they can be compliant with that,” Whaley-Martin said.
The guidelines, while specific in some areas, don’t provide a lot of detail in oth-ers. For example, the guidelines require providers to maintain adequate supplies of fuel.
The challenge for providers will be to demonstrate compliance with a vague rule, Whaley-Martin said.
In Louisiana, hospitals, and other providers, are fortunate, she said. They’ve done a lot of work to develop relationships within the hospital community and with the state to establish healthcare coalitions.
Those coalitions allow the hospitals and providers to lean on each other when there are emergencies, such as hurricanes, Whaley-Martin said.
“To me, being a part of that coalition helps a hospital become compliant with these regulations. It will be interesting to see if CMS agrees with that,” Whaley-Martin said.
Feds Propose Emergency Prep Rules But at What Cost? continued from page 1
Louisiana Medical News SEPTEMBER 2014 • 9
NEW ORLEANS: 504.822.8013BATON ROUGE: 225.924.1930SERVING ALL OF LOUISIANA
EVERY PRESCRIPTION FILLED TODAY HELPS US GIVE BACK TOMORROW
By CINDy SANDERS
Which region of the country has the fewest states that opted to expand Med-icaid, the highest rate of uninsured non-elderly adults, leads the nation in chronic conditions such as obesity and diabetes, and fi nds the majority of its states have poverty levels above the national average? No surprises here … it’s the South.
Jessica Stephens, a senior policy analyst with the Kaiser Family Foundation’s Commission on Medic-aid and the Uninsured, has been instrumental in working on several KFF projects this year assessing coverage and care in Southern states, along with opportunities and challenges the region faces to provide increased healthcare access and equity. Stephens, who received both her under-graduate degree and master’s in Health
Policy and Administration from Yale, is also part of the Disparities Policy Project for KFF.
In looking at expansion decisions by region, Stephens noted KFF uses the U.S. Census Bureau defi nition of the South, which includes 16 states – stretching west-ward to Texas and northward to Dela-ware – plus the District of Columbia.
“Six states including D.C. have implemented the Medicaid expansion,” Stephens said, listing Delaware, Mary-land, the District of Columbia, Arkansas, Kentucky and West Virginia. “They’ve all taken slightly different approaches,” she noted. “Arkansas, in particular, has adopted a private option where they are using Medicaid funds to assist newly eligible adults pay for private coverage through the marketplace,” Stephens added of a waiver granted by the Cen-ters for Medicare & Medicaid Services to allow the state to provide premium assis-tance.
Nationally, Stephens continued, 26 states plus the District of Columbia have implemented Medicaid expansion, which means nearly half of the U.S. states elect-ing not to expand at this time are located in the South – 11 of the remaining 24. “In the West and Northeast, the major-ity of states have (expanded). In the Mid-west, a larger number are not, but it’s still more than in the South.”
The reasons for not implementing expansion are multifactorial. Stephens said that in addition to general political opposition to the Affordable Care Act in many Southern states, there is also a concern over the sustainability of main-taining expanded Medicaid rolls even though the phased down match rate of 90 percent is still much higher than the general Medicaid population. And, she continued, “There are concerns over the Medicaid program overall … how it’s run in general.”
On the fl ip side, though, there is mounting concern over what the deci-sion to not expand means for a large number of people. Stephens said more than a third of the nation’s population, 37 percent, live in the South, and the region is also home to 4 of 10 people of color. “The expansion was important, in part, because it was going to expand Medicaid to adults who were historically excluded from the program,” she said.
A very large percent of those who make too much for traditional Medicaid but not enough to qualify for federal sub-sidies reside in the South. “Overall in the South, there are 3.8 million people who fall into this gap, and nationally, there are 4.8 million … so nearly 80 percent of all those who fall into the gap nationally are in the South,” Stephens stated.
She added people are often surprised to fi nd out just how little a family could make in order to qualify for traditional
Medicaid. Citing median levels, she noted, “For a family of three – one adult and two children – that family cannot earn more than approximately $12,000 a year for the parent to be eligible.” Stephens con-tinued, “Non-disabled, childless adults remain ineligible regardless of how much they earn.” Without expansion, she said, Medicaid eligibility for adults remains very limited.
Additionally, Stephens noted the de-cision not to expand Medicaid also further exacerbates healthcare disparities with people of color being disproportionately impacted by the choice. “Six in 10 blacks who would have been eligible for Medic-aid in the South, about 1.2 million people, are not because they fall into the coverage gap.”
Among states that did expand cov-erage, Stephens said reports are coming in that those states have been able to im-prove the effi ciency and function of their Medicaid programs by taking advantage of a number of ACA provisions. “We can tell the Affordable Care Act and the Med-icaid expansion has important potential to change delivery,” she said. “It also has the potential to reduce disparities in access to coverage and care by race and ethnic-
ity and also by geography if the Southern states would expand.”
Even without expansion, though, Ste-phens said outreach and consumer assis-tance is critically important to chip away at the 21 million in the region still lacking any type of coverage. About 48 percent of the South’s uninsured currently qualify for existing programs.
“Of the 21 million uninsured in the South, we have 7 percent who are Med-icaid-eligible adults, 11 percent who are Medicaid- or CHIP-eligible children, 30 percent who are eligible to obtain tax credits to purchase private coverage through the marketplace, 18 percent who are in the coverage gap, 21 percent who are ineligible for fi nancial assistance who have incomes above the tax credit limit or an offer of employer-sponsored coverage, and 13 percent who are ineligible due to their immigration status,” Stephens out-lined.
Ultimately, improving health out-comes will largely depend on the creation of dependable channels to access care … whether through the expansion of Medic-aid, implementation of other solutions to address the needs of the uninsured, or a combination of both.
Southern ExposureThe Medicaid expansion haves … and mostly have nots … in the South
Deadly and defiant, pancreatic can-cer was one of the major oncologic threats Congress hoped to address with passage of the “Recalcitrant Cancer Research Act,” which was signed into law at the beginning of 2013.
Garnering broad bi-partisan support, the statute honed in on cancers with five-year relative survival rates below 50 per-cent. Starting with pancreatic and lung cancer, the law calls for the National Can-cer Institute to develop a scientific frame-work and strategic plan to move the science forward at a more rapid pace to address these deadly diseases.
Leading the call to pass the legislation and increase research, collaboration and patient resources is the Pancreatic Can-cer Action Network (PanCAN). Formed in 1999, the California-based national or-ganization will have awarded almost $23 million in grants to 110 research scientists around the country by year’s end. Ad-ditionally, the Patient & Liaison Services (PALS) has shared current, reliable infor-mation with more than 80,000 patients and family members, including a comprehen-sive clinical trials database to link patients with the latest treatment options and re-
search studies.A PanCAN research study published
in Cancer Research this past May predicted pancreatic cancer would become the sec-ond leading cause of cancer-related deaths by 2020 and also estimated the increase in liver cancer deaths would make lung, pan-creas, liver and colorectal the top four can-cer killers in the country by 2030.
“When we think of ‘big picture’ can-cers, we think lung, breast, prostate and colorectal,” said Lynn Matrisian, PhD, MBA, vice president of scien-tific and medical affairs for PanCAN. More than 800,000 Americans will receive a diagnosis of one of these types of cancer this year (see box).
Yet, noted Matrisian, pancreatic cancer, which is the 12th most commonly diagnosed cancer, is currently the fourth leading cause of cancer deaths in the United States. “Pancreatic cancer surpassed prostate cancer a couple of years ago and is expected to surpass breast can-cer in the next year or two and the colorec-tal cancers around 2020,” she explained.
While great strides are being made in lowering overall cancer death rates, Matri-
sian said it has been much more difficult to gain traction in improving pancreatic cancer survival. “For pancreatic cancer, we haven’t made any change much at all in the death rate since we began keeping records. The five-year survival rate is 6 per-cent. An estimated 73 percent of patients die within the first year of diagnosis.” She added, “It’s the only one of the major can-cers with that five-year survival rate in the single digits.”
The reasons for the high mortality rate are multifactorial and include a need to better understand the pathogenesis of the disease and to identify it earlier when treat-ment options have a greater opportunity for success. “The pancreas is deep within your body. The symptoms are pretty vague and can be attributed to multiple diseases so it’s often diagnosed quite late,” Matrisian said. She added, an aging and growing popula-tion is anticipated to increase the number of cases of pancreatic cancer in coming years, which in turn is expected to lead to pancreas cancer becoming the number two cancer killer considering its mortality rates.
Yet, she stressed, “It doesn’t have to happen if we can change things now.” Ma-trisian said she sees the information as a call to action and pointed to the preventive, di-agnostic and treatment successes that have occurred in many diseases through focused research efforts.
Stand Up To Cancer (SU2C) is an-swering that call with the formation of their second pancreatic cancer Dream Team. Announced in April, the SU2C-Lustgarten Foundation Pancreatic Cancer Convergence Dream Team is focused on immunotherapy and is being led by noted physician-scientist Elizabeth M. Jaffee, MD, professor of oncology at Johns Hop-kins School of Medicine and co-director of the Gastrointestinal Cancers Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore.
University of Penn-sylvania translational research expert Robert H. Vonderheide, MD, DPhil, has joined Jaffee as co-leader of the project — “Transforming Pancreatic Cancer into a Treatable Disease.” The multidisciplinary team includes seven other principals from around the country plus three patient ad-vocate members. Funding for the $8 mil-lion, three-year grant is a collaborative effort of SU2C, The Lustgarten Founda-tion and the Fox Family Cancer Research Funding Trust.
The Dream Team will use the grant to develop new therapies to engage a patient’s own immune cells in the battle against pancreatic cancer. Jaffee has led the charge on creating an immunologic response, developing a novel pancreas cancer vaccine with colleagues more than a decade ago targeting pancreatic ductal
adenocarninomas (PDAC), the most com-mon form of pancreatic cancer.
“Pancreatic cancer suppresses the body’s anti-tumor immune response,” Jaffee explained. “These tumors do not allow immune cells that can recognize and kill them to even enter the pancreas. We think we can use vaccination to acti-vate anti-tumor immune cells and then use other agents to get those cells into the pan-creas where they can attack the tumor.”
Most recently, she noted, “We tested our newer vaccine, which is a combination of two vaccines – the first primes the im-mune system and the second targets can-cer cells – and we now give a boost to the immune system.” She continued, “We’ve tested this in advanced patients who have failed all other chemotherapies, and we showed it significantly improved survival.”
Jaffe added the median survival dou-bled from three months to more than six-and-a-half months. “Patients who did well are doing well long-term,” she added, not-ing some of these advanced patients have now survived more than a year out from the immunotherapy. “There really aren’t side effects so the patients have a better quality of life,” she added of another plus. The outcomes have resulted in accelerated approval status from the Food & Drug Ad-ministration.
While Jaffee and her colleagues at Johns Hopkins have made important prog-ress, she noted bringing the Dream Team together will enhance everyone’s work. “Each center has come up with a project based on the science they were develop-ing,” she said of the two Phase I studies and three multicenter Phase 2 trials being launched. “We’re going to combine now and share our technologies to analyze the different clinical trials. We’ll compare mechanisms to see if we should combine agents,” Jaffee continued.
Calling the Dream Team an “all out massive attack on pancreatic cancer,” Jaffee said it is a wonderful opportunity to bring experts from eight different centers together to advance pancreatic research. She also said it’s possible immunotherapy could be widely available to patients in the next two years pending outcomes of cur-rent trials.
While improved treatment clearly would be a critically important advance, Jaffee said there is another exciting devel-opment underway. She and her team have recently published their first paper show-ing prolonged progression of the disease in animal models.
“We don’t know when the first genetic changes are occurring and at what age,” Jaffee noted. However, she continued, “Cancer starts to develop 20-30 years before you see it.” By looking for early changes, such as mutated KRAS, the hope is to tar-get a pre-malignancy and keep it from ever developing into pancreatic cancer.
“Our goal is to eventually prevent this disease from the start,” Jaffee concluded.
Teaming Up to Turn the Tide on Pancreatic Cancer
Dr. Lynn Matrisian
Dr. Elizabeth M. Jaffee
Louisiana Medical News SEPTEMBER 2014 • 11
Legislative AffairsBY CINDY BISHOP
From Louisiana Department of Health and HospitalsBayou Heath has put out a Request for
Proposals (RFP) for Louisiana’s Medicaid managed care program on the Louisiana Procurement and Contract Network site. Companies interested in bidding to be one of the coordinated care networks can apply. Louisiana’s Medicaid Managed care pro-gram referred to as Bayou Health serves more than 900,000 Medicaid recipients through a network of managed care organi-zations (MCO). The RFP for Bayou Health seeks competitive bids for the contracts to serve as the MCOs for Bayou Health be-ginning Feb. 1, 2015. The RFP may be viewed at http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/3077.
From the American Academy of Orthopaedic Surgeons
The American Academy of Orthopae-dic Surgeons (AAOS) has opened the call for submissions to its 10th annual MORE Awards. These awards recognize excel-lence in accurate reporting on musculoskel-etal health issues, healthy behaviors, and high-quality care of bones and joints. The Academy invites all journalists to submit their stories of prevention and treatment of musculoskeletal issues, or stories of recov-ery from these injuries or conditions. Stories can cover any bone and joint health related topic, whether it’s on a particular ortho-paedic condition, clinical research, muscu-loskeletal health trends, health policy as it relates to bone and joint health, orthopae-dic injuries or innovative treatments. The entry deadline is Monday, October 13, 2014. Entries must have been published or broadcast between October 1, 2013 and October 1, 2014. Interested journalists are asked to visit aaos.org/moreawards to sub-mit digital versions of their work. There is no fee to enter.
From PolicyLink.org Last year we launched the Healthy
Food Access Portal to be a resource to the movement to improve access to affordable, healthy foods in underserved communities. Since its launch, tens of thousands of peo-ple across the country have benefi ted from the wealth of resources, tools, and analysis featured on the website. The movement to create a more equitable food system in the United States is taking off and we are thrilled the portal has been a valuable re-source to so many of you. On the newly redesigned website (healthyfoodaccess.org) you can:
• Use a new searchable map to fi nd
policy efforts and resources in your state
• Find available funding opportunities in our updated database
• Learn from your peers via new pro-fi les, webinars, and stories
• Check out new videos of healthy food leaders from around the coun-try
Upcoming Conferences Plans are underway for the 2014 Loui-
siana HIPAA and EHR Conference. If you would like to be a sponsor for the confer-ence, contact [email protected]
The dates of the conference are Octo-ber 20 and 21, 2014 at L’Auberge Casino Resort, Baton Rouge, LA
The Louisiana Orthopaedic Associa-tion is planning their 2015 Annual Meet-ing slated for February 26-28, 2015 at the Sheraton New Orleans. If you would like to be an exhibitor/vendor or submit an ab-stract for consideration, email Cindy Bishop at [email protected] or Andrew Mann @ [email protected]. The deadline to submit an abstract is October 1, 2014.
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.
We all know chronic illness is destroying lives. And crippling the healthcare system. That’s why Blue Cross has created Quality Blue Primary Care, a program that rewards doctors for getting better health results for our Blue Cross members. Especially those with chronic health issues.
Our Quality Blue Primary Care program offers primary care practices in our network access to technology, tools and services to help them focus on what they do best: treating patients. Plus, providers and clinics enrolled in the program are paid a monthly care management fee—on top of their usual fee-for-service amount.
Patients benefit. Providers benefit. And together, we create a healthier, more affordable healthcare system for all of us.
For more information on Quality Blue Primary Care:Call 800.376.7765Email [email protected] Visit www.bcbsla.com/qbpc
Dr. David CarmoucheExecutive Vice President of External Operations & Chief Medical Officer
Blue Cross and Blue Shield of Louisiana
We invite our network primary care doctors in Family Medicine, Internal Medicine or General Practice to learn more about Quality Blue Primary Care.
Introducing A New Primary Care Program
That Rewards Doctors and Patients
for Better Health.
01MK5620 06/14 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.
12 • SEPTEMBER 2014 Louisiana Medical News
By LyNNE JETER
Prior to the collapse of the USSR, Alina V. Chervinskaya, MD, PhD, and her team built the first salt room at the In-stitute of Pulmonology in Leningrad as a way to treat respiratory diseases. The salt room, dubbed the halochamber, created an environment for dry salt aerosol treat-ment, known as halotherapy.
Chervinskaya, a pulmonologist and head of the Clinical Research Respira-tory Center in St. Petersburg, Russia, noted that earlier attempts to create an ar-tificial microclimate with “all sorts of salt-based minerals,” such as halite, sylvinite, and salt bricks, had failed.
In research papers, Chervinskaya showed that dry sodium chloride aerosol with a negative electrical charge could penetrate deep into the respiratory tract, dissolve mucus, improve the function of cilia and fight bacteria and bronchial in-flammation.
“The only effective way to build a function-ing salt cave was the cre-ation of dry salt aerosol with the help of special equipment: halogenera-tors,” said Chervinskaya, whose team collaborated with Aeromed, a St. Petersburg-based en-gineering firm, to create a scientifically substantiated method – controlled halo-therapy – in 1995 as a new method of treating diseases of the respiratory system.
Controlled halotherapy, Chervins-kaya explained, allows for differentiated metering and control of the level of salt aerosol when performing treatments.
“This is very important, because it
allows for objective treatment, which en-hances the effectiveness and safety of the procedure, and optimizes the length of each session,” she said.
Chervinskaya also helped develop the Halomed device, a salt generator that can be set for different levels of salt concentra-tion. It’s recommended for patients with colds, sinusitis, bronchitis, allergies and asthma, and also for eczema and psoriasis.
“Before our invention, it was impossi-ble to manage and maintain different lev-els of the concentration of dry salt aerosol in the salt chamber,” she said. “Our halo-generators receive feedback from a con-centration sensor and a microprocessor, which allows us to establish the necessary
concentration of aerosol for our patients and maintain its level throughout the pro-cedure.”
When salt rooms began popping up outside Russia and the Baltic countries in the early 2000s, Chervinskaya was faced with a significant hurdle that required ed-ucating the medical community and pa-tients independently seeking salt therapy about the proper use of halotherapy.
“The term, halotherapy, came into fashion, but it was being used in the en-tirely wrong way! These unscrupulous offers, practically changing the meaning and introducing confusion and distrust, discredited halotherapy and (gave) rise to sharp criticism in the European medical
community,” she pointed out. Chervinskaya realized that of the
hundreds of salt rooms built in Europe and the United States, only a few had modern equipment for full, effective, and safe use of the method of controlled halo-therapy. “This situation,” she cautioned, “hindered the advancement of halother-apy, and aroused distrust in the medical community.”
Since the 1990s, Chervinskaya has penned hundreds of scientific publications, chapters in monographs and textbooks, and dozens of papers at professional forums on the subject. She chronicled the develop-ment and implementation of a comprehen-sive system of preventive and restorative treatment of diseases affecting the respi-ratory system in her doctoral dissertation, “Haloaerosol Therapy in the Treatment and Prevention of Respiratory Diseases.”
She’s also become a well-known speaker to physician groups on topical problems of rehabilitation in pulmonol-ogy, physiotherapy, aerosol medicine, spe-leotherapy, halotherapy, air ion therapy, nebulizer therapy, and also controlled re-spiratory environments.
“I get referrals from some naturo-pathic and homeopathic MDs. Some mainstream MDs approve of patients using salt therapy, but don’t seem to men-tion it to other patients,” said Chervins-kaya. “I do have several MDs as clients and/or MDs who send family members for a respiratory condition.”
Perhaps one reason for the lack of en-thusiasm: “In general, salt therapy is too new and insurance companies don’t know about it yet,” Chervinskaya said. “Some very flexible spending plans in the U.S. cover salt therapy.”
Salt therapy can easily pay for itself, she emphasized.
“However, due to improving respira-tory conditions so that less medical inter-vention is needed, salt therapy works as a course of therapy, and most salt rooms offer especially good rates for multiple ses-sions,” she said.
At the St. Louis Salt Room, for ex-ample, a course of therapy (10-20 sessions) costs $150 to $250 for adults; $225 to $400 for children.
“The average annual cost, when two courses of therapy are done, is $300 to $500 (for adults); $450 to $800 for chil-dren,” she said. “Thousands can be saved on medical expenses, not to mention the much higher quality of life that comes with fewer sick days, more energy and less risk for otherwise high-risk individuals.”
From Russia, With LoveSalt rooms are popping up across U.S., using haloaerosol therapy for the treatment and prevention of respiratory diseases
Dr. Alina V. Chervinskava
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Louisiana Medical News SEPTEMBER 2014 • 13
In the News
Kellner Joins Lafayette General’s Neuroscience Center
LAFAYETTE – Lafayette General Health welcomes a new neurologist to its staff. Virginia Kellner, M.D., is joining neurologists David Weir, M.D., Damon Patterson, M.D., and Adam Foreman, M.D., at the Neuroscience Center of Acadiana.
Dr. Kellner is return-ing to Acadiana from St. Louis, Missouri, where she completed her fellowship and residency. Dr. Kellner treats a variety of neurologi-cal conditions, including migraines, epi-lepsy, neuropathy and more. Her offi ce is located in Suite 202 at 136 Hospital Drive, across from Lafayette General Medical Center.
Dr. Kellner earned her Doctor of Medicine from Louisiana State University School of Medicine in New Orleans. She previously graduated magna cum laude while obtaining her Bachelor of Science degree from Vanderbilt University. The previous Lafayette High School valedic-torian completed her residency at Wash-ington University’s Barnes Jewish Hospi-tal and her fellowship at Saint Louis Uni-versity Hospital in St. Louis, MO.
Board certifi ed with the American Board of Psychiatry and Neurology, she is a member of the American Academy of Neurology and the American Medical Association.
LGH Welcomes Internal Medicine Physician
LAFAYETTE – Lafayette General Health is pleased to announce that An-gela Ducote Snow, M.D., has joined Lafayette Gen-eral’s Internal Medicine Physicians and the prac-tice of Michael Alexander, M.D., Bradley Chastant II, M.D, and Juan Perez-Ruiz, M.D. She is now taking appointments at her new offi ce located in the Grant Molett Medi-cal Arts Center at the corner of S. Col-lege Road and Heymann Blvd. To make an appointment with Dr. Snow, call (337) 289-8717.
Dr. Snow is a well-established physi-cian in the community, having worked in Lafayette since 2007. She manages both acute and chronic medical conditions, performs routine maintenance exams, preventive screenings and vaccinations, and offers referrals.
A graduate of the LSU School of Medicine in New Orleans, Dr. Snow earned her Doctor of Medicine degree in 2004. She earned her Bachelor of Sci-ence in Psychology from Tulane Univer-sity in New Orleans. Her residency and internship were completed at Baylor College of Medicine’s Department of In-ternal Medicine in Houston, TX.
Prior to practicing internal medicine in Lafayette, she was a research data co-ordinator at Ochsner Cancer Institute
and a research assistant at St. Charles General Hospital in New Orleans.
Dr. Snow has a Louisiana State Medical License and is a board-certifi ed diplomat with the American Board of In-ternal Medicine. She is a member of the American College of Physicians, Ameri-can Medical Association, Lafayette Par-ish Medical Society and the Louisiana State Medical Society.
Memorial Welcomes Clifford Courville, MD
LAKE CHARLES- Memorial Medical Group welcomes Clifford Courville, MD, a fellowship-trained pulm-onologist. He will join Drs. Robert Broussard, Manley Jordan, Gary Kohler and Ben Thompson on the staff of Pulmonary Associ-ates of Southwest Louisi-ana, located at 2770 3rd Avenue, Suite 110 in Lake Charles.
Dr. Courville received his bach-elors of science degree from Louisiana State University A&M, where he gradu-ated with a 4.0 grade point average. He then graduated from the LSU School of Medicine in New Orleans, where he received many awards for his outstand-ing performance, including the John B. Bobear Pulmonary Award, the ACP In-ternal Medicine Award of Excellence and the Richard M. Padison, MD Award for Physician’s Physician. Dr. Courville then
headed east to the University of Alabam-aat Birminghamto complete his internal medicine internship and residency, as well as his fellowship in pulmonology. While there, he once again received sev-eral awards including Best Teaching In-tern and Best Teaching Resident.
A member of the American College of Chest Physicians and the American Thoracic Society, Dr. Courville diagno-ses and treats a variety of diseases and conditions of the chest including COPD, pneumonia, asthma, emphysema and other pulmonary and respiratory condi-tions.
LHA Welcomes New Policy Analyst Mike Thompson
BATON ROUGE- On Aug. 1, Mike Thompson joined the Louisiana Hospital Association as Healthcare Policy Analyst. Mike is well known in hospital advocacy circles as the former Health Legislative Assistant and Deputy Press Secretary for Congressman Charles Boustany, Jr., MD. Mike brings over ten years of experience working in D.C. for House and Senate members. In his previous role, Mike has been heavily involved in LHA efforts re-lated to VA claims issues and will be con-tinuing that involvement in his role here. Mike holds an undergraduate degree from LSU, a MS from UL-Lafayette, and a graduate certifi cate from George Wash-ington University.
Dr. Virginia Kellner
Dr. Angela Ducote Snow
Dr. Clifford Courville
14 • SEPTEMBER 2014 Louisiana Medical News
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Charles R. Bowie, M.D. Joins The NeuroMedical Center
BATON ROUGE- The NeuroMedical Center is pleased to announce the asso-ciation of Charles R. Bow-ie, M.D., in the practice of neurosurgery. Dr. Bowie is a native of Eunice, Louisi-ana. He attended Louisi-ana State University and received his medical de-gree from Louisiana State University Medical Center in Shreveport. Dr. Bowie completed Neurosurgery residency at the Univer-sity of Miami Miller School of Medicine - Jackson Memorial Hospital, in Miami. Following residency, Dr. Bowie under-went fellowship training in Endovascular Neurosurgery/Neurointerventional Ra-diology. Dr. Bowie is board eligible in neurosurgery and has special interest in cerebral vascular conditions, stroke, cra-nial and spinal tumors, and degenerative disorders of the spine. The NeuroMedi-cal Center is located 10101 Park Rowe Avenue, in Baton Rouge.
Our Lady of the Lake Earns Top-Level Accreditation as Bariatric Center
BATON ROUGE – Our Lady of the Lake Regional Medical Center has re-ceived full accreditation as a compre-hensive bariatric facility by the new Met-abolic and Bariatric Surgery Accredita-tion and Quality Improvement Program (MBSAQIP).
MBSAQIP accreditation signifi es that Our Lady of the Lake has demon-strated a commitment to delivering the highest quality of care for bariatric sur-gery patients. To earn accreditation, the hospital met the essential criteria that ensure its ability to support a safe bariatric surgical care program and mea-sure up to the institutional performance requirements outlined by the accredita-tion standards.
The MBSAQIP is a joint program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. The program accredits inpatient and outpatient bariatric sur-gery centers that have undergone an in-dependent and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards.
According to the CDC, more than one-third (or 78.6 million) of adults in the United States are obese. Obesity is as-sociated with illnesses that range from diabetes and heart disease to certain types of cancers. Bariatric surgeries have been shown to reduce obesity, improve mortality and decrease the health risks from chronic diseases.
LSUHSC’S Fontham Appointed to NCI Research Evaluation Board
NEW ORLEANS– Dr. Francis Col-lins, Director of the National Institutes of Health, has appointed Elizabeth T. H. Fontham, MPH, DrPH, Founding Dean
and Emeritus Professor at the LSU Health New Orleans School of Public Health, to the Board of Scientifi c Counselors for Clinical Sciences and Epidemiology of the National Cancer Institute. Dr. Fon-tham will serve a fi ve-year term.
According to the National Cancer Institute, the Board of Scientifi c Coun-selors (BSC) evaluates the performance of intramural scientists and the quality of their research programs, which represent an integral part of the overall National Institutes of Health mission. The BSC serves as the only formally constituted group of outside scientists to review the National Cancer Institute’s entire intra-mural program in a systematic fashion and to provide advice to the Scientifi c Director. The NCI also requests the BSC’s ideas and suggestions about administra-tion of the NCI’s intramural program, al-location of resources (budget, space and personnel), specifi c projects including new areas of development and ways to encourage higher risk, high pay-off proj-ects.
Dr. Fontham has served on the LSU Health New Orleans faculty since 1980. She is a member of the Louisiana Cancer Research Consortium, serves as Senior Consultant Epidemiologist to the Loui-siana Offi ce of Public Health, and was recently named a Senior Research Fel-low of the International Prevention Re-search Institute in Lyon France. Dr. Fon-tham’s major area of research is cancer epidemiology, with a particular interest in tobacco, as well as nutrition-related cancers and gastric carcinogenesis. Dr. Fontham was a member of the national Board of Directors of the American Can-cer Society from 2001-2010 and served as President in 2009.
Andrea Brown, MD, FAAFP, Joins Baton Rouge General Physicians
BATON ROUGE- Andrea Brown, MD, FAAFP, has joined Baton Rouge General Physicians. Dr. Brown is board certifi ed in family medicine and has more than 15 years of experience. She earned her medical degree from Louisiana State Univer-sity School of Medicine in New Orleans and com-pleted her residency training at Baton Rouge General Medical Center’s Fam-ily Medicine Residency Program. She is a Fellow of the American Academy of Family Physicians and a member of the Louisiana Academy of Family Physicians. Her offi ce is located at 23845 Church Street in Plaquemine.
Two New Providers Join Louisiana Heart Medical Group
LACOMBE- The Louisiana Heart Hospital (LHH) announced that it com-pleted agreements for clinical integra-tion with Family Practitioner Devan Szcz-epanski, M.D. and Preventive Cardiolo-
gist Umesh A. Patel, M.D., F.A.C.C. These agree-ments represent another important step in the growth of the Louisiana Heart Hospital integrated delivery system.
“We are thrilled to add such talented physi-cians as Dr. Szczepanski and Dr. Patel to our grow-ing healthcare team,” said Steve Blades, CEO of the Louisiana Heart Medi-cal Group and Senior Vice President for Physician Services for Cardiovascular Care Group (CCG), the parent company of LHH.
Dr. Szczepanski has practiced since 2011 and is Certifi ed by the American Board of Family Medicine. She received a Master of Science in Psychology from Louisiana State University Graduate Col-lege and her medical doctorate from Louisiana State University School of Medicine in New Orleans. She com-pleted her residency in Family Medicine at LSU Health Sciences Center in Lafay-ette. She is a member of the American Medical Association, the Louisiana State Medical Society, the American Board of Family Physicians, and the American Academy of Family Physicians.
Dr. Patel has practiced on the North-shore since 1990 and is Board certifi ed in Internal Medicine and Cardiovascular Diseases. He is also licensed in Nuclear Cardiology. He received his medical doctorate from University of London and completed his internship at London University Medical. Patel performed his Internal Medicine Residency and his Car-diology Fellowship at Tulane University Medical School. He is an American Col-lege of Cardiology Fellow and is a mem-ber of the American Heart Association, the American Stroke Association, the American Society of Echocardiography, and the American Society of Nuclear Cardiology.
Graham Named LHA Chair-Elect
BATON ROUGE- Larry Graham, President and CEO of the Lake Charles Memorial Health System, has been named Chair-Elect of the Louisiana Hos-pital Association (LHA). Members of the LHA announced their 2014-2015 Board of Trustee Offi cers at their annual busi-ness meeting on July 21.
Graham served as Treasurer on the 2013-2014 LHA Board of Trustees. He joined Lake Charles Memorial as chief executive offi cer on Dec. 1, 2006 with more than 32 years of experience in healthcare administration. He is a Fellow of the American College Executives.
Established in 1926, the Louisiana Hospital Association is a non-profi t or-ganization representing more than 140 hospitals and healthcare provider groups across the state. The mission of the LHA is to support its members through advo-cacy, education and services.
Dr. Charles R. Bowie
Dr. Andrea Brown
Dr. Devan Szczepanski
Dr. Umesh A. Patel
Louisiana Medical News SEPTEMBER 2014 • 15
In the News
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Tri Parish Rehabilitation Hospital Opens Deridder Campus
DERIDDER- Maxim Management Group announced that Tri Parish Reha-bilitation Hospital recently opened a new campus inside of acute care Beauregard Memorial Hospital in DeRidder. The new campus, located on the third fl oor of Beauregard Memorial Hospital, adds 16 beds. Currently, Tri Parish Rehabilitation Hospital is a 20-bed freestanding, inpa-tient rehabilitation hospital located in Rosepine, La. The expansion with Reha-bilitation Hospital of Beauregard will allow them to serve more than 700 patients a year requiring physical rehabilitation inpa-tient services. Maxim Management Group will be holding a grand opening celebra-tion on Tuesday, September 9 from 11 a.m. to 1 p.m. The event is open to the public and will offer refreshments and a ribbon cutting.
“We are excited to be expanding our services to DeRidder,” said Mark J. Harris, chief executive offi cer of Maxim Manage-ment Group. “This expansion allows us to provide our services to more people in the community; it provides an opportunity for rehabilitation to those who may be trav-eling to other rehab hospitals. With this new campus, patients are also able to continue their care with local physicians in the DeRidder community.”
The 10,000 plus square-foot, half-mil-lion-dollar renovated campus is located on the third fl oor of Beauregard Memorial Hospital. In addition to 16 beds located in private and semi-private rooms with pri-vate showers, the facility has a large din-ing area, therapy gyms and an impressive nurse station.
“The third fl oor area had been used primarily for administrative offi ces.” said Harris. “It is now a state-of-the-art facility.”
The part-time and full-time inter-disciplinary staff of 80 hires will be led by Dr. Jenness D. Courtney III, Tri Parish Rehabilitation Director. Like the location in Rosepine, the Rehabilitation Hospital of Beauregard’s staff will provide physi-cal, occupational, speech and respiratory therapy to patients, as well as rehabilita-tive nursing and social services. As part of their care, patients will receive a minimum of three hours of intensive therapy per day, fi ve days a week, and 24/7 nursing care.
Louisiana Patient’s Compensation Fund Board Re-elects Cossé as Chair
BATON ROUGE - At its July 10 meet-ing, the Louisiana Patient’s Compensation Fund (LPCF) Oversight Board re-elected Clark Cossé, LHA’s chief governmental offi cer and general counsel, as chair for the eighth consecutive one-year term. Cossé represents hospitals on the LPCF Board, which oversees the payment of large medical malpractice claims against private physicians, hospitals and other healthcare providers. During his tenure, the LPCF has constitutionally protected its funds from appropriation or sweeping by the legislature and governor, increased its ability to invest and improved its return on its reserves.