PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER What Does UnitedHealth’s Latest Move on Hysterectomies Mean? Nation’s largest health insurer stiffens rules on hysterectomy coverage UnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterectomy coverage. ... 4 Benefitting Central Mississippi CHS forms Merit Health; improved service, operational efficiencies anticipated; CMMC executive shake- up and patient dumping allegations discussed Since Community Health Systems (NYSE: CHS) completed the acquisition of Health Management Associate (NYSE: HMA) hospitals last January, the company has quietly made changes to the Mississippi facilities, more publicly in the last few ... 5 April 2015 >> $5 PROUDLY SERVING THE MAGNOLIA STATE Aurora Wong, MD PAGE 3 PHYSICIAN SPOTLIGHT ONLINE: MISSISSIPPI MEDICAL NEWS.COM Three Generations Overlap Medical Practice Clarksdale physician keeps steady pace at 80 Rural Hospitals Adopting Survival Strategies Q&A with MHA’s Mendal Kemp BY LUCY SCHULTZE Between more stringent standards and shrink- ing reimbursements, the small, locally owned hos- pital may soon make the endangered species list. Still, don’t discount rural hospitals’ ability to adapt and survive. That’s the message of an administrator who knows well Mississippi’s collection of critical access hospitals and other small hospitals under 50 beds. As director of the Mississippi Hospital Association’s Center for Rural Health, Mendal Kemp provides support for 40 such institutions across the state, with goals like aiding their strategic planning and performance improvement. A bill being considered by the 2015 session of the Mississippi Legislature stands to give them a much-needed boost, through a grant program that would help small hospitals improve their services and make capital improvements. House Bill 114, sponsored by Rep. Sam C. Mims V (R- McComb), passed the House in February. It would provide $10 million per year with grants capped at $500,000 per hospital. Meanwhile, strategies like partnering with bigger systems, diversifying services and tapping telemedicine resources are helping small hospitals survive in the era of big medicine. What are some of the main challenges you’re working on now on behalf of rural hospitals? “Our division works to improve the quality of services, and we have a lot of quality measures that we’re working on. “Studies show, both nationally and here in Mississippi, that the (CONTINUED ON PAGE 8) BY LUCY SCHULTZE As a physician, it’s one thing to be able to compare practice notes with a parent or spouse who’s also in the medical field. But for Oxford pediatrician James Edward “Trey” Warrington III, MD, the experience of caring for Missis- sippi patients is one he shares today with not only his fa- ther, but his grandfather, too. “It’s an honor for me to carry on my family’s name in medicine,” said Warrington, whose father, James Edward Warrington Jr., DO, and grandfather, James Edward (CONTINUED ON PAGE 8) Increase web traffic Powerful branding opportunity Any metro market in the U.S. Preferred, certified brand-safe networks only Retargeting, landing pages, SEM services available [email protected]GUARANTEED CLICK-THROUGHS Get verified results (impressions and/or clicks) for (LOCAL) online advertising. Mendal Kemp L-R:Trey Warrington, MD, his grandfather, James Edward Warrington Sr., MD, and father, James Edward Warrington Jr., DO.
Transcript
PRSRT STDU.S.POSTAGE
PAIDFRANKLIN, TN
PERMIT NO.357
ON ROUNDS
PRINTED ON RECYCLED PAPER
What Does UnitedHealth’s Latest Move on Hysterectomies Mean?Nation’s largest health insurer stiffens rules on hysterectomy coverageUnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterectomy coverage. ... 4
Benefi tting Central MississippiCHS forms Merit Health; improved service, operational effi ciencies anticipated; CMMC executive shake-up and patient dumping allegations discussed Since Community Health Systems (NYSE: CHS) completed the acquisition of Health Management Associate (NYSE: HMA) hospitals last January, the company has quietly made changes to the Mississippi facilities, more publicly in the last few ... 5
April 2015 >> $5
PROUDLY SERVING THE MAGNOLIA STATE
Aurora Wong, MD
PAGE 3
PHYSICIAN SPOTLIGHT
ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM
Three Generations Overlap Medical PracticeClarksdale physician keeps steady pace at 80
Rural Hospitals Adopting Survival StrategiesQ&A with MHA’s Mendal Kemp
By LUCy SCHULTZE
Between more stringent standards and shrink-ing reimbursements, the small, locally owned hos-pital may soon make the endangered species list. Still, don’t discount rural hospitals’ ability to adapt and survive.
That’s the message of an administrator who knows well Mississippi’s collection of critical access hospitals and other small hospitals under 50 beds. As director of the Mississippi Hospital Association’s Center for Rural Health, Mendal Kemp provides support for 40 such institutions across the state, with goals like aiding their strategic planning and performance improvement.
A bill being considered by the 2015 session of the Mississippi Legislature stands to give them a much-needed boost, through a grant program that would help small hospitals improve their
services and make capital improvements. House Bill 114, sponsored by Rep. Sam C. Mims V (R-McComb), passed the House in February. It would provide $10 million per year with grants capped at $500,000 per hospital.
Meanwhile, strategies like partnering with bigger systems, diversifying services and tapping telemedicine resources are helping small hospitals survive in the era of big medicine.
What are some of the main challenges you’re working on now on behalf of rural hospitals?
“Our division works to improve the quality of services, and we have a lot of quality measures that we’re working on.
“Studies show, both nationally and here in Mississippi, that the (CONTINUED ON PAGE 8)
By LUCy SCHULTZE
As a physician, it’s one thing to be able to compare practice notes with a parent or spouse who’s also in the medical fi eld.
But for Oxford pediatrician James Edward “Trey” Warrington III, MD, the experience of caring for Missis-sippi patients is one he shares today with not only his fa-ther, but his grandfather, too.
“It’s an honor for me to carry on my family’s name in medicine,” said Warrington, whose father, James Edward Warrington Jr., DO, and grandfather, James Edward
(CONTINUED ON PAGE 8)
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Mendal Kemp
L-R:Trey Warrington, MD, his grandfather, James Edward Warrington Sr., MD, and father, James Edward Warrington Jr., DO.
2 > APRIL 2015 m i s s i s s i p p i m e d i c a l n e w s . c o m
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By LUCy SCHULTZE
From a hospital management per-spective, shifting the time when lab techs come in to take patients’ blood samples from 4 a.m. to 8 a.m. can be a relatively simple change.
But of course, when you’re the one trying to catch up on sleep so your body can heal, it makes a dramatic difference.
“There are so many ways we can im-prove patients’ rehabilitation experience that don’t even cost money,” said Aurora Wong, MD, who’s maintaining a patient-centered approach as medical director of North Mississippi Medical Center’s 28-bed Rehabilitation Institute.
“When you come to a hospital, it’s dreary. They strip off your clothes and put in an IV,” she said. “In our unit, there are windows everywhere so that the sunshine can come in. We try not to disturb people while they’re sleeping. And we let them wear their own clothes, so they can feel like a human being again.”
Between simple adjustments and sig-nifi cant investments, Wong sees a host of opportunities to provide a more positive environment to help patients get back on their feet.
She is continuing in the path laid by the institute’s former director, Brian Con-dit, MD, who departed in December to take an administrative post for a hospital system in Virginia. Wong who worked under Condit as staff physiatrist for a year looked to him as a mentor – then was surprised to fi nd herself suddenly being tapped to fi ll his shoes.
“My life has really changed,” she said. “The fi rst couple of weeks were bumpy, with a lot of meetings and a lot of people wanting to meet me. There’s hesitancy whenever there’s change.
“But since then, we have really come together – the therapists, nurses, social workers and case managers – to really ramp up this unit. We are at full capacity and things are good.”
Wong came to Tupelo from Ken-tucky’s coal-mining country, where she spent three years as medical director for
a 22-bed rehabilitation unit in the small town of Hazard. The experience honed her abilities shaping a unit around pa-tients’ needs and achieving success despite limited resources.
When NMMC reached out to her with an opportunity to move south, she absorbed the differences between the two situations as she weighed her choice.
“I couldn’t believe the amount of re-sources here, compared to my experience in Kentucky,” she said. “This is a huge 650-bed hospital, with a large medical community and a lot of support. But ul-timately, it was the people who won me over. I’ve never experienced so many peo-ple being so genuinely friendly.”
Wong relocated in January 2014 with her family, which includes husband Tim Wong, a former fi nance executive; and their daughter Evey, now 2.
“We considered positions in Boston, Vancouver, Washington and Colorado, but opted not to move to a big city,” she said. “I felt like they’re the kind of places where they work you like a dog and don’t appreciate your effort. Here, you can work hard and have the support you need to build a program that’s great.”
Wong’s work ethic is among the lega-cies of her Chinese heritage. Her great-grandfather immigrated to Jamaica from Hong Kong more than 100 years ago to fi nd work. His family ultimately estab-lished a small bakery in Montego Bay, where Wong was raised.
Her three sisters pursued careers in law, banking and computer engineering, while Wong followed her desire so help others to a career in medicine.
“My parents worked really hard to put me through medical school,” she said. “The philosophy in our home was to be as strong as possible and as independent as possible.”
Wong completed undergraduate studies at the University of Toronto before returning to the Caribbean to attend St. George’s University School of Medicine in Grenada, West Indies. She was initially focused on pursuing a career in surgery – until a two-year residency at St. Francis Medical Center in Trenton, N.J., con-vinced her surgery wasn’t for her.
She discovered the fi eld of physical medicine and rehabilitation, fi nding it a much better fi t for her personality. She spent a three-year residency in PM&R at Tuft’s Medical Center in Boston, with the third year as chief resident. In her train-ing, she specialized in the management of stroke, traumatic brain injury, poly-trauma, spinal cord injury, multiple scle-rosis, amputee and oncology patient care.
At NMMC, Wong brings to the Re-habilitation Institute not only her expe-rience and training, but also her Asian sensibilities about the importance of a ho-listic approach in treatment.
“Rehabilitation is not just about ad-dressing someone’s physical challenges,” she said. “A lot of times people have men-tal barriers to overcome as well, such as depression. Our focus on making sure people are well-rested, eating right and spending their days in a positive environ-ment makes our program different from most rehabilitation units in the South.”
Among the ways the program is evolving under Wong’s leadership has been the addition of healthier options for patient meals; there’s at least a grilled-chicken option alongside fried chicken now. She also wants patients to have a choice of green tea or chamomile tea over coffee. Opportunities for healing activities like meditation, tai chi and yoga are on her agenda as well.
Meanwhile, the unit is enjoying a recent renovation that upgraded patient spaces with private rooms and bathrooms. A new dining area gives patients the psy-chological boost of sharing meals together. It overlooks a new courtyard with a gar-den and patio area that will be completed this spring and used for activities and downtime.
While nice facilities make a differ-ence, Wong’s experience in Kentucky taught her that even very inexpensive ap-proaches can positively affect patient out-comes.
“Positivity heals,” she said. “Even little things like encouraging people to bring in pictures of their loved ones and put them up in their room helps inspire them to get better.”
Aurora Wong, MDPhysicianSpotlight
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UnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterec-tomy coverage.
Even though the insurer’s plan to impose tighter restrictions on the use of the morcellator has garnered the most attention – many hospitals ceased using the laparoscopic surgical device after the FDA reported in April 2014 the fast-spinning blade can actually spread uterine sarcoma in some women un-dergoing hysterectomies – the squeeze is also being felt on the performance of hysterectomies in general.
UnitedHealth (NYSE: UNH), the insurer of 40 million patients based in Minneapolis, Minn., now requires spe-cifi c authorization before most types of hysterectomies are performed. Only vaginal hysterectomies – the least inva-sive and inexpensive option – done on an outpatient basis are exempt. The policy doesn’t affect hysterectomies performed in cancer treatment. Approximately half a million hysterectomies are performed annually in the United States.
Before UnitedHealth announced its policy decision, Anthem was the only major commercial insurer requiring pre-authorization for hysterectomies. Cigna and Aetna haven’t indicated they will follow suit. An Aetna spokesperson said the decision is “best left up to the physician and patient based on clinical circumstances,” a position also adopted by the American College of Obstetri-
cians and Gynecologists (ACOG). Days after UnitedHealth’s an-
nouncement, ACOG members buzzed about the issue at an ACOG national leadership conference.
“It’s been good fod-der for discussion, though we’re taking it very seri-ously,” said Ravi Johar, MD, an OB/GYN from St. Louis, Mo., past president of the St. Louis Metropolitan Medical Society. “For UnitedHealth to reverse course, no one knows exactly what it means.”
Johar, council chair of the Missouri State Medical Association, said OB/GYNs are certainly accustomed to the pre-certifi cation process.
“We’ll do what we’ve always done,” he said. “We’ll discuss with patients all of the options and go from there. The decision is between the patient and physician. My job is to provide the best medical care possible. How that affects them fi nancially is a big impact, but it’s not my area of expertise.”
UnitedHealth is a good weathervane in the post Affordable Care Act era, with its combination of market power, community support, and access to exceptional data, said Jay Wolfson, DrPH, JD, Distinguished Professor of Public Health, Medicine and Pharmacy at the University of South Flor-ida (USF) Morsani College of Medicine.
“In this case in particular, it’s impor-tant to recognize that UnitedHealth, over the past couple of years, has been the most aggressive of the health insurers in tight-ening up their markets,” he said. “They
began eliminating a lot of physicians and hospitals from their panels in many com-munities.”
For example, said Wolfson, cancer and children’s hospitals were removed from UnitedHealth’s list of risk providers, based on the argument of cost being sig-nifi cantly higher at those healthcare facili-ties than others.
“Procedures in hospitals like MD An-derson, Sloan Kettering and Moffi tt may cost 50 percent more than non-specialty, community facilities,” he said. “That’s to be expected because they’re teaching hos-pitals.”
Wolfson also pointed out that Unit-edHealth acquired Optum, a healthcare technology firm established in 2010, which he considers one of the “best staffed analytic division of third parties.”
“Optum focuses on quality, outcome and cost-effective analyses of United’s (and other available) databases” said Wolf-son. “Their research translates into what, to whom and how much United will pay.”
That influence has infiltrated the healthcare industry in many ways. In Jan-uary 2013, while outsourcing work with Optum before bringing the fi rm in-house, UnitedHealth Group’s Center for Health Reform and Modernization proposed the use of predictive modeling software, par-ticularly in Medicare and Medicaid pro-grams, as tools for care management and information security as a possible solution to both healthcare fraud and preventable hospitalizations.
“As part of the ACA, they’ll continue to drill down and drive down costs and utilization and attempt to be as directive
as they can to their patients, physicians, hospitals … to optimize cost, utilization and safety while also reducing liability,” said Wolfson.
Some hospital systems are adopting a tough stance against UnitedHealth’s cull-ing process and policy changes they view as unfavorable.
“Three years ago, BayCare (Health System, Tampa Bay’s dominant non-profi t hospital chain), went up against UnitedHealth over reimbursement is-sues,” noted Wolfson. “Unlike most stand-offs, there was no last minute negotiation and 450,000 members in Tampa Bay had to change hospitals and physicians be-cause BayCare stood its ground against this healthcare delivery powerhouse.”
Wolfson also sees a trend of separate policy issues, in part led by UnitedHealth, that are shaking up the medical device manufacturing industry and the pharma-ceutical sector.
“Until recently, pharmaceutical companies have had a tremendous infl u-ence in medical schools and communities concerning what medications physicians prescribe,” he said. “Now some medical schools across the country like ours have gone ‘drug-free’ and no longer allow phar-maceutical reps to teach in our classrooms or offer ‘educational’ program lunches.”
The same cycle holds true for manu-facturers of medical devices, Wolfson said.
“The device manufacturing industry has also heavily affected medical prac-tice,” he said. “Their signifi cant infl uence is waning.”
In response to UnitedHealth’s pol-icy change on hysterectomies, medical schools will place a stronger emphasis on technical skills to perform vaginal hyster-ectomies.
“We’ve developed a generation of surgeons who don’t know how to do vagi-nal surgery, quite frankly,” said Neil Fin-kler, MD, an OB/GYN in Orlando and CMO at Florida Hospital Orlando.
“So many physicians stopped using vaginal hysterectomies and it’s not being taught very much,” Wolfson added. “Our younger medical students don’t have the skills. It’s easier to use a device, which generates more revenue and becomes a standard. Most clinicians interviewed say it’s safer, less complications, but it’s not done because it’s just not being done. That’ll change.”
What Does UnitedHealth’s Latest Move on Hysterectomies Mean?Nation’s largest health insurer stiffens rules on hysterectomy coverage
Dr. Jay Wolfson
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Since Community Health Systems (NYSE: CHS) completed the acquisition of Health Management Associate (NYSE: HMA) hospitals last January, the company has quietly made changes to the Mississippi facilities, more publicly in the last few months.
On Jan. 28, CHS spun off six affiliated hospitals in the Jackson/Vicksburg region and 36 affiliate clinic locations to form Merit Health, a singular regional health-care system.
The member hospitals, representing more than 1,200 licensed beds, 3,300 em-ployees and 1,800 physicians on medical staff, are Central Mississippi Medical Cen-ter (CMMC) in Jackson, River Oaks Hos-pital and Woman’s Hospital in Flowood, Crossgates River Oaks Hospital in Bran-don, Madison River Oaks Medical Center in Canton and River Region Health Sys-tem in Vicksburg.
By joining forces, CHS said Merit Health hospitals will have the scale to ex-pand and upgrade services, while also im-proving operational efficiencies.
New signage has already popped up to reflect Merit Health preceding hospital names. In late February, Merit Health an-
nounced the opening of The Joint Center at River Oaks in Flowood and River Re-gion in Vicksburg, signaling a first of its strong consolidation initiatives.
However, looming darkly, CMMC, a Level 3 state trauma center, has come under scrutiny regarding a federal investi-gation for alleged “patient dumping,” that also included an executive shakeup. Last year, The Clarion-Ledger reported the for-profit hospital in south Jackson repeatedly transferred emergency patients paid by the state to treat, possibly violating state hospi-tal regulations and federal law.
Mississippi Medical News recently spoke about the group’s new business direction with Tobey Houston, vice president of net-work development for Merit Health.
CHS has formed Merit Health to consolidate the metro Jackson/Vicksburg hospitals. Could you share anticipated improvements, how they will be achieved, and other expected changes?
Merit Health affiliates have worked together for some time to coordinate clini-cal and administrative strategies and best practices in areas like patient safety, clini-cal protocols and information technology.
Our new structure creates opportunities to expand services in primary care, medical and surgical sub-specialties, and it’ll help us leverage our size to recruit new physi-cians to the Jackson market. We’re more closely coordinating and standardizing the management of our facilities to help us op-erate more efficiently, avoid duplication and further develop the services our hos-pitals provide.
Why did CHS form Merit
Health? Is this part of a company strategy that perhaps we haven’t seen locally?
Merit Health hospitals have had a long-term working relationship with one another. The creation of the Merit Health network helps create a more sustainable operating structure for our hospitals.
Please address executive
changes and allegations of patient dumping at CMMC.
Lisa Dolan is serving as interim CEO of Merit Health Central CEO, following the resignation of Charlotte Dupre. Sepa-rately, Merit Health Central’s CFO Scott Whittemore accepted a position at the University of Mississippi Medical Center
(UMMC) in Grenada and Lexington to move closer to his hometown and family.
Our physicians and employees are dedicated to creating the best possible outcomes, safe environments for care and satisfying experiences for our patients. All Merit Health hospitals are committed to providing emergent care to patients and closely adhering to laws regulating emer-gency services. The decision to transfer pa-tients is based on the level of care needed and the hospital’s ability and capacity to care for them.
What other hierarchal changes
are expected locally? Merit Health hospital leadership have
developed collegial relationships across the network after years of working together, creating a strong foundation for continued collaboration between our facilities. We continue the search for someone who is the right fit for our community and patients to fill the role of network CEO and look for-ward to making other network leadership announcements soon.
Does CHS plan to expand the
number of resident slots/internships
Benefitting Central MississippiCHS forms Merit Health; improved service, operational efficiencies anticipated; CMMC executive shake-up and patient dumping allegations discussed
(CONTINUED ON PAGE 8)
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With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states ei-ther allowing for or considering decrimi-nalization and/or medical use of the drug, the great marijuana debate has become a legislative hot topic over the last three years. For Stuart Gitlow, MD, MPH, DFAPA, however, talk of medical benefits associated with inhaling the plant is just smoke and mirrors.
Gitlow, who con-cludes his term as presi-dent of the American Society of Addiction Medicine this month, said there are two major issues with the drug … addiction and toxicity. The double board-certified psychiatrist, who has a private practice in Rhode Island, is concerned by the possi-bility of adding marijuana to the mix of alcohol and tobacco as yet another sub-stance with the potential to do more harm than good.
The DrugMarijuana refers to the dried leaves,
flowers, stems and seeds from the hemp plant Cannabis sativa, which contains
the mind-altering chemical delta-9-tet-rahydrocannabinol (THC), along with other compounds. The National Institute on Drug Abuse (NIDA) has found mari-juana to be the most common illicit drug in America and one for which usage is on the rise. The national organization stated marijuana’s popularity, particularly since 2007, has coincided with a diminishing public perception of the drug’s risks.
However, at the same time risk per-ception has been declining, the drug’s potency has actually been on the rise. In looking at the amount of THC in mari-juana samples confiscated by the police, the THC concentration averaged close to 15 percent in 2012 as compared to around 4 percent in the 1980s, according to the NIDA fact sheet on marijuana.
Gitlow agreed, saying, “The mari-juana that is available today is much different, much more potent, than the marijuana that was available in the ‘60s. More research needs to be done to see if there are even more long-term issues with this more potent form.”
AddictionGitlow noted marijuana works like
any other addictive drug. “There’s not debate at all within the medical commu-nity that it’s addictive … that’s a given,” he said. “It’s like any other psychoactive
drug … it’s not addictive to the majority of those using it once or twice.” However, he continued, “There’s no way of knowing if a person is going to have a problem with the drug until they try it … and then they are playing Russian roulette.”
Gitlow explained, “Addictive disease is not about the drug, it’s about a brain ab-normality. It exists before somebody picks up the drug.” The three factors required for addiction, he said, are a genetic ab-normality, environmental trigger and the drug. “Addictive disease is in only, give or take, 15 percent of the population.”
He added popular consensus is that about 9 percent of adults and 17 percent of adolescents who use marijuana become addicted. In addition, NIDA’s marijuana fact sheet noted addiction rates jump in daily users, with as many as 25-50 percent becoming addicted.
Toxicity“There’s a second issue with mari-
juana, and it’s independent of addiction. Marijuana has toxic ramifications,” Git-low said. “Marijuana makes you stupid,” he stated bluntly. “It lowers IQ. It causes slowing of the processing speed. It causes abnormalities of attention and focus. It ba-sically dumbs you down, and it does that more or less universally.”
When marijuana is smoked, the THC passes quickly from the lungs into the bloodstream and to the brain. THC targets cannabinoid receptors, which have a higher density in areas of the brain that influence pleasure, memory, concentra-tion, coordination, thinking and time per-ception. Additionally, THC’s chemical makeup is similar to a naturally occurring brain chemical called anandamide. That similar structure lets THC be ‘recognized’ by the brain, allowing the outside com-pound to alter normal brain communica-tion.
Of major concern is the affect mari-juana has on brain development when used heavily among adolescents. A recent study showed marijuana users who began in adolescence had fewer connections in the areas of the brain that control memory and learning. A large, long-term New Zea-land study found those who began heavily smoking marijuana in their teens lost an average of eight IQ points between ages 13 and 38. However, that impact on IQ wasn’t replicated in the study among those who didn’t begin smoking until adulthood.
NIDA also cited issues with cardiopul-monary and mental health. Gitlow said, “There’s a five-fold increase in psychotic disorders among those who use marijuana as compared to those who don’t.”
Alcohol vs. Tobacco, Marijuana
Last month, results of a new study stating marijuana is 114 times less lethal than alcohol made the media rounds and became fodder for late night comics. Git-low said comparing the two is like com-
paring apples and oranges. “They affect different parts of the brain,” he said.
Gitlow also noted it is possible to in-gest enough alcohol in one sitting to kill you, which isn’t really true of marijuana or tobacco. “So I could make the argument that cigarettes are safer than alcohol,” he said. However, there aren’t many physi-cians recommending a patient give up the occasional glass of wine and take up smok-ing tobacco instead.
“We’re not prohibitionists,” Gitlow continued. “No one at the American So-ciety of Addiction Medicine says alcohol should be banned, but all these drugs col-lectively are an enormous burden on the American public from an economic and health-related standpoint.”
Considering the dangers of tobacco and alcohol, Gitlow said he couldn’t fathom why, as a country, we would want to add marijuana to the mix. “Why would we want to make our burden worse?” he questioned.
Possible BenefitsGitlow reiterated his frustration at
claims of marijuana being a medical mar-vel. “There is no medical purpose. No one has ever proven through a double-blinded trial a medical benefit of marijuana.” He continued, “That’s not to say there aren’t components within the plant that might not have medical application.”
However, Gitlow said breaking down the more than 100 components in mari-juana would require scientific investiga-tion just like any other drug in this country seeking approval from the Food and Drug Administration. He added marijuana lob-byists bringing anecdotal evidence to legis-lators interested in the bottom line doesn’t constitute a thorough research endeavor.
NIDA’s viewpoint is similar, noting that so far clinical evidence does not show the therapeutic benefits of marijuana out-weigh the health risk. In it’s assessment of the drug, the national organization stated, “To be considered a legitimate medicine by the FDA, a substance must have well-defined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. As the marijuana plant contains hundreds of chemical com-pounds that may have different effects and that vary from plant to plant, and because the plant is typically ingested via smoking, its use as a medicine is difficult to evaluate.
“However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant – such as cannabidiol, a non-psychoactive cannabinoid compound that is being studied for its effects at treat-ing pain, pediatric epilepsy, and other dis-orders.”
With the increased attention being given to marijuana around the country, it’s a safe assumption that opponents and proponents will continue the debate.
Marijuana, Medicine & AddictionA conversation with ASAM President Dr. Stuart Gitlow
Dr. Stuart Gitlow
m i s s i s s i p p i m e d i c a l n e w s . c o m APRIL 2015 > 7
www.bcbsms.comBlue Cross & Blue Shield of Mississippi, A Mutual Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.
By JULIE PARKER
It’s not sexy, but it’s certainly impor-tant.
The Notebook, that is, a new stan-dards “cleaning product” directory so completely new across the entire acute care spectrum that no one has touched it.
“If it was easy to do, it’d have been done,” said Stephen Sawyer, di-rector of healthcare stra-tegic sourcing for CBRE | Global Corporate Ser-vices in Charlotte, NC.
Sawyer, who previ-ously worked in a group purchasing organization, has voluntarily undertaken the tedious task of assembling a compendium of cleaning product in-formation for healthcare administrators, with information ranging from the listing of chemicals used in cleaning products to the infectious diseases germs killed by an-tibacterial lotions.
“The healthcare industry could learn a lot from the hospitality sector,” said Sawyer, noting that hotel chains like Mar-riott set the standard for homogenous
janitorial supplies. “As hospitals merge and acquire physician practices, it would benefit them to follow this standardiza-tion trend. Like a hotel, hospitals can and should condense their manufacturer supply base to one brand. Standards by definition reducing waste and hard cost.” Sawyer, who suffered from asthma and allergies as a child, was recently in a cough-riddled waiting room of an urgent care clinic when he asked the administra-tor which germs their antibacterial lotion killed.
“Administrators and clinicians are so busy, it’s one of the last things they might think about,” said Sawyer. “Know-ing the particulars of varying manufac-tured products is a task that gets buried with higher priority patient care and ad-ministrative processing tasks. If they do have or know information, it’s typically piecemeal because that information isn’t commonly shared with its venue of use. I consider this product directory a sup-port mechanism – an important com-ponent of the educational toolbox – to hand out to patients and anyone in a medical office that needs or wants to know how these products will affect them.” To complete this arduous task, Sawyer
partnered with various manufacturers in five janitorial industries. “I haven’t had one manufacturer tell me they already have this information handy,” he noted.
To facilitate manufacturer responses, Sawyer provided questionnaires that made it easy for them to fit their solutions into the mold or wireframe.
“For example, can liners more com-monly known as trash bags, and other products are categorized in multiple ways, such as soaps and lotions, house-keeping and floor care chemicals and related products, and paper towels, tis-sues and dispensers,” he said. “The Note-book will eliminate inconsistencies of products, service cleaning and pricing.” At press time, Sawyer was near completion of the soup-to-nuts “cleaning program” compendium that CRBE will gladly share with healthcare clientele at no charge. As products are added, deleted or changed to the skeleton directory, he’ll provide instan-taneous updates.
“We’re not expecting accolades for compiling this information,” said Saw-yer. “Packaging this important type of information was simply the right thing to do. When the next epidemic comes, with healthcare providers having instant access
to this specific data, we’ll be better pre-pared to deal with it and therefore miti-gate the damage.”
Sawyer, who specializes in healthcare brand identity, said the information will also boost the patient experience, which represents one of the top three priorities of healthcare leaders over the next three years, according to new research by The Beryl Institute, a global company focus-ing on patient experience improvement.
“Creating consistency while capital-izing on economies of scale should be a core proponent of a system’s strategy,” he said. “Identifying solutions that assist in delivering a uniform brand while chal-lenging suppliers to create new visual and budgetary business models will produce a competitive advantage and best-in-class outcomes.”
Creating standards that can be repli-cated from location to location will deliver the outcomes that enhance the patient ex-perience, Sawyer pointed out.
“Leveraging the expertise and knowl-edge available,” he said, “will eliminate waste and reduce cost while promoting the brand and allowing healthcare lead-ers to keep their eye on delivering superior patient care.”
Compiling ‘The Notebook’ A free comprehensive standards ‘cleaning product’ directory is near completion for the healthcare industry
Stephen Sawyer
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critical access hospitals render the same quality of care – and in some cases better care – than the urban hospitals do. But we’re working toward new quality mea-sures, because these hospitals will soon be going to a value-based reimbursement sys-tem, which will penalize you if you don’t meet certain quality measures.
“These hospitals can’t stand any addi-tional cuts, so we’re working hard to try to improve their services. We’re getting there, with some hospitals already reporting this data. It’s really going to take hospitals being good at everything – particularly readmis-sions within 30 days.
“These hospitals are working to be in full compliance with all the requirements. They see the writing on the wall. Most of them will survive, and some probably won’t.”
How much are rural hospitals’ challenges helped when they are absorbed into a bigger system?
“The pros are quite numerous, because of the resources that the large hospitals have. Even things like their personnel poli-cies can be shared. And, for example, the University of Mississippi Medical Center owns the hospital in Lexington and sends physicians up there to staff specialty clinics. That community wouldn’t have specialty services if they didn’t do that.
“It’s hard for these hospitals to stay in-dependent. We’re seeing that about half of them have already joined a system, as with Baptist Health Systems’ recent acquisition
of Leake County’s hospital. In that case, the local leaders were smart when they put out their request for proposals several years ago, in that they required the buyer to build a new hospital in three years. Baptist agreed, and now that facility is open.
“The downside, of course, is losing some local control. But I think in recruiting physicians and nurses and staff, the small, independent hospitals are just at a real dis-advantage.”
How are small hospitals adjusting their services?
“They can’t be all things to all people, and they can’t provide specialty services like surgery a lot of times. It’s difficult, because the expectation is for a hospital to be there seven days a week, 24 hours a day, with staff ready to take care of almost anything, because you can’t turn anyone down. The expectations are really high, and these com-munities are trying to meet that challenge by providing adequate services.
“At the same time, some hospitals are seeing: ‘Well, maybe we don’t need inpa-tient care.’ They may be averaging only two or three patients a day. So, like the hospital in Kilmichael recently, they decide to end inpatient service. Others are saying, ‘Well, we could just adjust our hours and become a rural health clinic.’ They’re doing com-munity needs assessments all around, trying to find out exactly what services have been offered that aren’t really needed so that they can concentrate on services that are needed.
“Telemedicine is also changing the
way these hospitals provide services. For example, in 17 of our small, rural hospitals, there are telemergency rooms tied into the university. There are certified ER physi-cians who work with these nurse practitio-ners to take care of the patient, so that the patient doesn’t have to travel for that care.”
How well do you think the broader medical community understands rural hospitals?
“The world of rural hospitals is kind of misunderstood sometimes. Being big does not always mean being better. In sat-isfaction surveys, patients say they want to be in a smaller environment for certain situations. The people in those local com-munities know the staff. The care is more personalized.
“I think that small rural hospitals ought to get another look. Some people are really not even aware of the services that they ren-der. Patients will drive to Tupelo or Mem-phis to get lab work done, when really they can have it done at their local hospitals. Physical therapy is another service that pa-tients often don’t realize is offered in their own communities.
“And for physicians, nurses and other health professionals, they should be aware that even though the volume of patients isn’t the same as in bigger cities, they can get a lot of satisfaction from living and serving in rural areas. These hospitals are getting on board with electronic health records. A lot of them have MRIs and highly specialized equipment. They deserve another look.”
Rural Hospitals Adopting Survival Strategies, continued from page 1
Warrington Sr., MD, both practice family medicine in the Delta.
“It’s a lot to live up to, but I think sharing a name with my father and grand-father is part of my drive for wanting to be a better doctor,” the youngest Warrington said. “I want to maintain the legacy that they’ve both worked so hard to establish.”
As the eldest Warrington continues to practice at age 80, the family is achieving a rarity in medicine: Three generations of physicians practicing at the same time.
Warrington Sr. began his career in the early 1960s, finishing at the University of Mississippi School of Medicine in 1959. He completed his training through the U.S. Navy, with an internship at the U.S. Naval Hospital in San Diego, Calif., and residency at the U.S. Naval Aerospace Medical Institute in Pensacola, Fla.
In the decades since then, he has served the patients of the Mississippi Delta with a legendary devotion and rare work ethic.
“The practice of medicine is my life,” said Warrington Sr. “Some of my patients have been with me for 45 or 50 years. I love them, and they love me.”
Still keeping a pace that his son and grandson regard with awe, Warrington Sr.’s practice and facility holdings stretch across four counties. He is based in Clarks-dale, where he sees patients in his medical office, but lives in Marks, where he and Richard Waller, MD, took over Quitman County Hospital in 1983. His holdings also include nursing homes in Marks and Tunica.
During the first era of his career, from the mid-1960s to mid-80s, Warrington Sr. was based in Shelby and made his clinic available to patients 24/7. He cut back to more realistic hours when he moved his practice to Clarksdale in 1985.
Today, the Clarksdale clinic still sees an average of 75 patients each day, with services like x-ray, EKG and most lab tests performed in-house. Warrington Sr.’s day starts at 4 a.m. to provide time for hospi-tal rounds before he arrives at the clinic at 7:15. The clinic closes when the last pa-tient has been seen.
Additionally, Warrington Sr. takes backup call in the emergency room at Quitman County Hospital every other night and every other weekend. Taking occasional Friday afternoons off has been a recent concession.
“I do have full days,” he admits. “But I really do enjoy it – and I guess I’ll con-tinue for as long as I do.”
Working alongside him for some 40 years has been his sister, Sheila Ryals, a physician’s assistant who manages the clinic.
In the late 1980s to early 1990s, War-rington Sr. was also joined in practice by his son. James Edward Warrington Jr., DO, finished at the Nova Southeastern University College of Osteopathic Medi-cine in Ft. Lauderdale, Fla., in 1985 and spent the first decade of his practice work-ing alongside his father.
“You won’t find anybody more
dedicated than my father,” Warrington Jr. said. “He’ll take care of anybody and everybody; it doesn’t matter if they have money or not.”
Striking out on his own, Warrington Jr. spent the next decade of his practice at Cleveland Medical Clinic before joining the staff of North Sunflower Medical Cen-ter in Ruleville. There, he serves as medi-cal director for the NSMC’s wound care clinic and provides an outpatient practice at the NSMC Clinic. He also serves as medical director for two nursing homes in Cleveland and Greenwood.
“I’ve moved around a lot, so it feels good to have patients who’ve followed me from Shelby to Cleveland to Ruleville,” Warrington Jr. said. “You realize how much people depend on you. And it’s amazing to think I’m now seeing the children of the people I started treating years ago.”
Warrington Jr. also sees patients who’ve been treated by his father – or even delivered by him, since the senior Warrington’s practice included obstet-rics until the mid-80s. Patients have also started to connect him with his son.
“I’m proud of Trey,” Warrington Jr. said. “I get compliments about him all the way from Oxford.”
For Warrington III, following in his father’s and grandfather’s footsteps was a natural decision.
“I never really considered doing any-thing else,” he said. “I felt like that’s just what we did as a family, because every-
body was in the medical field.”From his perspective, that legacy
also included his mother, a nurse; and his great-uncle, Paul Warrington, MD, of Cleveland. On a similar track, his younger brother, Zachary, holds a PharmD degree from the University of Tennessee Health Science Center and works in compound-ing for the North Sunflower Medical Cen-ter pharmacy.
During his youth, Warrington III was always impressed by the way people would approach his father and grandfather when they were outside the clinic setting.
“Living in a small town, people would always want to walk up and talk to ‘Dr. Warrington,’ and they always seemed to enjoy the interaction,” he said.
Likewise, patients from the Missis-sippi Delta often recognized the name when he saw them for treatment while completing his training at the UT Health Science Center in Memphis.
“I’ve seen how my father and grand-father really have played a big part in a lot of people’s lives,” Warrington III said.
“Patients will always tell me about how they never felt rushed through a visit with my grandfather. They feel like he’s there for them and spends as much time with them as they needed.
“Even if he’s only in the room for five or 10 minutes, they feel like they’ve gotten his undivided attention. That’s something I strive to emulate.”
Three Generations Overlap Medical Practice, continued from page 1
available within Merit Health and/or work closer with UMMC with Dr. Lou Ann Woodard at the helm?
Merit Health continuously looks for ways we can develop relationships with organizations in our community that align with our work to increase access to health services and quality patient care. We’ve enjoyed our relationship with UMMC and look forward to working with Dr. Wood-ard in her new role. As the development of our network continues to evolve, we’re excited about the opportunities that may exist between us and other organizations in the Jackson community.
What else would you like
the medical community to know about CHS and Merit Health that would affect our state’s physician workforce and healthcare leaders?
This is an exciting time for Merit Health hospitals as we formalize the col-laboration that’s existed in our market for years. We’re committed to enhancing the quality care, access to services and op-erational excellence of the facilities in our network. We’re also actively recruiting new physicians who can expand existing services and offer new specialties to the Jackson area, and growing our relation-ships with other physician groups who are already providing care to our community.
Benefitting,continued from page 5
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N E E D A G I F T
S H E W I L L
L O V E ?H E R S O U T H . C O M
stdom.com
Skilled Hands . Compassionate Hearts .
The Rane Center 971 Lakeland Drive, Suite 401
Jackson, MS 39216601-939-4230
www.theranecenter.com
St. Dominic’S iS PleaSeD to Welcome
Erin Murphy, M.D. to the meDical Staff.
Dr. Erin Murphy graduated from Georgetown University Medical School in 2005. Her training in general surgery was at the University of Texas Southwestern Medical Center, after which she did a research fellowship at Stanford University. She completed her vascular surgery training at the University of Pennsylvania and was appointed to the faculty of Columbia University Medical Center in New York. Dr. Murphy has authored over 50 medical journal articles, book chapters and editorials.
Dr. Murphy has now joined Dr. Seshadri Raju at the Rane Center in Jackson, specializing in venous and lymphatic diseases. Techniques developed at the Rane Center have substantially influenced the way venous disease is treated today.
Patients increasingly want to access online services to enhance convenience and communication with providers, ac-cording to a recent national survey con-ducted by TechnologyAdvice Research. Yet, the majority of respondents in the “2015 Trends in Patient Engagement” survey said a number of digital solutions that would be helpful are not offered by their primary care practices.
“Only 19 percent said their physician offered online appointment scheduling,” noted Cameron Graham, survey author and managing editor for TechnologyAd-vice, a company that conducts research and analysis of IT products in a number of industries including healthcare. “Only 17 percent said their physician offered on-line bill pay.”
In addition to scheduling and pay-ment functions, Graham said view-ing test results or diagnoses online also ranked high among survey participants. However, only 27.8 percent said their physician provided that option. Graham pointed out all three of the most desired digital services are fundamental patient portal features. With that in mind, he continued, “There’s a big discrepancy between what patients report having ac-cess to and the EHR adoption rate among physicians.”
Graham said electronic health re-cord adoption rates are in the “high 70s, low 80s” by office-based physicians in the United States. “A lot of those systems should have online appointment and bill pay capabilities,” he said, adding some of the older systems might not have those options but virtually all newer products offer robust patient portal resources.
“I think one of the big takeaways is that the patients don’t seem to be aware of the tools their physicians probably have,” he said. The other option, Gra-ham continued, is that offices have these capabilities but are not using them. Either answer could spell trouble for practices.
“When we asked how important these services were when people were choosing a physician, 60.8 percent said it was ‘important’ or ‘somewhat impor-tant,’’ Graham said. “If physicians are offering these in-demand digital services, a more proactive approach to promot-ing them is needed and could create an advantage in attracting and retaining pa-tients.”
Graham added he also believes phy-sicians need to more fully embrace digital services. “Patients value them a lot. Physi-
cians think of them as an extra or add-on.” With meaningful use require-ments staged to increase health information ex-change and promote patient engagement, Graham noted the effec-tive use of patient portals could help practices hit the necessary benchmarks to access in-centives.
However, he noted, there probably won’t be a ‘one size fits all’ solution when it comes to patient engagement. “We did find age played a role in which services patients wanted their physicians to offer,” he said. Not surprisingly, the demand was much higher by younger adults than in the senior population. “Among the 25- to 34-year-old demographic, almost 40 per-cent said they would like to have a smart phone app for scheduling appointments; but among the 65 and older demo-graphic, only 3.8 percent said that would be something they’d want.”
Similarly, 35.3 percent of patients ages 25-34 would like for their physician practice to offer secure messaging outside of office hours compared to just 11.5 per-cent of those ages 65 and older. Of the six digital services listed on the survey (online appointment scheduling, smartphone app for scheduling, online test results/diagno-ses, online bill pay, secure messaging, and health resources/educational material), 23.5 percent of those ages 25-34 reported they didn’t want their physician to offer any of the services, while 44.2 percent of participants 65 and older had that same response.
Graham continued, “I think it’s important for physicians to be aware of what these different demographic groups
want.” He added such information could help providers tailor their message ac-cordingly when discussing the different ways patients could access the practice and engage with providers.
Another disconnect highlighted by the survey was provider follow-up. While 68.6 percent of respondents said it was either ‘very important’ or ‘somewhat im-portant’ that a physician follow up with them, only 30 percent reported receiv-ing any follow-up from the practice that wasn’t tied to bill pay. “They’re very good about following up related to money,” Graham pointed out, but patients want more than that. In addition to building rapport with a patient, Graham said digi-tal communication offers an easy way to make sure instructions were understood and are being followed, check on medi-cation adherence, share prevention tips, and remind patients about the need to schedule routine screenings and services.
The “Trends in Patient Engage-ment” survey included responses from more than 400 adults across the United States regarding their digital experience at primary care practices. The survey was conducted Jan. 5-7, 2015. A download of the survey whitepaper is available at tech-nologyadvice.com/research.
TechnologyAdvice, which is head-quartered in Brentwood, Tenn., offers free, neutral research and analysis of IT products to connect businesses with tech-nology options that best address each company’s specific needs. The company works with businesses and practices look-ing for the right software for just a few people up to large enterprises in need of solutions for thousands and has assisted Apple, Oracle and HP in selecting new technology. Last year, TechnologyAdvice was named to the top half of the Inc. 5000 list of America’s fastest-growing private companies.
Survey Says … A Digital Disconnect Exists Between Patients, Practices
Cameron Graham
REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: [email protected] for information.
10 > APRIL 2015 m i s s i s s i p p i m e d i c a l n e w s . c o m
NMMC Announces MIS Leaders
North Mississippi Medical Center’s Management Information Services de-partment has recently been restructured with new leadership roles.
Slayton Austria, who was named as vice president and chief information of-ficer in September 2014, has restructured and added to the MIS management team to improve customer service.
Donny Wiggins has been named director of Business Systems Opera-tions and will oversee op-erations for financial man-agement systems, supply chain, business intelli-gence and development.
Wiggins has more than 20 years of health care information technol-ogy experience. He received his bache-lor’s degree from Arkansas State Univer-sity in 1990 and a master’s degree from the University of Phoenix in 2007.
He spent his early career working as a programmer, analyst and manager. For 10 years he worked at St. Jude Chil-dren’s Research Hospital, the last five as the Deputy Chief Information Officer. He previously served as vice president of software development at Sedgwick-CMS, and most recently worked as se-nior director of financial applications for a health care management company.
Rachael Hill has been named direc-tor of Clinical Systems Operations and will oversee operations for ambulatory, ancillary, hos-pital systems and clinical applications support. Hill has held various positions, including cardiology nurse and continuing education coordinator, during her 24-year tenure at NMMC. The past 17 years have been in clinical information systems.
Hill earned an associate’s degree in nursing from Itawamba Community Col-lege in 1992 and a bachelor’s degree in nursing from Mississippi University for Women in 1994.
Greg Garvin has been named di-rector of Technical Operations and will oversee operations for customer service, cable in-frastructure, network, tele-phony and system admin-istration. He has 26 years’ experience in computer science with four years in programming, seven years in computer systems administra-tion and 15 years in system administra-tion management.
Garvin began his career as an Intel-ligence Analyst in the United States Navy stationed at Fort Meade, Md., working in the National Security Agency. After an honorable discharge, he began working for the City of Memphis as a computer programmer. He joined the NMMC staff 23 years ago, serving various roles in Management Information Services. He holds a bachelor’s degree from the Uni-versity of the State of New York.
Online Event Calendar
To submit or view local events visit the Mississippi
President Chris FerrellChief Financial Officer Ed Tearman
Executive Vice President Of Digital And Support Services Blair Johnson
Director Of Financial Planning And Analysis Carla Simon
Vice President Of Human Resources Ed WoodVice President of Content Curt Cordes
Vice President Of Production Operations Curt Pordes
Group Publisher Eric NorwoodChief Revenue Officer Dave Carter
Director Of Digital Sales & Marketing David WalkerController Todd Patton
Creative Director Heather Pierce
By JULIE PARKER
Successful completion of a full week of end-to-end testing of the new ICD-10 coding shows the healthcare industry is ready for the next step toward total conversion from ICD-9 coding, Mari-lyn Tavenner, former administrator of the Centers for Medicare and Medicaid Services (CMS) said before her departure from the federal agency earlier this year.
To promote the healthcare indus-try’s smooth transition from ICD-9 to ICD-10, CMS is conducting a compre-hensive program of testing. In the first full week of testing -- from Jan. 26 to Feb. 3 – CMS received nearly 15,000 test claims from 660 providers.
“Testing allows us to identify areas of improvement, and we’ll work with out-side entities and stakeholders to improve those very small deficiencies identified,” she said at the time. “And we’ll continue to do testing, especially in those areas we identify as needing improvement.” Tavenner added, “Because ICD codes are required on medical bills, we want healthcare providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.”
CMS also identified a point that’s prompted some confusion among the healthcare community. Acting Adminis-trator Andy Slavic has reiterated ICD-9 coding is to be used for services provided before the Oct. 1 deadline; ICD-10 cod-ing will be used for services provided on or after Oct. 1. Prior to Oct. 1, ICD-10 can be used only for test purposes. How-ever, once we hit Oct. 1, 2015 only ICD-10 can be used for services rendered on or after that date. But claims submitted after Oct. 1, 2015, for services provided before that date, must still use ICD-9 codes.
Margie Maley, BSN, MS, coding educator and consultant with Karen-Zupko & Associates Inc., a national consulting firm based in Chicago, said she’s strongly advising clients that bill directly to Medicare to apply for end-to-end testing.
“If you don’t get accepted for end-to-end testing, at the very least conduct acknowledge-ment testing,” she said, noting that applications for the next available end-to-end testing (mid-July) became available on all carrier websites (MACs) on March 13.
“Medicare is only accepting up to 850 providers per testing week, so act fast,” urged Maley. “Even our or-
thopedic clients who must deal with the greatest increase in ICD-10 codes and reorganization have jumped onto the testing bandwagon successfully.”
Maley pointed out that claims test-ing highlights more than ICD-10 issues.
“Medicare says that 6 percent of testing errors were due to ICD-10,” she emphasized. “Yet more than twice that – 13 percent – were due to provider-preventable errors, such as incorrect NPI or submitter ID, or invalid place of ser-vice or HCPCS codes.”
Carrier software bugs are also being caught in the testing phase.
“A lot of this is just the nature of software development … not necessarily a coding issue,” Maley said. “Everyone is creating new features to deal with ICD-10 and they need to be tested so bugs are caught and fixed before the dead-line. So make sure your practice is part of the testing process. You never know what you might learn about your own processes.”
CMS is clearly ready for ICD-10, emphasized federal officials.
“And thanks to our many partners — spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups — the healthcare community at large will be ready for ICD-10 on Oct. 1,” Tavenner promised before stepping down. “I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of healthcare for all Americans.”
For healthcare providers unable to complete the necessary systems changes to submit claims with ICD-10 codes by Oct. 1, CMS has provided free billing software via MAC websites.
This billing software has been up-dated to support ICD-10 codes to offer submitters an ICD-10 compliant claims submission form; coding assistance isn’t provided. Alternatively, all MACs web-sites provide internet portals; a subset of those portals offer claims submission.
Gearing up for ICD-10 CMS confirms Oct. 1 switch; healthcare consultant offers cautionary notes
Margie Maley
GrandRounds
Donny Wiggins
Rachel Hill
Greg Garvin
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GrandRoundsBaptist Health Systems Announces Employee Additions and Certifications
Wendy Polk, APR, has joined Bap-tist Health Systems in Jackson, Miss. as Director of Corporate Communications. She holds a Bachelor of Sci-ence degree from the University of Southern Mississippi and a Master of Science in Communi-cation from Mississippi College. For almost 25 years, she has worked in the field of communications in the Jackson area. She previously served as the Director of Marketing and Communications for River Oaks Healthcare and as a Strate-gic PR Manager at GodwinGroup.
Amanda McGruder, MBA, RRT-NPS, has joined Baptist Health Systems in Jackson, Miss. as the Director of Respira-tory Care. She has 18 years of respiratory care experi-ence. McGruder was pre-viously an account execu-tive for Draeger Medical Inc. and had served as a respiratory therapist at Baptist in the past. McGruder holds a Master of Business Administration, Bachelor of Science in Business Administration and a Minor in Health Care Management from Kaplan University. She received her respiratory therapy degree from Hinds Community College and received certification as a Neonatal Pediatric Specialist.
Baptist Physical Therapist Mary Austin and Baptist Occupational Thera-pist Lisa Hodges have become Certi-fied Ergonomics Assessment Specialist (CEAS).
This certification pro-vides training in OSHA-compliant ergonomics analysis applicable in in-dustry, healthcare and of-fice workplace. Ergonom-ics assessments help to identify potential hazards that contribute to the development of musculoskeletal disorders. It provides implementation of cost-effective, high-impact solutions for prevention of work-place injury.
As a certified ergonomic assess-ment specialist, one can be instrumen-tal in delivering practical solutions for risk reduction and increased employee productivity.
Lift System Reducing Nursing Injuries
Methodist Rehabilitation Center has reduced nursing injuries by more than 80 percent since it began installing a 132-unit, ceiling-mounted lift system in 2010.
The number of injuries dropped from 54 in 2009 to 10 by 2013 accord-ing to Marcia King, Methodist Rehab’s director of education and process im-provement.
Methodist Rehab treats patients with stroke, brain and spinal cord in-juries, so staff has long faced the chal-lenge of moving people who have pa-
ralysis, crippling muscle stiffness and other disabling conditions.
But recent trends had converged to make the job even tougher. The state’s rising obesity rate meant patients were heavier than ever at a time when a fail-ing economy was keeping older nursing personnel in the work force.
Susie Haseloff, Methodist Rehab’s employee health nurse said they were seeing increased injuries from handling patients.
A hospital committee began re-searching the problem in 2009, focusing first on safe-lifting policies, staff education and the use of equipment. While mem-bers were impressed with the success of ceiling-mounted lifts being used at Veter-an’s Administration hospitals, they initially thought the system would be deemed too expensive—the proposed132 units would cost $759,000 to install.
But Methodist Rehab’s administra-tion decided to make the investment, believing it would benefit employee and patient welfare and eventually pay for itself.
Haseloff said the lifts have already helped reduce Worker’s Compensation and employee replacement costs from $233,761 in 2009 to $2,097 in 2013. The hospital expects to recoup its initial in-vestment by the end of this year.
All patient rooms at Methodist Re-hab’s main campus feature the ceiling lifts, including those currently being renovated for the reopening of MRC’s third floor this fall.
The first Methodist Rehab facility to get the lifts installed was Method-ist Specialty Care Center in Flowood, Mississippi’s first residential care facil-ity designed especially for the younger, severely disabled person. All 60 rooms have lifts, and King said they’ve been well received by patients and staff.
Mississippi Surgical Center Obtains Accreditation from AAAHC
Mississippi Surgical Center in Hinds County is pleased to announce that it was recently accredited by the Accredi-tation Association for Ambulatory Health Care, Inc [AAAHC]. Mississippi Surgical Center has been a service provider since 1987 for General and Plastic Surgery, Otolaryngology, Pain Management, Or-thopedics, Opthamology, Opthalmic Plastics, Obstetrics / Gynecology.
Surgical Care Affiliates partners with physicians, health systems and pay-ers to develop and implement surgical services strategies across the country. As of September 30, 2014, SCA oper-ated 182 surgical facilities – including ambulatory surgery centers, surgical hospitals and one sleep center – in part-nership with approximately 2,000 phy-sicians and in affiliation with 41 health systems. SCA’s clinical systems, service line growth strategies, benchmarking processes, and efficiency programs cre-ate measurable advantage for surgical facilities – clinically, operationally and fi-nancially. For more information on SCA and Mississippi Surgical Center, visit www.mssurgicalcenter.com.
Wendy Polk
Amanda McGruder
Mary Austin
American College of Cardiology Mississippi Chapter Recognized for Excellence
The Mississippi Chapter of the American College of Cardiology has been rec-ognized with a James Dove Chapter Award for excellence in data, information and knowledge, and transformation of care. The chapter was one of five chapters hon-ored this year during the Col-lege’s annual chapter awards program, which recognizes excellence in chapters’ efforts in honor and memory of ACC Past President James Dove, M.D., MACC.
Mississippi Chapter Presi-dent William “Bo” Calhoun, M.D., FACC, accepted the award on behalf of the chap-ter, which was honored for having a statewide STEMI and stroke network linked to the ACC’s National Cardiovascu-lar Data Registries. In Mississippi, every emergency room has a designated percuta-neous coronary intervention facility where they can transfer heart disease patients. Each site is required to participate in NCDR, which tracks the quality of the network and each facility. Registry data has shown that the system has helped to reduce the number of heart disease related deaths in the state.
The College founded the chapter system in 1986 to further its mission through supporting the cardiology community at a local level. The James Dove Chapter Awards Program showcases the achievements of Chapters by highlighting accom-plishments and continuing the legacy of Dr. Dove whose passion was to challenge the College and its members to always strive to continually improve practices, envi-ronments, patient care and the profession, no matter the challenges.
Winners of this year’s awards were chosen based on the state of the state reports submitted by chapters each fall that highlighted accomplishments and opportuni-ties. Kentucky, Missouri, Puerto Rico and Virginia were also recognized for accom-plishments over the past year.
Improving Accuracy for Measuring BP in Obese PatientsRecent Middle Tennessee School of Anesthesia graduate Mindy Mullins, DNAP,
CRNA, received the inaugural President’s Medal for her innovative capstone project that focused on improving the accuracy of blood pressure measurement for obese patients.
Mullins, who works as a CRNA at Bap-tist Memorial Hospital – North Mississippi in Oxford, said the idea stemmed from her experience working in her hospital’s Bariat-ric Center of Excellence. “We care for a high percentage of individuals who are obese. The simple task of blood pressure measure-ment is difficult at times,” she said.
Due to the extra weight impacting the upper arm’s shape and size that causes poor blood pressure cuff fitting, Mullins said it is common to place the cuff on the fore-arm. “Either the cuff doesn’t wrap properly around the upper arm, or it extends below the antecubital fossa,” she noted. “Because CRNAs rely on the blood pressure measurement to assess a patient’s hemodynamic sta-tus and anesthetic depth perioperatively, I became curious. Is the blood pressure mea-surement from the alternate approach valid?”
For her capstone project, Mullins reviewed 42 studies and honed in on an additional 15 studies dating from 1956-2013 focused on upper arm vs. forearm noninvasive blood pressure measurement and found concerns about accurate readings are warranted. Her research uncovered:
The findings of extant evidence and manufacturers of oscillometric monitoring de-vices discourage a forearm approach in obtaining blood pressure measurements.
The quality of evidence strongly warrants further investigation of the approach in obtaining valid measurements with unified measurement methods, data collection pro-cedures, and validated tools.
In the presence of numerous comorbidities or complex positioning with improper noninvasive blood pressure measurement technique, invasive monitoring should be considered in patients who are obese to avoid perioperative complications.
Mullins is now conducting a study to compare the accuracy of GE Critikon radial cuffs – a cuff validated for forearm blood pressure measurement – with the correct-sized upper arm cuff in obese individuals. Her study could potentially be the first to use a validated tool on the forearm versus a validated tool on the upper arm and impact best practices going forward.
MTSA Pres. Dr. Kenneth Schwab with Mindy Mullins.
Central Mississippi Medical Center is now Merit Health CentralMadison River Oaks Medical Center is now Merit Health MadisonCrossgates River Oaks Hospital is now Merit Health Rankin River Oaks Hospital is now Merit Health River OaksRiver Region Health System is now Merit Health River RegionWoman’s Hospital is now Merit Health Woman’s Hospital
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