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PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER Determining Fair Market Value of Physician Compensation Horne’s Matt Malone discusses ‘the devil in the details’ Hospitals are investing more in creating outpatient service departments to meet rising patient demand while simultaneously reducing inpatient surgical procedures and generating new revenue streams, said Matt Malone, CPA, a member of HORNE’s Health Care Valuation specializing in physician contracts ... 3 The Secret Suffering of Doctors Ophthalmologist pens book about the looming crisis in medicine, a remedy for burnout Missed family gatherings and soccer games, frustration with bureaucracy, dwindling self- worth and utter exhaustion often overshadow the initial call to heal others ... 5 January 2015 >> $5 PROUDLY SERVING THE MAGNOLIA STATE Robert McGuire, MD PAGE 2 PHYSICIAN SPOTLIGHT ONLINE: MISSISSIPPI MEDICAL NEWS.COM Maternal Fetal Medicine Program Fills Service Gap in North Miss. Relationship with region’s OB/GYNs key in Tupelo program’s success Medical Community Stands to Benefit from Economic Development Effort Mississippi Bio-Medical Business Collaboratory launches as communities seek to capitalize on incentives BY LUCY SCHULTZE Telehealth jobs and training opportunities are among ways the medical community stands to benefit from a new economic-develop- ment project in central Mississippi. The Mississippi Bio-Medical Business Collaboratory, which recently opened its doors in Canton, is already home to eight busi- nesses within its 60,000-square-foot facility. Among them are those that provide medical technology support, senior care, child therapy and medical education. As the spaces are being built out, the initial collection of busi- nesses will occupy only about half of the Collaboratory’s square foot- age, providing room for more businesses to join in the future. (CONTINUED ON PAGE 4) BY LUCY SCHULTZE A new program at North Mississippi Medical Center is improving and stream- lining care for women in high-risk pregnancies while allowing them to stay close to home. Now in its second year, NMMC’s Maternal Fetal Medicine (MFM) program sees patients either for a single consultation or ongoing care, while also connecting them with the right resources for postpartum needs. “When your newborn may require hospitalization, it takes a lot of fear out (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. The Mississippi Bio-Medical Business Collaboratory
Transcript
Page 1: Mississippi Medical News January 2015

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

ON ROUNDS

PRINTED ON RECYCLED PAPER

Determining Fair Market Value of Physician Compensation Horne’s Matt Malone discusses ‘the devil in the details’

Hospitals are investing more in creating outpatient service departments to meet rising patient demand while simultaneously reducing inpatient surgical procedures and generating new revenue streams, said Matt Malone, CPA, a member of HORNE’s Health Care Valuation specializing in physician contracts ... 3

The Secret Suffering of DoctorsOphthalmologist pens book about the looming crisis in medicine, a remedy for burnout

Missed family gatherings and soccer games, frustration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial call to heal others ... 5

January 2015 >> $5

PROUDLY SERVING THE MAGNOLIA STATE

Robert McGuire, MD

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM

Maternal Fetal Medicine Program Fills Service Gap in North Miss.Relationship with region’s OB/GYNs key in Tupelo program’s success

Medical Community Stands to Benefi t from Economic Development EffortMississippi Bio-Medical Business Collaboratory launches as communities seek to capitalize on incentives

By LUCy SCHULTZE

Telehealth jobs and training opportunities are among ways the medical community stands to benefi t from a new economic-develop-ment project in central Mississippi.

The Mississippi Bio-Medical Business Collaboratory, which recently opened its doors in Canton, is already home to eight busi-

nesses within its 60,000-square-foot facility. Among them are those that provide medical technology support, senior care, child therapy and medical education.

As the spaces are being built out, the initial collection of busi-nesses will occupy only about half of the Collaboratory’s square foot-age, providing room for more businesses to join in the future.

(CONTINUED ON PAGE 4)

By LUCy SCHULTZE

A new program at North Mississippi Medical Center is improving and stream-lining care for women in high-risk pregnancies while allowing them to stay close to home.

Now in its second year, NMMC’s Maternal Fetal Medicine (MFM) program sees patients either for a single consultation or ongoing care, while also connecting them with the right resources for postpartum needs.

“When your newborn may require hospitalization, it takes a lot of fear out (CONTINUED ON PAGE 8)

Increase web traffi c Powerful branding opportunity Any metro market in the U.S. Preferred, certifi ed brand-safe networks only Retargeting, landing pages, SEM services available

[email protected]

GUARANTEED CLICK-THROUGHSGet verifi ed results (impressions and/or clicks) for (LOCAL) online advertising.

The Mississippi Bio-Medical Business Collaboratory

Page 2: Mississippi Medical News January 2015

2 > JANUARY 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

By LUCy SCHULTZE

When Robert A. McGuire Jr., MD, was ready to begin his subspecialty train-ing in orthopedic surgery, his choice was handed to him like a military directive.

“I actually wanted to be a hand sur-geon,” said McGuire, the M. Beckett Howorth Professor and Chair in the De-partment of Orthopedic Surgery and Re-habilitation at the University of Mississippi Medical Center.

But as he fi nished his residency in the early 1980s, his chairman and command-ing offi cer at the Naval Medical Center in Portsmouth, Va., had different ideas about his direction.

“He said, ‘I already have a hand sur-geon. You can be the spine surgeon. Go fi nd a fellowship,’” McGuire recalled with a chuckle. “It turned out to be the best choice I could have made.”

After completing his service to the U.S. Navy in 1990, McGuire has gone on to lead a 25-year career at UMMC as a pacesetter in the fi eld of spine surgery and a pioneer in the development of new tech-niques and technologies. Most recently, he was elected to lead North America’s section of the international organization which promotes excellence in musculo-skeletal care.

“My hope is that, in the future, all of the treatments in our fi eld would be fully standardized,” he said. “The goal is, whether you’re injured in Russia or Co-lombia or Kuala Lumpur, you’ll receive the exact same treatment for a broken leg and be able to expect the same outcomes.”

McGuire’s three-year term as presi-dent of AO North America is set to begin in July at the AO Trustees’ meeting in Malaysia. He previously served as chair-

man of the board for AO Spine North America from 2006-09.

“I used that term to ramp up our re-search, so that we are now on the forefront with a lot of the cervical myelopathy stud-ies and clinical management of patients,” he said. “Many papers that were presented at that time are now the standard of care.”

The AO organization began 55 years ago with the goal of improving and stan-dardizing the treatment of musculoskel-etal injuries and degenerative conditions across several disciplines, McGuire said. Today, that network includes orthopedic surgeons, craniomaxillofacial surgeons, neurosurgeons, plastic surgeons and even veterinarians all over the world.

“We all speak the same language, be-cause of the classifi cation system that has been developed,” McGuire said. “If some-body in China says, ‘I have a Type A2

fracture of the spine,’ I know exactly what he’s talking about because of the interac-tion that we’ve had. The data we’ve gath-ered, we can now use as an educational platform to teach our residents to treat this particular fracture in a very standardized way and have the same outcomes.”

Along the way, the organization has connected surgeons like McGuire with de-signers of surgical instruments and devices to develop the tools they need.

“Spine care was in its infancy when I began,” he said. “We didn’t have a lot of the technology we have now. I’m thank-ful to have been part of this fi eld as it has matured, and to have had the chance to help design instrumentation and different techniques that are now mainstream.”

Among his efforts, McGuire worked with a Cleveland, Ohio-based company to design a screw system for reconstruct-ing the spinal column to treat deformities in adults, adapting a long-rod system he had seen used in Japan. He also took part in designing a system for cervical spine reconstruction using titanium cages and screw systems.

“Being part of the innovation of these things really makes you feel pretty good as you look back,” he said. “We did create some things that made it easier for other people to be able to manage these cases.

“I’ve been very fortunate to go all over the world over my career, and to hear people from different countries say, ‘I used that instrumentation. It made a lot of sense and the patients did well’ – that, to me, is the ultimate compliment.”

A native of Alabama, McGuire earned his undergraduate degree from Auburn University. He went on to the University of Alabama Birmingham School of Medicine through the Military

Health Professions Scholarship (MHPS) program.

McGuire completed his internship and residency in orthopedics at the Naval Medical Center, followed by a fellowship at the Spinal Cord Injury Unit/Adult Spine Surgery at the University of Miami School of Medicine. He also completed a fellowship in pediatric reconstruction and scoliosis at Miami Children’s Hospital.

McGuire served as co-director of spine surgery service in the orthopedic department at the Naval Medical Center before joining UMMC. In choosing the course of his post-military career, Mc-Guire considered a handful of institutions.

“This was in 1988, and the question I would always ask is, ‘What are your plans for the year 2000?’” McGuire re-called. “I’d been to Virginia, Florida and Alabama, and UMMC was the only place where the leadership actually had a plan. So I jumped at the chance to be part of a program that was on the move.”

From the time he joined UMMC in 1990, McGuire worked with H. Louis Harkey III, MD, now UMMC’s chair of neurosurgery, to offer a spine program that spanned the two specialties.

“Our program has always been a little bit unique, in that we’ve had that collabo-ration and cooperation,” McGuire said. “For 25 years, we’ve been able to main-tain that continued relationship, which has served the people of Mississippi quite well.”

That relationship has included in-teraction between the two groups of resi-dents, as well as having fellows who were shared between the two departments.

“A lot of people stayed to practice in Mississippi after they fi nished the pro-gram,” McGuire said. “I think the combi-nation has worked extremely well in being able to provide physicians to manage pa-tients throughout the state of Mississippi.”

Outside of his work, McGuire has en-joyed such hobbies as boat racing and fl y-ing hot-air balloons. Today, he is an avid cyclist and enjoys visiting mountain bike trails throughout Mississippi.

He and his wife, Nancy, have four grown children.

Robert McGuire, MDPhysicianSpotlight

Get the current online edition of Mississippi

Medical News delivered to your desktop.

mississippimedicalnews.com

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Page 3: Mississippi Medical News January 2015

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By JULIE SPEED

Hospitals are investing more in creat-ing outpatient service departments to meet rising patient demand while simultane-ously reducing inpatient surgical procedures and generating new rev-enue streams, said Matt Malone, CPA, a mem-ber of HORNE’s Health Care Valuation specializ-ing in physician contracts.

“The Stark law is implicated in post-acqui-sition employment arrangements because physician compensation is required to be consistent with fair market value (FMV),” said Malone, adding “the federal anti-kick-back statute is implicated because of the referral relationship between the newly-em-ployed physician and the hospital-employer. To mitigate compliance risk and document the determination of FMV physician com-pensation, most hospital internal processes and some third-party independent apprais-ers rely primarily on published survey data to assess the relative value of the physician’s service. Widely available physician com-pensation surveys assist with benchmarking

and evaluating compensation and provide a look at physician compensation and pro-duction in an array of metrics.”

Those surveys aren’t without their weaknesses, Malone said, and simple re-liance on compensation and production survey data to create a FMV compensation model often isn’t enough to derive FMV physician compensation.

An issue with physician compensation data, as reported in some of the market sur-veys, is self-reported information, including some portion of ancillary technical compo-nent profits, said Malone.

“Consider for example, a physician group practice that internally distributes profits from in-office ancillary services, such as imaging or clinical lab services, versus a hospital-controlled group that retains the billings and profits from the same services,” he explained. “In this example, physicians from the group practice would report higher compensation due to the ‘baked in’ ancillary profit, while physicians employed by the hospital-controlled group would re-port lower compensation.”

However, market surveys simply aver-age responses regardless of clear differences in the practices. Those differences create a challenge for administrators relying on mar-

ket data to determine compensation levels where no ancillary technical component profits are present, such as in direct hospital employment of physicians. The market data doesn’t self-adjust for this obvious discrep-ancy, nor does it provide information to help assess TC-free adjusted rates, said Malone.

However, he added, the market gravi-tates toward unadjusted survey numbers, as the hypothetical physician considering employment amongst other available alter-natives, generally wouldn’t be expected to ac-cept employment at adjusted, TC-free rates.

“Prudent practice indicates the use of multiple valuation approaches and methods in determining FMV physician compensa-tion, a practice that’s advantageous when considering the shortcomings pointed out by many thought leaders regarding the use of market data only,” Malone said. “In one such approach, the income approach, the valuator analyzes the historical and ex-pected financial statements. Adjustments to account for non-professional services … an-cillary income now retained by the hospital-employer outside the practice’s operations … are applied to reflect the true operation of the physician’s practice.”

Adjustments to arrive at the applicable basis of accounting, and also normalizing

adjustments to account for non-recurring or extraordinary items, are also applied to yield net professional economic earnings, which is the income the physician is able to generate from professional services and what’s used as the basis of compensation. A significant by-product in the application of the income approach is in recognizing spe-cific economic dynamics present within the practice and local market, including rates paid by payers specific to the local practice, said Malone. The application of multiple approaches culminates in the synthesis and reconciliation process, at which point all methods are assessed as more or less reliable based on such factors as reliability of data and pertinence to the subject arrangement.

“A position taken solely in reliance on surveys can be weakened by nature of the data,” he said. “A deeper dive to under-stand the survey data, coupled with the use of other approaches and methods, can help mitigate the risk of miscalculating FMV compensation.”

The income approach in particular adds additional credibility to the analysis when ex-ecuted correctly, said Malone, noting that experienced valuators can play a vital role by assisting hospitals in navigating the complex FMV physician compensation process.

Determining Fair Market Value of Physician Compensation Horne’s Matt Malone discusses ‘the devil in the details’

Matt Malone

Page 4: Mississippi Medical News January 2015

4 > JANUARY 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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Sparking a CauseAnnual fundraiser supports heart disease and stroke researchBY JULIE SPEED

The American Heart Association (AHA) will host the 37th annual fundraising gala on Jan. 30 at the Country Club of Jackson, beginning at 6:30 pm. Formerly known as Art for Heart, the Jackson Heart Ball is a headline winter philanthropic event for Metro Jackson.

“Through research funded by the American Heart Association, we’re making progress in treatment of heart disease,” said Shannon Warnock, co-chair of the 2015 Jackson Heart Ball.

“We now enjoy effective and well-tolerated cholesterol and blood-pressure treatments, better stents, heart catheterizations through the wrist, implantable defi brillators, mechanical hearts, heart valve replacement without open-heart surgery, ablation of heart rhythm disorders, and improved awareness of risk factors.”

The Jackson Heart Ball is a celebration of the community’s support of the lifesaving mission of the AHA, contributing over $6.3 million to the cause since its inception toward research and education programs in Mississippi and around the nation.

The event will feature silent, live and interactive art auctions, a seated dinner and live entertainment. The Richard Lee Miller Heart Saver Award, honoring a community member whose CPR intervention was life-saving, will be presented at the Jackson Heart Ball.

“The American Heart Association depends on the commitment of hundreds of volunteers in our community, and we’re thankful to the Miller family for supporting this initiative to honor the late Richard Lee Miller, whose devotion to his family, community and the Heart Ball was beyond measure,” said James Warnock, MD, co-chair of the Jackson Heart Ball, noting Miller’s widow is a sponsor of the gala.

Jackson Heart Ball sponsors are: BankPlus, Baptist Health Systems, Blue Cross & Blue Shield of Mississippi, Butler Snow LLP, Ergon, Gertrude C. Ford Foundation, St. Dominic Health Services, University Medical Center and Yates Construction.

VIP Jackson Magazine, Social South Magazine, Portico Jackson Magazine, Mississippi Aesthetic Magazine, Mississippi Attorney at Law Magazine and WJTV are media sponsors.

For more information about the 2015 Metro Jackson American Heart Association’s Heart Ball, contact (601) 321-1213 or www.heart.org/metrojacksonheartball.

“If doctors or nurses or healthcare-technology companies have business ideas that they want to explore or expand, we can help them get started,” said Tim Coursey, who has led the Collaboratory’s development as executive director of the Madison County Economic Devel-opment Authority.

The project captures the essence of Mississippi’s current focus on healthcare as an economic driver.

Gov. Phil Bryant has made the idea central to his economic-development strat-egy for the state, laying out new incentives for clustering businesses when he signed 2012’s Health Care Industry Zone Act. It

provides tax benefi ts for companies that invest at least $10 million and/or create at least 25 full-time jobs and locate within cer-tain defi ned Health Care Industry Zones.

Communities around the state have since been working to position themselves to attract healthcare-related businesses. While the companies currently housed at the Mis-sissippi Bio-Medical Business Collaboratory are too small to meet the requirements for the incentives – which chiefl y reward brick-and-mortar investments – the next step for those that grow would be to build their own facilities within the Madison County Health Care District where they could take advan-tage of the incentives.

“There are parts of the state that are very excited about the Health Care Industry Zone Act

– particularly the areas with higher popula-tion centers – and they are working to see how they can put the Health Care Zones into practice,” Coursey said.

“For those of us in economic develop-ment, we’re aware that the people who lead these businesses are smart. You cannot just coax them into your community. It’s not enough just to say, ‘This is a great place. We know you’re going to do well here, and we’re going to give you all these incentives.’ You have to have some type of proof for them, or your help has to be really, really grand.

“Their investment is signifi cant, and what you’ve got to do is mitigate their risk.”

In Madison County, leaders had been working on ways to grow its biomed-

ical sector for several years.

Among the models it’s sought to replicate is the HudsonAlpha Institute for Biotech-nology in Huntsville, Ala., a center for re-search, education and entrepreneurship in the fi eld of genomic technology.

Simply positioning businesses in com-plimentary fi elds next to one another can help spark growth, Coursey said.

“It’s amazing to see all the things that have happened as a result of the collabora-tion that’s going on,” he said of the Canton project. “People are literally getting con-tracts just because they’ve been put in touch with the right people, which can come as a result of having conversations with people who share your building.”

The Mississippi Bio-Medical Business Collaboratory was converted from what was originally a Nissan training facility. It had since housed a WIN Job Center and various other public-service tenants over the past decade, Coursey said.

Its new tenants include: Telehealth One, APS, Global Training Institute, ThinkAnew, Simple Strokes Therapy, Se-nior Benefi ts Resource Center, Innovate, and Bradley Arant Boult Cummings.

Some of the businesses stand to pro-vide a direct benefi t to Mississippi’s medi-cal community, Coursey said. Telehealth One, led by former University of Mississippi Medical Center Chief Administrative Offi -cer David Powe, will be hiring a medical staff and technicians as part of its work in providing remote monitoring and health-care services.

Meanwhile, Global Training Institute (GTI) will be providing space for training courses for physicians, nursing personnel, fi rst responders and the military. GTI will begin hosting classes this month. It is cur-rently building out 20,000 square feet of simulation space, including eight operating rooms and two simulation labs.

“This facility will be a convenient place where our physicians in Mississippi can take advantage of the training that medical de-vice companies offer – and some of our phy-sicians will be offering training themselves,” Coursey said. “We’ll be saving them time and money by providing a training space close to home.”

Occupying the largest amount of space in the Collaboratory as it launches is Think-Anew, a provider of managed IT services for long-term-care facilities.

“We have what I call a partnership with ThinkAnew, as we seek to fi nd ways to help them fi nd the people and resources they need to grow,” Coursey said. “In re-turn, they provide our tenants with IT services that meet the rigorous security re-quirements that healthcare companies re-quire today.”

As the Mississippi Bio-Medical Busi-ness Collaboratory gets off the ground, Coursey said a long-term goal for Madison County will be to build a much larger facil-ity that, like HudsonAlpha, could focus in on a particular area of biomedical research and technology.

For information on business or training opportunities through the Mississippi Bio-Medical Business Collaboratory, contact Coursey at (601) 605-0368 or [email protected].

Medical Community Stands to Benefi t, continued from page 1

Tim Coursey

that are very excited about the working on ways to grow its biomed-ical sector for several years.

Page 5: Mississippi Medical News January 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 JANUARY 2015 > 5

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MS SW130271 MS Med News.indd 1 3/11/13 2:50 PM

By JULIE SPEED

Missed family gather-ings and soccer games, frus-tration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial call to heal others.

In the environ-ment of protracted work days, count-less rounds, scarce breaks, and pagers ringing incessantly have led many physicians to opt for early retirement, sec-ond-guess their chosen profession, and/or suffer professional burnout.

Alarmingly, more than 400 doctors commit suicide annually; the suicide rate is four times higher for women physicians than women in other professions.

According to a recent Medical Econom-ics survey, more than one-third of physi-cians reported that if they could go back in time, they would choose a different specialty – or a different career altogether.

With an estimated 90,000 too few physicians practicing by 2020, America’s doctors will continue to work overtime to

meet the demand. “Most o f

us followed a calling to serve

others through prac-ticing medicine,” said

Starla Fitch, MD, au-thor of Remedy for Burn-

out: 7 Prescriptions Doctors Use to Find Meaning in

Medicine (Langdon Street Press, 2014). “We’ve dedi-

cated our time, talent and treasure to healing others,

but as we (did), many of us forgot how to heal ourselves.”

Encountering burnout led to an experience for Fitch,

a board-certifi ed ophthalmolo-gist specializing in oculoplastic

surgery, which renewed her spirit. One result: she established the popular love-medicineagain.com, an online community to help medical professionals reconnect with their passion for the practice after surviving life-altering burnout. A featured blogger for Huffi ngton Post, certifi ed life coach and CBS contributor, Fitch wrote Remedy for Burnout to benefi t colleagues and doctors-in-training.

“The level of burnout among physi-cians is at an all-time high,” said Fitch.

“A great many of my burned-out colleagues are frustrated with the changes in the relation-ships within medicine.”

One such dysfunc-tional relationship: the tie between doctors and insurance companies. Case in point: a large managed-care network recently removed Fitch’s practice from its list of preferred providers.

“Had we not taken good care of our patients? Weren’t we available for those patients 24/7? Did patients complain that my partners and I didn’t deliver quality care? No. No. And no. The managed-care network decided to provide the types of services we provide,” Fitch explained. “It opted to move the services in-house to save money, regardless of the conse-quences to its patients.”

The impact of that decision? One af-fected patient had been diagnosed with eyelid cancer. Surgery had been sched-uled to remove the growth, followed by another surgery for reconstruction, Fitch said.

“The loss of continuity that has emerged in our healthcare system hasn’t only disrupted our patients’ health,” she

said, “it’s disrupted physicians’ quality of care.”

Fitch’s personal prescriptions call for doctors to:

Develop resilience.Practice faith, which Fitch describes

as “front and center faith … the kind we doctors have when we make that fi rst inci-sion and trust we’ll be able to later close the wound.”

Cultivate self-worth. “Too often, we see ourselves incorrectly,” explained Fitch. “Instead of looking in the mirror and see-ing the specialness we possess, we allow what we think other people think about us to enter the equation.”

Promote creativity. “Your staff has more creative tips up their sleeves than you can imagine,” said Fitch. “Brainstorm with them on ways to improve patient fl ow, appointment time congestion, or any number of things that will allow for hap-pier employees and healthier patients.”

Fitch also included a section on inter-personal prescriptions, encouraging physi-cians to:

Foster support. “’Grinning and bear-ing it’ isn’t a successful coping mecha-nism,” said Fitch. “The stigma around doctors asking for help lingers, unfortu-nately.”

The Secret Suffering of DoctorsOphthalmologist pens book about the looming crisis in medicine, a remedy for burnout

Dr. Starla Fitch

By JULIE SPEED

Missed family gather-ings and soccer games, frus-tration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial

for early retirement, sec-ond-guess their chosen profession,

meet the demand.

ticing medicine,” said Starla Fitch, MD, au-

thor of out: 7 Prescriptions Doctors

Use to Find Meaning in Medicine

Press, 2014)cated our time, talent and

treasure to healing others, but as we (did), many of us

forgot how to heal ourselves.”Encountering burnout

led to an experience for Fitch, a board-certifi ed ophthalmolo-

(CONTINUED ON PAGE 10)

Page 6: Mississippi Medical News January 2015

6 > JANUARY 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 JULIE SPEED

During one of the most competitive and financially challenging times to ac-quire funding from one of the nation’s most significant research sponsors, the University of Mississippi Medical Center (UMMC) has received more awards and funding than the previous year.

The National Institutes of Health (NIH), the central federal agency for bio-medical and health-related research, has been forced to become more selective in distributing its awards over the last few years, a result of cost-cutting and down-sizing among government agencies.

But in that same time, UMMC has managed to attract more funding for its extensive research portfolio, nearly $42 million this fiscal year, a feat placing the university among the nation’s leading 10 medical centers for increased percent-age of NIH funding. During the last fis-cal year, NIH-funded projects at UMMC stood at $23.1 million.

“We’re very proud that our NIH funding is on the rise,” said Richard Sum-mers, MD, associate vice chancellor for research at UMMC. “It gives us incredible prestige and credibility in the academic community to have that source of fund-ing, and we’re going to look forward to

doing that further every year. It’s a real challenge because it’s a pretty hard and competitive point right now.”

Overall, UMMC re-ceived more than $52.1 million in 2014 for re-search from multiple funding sources, repre-senting an 83 percent increase in research funding from 2013.

“This success comes from the hard work of the individual researchers at our institution,” said Summers.

Researchers such as John Hall, MD, chair of the department of physiology and biophysics and lead investigator in UMMC’s Mississippi Center for Obesity Research, continue to attract NIH fund-ing because of the magnitude and poten-tial global impact of his studies.

“We were fortunate to receive two major NIH grants this past year,” said Hall, citing $11.4 million and $10.3 mil-lion grants, both over a five-year period that will allow his team’s research to con-tinue into obesity and cardiovascular and kidney diseases.

The second grant comes from the National Heart, Lung and Blood Institute, a component of NIH, and is a continua-

tion of a program project grant for car-diovascular studies that has been funded at UMMC for nearly half a century, said Hall.

Thomas Mosley, MD, a UMMC professor of geriatrics and lead researcher at the MIND Center, has drawn funding from many sources for his Alzheimer’s dis-ease research.

“We’ve been successful and lucky in some ways,” he said. “We’ve certainly worked hard and we’ve tried to be very strategic about the institutes where we seek funding. Specifically, we try to closely match the institute’s priorities.”

Mosley said because cohort-studies like his are costly to run, it’s become in-

Continued Funding: The Nectar of GrowthUMMC among top 10 medical schools to see research funding increase

John Palmer Donation Lifts UMMC’s MIND Center Above Fund-raising Goal

Jackson businessman John N. Palmer, founder of SkyTel, has donated $1 million to the MIND Center, a University of Mississippi Medical Center institution dedicated to fighting Alzheimer’s disease.

Palmer, the chairman and founder of GulfSouth Capital Inc., a Jackson-based private investment firm, presented the gift to the Memory Impairment and Neurodegenerative Dementia Research Center, which is committed to finding treatments and a cure for dementia and Alzheimer’s.

The gift from the telecommunications pioneer and former U.S. ambassador to Portugal pushed donations to the MIND Center above the $10 million mark – a goal set in 2010, the year it opened at UMMC.

”I’m convinced that continued support from the private sector will help our UMMC researchers find effective treatments for this disease,” Palmer said.

Even though his contribution is earmarked for the MIND Center, Palmer channeled it through the recently launched Manning Family Fund for a Healthier Mississippi, a fund-raising campaign committed to battling a variety of health issues in the state.

The donor-supported program is a partnership between UMMC and the state’s First Family of Football, led by Ole Miss sports legend, Archie, and his wife, Olivia Manning.

“I thought the Mannings’ program was a fantastic idea when I first heard about it,” said Palmer, a Corinth native who attended Ole Miss on a basketball scholarship in the 1950s. “The Manning Family Fund will have a significant impact on the health of all Mississippians. I wanted to leverage my gift to the MIND Center and challenge others to support the Mannings’ effort.”

The fight against Alzheimer’s is personal with Palmer, 80, whose wife, Clementine Palmer, and her mother, Clementine Brown, of Jackson succumbed to it several years ago, he said.

While he was an ambassador to Portugal (2001-04), Palmer noticed his wife’s memory problems. Because of the rapid progression of the disease, he ended his tenure in Lisbon and returned so she could be cared for at home.

A brain disease that shrinks memory and reasoning, Alzheimer’s has struck more than 5 million Americans, including more than 50,000 Mississippians, reports the Mississippi chapter of the Alzheimer’s Association.

People over 80 years of age have a 50/50 chance of having this disease. As the population ages, the incidence of Alzheimer’s grows exponentially.

“It’s a huge problem that’s arguably the biggest challenge facing medicine for the next 100 years,” said Thomas Mosley, MD, director of the MIND Center.

The MIND Center, working in partnership with some of the nation’s most prestigious institutions, is pursuing promising studies on dementia risk factors, genetics and the links between Alzheimer’s and other diseases. With a variety of contributions from businesses and the community, the center has added top researchers and state-of-the-art equipment, Mosley said.

Palmer helped establish a Board of Directors and has served as the chair since the MIND Center was created. He and Mosley “shared a vision” that produced the research institute, which now also offers clinical treatment for patients with dementia, Mosley explained.

“Ambassador Palmer’s most recent gift comes at a fantastic time,” Mosley said, adding that it enables the center to “ramp up” the recently created partnership with UMMC’s Telehealth program to offer dementia care to underserved parts of the state. These gifts will allow UMMC to recruit more top researchers to the MIND Center and motivate others to give, Mosley said.

 “Seeing the kind of expertise we have at the MIND Center,” Palmer said, “and the scope and potential of UMMC, I thought, ‘This could make a difference.’ ”

Dr. Richard Summers (CONTINUED ON PAGE 8)

Page 7: Mississippi Medical News January 2015

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YOU HAVEA PARTNERON YOURJOURNEY

By CINDy SANDERS, ELISABETH BELMONT & JOEL HAMME

Already one of the most highly regu-lated industries in America, 2015 looks to be another active year across healthcare’s legal landscape. Two past presidents of the American Health Lawyers Association, Elisabeth Belmont and Joel Hamme, took time to share insights and predictions for the coming year on a variety of topics rang-ing from the Affordable Care Act to fraud and abuse enforcement.

Subsidies in the Health Insurance Exchanges

Under the Affordable Care Act, in-dividuals with incomes between 100 and 400 percent of the federal poverty level are eligible to receive federal tax credit subsidies for purchasing health insurance on the exchanges. Hamme noted that in King v. Burwell, the Fourth Circuit court ruled the IRS acted lawfully in interpret-ing such subsidies were permissible not only for state exchanges but also for fed-erally run exchanges and those that are a federal-state partnership. However, the Supreme Court has agreed to review this decision.

Hamme explained, “Of the 50 states and the District of Columbia, only 17 have state established exchanges; 7 have partnership exchanges and the remain-

ing 27 are federally operated. Thus, if the Supreme Court were to overturn the Fourth Circuit’s decision, individuals in two-thirds of the 51 jurisdictions would be ineligible for subsidies for purchasing health insurance on the exchanges.” He added that while there was some debate as to how detrimental such a decision would

prove to be to the ACA, certainly it would be a major setback. “The King case essen-tially represents the last major legal hurdle for the ACA. If the subsidies challenge fails, ACA opponents will be relegated to trying to repeal or significantly modify the ACA by legislative and executive branch actions.”

Fraud and AbuseOn Oct. 31, 2014, the U.S. Depart-

ment of Health and Human Services Office of Inspector General (OIG) released the FY-2015 Work Plan. Always eagerly antici-pated, the document gives insight into the OIG’s planned reviews and activities with respect to HHS programs and operations. Belmont noted, “In the introduction to the Work Plan, OIG stated that, in the coming year, the agency plans to continue to focus on issues such as emerging payment, eligi-bility, management, IT security vulnerabil-ities, care quality and access in Medicare and Medicaid, public health and human services programs, and appropriateness of Medicare and Medicaid payments.”

Belmont highlighted a few areas of in-terest for this year:

Hospitals: With 22 substantive areas under review, the OIG is deeply engaged with hospital reviews both on the billing and payment side, and quality of care is-sues, which are a particular priority for current Department of Justice (DOJ) and OIG enforcement efforts. OIG continues to scrutinize CMS contractors’ implemen-tation of outlier reconciliation (of which the OIG has been critical for many years) and remains intensely interested in inpatient versus outpatient payments, the “two mid-night” rule for inpatient admissions, and cardiac catheterizations.

Hot Button Legal Issues to Watch in 2015

(CONTINUED ON PAGE 9)

About the ExpertsElisabeth Belmont, Esq. serves as corporate counsel for MaineHealth, ranked among the nation’s top 100 integrated healthcare delivery networks. She is a member of the Board on Health Care Services for the Institute of Medicine and its Committee on Diagnostic Error in Health Care. Belmont is also a member of the National Quality Forum’s Health IT Patient Safety Measures Standing Committee. In addition to serving as a past president of the American Health Lawyers Association, she is also the former chair of

the organization’s HIT Practice Group and the current chair of the Inhouse Counsel Program. In 2007, Modern Healthcare named her to their list of “Top 25 Most Powerful Women in Healthcare.”

Joel Hamme, Esq. is a principal with Powers, Pyles, Sutter & Verville in Washington, D.C. He joined the firm in 1998 and focuses his practice on long term care, Medicare and Medicaid reimbursement issues, provider licensure and certification matters, and litigation in his areas of expertise. He is a member of the District of Columbia and Pennsylvania bars, as well as the bars of the Supreme Court of the United States and numerous federal appeals courts. A past president of AHLA, Hamme is a frequent speaker and lecturer on healthcare issues and has authored

numerous articles and book chapters relating to healthcare law.

Page 8: Mississippi Medical News January 2015

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of the situation just to know ahead of time who will be caring for them and where they will be,” said OB/GYN Justin Brewer, MD, MFM spe-cialist for the Tupelo hospital.

The program fills a service gap for women with high-risk pregnan-cies or fetal issues that require care beyond the community hospital level. Before NMMC launched the program in mid-2013, those women had go to Jackson, Memphis or Birmingham to receive the care they needed.

“For pregnant women preparing to have their babies, it’s comforting to be able to deliver close to their family and their support system,” Brewer said. “Now we’re able to keep most families here locally.”

Patients enter the MFM program through referrals from OB/GYNs in the region, with whom Brewer has worked closely to get the program off the ground. They refer to him patients in two groups: First, those whose pregnancies are high-risk because of advanced maternal age or a mother’s medical condition like severe dia-betes or high blood pressure; and second, those for whom screenings have suggested a problem with the baby.

“She may get a quad screen that comes back showing an elevated risk for chromosomal problems, or an ultrasound

showing the baby’s not growing well,” Brewer said. “Complicated twins or trip-lets are also among the cases we’ve seen.”

For cases in which a newborn will require surgical repair after delivery, the MFM program works closely with Le Bon-heur Children’s Medical Center in Mem-phis to provide a streamlined continuum of care.

“If they need to deliver at a tertiary care center, they will go to Memphis to deliver, so that the baby can get any repair care that it needs,” Brewer said.

“Before our program began, a lot of these defects weren’t addressed until the time of delivery, so patients were shocked and upset when their newborn underwent surgery out-of-town.

“Now that we can find a fair por-tion of them during pregnancy and get the parents plugged into the Le Bonheur system, they have months to prepare for what’s coming and have a chance to meet the doctors who’ll be taking care of their babies for the long term.”

Another recent development, the Uni-versity of Mississippi Medical Center has added a pediatric cardiologist to its Tupelo outreach clinic, complementing those Le Bonheur already provides in Tupelo.

“With these resources, women who need a fetal echocardiogram are able to get them locally,” Brewer said. “All of these services decrease the trips they have to make.”

On the other end of the spectrum are

those patients who are referred to Brewer for further testing and medical manage-ment, but whose issues can be controlled or resolved.

“At the end of the day, my goal is to get these patients where they can deliver at their home hospitals with their OB/GYNs,” Brewer said. “There is a small percentage that has to deliver in Tupelo or at a tertiary care center for fetal indica-tions. But in the vast majority of cases, we can sketch out a plan for them and they go back to their home hospital.”

Having that kind of reciprocal rela-tionship with the OB/GYN community in north Mississippi has been critical to the MFM program’s success, Brewer said. His relationships extend from Ox-ford and New Albany to Columbus and West Point.

“All the OB/GYNs are very good and very sharp,” he said. “They’re able to pick up a lot of problems that could otherwise have been missed and shift it to us when they need to.”

The program realizes a long-term goal for the Tupelo medical community, said Ellen Friloux, NMMC administrator for Women and Chil-dren’s Services. The first attempt at establishing an MFM program resulted in a UMMC outreach clinic that operated in Tupelo in the late 1990s, she said.

“It was going re-ally well for three or four years, and went from once a month to once a week,” she said. “But they lost some faculty and had to shut it down.”

With no assurances that it would re-

turn, NMMC began to work toward set-ting up its own clinic. But recruiting an MFM specialist was difficult.

“We knew it would be a long shot, be-cause they tend to like to be in an academic setting or in a big city where they have lots of support and several other MFMs around them,” Friloux said. “We talked to a couple of people before Dr. Brewer, but were not able to interest anyone in coming and being a solo practitioner in an isolated part of the state.”

Ultimately, Brewer himself proved to be the missing piece. A native of Oxford, he already had relationships with OB/GYNs in north Mississippi and was pre-pared to take on the challenge. NMMC recruited him during the first year of his three-year fellowship at UMMC, and he began working with Friloux during his training to define how the program would develop.

“He’s just been really easy to work with and has a very strong work ethic, and has a great way with referring physicians,” she said. “He’s already taken on a lead-ership role both within our medical and nursing staff and on a statewide level.”

Both Brewer and Friloux serve on the steering committee for the Mississippi Perinatal Quality Collaborative through the State Department of Health.

Looking ahead, NMMC is consider-ing the addition of a hospitalist program for the Women’s Hospital to improve cov-erage for high-risk transfer patients, since Brewer’s presence has produced more re-ferrals.

The hospital also knows it will need to soon add a second MFM specialist to sup-port Brewer — this time, though, it expects recruiting to be much easier.

Maternal Fetal Medicine Program Fills Service Gap, continued from page 1

Dr. Justin Brewer

Ellen Friloux

creasingly important to cultivate buy-in from multiple institutes within NIH.

“So instead of going to just one insti-tute and saying we need a whole lot of sup-port to get this study done, we look for ways to work across institutes and get multiple partners involved,” explained Mosley.

The tightening of the purse strings at NIH also has prompted the MIND Center to identify alternative funding sources, said Denise Lafferty, chief of operations at the center.

“The compound effect comes into play and one result impacts the other; the NIH funding helped us to get state funding and the state funding and private support can help us get more NIH funding,” said Lafferty.

During 2013, Mississippi allocated $3 million to the MIND Center, marking the first time for state funding at the center, she said.

The federal and private funding – for which the MIND Center has raised more than $10 million – encouraged state leaders to pay attention, Lafferty said.

The funding from the state and pri-vate entities is helping defray infrastructure projects, which also is critical in gaining NIH funding, said Lafferty.

“If you don’t have the staff and equip-ment to be able to prove you can really deliver the results of the grant,” she said, “then they’re less likely to give you the funding.”

Even as the future of research funding means finding alternative strategies to ob-tain it, UMMC and its researchers remain committed to the cause, said Summers.

“It’s always important to remember the point of the research mission isn’t to get grants,” said Summers. “That’s very important as the fuel for funding the re-search mission, but the point of the re-search mission is the discovery itself and the discovery in the context of helping the healthcare of Mississippians. That’s the real main goal.

“As long as we have our eyes on the prize of discovery and improving the health care of Mississippians, that’s really what we want to do.”

Continued Funding, continued from page 6

Page 9: Mississippi Medical News January 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 JANUARY 2015 > 9

Hospice: Hospice billings for general inpatient care, a focus of relators and the DOJ, is under close review by the OIG.

Freestanding Clinic Providers: OIG continues to examine certain pay-ment systems such as provider-based ser-vices and freestanding clinic payments, with an eye toward reducing disparity of payments based on site of service.

Laboratories: OIG added a review of independent clinical laboratory billing requirements, without further specifying the billing requirements at issue. This may coincide with increased local coverage de-terminations by contactors, OIG enforce-ment against clinical laboratories under its Civil Monetary Penalties Law authority, and OIG’s general heightened scrutiny of technical billing and payment compliance by clinical laboratories, especially specialty laboratories.

Accountable Care Organiza-tions: OIG intends to conduct a risk as-sessment of CMS’ administration of the Pioneer ACO Model.

Medicaid Managed Care: OIG added a review of state collection of rebates for drugs dispensed to Medicaid managed care enrollees.

Medicare Part D: This is an area where there will be continuing scrutiny of the quality of Part D data submitted to CMS. The OIG also plans to follow up on the steps CMS has taken to improve its oversight of Part D sponsors’ Pharmacy and Therapeutics Committee conflict-of-interest procedure in the wake of the OIG’s critical 2013 report.

Private Rights of Action to Enforce Medicaid Program Requirements

Whether or not Medicaid beneficiaries and providers have private rights of action to sue state officials for alleged violations of Medicaid Act provisions has been hotly contested for many years. Now the Su-preme Court has agreed to review at least part of the debate.

Hamme said, “In Armstrong v. Excep-tional Child Center, the Supreme Court granted certiorari to decide whether the constitutional Supremacy Clause affords Medicaid providers a private right of ac-tion to enforce the ‘equal access’ provision of the Medicaid Act. This provision states that Medicaid rates for fee-for-service pro-viders must be consistent with efficiency, economy, and quality of care and be suffi-cient to enlist enough providers so that care and services are as available to Medicaid patients as they are to the general public in the same geographic area.”

In Exceptional Child Center, a group of Medicaid providers in Idaho who fur-nish services to individuals with intellec-tual disabilities sued state officials alleging inadequate Medicaid rates. The state had failed to increase the rates even though sev-eral studies commissioned by the Medicaid agency concluded the rates were insuf-ficient. Hamme noted both a federal dis-trict court in Idaho and the Ninth Circuit concluded the Supremacy Clause could be used as a basis to enforce the equal ac-cess provision privately and that the Med-

icaid rates in this case contravened that provision. He added, the Supreme Court has confined its review to the Supremacy Clause – private right of action issue only.

“The case is highly important to Med-icaid providers and beneficiaries because an unfavorable ruling would mean that they would be generally unable to seek judi-cial enforcement of numerous provisions of the Medicaid Act relating to rates, services, and program administration,” Hamme said. “Without such a right, they would, in-stead, be dependent on federal government program oversight through proposed state plan amendment reviews and general en-forcement mechanisms and/or on the will-ingness of states to police themselves. From the perspectives of Medicaid providers and beneficiaries, neither of those has proven to be sufficient historically.”

Health Information & Technology

A huge area of growth and potentially thorny legal issues, Belmont said providers must look at all aspects of HIT applica-tions. She predicts telemedicine and remote patient monitoring will continue to emerge as a care and cost-savings solution in 2015, particularly as healthcare consumers be-come increasingly comfortable relying on electronic devices and remote monitoring to manage chronic diseases. However, Bel-mont continued, using such technology raises a number of legal issues including provider compensation, ensuring referrals to hospitals or additional services are in compliance with the Stark Law and federal and state anti-kickback statutes, compliance with state licensing and practice standards, and compliance with federal and state pri-vacy and security requirements.

‘Big Data,’ she said, is rapidly becom-ing the new normal. Belmont pointed to two reports addressing the public policy implications of the proliferation of big data by the White House. Rather than trying to slow the accumulation of data or place bar-riers on its use in analytic endeavors, the reports called for the development of policy initiatives and a legal framework to foster innovation and promote the exchange of information to support public policy goals while limiting harm to individuals. “In the coming year, healthcare providers’ compli-ance efforts should focus on: (i) how is the increased use of data changing the compli-ance landscape; (ii) what are the risks of Big Data; (iii) what role do compliance officers have in the shift to quality-based health-care; and (iv) how is Big Data changing compliance?” Belmont suggested.

“Data now is recognized as one of a healthcare organization’s most valuable as-sets, especially as a result of the transition to a more analytically driven industry,” she continued. “Given the increasing im-portance of data to a healthcare organiza-tion, it is advisable for the organization to implement appropriate data governance best practices.”

With the accumulation of data also comes an obligation to make sure protected health information (PHI) stays protected. “In 2015, healthcare privacy and security compliance will continue to expand with

respect to the scope, number of enforce-ment bodies and increased enforcement activity, and overlapping sets of require-ments,” Belmont said. “In addition to the requirements of the HIPAA Privacy and Security Rules, healthcare providers also will need to navigate requirements promul-gated by the Federal Trade Commission, Centers for Medicare and Medicaid Ser-vices, Office of the National Coordinator, and state attorney generals. Additionally,” she continued, “increasing exposure for privacy and security breaches may occur as the result of state common or statutory law, despite there being no private right of action with regard to HIPAA violations. As a consequence, healthcare organizations and practitioners need to manage the com-plex daily operational processes required to maintain appropriate privacy and security of protected health information and devote necessary resources to ensure regulatory compliance. “

M&A, Acquisitions and Joint Ventures

Belmont predicted the healthcare sec-tor could expect to see an increase in vari-ous forms of organizational and clinical integration this year as a result of continu-ing payment pressures to reduce operating expenses and maximize operational effi-ciencies; the need to grow market share and diversify service offerings including expen-sive but competitively desired technologies; and requirements of federal and state health

reform initiatives to achieve higher-quality patient outcomes. She added providers might also seek to participate in population and care management arrangements such as ACOs, shared service arrangements or telehealth outreach initiatives. Those col-laborative partnerships, she pointed out, might be limited to certain lines of business rather than the full merger or acquisition of an entire enterprise.

“Mergers, acquisitions, joint ventures and other innovative arrangements in an increasingly integrated market present legal and regulatory issues that depend on the nature of the parties, the legal and business structure of the particular affili-ation and the nature of the services to be provided by the new or surviving entity,” Belmont explained. “Healthcare providers thus will need to will need to be aware of evolving structural, legal and business is-sues including: compliance with the Stark law and the Anti-Kickback statute; anti-trust requirements; tax status and potential liability; applicable state laws that restrict the corporate practice of medicine and the splitting of professional fees; and applicable state laws that require regulatory notices or approvals (e.g., transfer of specialty pro-vider license).”

Medicaid Eligibility ExpansionSince the Supreme Court ruling that

mandatory Medicaid expansion wasn’t permissible, 29 states voluntarily have au-

Hot Button Legal Issues, continued from page 7

(CONTINUED ON PAGE 10)

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thorized Medicaid eligibility expansion or obtained federal approval of an alternate expansion plan to take advantage of gen-erous federal fi nancial support tied to the program. However, Hamme pointed out, the 2014 election results impacting gover-norships and state legislatures seem to have strengthened the numbers of those oppos-ing such expansion in several states that were still weighing the options. “In at least one state, it is conceivable that Medicaid eligibility expansion will be rescinded after having been implemented,” he said.

Hamme continued, “For 2015, the key Medicaid eligibility expansion devel-opment will be whether the slow erosion of state opposition to expansion continues as states decide that they do not want to forego the fi nancial advantages of expan-sion or whether this erosion is abated by those fi ercely opposed to the ACA.” He added it will be interesting to see how fl ex-ible the federal government might be with respect to work and work search require-ments and benefi ciary cost-sharing obliga-tions for states that are seeking waivers for alternate expansion models.

Corporate Governance“The business of governing acute care

health systems has become increasingly complex as board governance and indus-try structure have worked to keep with the pace of reform and consolidation,” Belmont pointed out. She added govern-ing boards are grappling with the push for consolidation as new care models and the economics of healthcare delivery move to-ward larger organizations.

“Most boards receive a signifi cant vol-ume of input on the general trend of con-solidation but less input on the full range of strategic alternatives that exist and the pro-cesses and tactics that can realize the board’s desired outcome — typically the long-term security of high-quality, effi cient care across a range of desired services for the commu-nity,” Belmont said. “Signifi cant innovation has occurred in the variety of structures that hospitals and healthcare systems are using to collaborate. To maximize the outcomes of each of these strategic options, board members must have a general understand-ing of the purpose and use of each structure, and the factors that infl uence feasibility,” she continued. “Healthcare organizations thus need to ensure that their boards are equipped with knowledge of these innova-tive structures in order to appropriately execute their fi duciary duties within an in-creasingly complex operating environment.”

Regulation and Monitoring of the 340B Drug Discount Program

For more than 20 years, certain healthcare providers serving a signifi cant number of indigent, uninsured and under-served patients have qualifi ed to participate in the 340B Program as covered entities, which has made them eligible for steep discounts on prescriptions for individuals receiving outpatient services. However, the program has grown substantially over the last two decades and led critics to charge the Health Resources and Services Admin-istration (HRSA) has been lax in oversight

and failed to issue regulations clarifying key program requirements or features such as defi ning ‘eligible patient.’

Hamme said that as a result of this criticism, HRSA planned to issue pro-posed regulations, and Congress had been urged to investigate and reform the 340B Program. Before that could happen, how-ever, drug manufacturers sued HRSA over regulations concerning the purchase of or-phan drugs. “A federal court later invali-dated the orphan drug rule, but in doing so, explained that under the 340B statute, HRSA’s authority to issue substantive rules is confi ned to a number of narrow areas such as civil money penalties, administra-tive dispute resolution, and ceiling prices,” he explained.

Hamme added HRSA has announced it will issue interpretive guidance on key cri-teria of the 340B Program in 2015 and will confi ne its notice and comment rulemaking to the narrow areas outlined by the court. Hamme said to expect Congress to intensify scrutiny of the program this year, as well.

Quality of CareWith an emphasis on adopting perfor-

mance improvement strategies to achieve higher-quality patient outcomes while maximizing operational effi ciencies, Bel-mont said she expected quality of care ini-tiatives to accelerate in 2015. “New models of care that emphasize care coordination across hospitals and health systems, other providers, and the community are a criti-cal element for quality improvement,” she said. With that comes a need for an in-teroperable HIT infrastructure that aligns clinical decision support and clinical qual-ity measurement. Belmont suggested read-ing the 10-year vision report for leveraging health IT by the Offi ce of the National Coordinator for Health IT and the ONC’s 10-year roadmap for achieving an interop-erable health IT infrastructure. For more information, go to healthit.gov.

ACA Going ForwardAs Hamme pointed out, the ACA has

already generated several legal decisions and navigated a number of political and operational obstacles in its relatively short life. However, a number of hurdles … in-cluding the decision on exchange subsidies and the law’s unpopularity among large swaths of the public … remain.

“During 2015, interested observers should look to various barometers to as-sess whether the ACA is working … and equally important … whether it is gaining the public acceptance needed to assure its political survival,” Hamme said. He added some of those measures would include the administration of the exchanges, whether offerings to consumers were deemed ac-ceptable in terms of plan choices and af-fordability, a continued decline in the number of uninsured, and whether or not the ACA could continue to withstand legal and political assaults.

“Like 2013 and 2014, the coming year will witness numerous developments that will lead either to the ACA’s long-term vi-ability or its premature demise,” Hamme concluded.

Hot Button Legal Issues, continued from page 9

Embrace compassion. When Fitch asked a colleague advice he would give his 29-year-old self, the doctor said: “Try to be more empathetic. That’s more impor-tant than anything else. Having some idea of a patient’s situation really changes the way you treat people.”

Encourage connection, “the spark that ignites when you have a conversation in the doctors’ lounge and you laugh at the same jokes, commiserate over the same wins or losses of sports teams, or offer con-gratulations or condolences for the highs and lows we all experience,” she said. “These relationships have a profound im-pact on doctors’ lives and are, therefore, the ones that need fostering.”

Going forward, Fitch hopes physi-cians fi nd their own personal remedy to overcome burnout. She uses “entrain-ment,” a word from the biomusicology world that means “the synchronization of organisms to an external rhythm, often produced by other organisms with which they interact socially.”

“Sometimes when I’m in the OR, I ask the anesthesiologist to slightly turn down the volume of the patient’s pulse ox-imeter,” she said, “as I can feel my own pulse trying to keep time with the patient’s rhythm.”

Fitch encourages physicians to “be brave and reach out to others in the com-munity.”

“Together,” she said, “we can all fi nd meaning in medicine.”

The Secret Suffering, continued from page 5

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Page 11: Mississippi Medical News January 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 JANUARY 2015 > 11

GrandRounds

Nicole C. Lott

Vacant UMMC Rehab Facility To Be Repurposed As Ebola Unit

A decommissioned patient-care building at the University of Mississippi Medical Center is being retrofitted as an isolation and treatment unit in the event of a confirmed or probable Ebola case in Mississippi, UMMC and state health offi-cials announced today.

UMMC officials said they are in the process of renovating space in the former University Rehabilitation Center (URC), a stand-alone structure removed from other patient-care facilities on campus. URC closed in late October as part of a planned consolidation of inpatient re-habilitation services with Methodist Re-habilitation Center, also on the UMMC campus.

State Health Officer Dr. Mary Currier emphasized that the chances of an actual case appearing in the state are still ex-tremely low, but developing a specialized unit where well-trained staff can safely care for a patient is crucial for the state to be fully prepared.

Patients who have recently traveled to West Africa and who develop symp-toms consistent with Ebola virus would be considered a probable case. At this time, the MSDH is not monitoring any travelers or health-care workers exposed to Ebola.

Several rooms in the URC are being adapted as a biocontainment unit that can accommodate up to two patients. The renovation will take two weeks, ac-cording to Jonathan Wilson, UMMC’s chief administrative officer.

UMMC has been intensively training a team that would be involved in the di-rect care of a patient, should there be one. Since providing care will be a round-the-clock activity, the Department of Health is asking other hospitals to identify experi-enced clinical volunteers who could aug-ment UMMC’s Ebola care team.

Keeton said the current preparations for Ebola will lay the groundwork for the development and maintenance of a per-manent team of health-care workers spe-cially trained to handle infectious disease outbreaks and other biological threats.

Camellia Healthcare Celebrates 40 Years

Camellia Healthcare’s start in 1974 was, well, inauspicious. The company began in Hattiesburg as a one-room op-eration founded by W.A. Payne while a student at the University of Southern Mis-sissippi.

Today Camellia operates 20 home health and 17 hospice locations employ-ing more than 1,500 healthcare profes-sionals throughout five Southeastern states. And its growth and high profes-sional standards have led the company to be recognized both locally and nationally. For the past two years Inc. magazine has ranked Camellia on its Inc. 5000, a list of the fastest-growing private companies in America.

The company has been recognized as one of Mississippi’s Best Places to Work by the Mississippi Business Journal

and the 2014 Nurse Employer of the Year by the Mississippi Nurses Association.

And that one-room office has ex-panded to locations in Louisiana, Georgia (Atlanta area), Tennessee (metro Knoxville and Chattanooga) and Alabama.

And Camellia goes the extra mile to bring healthcare and home hospice ser-vices to patients in a comfortable family setting.

Last year Camellia healthcare rep-resentatives logged 4.1-million miles in their vehicles to reach patients — or 170 times around the world.

Camellia Healthcare is a Medicare-certified, state-licensed provider of home health and hospice services.

Hattiesburg Clinic Neurology Welcomes Nicole Lott

Nicole C. Lott, CNP, recently joined Hattiesburg Clinic Neurology as a nurse practitioner.

Lott earned her Bach-elor of Science in nursing and her Master of Sci-ence in nursing through The University of Southern Mississippi in Hattiesburg, Miss.

She is certified as a family nurse practitioner by the American Academy of Nurse Practitioners. Lott is a member of the American Association of Nurse Prac-titioners.

Alzheimer’s Care Offered Via UMMC’s Telehealth Program

One of the nation’s leaders in provid-ing health assessments via computer, the University of Mississippi Medical Center is branching out to offer patients suffering from Alzheimer’s disease or other forms of dementia another form of access to medical specialists.

The new program, TeleMIND, is be-ing implemented in stages around the state, said Dr. Kristi Henderson, UMMC’s chief telehealth and innovation officer. She said there’s a strategic plan around where they locate based on need as well as partners that want the new service in their community. The service began in Grenada and Lexington and will have lo-cations in the Mississippi Delta in the next phase of implementation.

Dr. Tom Mosley, professor of clinical geriatrics and gerontology and execu-tive director of UMMC’s The MIND Cen-ter, which delivers the TeleMIND service, said the program is “piggy-backing” off the already fantastic success coming from Henderson’s work with telehealth in Mis-sissippi.

TeleMIND, much like previously im-plemented telehealth programs, allows patients to visit a clinic in their vicinity so that they can be examined via live audio and video by a UMMC physician in Jack-son. At the remote location, the patient will be in the room with a health-care professional trained to help facilitate the virtual exam.

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MEDICAL SCHOOLBaylor College of Medicine,

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To schedule an appointment with Dr. Baldwin or Dr. Cumbie, please call 601-200-2780.

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Page 12: Mississippi Medical News January 2015

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