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PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER Treating Hereditary Heart Disease UMMC cardiologist leads only heart program of its kind statewide Michael R. McMullan, MD, has returned to his Mississippi roots to direct a program at the University of Mississippi Medical Center (UMMC) offering specialized care to an under-treated population: adults with hereditary heart disease ... 3 Catching Fire: Lean Healthcare Transformations Joan Wellman pioneered application of Toyota principles in healthcare; helps complex health systems facilitate large- scale change Last June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health – converged on the campus of Nemours Children’s Hospital in Orlando ... 4 June 2014 >> $5 PROUDLY SERVING THE MAGNOLIA STATE Mark Lee, MD PAGE 2 PHYSICIAN SPOTLIGHT ONLINE: MISSISSIPPI MEDICAL NEWS.COM Greenville Cardiologist Leads ACC Board of Governors National leadership role pivotal in pressure-cooker year for medicine A Celebrated 64-year Career Tupelo general practitioner hangs up stethoscope at age 93 BY LYNNE JETER/NMMC TUPELO—World War II broke out when Eugene Murphey III, MD, was a college student. House calls were routine. Emergency departments con- sisted of tiny rooms, staffed by “on-call” doctors. Who knew that decades later, Murphey would become the first of his partners to start a practice and the last to retire? “I’m long past retirement age,” quipped the good-natured Murphey, who hung up his stethoscope with a bit of fanfare: “I decided to quit on March 4, Mardi Gras Day.” Born in West Point in 1920, Murphey moved with his family to Itta Bena as a toddler but around age 6, his family moved to Long Beach, where his mother taught school and his father was a banker. His paternal grandfather, the original Eugene Murphey, was a beloved general practitioner in Macon. “He’s probably the one who influenced my decision to become a doctor,” he admitted. (CONTINUED ON PAGE 8) BY LYNNE JETER GREENVILLE — Among national leaders draped regally in tradition-rich red robes with royal blue detailing at the American College of Cardiology’s 63rd Annual Scientific Session in Washington, DC, Mississippi cardiologist Michael Mansour, MD, FACC, stood out. He listened intently to the address detailing priority agenda items by the professional society’s immediate past president, John Gordon Harold, MD, MACC. Mansour, a Greenville cardiologist with board certifications in internal medicine, cardiovascular diseases, interventional cardiology, nuclear cardi- ology, and cardiovascular computed tomography, was elevated March 31 to chair the ACC Board of Governors for the 2014-15 session. “The Board of Governors has the critical task of being the liaison to the College in working with individual states to address the unique challenges each face and also learn from each state’s successes in providing the best possible care to cardiovascu- lar disease patients,” Mansour said. “I’m proud to take the helm of this body of leaders and help to guide the College in what should prove to be both (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. (CONTINUED ON PAGE 6) Dr. Michael Mansour
Transcript
Page 1: Mississippi Medical News June 2014

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

ON ROUNDS

PRINTED ON RECYCLED PAPER

Treating Hereditary Heart DiseaseUMMC cardiologist leads only heart program of its kind statewide Michael R. McMullan, MD, has returned to his Mississippi roots to direct a program at the University of Mississippi Medical Center (UMMC) offering specialized care to an under-treated population: adults with hereditary heart disease ... 3

Catching Fire: Lean Healthcare TransformationsJoan Wellman pioneered application of Toyota principles in healthcare; helps complex health systems facilitate large-scale change

Last June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health – converged on the campus of Nemours Children’s Hospital in Orlando ... 4

June 2014 >> $5

PROUDLY SERVING THE MAGNOLIA STATE

Mark Lee, MD

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM

Greenville Cardiologist Leads ACC Board of GovernorsNational leadership role pivotal in pressure-cooker year for medicine

A Celebrated 64-year CareerTupelo general practitioner hangs up stethoscope at age 93

By LyNNE JETER/NMMC

TUPELO—World War II broke out when Eugene Murphey III, MD, was a college student. House calls were routine. Emergency departments con-sisted of tiny rooms, staffed by “on-call” doctors.

Who knew that decades later, Murphey would become the fi rst of his partners to start a practice and the last to retire?

“I’m long past retirement age,” quipped the good-natured Murphey, who hung up his stethoscope with a bit of fanfare: “I decided to quit on March 4, Mardi Gras Day.”

Born in West Point in 1920, Murphey moved with his family to Itta Bena as a toddler but around age 6, his family moved to Long Beach, where his mother taught school and his father was a banker. His paternal grandfather, the original Eugene Murphey, was a beloved general practitioner in Macon.

“He’s probably the one who infl uenced my decision to become a doctor,” he admitted.

(CONTINUED ON PAGE 8)

By LyNNE JETER

GREENVILLE — Among national leaders draped regally in tradition-rich red robes with royal blue detailing at the American College of Cardiology’s 63rd Annual Scientifi c Session in Washington, DC, Mississippi cardiologist Michael Mansour, MD, FACC, stood out. He listened intently to the address detailing priority agenda items by the professional society’s immediate past president, John Gordon Harold, MD, MACC.

Mansour, a Greenville cardiologist with board certifi cations in internal medicine, cardiovascular

diseases, interventional cardiology, nuclear cardi-ology, and cardiovascular computed tomography, was elevated March 31 to chair the ACC Board of Governors for the 2014-15 session.

“The Board of Governors has the critical task of being the liaison to the College in working with individual states to address the unique challenges each face and also learn from each state’s successes in providing the best possible care to cardiovascu-lar disease patients,” Mansour said. “I’m proud to take the helm of this body of leaders and help to guide the College in what should prove to be both

(CONTINUED ON PAGE 8)

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[email protected]

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

(CONTINUED ON PAGE 6)

Dr. Michael Mansour

Page 2: Mississippi Medical News June 2014

2 > JUNE 2014 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

MISSISSIPPI GULF COAST—It’s a daunting thing to consider going back to medical school when you’ve got a well-pay-ing job, three kids and a fourth one on the way.

But for Mark Lee, MD, the time was right to redefine the im-pact he wanted to make through his career.

“I didn’t want to look back later in life and have regrets,” said Lee, who left a 12-year career as an actuary in corporate invest-ment analysis to return to medical school in 2001.

“I had just decided it’s some-thing I really wanted to do,” he said. “I had a lot of thought and worry leading up to the decision, but once I committed, I never looked back.”

Since completing his train-ing as a pediatric neurologist, Lee spent three years on the faculty of the University of Mississippi Medi-cal Center before joining Singing River Health Systems on the Gulf Coast a year ago.

He is based at the Singing River Neu-roscience Center in Ocean Springs, which also houses specialists in adult neurology, pain management and physical rehabilita-tion.

The role Lee serves today in treating children with neurological conditions is a far cry from the experience he and his wife shared when their son was born with severe epilepsy in 1997.

“We really had no medical back-ground,” he said. “But I got interested in

the field, and that’s what led to me going back to medical school.

“It’s been gratifying, in that I’ve been able to help a lot of kids I see who have similar problems to my son.”

Epilepsy is Lee’s primary interest in his practice today. His patients are re-ferred most commonly for conditions like headaches, seizures, developmental delays and movement disorders.

The rarity of specialists practicing pediatric neurology provided an opening for Lee to fill a need on the Gulf Coast. Many of the families he now sees in Ocean Springs were his former patients at UMC,

who were having to drive to Jack-son for treatment.

Since joining Singing River Health Systems in June 2013, Lee has connected with Gulf Coast pe-diatricians for referrals while also maintaining a relationship with UMC and with pediatricians in the Jackson area.

“I’ve actually seen some kids from the Jackson area, just because the wait there is so long,” he said. “It can take as much as six months to get in at UMC, because they’re so backed up. So some pediatri-cians in Jackson will actually send them down here.”

Likewise, Lee is able to refer patients to Jackson when their needs call for specialized tests that are beyond what his practice can provide.

Lee’s move to the Gulf Coast has made for a less-intense work schedule grounded chiefly in clini-cal practice.

“Clinic is just as busy as it was at UMC, but the call situation is

a lot different,” he said. “When I was at the university, we would take call a week at a time and have calls through the night every night. Here, I take call 10 days a month and I’m very rarely called in the middle of the night.”

While he will occasionally admit his own patients to the hospital, he generally sees others’ patients in the hospital only on a consult basis.

Lee is originally from El Paso, Texas, and came to Mississippi with his family at age 11. He graduated from Pearl High School and studied mathematics at Mill-saps College.

He completed his medical degree and post-graduate training at UMC. After 12 years of being in the workplace, the first two years of classroom study were a wel-come change.

“I’d been wearing a coat and tie every day, and all of a sudden I got to wear shorts and flip flops,” Lee said. “Being out working for quite some time gave me more of an appreciation of being in school and being able to focus on just learning.”

While he was the fifth oldest in his medical-school class, his fellow students included pharmacists and nurses who, like him, were preparing for a second career. For Lee, the decision to return to medical school called for cashing in his 401K and living off of savings.

“It was about nine years of kind of lean times, but I’ve never regretted it,” he said. “I’m very happy about my decision.”

At UMC, Lee had the chance to be trained and mentored by the physicians who had been treating his son, includ-ing Colette Parker, MD, and Vettaikoru-makan Vedanarayanan, MD.

His own family’s experience also shapes the way he interacts with patients and their families today.

“I think it gives me empathy,” he said, adding that he doesn’t share his family’s story with everyone, but is glad to offer it when it can help.

“A lot of parents will have the im-pression that nobody really understands where they’ve been,” he said. “I think it helps them to know that I understand where their fears and frustrations are com-ing from, and it gives them confidence I’m giving them the best advice and treatment that I have to offer.”

Lee’s son Manning, now 16, is non-verbal, profoundly handicapped and con-strained to a wheelchair.

“But he also seems to be very con-tent,” his father said, “which is what we want.”

Lee and his wife, Angela, are also the parents of three daughters. Morgan, 22, is preparing to apply for dental school; Macey, 21, is in premed studies at Mis-sissippi College; and McKenzie, 12, is a seventh-grader in Ocean Springs.

While the family has been settling into life on the Gulf Coast, they return to the Jackson area often to spend time with extended family and attend Macey’s soft-ball and soccer games in Clinton.

“My wife is also from the Jackson area, so it’s been an adjustment for us,” he said. “Things are more laid-back here, and we’re still getting used to being in a different atmosphere. But we get back up to Jackson a good bit, and the three-hour drive is easy.”

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Page 3: Mississippi Medical News June 2014

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By LyNNE JETER/UMMC

Michael R. McMullan, MD, has re-turned to his Mississippi roots to direct a program at the University of Mississippi Medical Center (UMMC) offering spe-cialized care to an un-der-treated population: adults with hereditary heart disease.

McMullan, a De-catur native and alum-nus of the University of Southern Mississippi and the UMMC School of Medicine, rejoined the medical center after a seven-year absence to lead the state’s only adult congenital heart program.

Nationally, less than 10 percent of adults who need it receive this type of care, according to the Adult Congenital Heart Association.

“Our goal is to take care of … Missis-sippi,” said McMullan, also a professor of medicine at the medical school. “UMMC is positioned to care for every patient with congenital heart disease, no matter the complexity.”

Improved techniques, progressing technology, and advancing surgical and

post-operative care are helping adults with the disease live longer and health-ier lives, said McMullan. More than 1.3 million adults in the United States have congenital heart disease, outnumbering children with the condition.

“This population of patients is very underserved nationwide, and we’re thrilled to have a superstar like Dr. Mc-Mullan to lead our program,” said Jorge Salazar, MD, chief of UMMC’s Division of Cardiothoracic Surgery. “Adult con-genital heart patients are among the most challenging patients we care for, and now these patients can receive the very best treatment right here at home in Missis-sippi.”

At UMMC, specialists partner with primary care physicians and cardiologists throughout the state in treating adults with congenital heart disease. McMul-lan’s supreme goal: To “incorporate all of the congenital patients in our state under one roof,” he said.

“I believe that’s clearly in the best interests of our patients,” he said, “and that’s what ultimately drives me.”

McMullan would relish the time to tour the state and talk to every cardiolo-gist “and do whatever it takes to allow us to participate in their patients’ care – not

take away their patients, but make sure they see us for follow-up as needed, par-ticularly the highly complex cases,” he said.

Because many patients cannot travel to Jackson, McMullan is willing to set up clinics throughout Mississippi to see them, especially in cases where the patient falls between the cracks, such as the 30-year-old man with a heart attack who was sent to the PICU.

“He woke up in a bed that was next to a 2-year-old,” said McMul-lan. “Because adults get adult diseases, there needs to be a transition – from pediatric cardiologist care to adult cardiologist care. I believe part of my role here is to ensure that transition.” Because of the coordination between its pediatric cardiology program – Mary Taylor, MD, chief of pediatric critical care and division director of pediatric cardiology and of pediatrics critical care, and Makram Ebeid, pediatric interven-tional cardiologist -- and the congenital cardiac surgical program under the lead-ership of Salazar, who helped recruit Mc-Mullan to the medical center, UMMC accomplishes that goal, said McMullan, who joined UMMC from the Jackson Heart Clinic, PA, where he had been a

partner since 2007. Influenced by Patrick Lehan, MD,

one of Mississippi’s pre-eminent cardi-ologists, to specialize in the treatment of adult heart disease, McMullan pursued specialty training at UMMC and Duke University Medical Center. He was also drawn to the specialty because, he noted, “heart disease runs in my family.”

McMullan originally joined UMMC in 1998 as an assistant professor of medi-cine and developed the Adult Congenital and Valvular Heart Disease Clinic. Over the years, he has served as clinical chief of cardiology, director of the Cardiology Fellowship Training Program and from 2005 to 2007, chief of the Division of Cardiology.

McMullan serves in multiple pro-fessional organizations and has earned various teaching honors, including Department of Medicine Teacher of the Year and UMMC Clinical Profes-sor of the Year. He was also selected to UMMC’s Norman C. Nelson Order of Teaching Excellence and the Blake Academy for Excellence in Teaching. For three years, he served as governor of Mis-sissippi for the American College of Car-diology.

Treating Hereditary Heart DiseaseUMMC cardiologist leads only heart program of its kind statewide

Dr. Michael R. McMullan

Page 4: Mississippi Medical News June 2014

4 > JUNE 2014 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 LyNNE JETER

Last June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health – converged on the campus of Nemours Children’s Hospital in Orlando to see lean healthcare transformation in action.

As usual, Joan Wellman, president of Seattle-based Joan Wellman & Associates (JWA Consulting), worked quietly and diligently behind the scenes, connecting hospital system administrators with com-panies in a strategic way to build a more reliable healthcare system using lean man-ufacturing principles.

“A lean transformation is excruciat-ingly patient-focused,” said Wellman, who pioneered the application of Toyota principles in healthcare and helps com-plex systems facilitate large-scale lean healthcare transformations. “Every activ-ity in the organization is assessed, relative to whether it adds value for the patient. As waste is removed, more time and re-sources are paid to the patient. It’s a very smart move to use these principles in a highly competitive environment because

if you can do more for your patients with the same resources, you obviously have competitive advantage.”

Wellman’s lean transformation jour-ney began in the early 1990s, when she was consulting with Boeing on its lean manufacturing effort.

“We were taking executive teams from Boeing to Japan,” explained Well-man. “In the course of two weeks, we took them by Toyota, Honda, Fuji, Xerox and other prize-winning companies to see how their manufacturing processes work. They saw the same principles in action at all these companies.”

In 1994, Wellman recalls a Boeing executive, who served on the board of directors of a Seattle hospital, pondering whether lean principles could apply to healthcare.

“At that time, none of us were health-care consultants, but we saw the appeal,” she recalled. “We took a group of clini-cians to Boeing’s fi nal assembly line in Everett, Washington, and trained them in lean principles alongside operators on the line. Then we went back to the hospital and scratched our heads, trying to fi gure out how to make it palatable to health-care professionals so the same principles could be applied. We looked at the waste

and problems in hospital processes as we would in a lean manufacturing line.”

Wellman spent a year at the hospital, better understanding the healthcare sec-tor and the application of lean manufac-turing principles to a healthcare setting. In 1996, Wellman became involved in delivering a series of lectures at Seattle Children’s Hospital about concurrently improving patient fl ow and quality while also reducing costs.

In 1998, “it was time to put our big toe in the water,” said Wellman, who es-tablished JWA Consulting in 2000. A few years later, her book, Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value (CRC Press), was published with co-authors Pat Hagan and Howard Jeffries, MD. The book chronicles healthcare improvements at Seattle Children’s Hospital, Memorial Care, The Everett Clinic in Washington, and Children’s Hospitals and Clinics of Minnesota.

“I don’t see the lean principles move-ment slowing down at all because of the Affordable Care Act,” said Wellman, whose fi rm has grown to 22 associates. “I see an increased commitment and at-tention to building a more reliable sys-

Catching Fire: Lean Healthcare TransformationsJoan Wellman pioneered application of Toyota principles in healthcare; helps complex health systems facilitate large-scale change

Creating High-Powered Healthcare Improvement Engines

Chapter 3 of Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value (CRC Press, 2010), written by Joan Wellman with co-authors Pat Hagan and Howard Jeffries, MD, begs the question: What additional value do consumers in the United States receive for the extraordinary fi nancial commitment made to healthcare?

“A 2008 Commonwealth Fund Report ranked the United States last in quality of healthcare among 19 comparative, developed nations,” said Wellman, noting the United States spends twice as much per capita on healthcare than other developed nations. “Not a stellar track record for a society paying top dollar.”

The chapter, “Creating High-Powered Healthcare Improvement Engines,” provides a blueprint for change through:

• Brutally honest leadership• Moving from ‘episodic’

project based improvement to continuous improvement;

• Changing the mindset and the management system of the organization vs. just applying lean methods;

• Developing lean leaders; and

• Developing a long term plan that ensures that this is a pervasive effort.

“Although the quantitative evidence demonstrates undeniable success, some of the emotional aspects of staff and clinicians engaging in improving the healthcare system are even more exciting,” said Wellman, after helping an organization through the early years of its lean transformation. “The sense of accomplishment – ‘we can do this!’ – is palpable. Even during the very early days of this organization’s lean transformation, improvement team members frequently expressed their enthusiasm for being engaged in the work. Other team members saw this as one of the most rewarding times of their careers. Still others keep asking, ‘When are we going to do this again?’ Such comments are the reward for the lean leader.”

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Page 5: Mississippi Medical News June 2014

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 JUNE 2014 > 5

By CINDy SANDERS

Value-based reimbursements, ICD-10 re-boot, meaningful use, clinical integration physi-cian alignment, transparency, PQRS, 5010 implementation, e-prescribing, staffing and train-ing, compliance, audits … oh yes … and caring for patients

There’s no question the American healthcare system is in the midst of sea change as foundational rules are rewritten and a new infrastructure for care deliv-ery is being put in place. While provid-ers, practice managers and administrators are supportive of many of the concepts, it doesn’t make the transition any easier.

With wave after wave of change washing over practices, it’s certainly ‘sink or swim’ time. For those trying to navi-gate the rough waters, the Medical Group Management Association’s extensive re-sources, advocacy and insights on critical issues help shore up practice managers as they fight to keep afloat.

Laura Palmer, FACMPE, a senior industry analyst and subject matter expert for MGMA, said practices across the country are facing unprecedented change. While much of it is tied to the Afford-able Care Act, a move to restructure the deliv-ery and payment system was underway even before the landmark legislation was set in motion but has since been greatly accelerated. Today’s practice managers are being asked to alter ‘busi-ness as usual’ on most every front.

Benefits & EligibilityReferencing the ACA impact, Palmer

said it’s about much more than just ex-panding coverage. “It’s really a change in how insurance plans work,” she noted. Keeping up with who covers what, where, with whom and at what point has become increasingly complex as staff members drill down through eligibility require-ments and benefits to figure out the bot-tom line for patients.

While access might be expanding as more people join the insurance rolls, Palmer noted there has actually been a trend of narrowing networks. Not every physician or service provider is on every plan level under a payer. Adding to the confusion, not every family member is on the same plan.

“We’re starting to see more differenti-ation, and it’s more difficult for the patient and provider, who needs to know where to send someone for referrals,” she noted.

Whereas traditionally a lab company would have been on every plan under a payer, that’s not necessarily true today. A platinum plan might have more options than a gold or silver plan. “It’s a lot more complicated,” Palmer said. “You can’t depend on what you knew in the past to

be true.”Therefore, she continued, it’s critical

to regularly check coverage parameters and limits. Verifying benefits annually used to be pretty common. However, Palmer said that no longer works. “Best practices say we really need to check eli-gibility and benefits every single visit for every single patient,” she said.

Although patient benefits tied to large employers or government entities still aren’t likely to change more than once a year, the same isn’t necessarily true for smaller employers. And, Palmer pointed out, people change jobs much more fre-quently now so even if a company’s plan hasn’t changed, the patient’s job status might have.

Appropriate StaffingTrue access to care doesn’t mean sim-

ply having the coverage in place to allow a patient see a provider. The second part of the equation is having providers avail-able to meet appointment demands within a reasonable time frame.

“The days of a doctor’s office being closed for two hours over lunch are long gone,” Palmer said. In fact, she noted, many practices are looking at evening and/or weekend hours, group care set-tings and adding non-physician extenders to meet demand.

From a reimbursement standpoint, practices must see enough patients to keep the doors open. From a quality standpoint, which now ties to reimburse-

ments, it’s critical to meet best practice parameters. Palmer noted evidence-based standards might call for a patient with a specific complaint to be seen within 48 hours. Practices have to figure out how to do that or risk the consequences … both of missing quality benchmarks and of low-ered patient satisfaction scores, which also will soon tie into reimbursement rates.

“You don’t want patients to go to the Emergency Room because they couldn’t get an appointment,” Palmer said. She added, “Practices need to make sure they have adequate staff coverage and a triag-ing system in place to ensure patients are getting the right care in the right environ-ment in the right time frame.”

Making New Friends“Practices that in the past might have

been competitors in a particular commu-nity are now having to play nice with each other,” Palmer pointed out of new cover-age rules and clinical integration models.

Tied to the narrowing network trend, providers are finding payers and plans in-creasingly dictate referral patterns. Palmer said new payment models, such as the for-mation of accountable care organizations, also are forcing more collaborations en-couraged by both the financial setup and patient need.

She added that while this kind of col-laboration across care settings is generally viewed as a good move for quality patient care, it is different than traditional prac-tice silos and will take time for providers to

adjust to creating more community-based care than has been available in the past.

Adjusting to New Payment Models

Although the vast majority of reim-bursements remain in the fee-for-service world, the switch to a value-based sys-tem is already underway. “The practical aspect of how we deliver care is already changing,” Palmer said.

Practices have begun investing in changing technology and staffing models before reimbursements have caught up to the new way of doing business. Case managers, nutritionists and non-physician providers are being added … even when those services aren’t clearly reimbursable across most payers … because of the value they add to patient care.

Currently, Palmer noted, only about 3-5 percent of a practice’s reimbursements are tied to quality metrics. While those numbers have remained pretty steady for the past few years as reported to MGMA, Palmer said she was eager to see if there is a change indicated in this year’s data. Anecdotally, she said MGMA staff mem-bers have heard from more practices that contracts are being negotiated with qual-ity metrics in mind.

Despite payments lagging a bit be-hind, Palmer said practices have really embraced the concept of value-based care. “It’s the right thing to do,” she stated. “I think physicians and practices know to re-

Drowning in Sea ChangeMGMA Tackles Tough Issues to Help Practices Stay Afloat

Laura Palmer

(CONTINUED ON PAGE 9)

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Page 6: Mississippi Medical News June 2014

6 > JUNE 2014 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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After graduating from Long Beach High School in 1938, Murphey studied medicine at the University of Mississippi in Oxford.

“During my freshman year at Ole Miss, the Japanese attacked Pearl Har-bor and I was drafted as an inactive Army member, “he explained. “At that time, Ole Miss only had a two-year program, so medical students transferred elsewhere to finish their degree so I transferred to Tu-lane.”

After earning his medical degree, Murphey served a nine-month internship at Charity Hospital in New Orleans, fol-lowed by a nine-month residency there. While in New Orleans, he met his room-mate’s friend, Margaret Anne Cooper, and the two were married Dec. 6, 1945. Origi-nally, they planned to wed on Dec. 7, but moved it up a day after realizing the date’s significance.

“We always said we didn’t want two wars starting on the same day,” he joked.

After military training, Murphey was drafted into active service as a medical offi-cer. He was briefly assigned to Ft. Benning, Ga., then Brook Army Medical Center in San Antonio, Texas.

“Just as I finished my first year, they sent me to Japan,” he recalled. “The war had ended by then.”

After being discharged from the Army, Murphey completed a two-year fellowship in internal medicine at Ochsner Clinic in New Orleans. From there, he and Marga-ret Anne moved to Tupelo, his mother’s hometown and where his grandfather and several extended family members resided. At that time, fewer than a dozen physicians were on staff at North Mississippi Medical Center; he shared an office on East Main Street with OB/GYN P.K. Thomas, MD.

“When I came to Tupelo, the hospital didn’t have an EKG machine,” Murphey recalled. “If I needed to do an EKG on a patient, I had to take mine with me. It weighed about 50 or 60 pounds, and it had a handle so I guess you’d call it portable!”

In the early days, Murphey treated heart disease, diabetes, high blood pres-sure and a variety of medical conditions. Because of his advanced training, he was often called for consultation by other phy-sicians in Tupelo, and also by hospitals in New Albany and Fulton.

In those days, house calls were quite common.

“I was new to Tupelo and didn’t know my way around well,” he said. “There weren’t many streetlights back then. They would give me directions, and I’d have to find my way around in the dark.”

Murphey was also called to the Emer-gency Department day and night. “The ER was just one small room with little staff,” he said. “If a patient came in, we would have to go there to see them.”

In the early 1970s, OB/GYN Wal-ter Bourland, MD, and internal medicine physician Bill Wood, MD, joined the clinic; the four moved into a new professional building downtown that Thomas’ family built. Murphey and Wood later moved to a new building on Garfield Street.

In the 1980s, Murphey and Wood

merged with new internal medicine physi-cians Antone Tannehill, MD, and Frank Lummus, MD, to form Internal Medicine Associates—the predecessor to IMA-Tu-pelo.

Even though he didn’t have much spare time, he enjoyed taking photos and developing them in his darkroom at home. He enjoyed traveling, especially trips to England to purchase items for his wife’s antique store.

Perhaps surprisingly, Murphey was an amateur radio operator for many years and bought one of the first computers from Radio Shack.

The Murpheys have two children – daughter Margaret and son Cooper still reside in Lee County – and two grandchil-dren, and a great-grandchild. Margaret works as an oncology nurse at NMMC.

After Murphey developed lymph-edema, he “decided the (nation’s larg-est rural) hospital was just too big to get around” and gave up his hospital practice. But he continued to see patients at IMA-Tupelo until the last day.

In retirement, Murphey isn’t slow-ing down much. He enjoys meeting with the Southern Light Photography Club monthly and making travel plans. He re-mains active with the Tupelo Symphony Orchestra – Margaret Anne serves as ex-ecutive director – and with First Presbyte-rian Church.

A Celebrated Career, continued from page 1

tem – with better quality, better safety, and better patient flow – at a lower cost. Applying the lean production system to healthcare is one of few models anywhere that simultaneously addresses all of those issues.”

A lack of time, attention, and leader-ship passion are the primary barriers to lean principle implementation in health-care systems, said Wellman.

“Mainly, it’s the lack of time,” she said. “Money is not the issue because it’s rare for organizations to look back and say they aren’t getting financial gains from doing this work.”

The application of lean principles is also aggressively being used in another segment of the healthcare industry: the design of healthcare facilities around the world, said Wellman, whose firm is be-coming well known for its work in what JWA Consulting refers to as Integrated Facility Design, applying lean principles to the design and construction process.

“We just finished up some work in the Netherlands, and helped design a healthcare facility in Saudi Arabia,” she said. “We’re also doing work in Canada and the U.S., whose clinical processes are fairly similar but social systems are quite different. All those factors have to be taken into account. One thing’s for sure: With the healthcare industry facing financial challenges and other market pressures, lean healthcare transformation is catching fire.”

Catching Fire,continued from page 4

Page 7: Mississippi Medical News June 2014

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 JUNE 2014 > 7

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Meeting Demand for Online Based PharmD Education LECOM is only nation’s second osteopathic school to offer Doctor of Pharmacy Degree Program via distance education

By LyNNE JETER

BRADENTON, FLA.—The Lake Erie College of Osteopathic Medicine School of Pharmacy (LECOM) recently unveiled an online Doctor of Pharmacy (PharmD) degree, only the nation’s sec-ond osteopathic school to offer the tradi-tional four-year professional program via distance education.

The inaugural online class of 24 students will meet on the Florida cam-pus Aug. 18 for orientation, with an an-ticipated June 2018 graduation. LECOM administrators plan to reach capacity of 96 students in four years.

LECOM follows Creighton Univer-sity, the only other osteopathic program nationwide, in its increased online degree coverage. Creighton began its Doctor of Pharmacy online degree program in 2001.

“We knew this was a program stu-dents wanted,” said Katherine Tromp, PharmD, director of distance education for LECOM in Bradenton, Fla. “The pent-

up demand was there. The distance education program makes it easier for medical professionals who already maintain a busy schedule with work and family responsibili-ties. But don’t let it fool anyone into thinking it’s an easy program.

“The LECOM online Doctor of Pharmacy curriculum is quite compre-hensive, and takes about 60 hours a week to fulfill the laboratory, casework and presentation portions of the program. Time management skills are vital to the student’s and program’s success.”

Even though the majority of the pro-gram is online, students will be required to attend orientation and laboratory sessions on site, and also complete their clinical and experiential rotations at pharmacies, hospitals and wellness centers across the country. Students will also be required to travel to testing sites for exams.

Of 185 PharmD programs offered

worldwide, very few schools administer the coursework almost entirely online. In the United States, there are seven institu-tions accredited to offer the coursework online: two osteopathic schools, Shenan-doah University, University of Florida, University of Montana, University of North Carolina-Chapel Hill, and the Uni-versity of Oklahoma-Tulsa.

The schools’ program curriculums vary. The University of Florida’s online doctor of pharmacy degree program, which requires limited campus visitation, focuses on Medication Therapy Man-agement (MTM), an emerging area of pharmacy practice that recently became a billable service for some Medicare Part D and Medicaid recipients. UF is the only university offering this concentration.

LECOM is a solitary school of phar-macy functioning from two locations nearly 1,200 miles apart. On campus in Erie, Pa., an accelerated pathway allows PharmD students to complete the degree program in three years. On the Florida campus, students may opt for the tradi-

tional pathway or online, both four years. All three curricula offer a similar spec-trum of didactic courses, credit hours, and experiential education and experi-ences.

Course electives include research in-dependent study, cultural competence for healthcare professionals, advanced phar-maceutical compounding, drug discovery and development, health disparities, clini-cal toxicology, gerontology issues, travel medicine and a practical business study to build a solid personal finance foundation.

LECOM also offers a long-distance curriculum for the master’s degree pro-gram in medical education.

Katherine Tromp

Read Mississppi Medical News Online:

MISSISSIPPIMEDICALNEWS.COM

Page 8: Mississippi Medical News June 2014

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an exciting and challenging year for car-diology.”

Last year, the ACC formulated a comprehensive, mission-based strategic plan, with goals aligned to improve the personal experience of care and the health of populations, and also reduce the per capita cost of care. The College also seeks to strengthen the value of its formation 65 years ago through point-of-care and inter-active personalized educational activities, with a continued emphasis on the devel-opment of the clinical practice guidelines in collaboration with the American Heart Association and derivation of performance measures and appropriate use criteria de-signed to reduce variability and promote best practices.

“Our patient registries form the back-bone of our efforts to track the elements of care we provide, inform the design of local and systems-based quality improvement initiatives, and allow for the execution of outcomes-based and comparative effec-tiveness research,” said Harold, former chief of staff of Cedars-Sinai and a clini-cal professor in the Cedars-Sinai Heart Institute in Los Angeles. “We’ve begun to explore the potential of high through-put data and information management in partnership with other stakeholders. Consider a future in which genetic, pro-teomic and metabolomic information will be integrated seamlessly with the clinical data elements already captured as part of the daily workfl ow. Our competitive ad-

vantage in this space lies in the expertise we bring to the clinical assessment of the associations yet to be discovered. We’ll continue to advocate effectively for our patients, for the high quality, effi cient, effective and personalized care they de-serve, and for the highest interests of our profession. No doubt, our strategic plan will require timely and nimble revisions in anticipation of future challenges, but our legacy will be defi ned by our ability to stay focused on our mission.”

At the event, new ACC president Patrick T. O’Gara, MD, FACC, focused on three inter-related themes of chal-lenge, opportunity, and leadership. He highlighted some of the challenges facing cardiovascular professionals, including the transition from volume to value, uncertain payment mechanism, declines in GME funding, and work/life balance, while also addressing some “extraordinary oppor-tunities” that lie ahead. For example, he noted that “advances in genetics, ‘-omics,’ systems biology, and network medicine have the capacity to catapult ACC mem-bers into a near term future of more rapid delivery of more effective therapies for a variety of disorders, including hyperten-sion and atherosclerosis.”

“The fields of regenerative medi-cine and stem cell biology have witnessed paradigm-shifting breakthroughs — to an extent that our long-held hope regarding their practical applicability might yet be realized,” said O’Gara, one of nine chil-

dren whose mother infl uenced him with the frequent quote, “watch your brain!” “Investigator-initiated, ACC registry-based research will yield new discoveries rooted in patient outcomes. Harness-ing big data with advanced information technology systems will rapidly accelerate the pace with which new insights can be translated into practice. In our daily lives, we now routinely change the course of disease with trans-catheter valves, closure devices, biodegradable stents, hybrid in-terventions, catheter ablations, life-saving devices and new drugs and biologics. Telehealth and telemedicine will soon be-come commonplace and extend our abil-ity to reach greater numbers of patients in their own environments and provide more value at lower cost.”

With nearly 50,000 members world-wide, Mansour’s ACC role will be pivotal amidst the sea of change in healthcare delivery. As chair of the Board of Gover-nors, Mansour will lead a body of 66 gov-ernors from all 50 states, the District of Columbia, Puerto Rico, Canada, Mexico and the U.S. Uniformed Services elected to facilitate communication between Col-lege leaders and their members in the state they represent.

“The ACC is engaged on a daily basis with a wide range of issues to en-sure that our members are navigating the changes in healthcare in ways that protect patient’s interest and access to the most appropriate care,” said Mansour. “It’s particularly important to protect patients’ access in areas with high incidence of cardiovascular disease, especially if those areas are also underserved. Many of the challenges we face in Mississippi are also seen in rural areas throughout the United States and in underserved areas around the world. We deal with the issues that af-fect our members and patients every day in our own practices, but maintain a per-spective of our responsibility to advance changes in healthcare around the world.”

Mansour, an affi liate faculty in the Department of Medicine at the Univer-sity of Mississippi School of Medicine, his alma mater, has been a member of the Board of Governors and president of the ACC’s Mississippi chapter since 2011.

A graduate of Millsaps College, Mansour completed his internal medi-cine residency at the Ochsner Foundation Hospital, served as chief fellow in cardi-ology at the University of Florida School of Medicine, and interventional fellow in cardiology at Beth Israel Hospital at Har-vard Medical School. He has also served as assistant professor of medicine at the University of Florida, followed by clinical assistant professor of medicine at Emory University.

Mansour, a father of four with his wife, general practitioner Kathleen Man-sour, MD, FACC, also serves as an offi cer and member of the Board of Trustees of the Mississippi State Medical Association through 2016. He’s a partner with Car-diovascular Physicians, PA.

His research interest includes health-care disparities. He has worked to ad-dress disparities and improve outcomes in underserved and minority populations through his current practice, the ACC’s CREDO Initiative, the Robert Wood Johnson Foundation’s study on healthcare disparities and its program: Expecting Success, and community and statewide programs.

Greenville Cardiologist Leads ACC Board of Governors, continued from page 1

The American College of Cardiology (ACC) operates national registries to measure and improve care, provide professional medical education, disseminate cardiovascular research and bestow credentials upon cardiovascular specialists who meet stringent qualifi cations.

The Peripheral Vascular Intervention (PVI) Registry, the ACC’s newest registry, replaces and expands on the CARE Registry, assesses the prevalence, demographics, management and outcomes of patients undergoing percutaneous treatment for their peripheral vascular disease (PVD). In addition to continuing data collection for carotid artery stenting and carotid endarterectomy procedures, it also incorporates lower extremity peripheral arterial catheter-based procedures for more complete reporting on PVD treatments.

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ICD-10Recognizing that not every provider

in every setting is on the same page about the latest ICD-10 delay (with a new im-plementation date of Oct. 1, 2015 as con-firmed by CMS in May), Palmer said it cropped up as the number one concern for 2014 in MGMA’s annual Medical Prac-tice Today survey.

Chief among worries are cash flow concerns, vendor issues, testing, and ad-equate staff training. Palmer noted, “The delay in implementation is going to allow for more testing, and that’s got to be good for everyone.” She added, she thinks it will give vendors the needed extra time to re-solve software issues and practices time to get the technology and training in place.

However, Palmer acknowledged there would be some practices that once again put ICD-10 on the back burner only to panic again next year instead of using this time to really prepare.

Practice Setup“Integration and alignment issues are

still a big topic of conversation,” Palmer said.

What is the most effective practice model? Should practices merge? Sell to a hospital? Specialize or become multi-discipline? The ‘correct’ answer, she said, truly varies depending on circumstances and location.

“Healthcare is local,” Palmer pointed out. “What would work in Maine won’t

necessarily work in Arizona.”

The MGMA LifelineMGMA’s resources can serve as a

lifeline to practice managers who are treading water as fast as they can. Palmer stressed the organization’s role is not to make decisions for practice managers but to put them in a position to proactively make thoughtful choices based on their own unique set of circumstances.

The goal, she said, is to “bring people vetted information – good information from reliable sources – so practice man-agers can make informed decisions.” She continued, “There isn’t one right answer. The joke around here is if you’ve seen one practice … you’ve seen one practice.”

Although new delivery models are building local alliances, there is certainly still a competitive relationship among practices in a given geographic area. Palmer said a key benefit of MGMA is that it provides a safe environment for peer networking to allow the exchange of information across regions. Where a prac-tice manager might not ask the competing cardiology practice down the street how they are handling benchmarking or suc-cession planning, MGMA membership provides a forum where that manager could talk to cardiology practices outside the market catchment area to find out how they are addressing those issues.

Finally, she noted, MGMA offers the tools to allow managers to excel in their careers. “We provide professional devel-opment so we grow the next generation of practice managers,” Palmer stated.

Drowning in Sea Change, continued from page 5

GrandRounds

Legrand Announces Retirement From DMH

After more than 40 years of public service, Edwin C. LeGrand, III, is plan-ning to retire. Having served as the Ex-ecutive Director of the Mississippi De-partment of Mental Health (DMH) since 2007, he will be departing on June 30, 2014. LeGrand is a long-term DMH em-ployee, having started his career more than 40 years ago as a direct care worker at North Mississippi Regional Center (NMRC) in Oxford.

LeGrand also served as Deputy Di-rector of DMH for four years. He served as Director of the Bureau of Mental Re-tardation and was the Director of the Hudspeth Regional Center in Rankin County from 1982-1995. He began his career with DMH in 1974 at NMRC, where he served in many capacities, in-cluding Personnel Director/Assistant Director and Director of the Education Department. He received his Bachelors and Masters degrees from the University of Mississippi.

Since LeGrand began serving as Ex-ecutive Director, he has focused on ex-panding community-based services and

concentrating on a recovery-oriented system of care. Under his leadership, DMH improved access to crisis stabili-zation services. An individual can now receive services on a voluntary basis be-fore they decompensate to the point of meeting commitment criteria. He has consistently worked towards breaking down barriers and increasing the pub-lic’s understanding that mental health is an essential part of overall health. He reminds Mississippians every chance he gets that people should seek treatment for substance abuse and mental health with the same urgency as they would any other health condition.

LeGrand currently serves on the Mississippi Department of Rehabilitation Services Board. He is also a graduate of the Stennis Institute of Government. Le-Grand holds several professional licens-es and certifications including: Certified Public Manager, Licensed Nursing Home Administrator, Licensed Mental Health/Mental Retardation Administrator, Certi-fied Mental Retardation Therapist, and Certified Mental Health Therapist.

Page 10: Mississippi Medical News June 2014

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GrandRoundsUMMC’s Dr. John Hall Named SEC Professor of the Year

JACKSON, Miss.- The Southeastern Conference (SEC) announced University of Mississippi Medical Center’s Dr. John Hall the 2014 Professor of the Year.

Dr. John Hall was recognized for his excellence in the classroom and for his obesity and cardiovascular research. He has authored more than 530 publica-tions and has been cited more than 35, 800 times. His Textbook of Medical Phys-iology is considered the leading medical physiology textbook and is translated in 14 languages and is one of 18 books he has written or edited.

Hall won this award over at least 50,000 teachers and 14 universities in the SEC.

St. Dominic Hospital to Open Women’s Clinic in Madison

St. Dominic Hospital announces the opening of the Women’s Health and Healing Center in the Highland Medical Arts building in Madison, Miss. Dr. Philip Ley and Dr. Paul Seago have committed as clinic physicians and St. Dominic’s ex-pects to secure additional doctors in the near future.

The Women’s Health and Heal-ing Center is a multi-specialty, full ser-vice women’s clinic. The 16-room, 7,870 square foot Center is designed to offer a comfortable, spa-like atmosphere, where patients will experience personal attention. The Center is a subsidiary of St. Dominic’s.

Planned specialty areas at the Cen-ter include: Breast Surgery Including Oncology; Mammography; Heart and Lung Screenings; Gynecology; Urogyne-cology, General Health and Wellness.

St. Dominic’s Women’s Health and Healing Center will be open Monday through Thursday 8:00 a.m. – 5:00 p.m. and Friday 8:00 a.m. – 12:00 p.m.

King’s Daughters Medical Center Recognized for Providing Outstanding Patient Experience

King’s Daughters Medical Cen-ter announced that is has achieved the Healthgrades 2014 Outstanding Patient Experience Award™. King’s Daughters was identified as providing outstanding performance in the delivery of positive experiences for patients during their hospital stay, according to Healthgrades, the leading online resource for compre-hensive information about physicians and hospitals.

Healthgrades evaluated King’s Daughters performance as assessed by the hospital’s patients across 27 differ-ent questions that roll up to ten distinct measures. Ranging from cleanliness and noise levels in a patient room to factors such as pain management and responsiveness to patient’s needs, the measures also include whether a pa-tient would recommend this hospital to friends or family.

Page 11: Mississippi Medical News June 2014

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 JUNE 2014 > 11

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Hattiesburg Clinic Plastic Surgery Offers New Service

Hattiesburg Clinic Plastic Surgery now offers medical tattoo services through Becky Olsen, certified medical tattooist. Olsen specializes in medical tattooing and permanent makeup.

Medical tattooing includes areola pigmentation, hair simulation and scar camouflage. Many medical tattoo ser-vices are part of a recommended treat-ment plan from a physician and are of-ten described as the “final step” in the recovery process of a surgical patient. For breast cancer patients who have had breast reconstruction, areola tattoo-ing is a positive ending to a challeng-ing journey. For those who have lasting scars from procedures or injuries, scar camouflage blends the coloring in the skin to create a smooth, even skin tone.

Permanent makeup is used to en-hance patient features and give the ap-pearance of naturally beautiful makeup that doesn’t wear off. Permanent make-up includes eyeliner and eyelash en-hancement, lip liner, lip color and eye-brow enhancement or filler.

Doug Sills Appointed to CEO of Jackson Market

Doug Sills has been appointed to the role of Market CEO of CHS-affiliat-ed hospitals in the Jack-son area, effective May 1. Based in Flowood, he will lead collaborative ef-forts between Crossgates River Oaks Hospital in Brandon, Madison River Oaks Medical Center in Canton, River Oaks Hos-pital and Woman’s Hospital in Flowood, Central Mississippi Medical Center in Jackson and River Region Health Sys-tem in Vicksburg. He has served as CEO of River Region Health System since January 2011.

The six hospitals have a significant impact in the region. Collectively in 2013, they provided care for nearly 28,000 pa-tients who were admitted to the hospi-tals. They also delivered more than 4,600 babies and provided emergency services for nearly 145,000 ER visits.

Sills has more than 30 years of hos-pital management experience. In the last three years at River Region Health System, he has grown how the hospital cares for its community through the suc-cessful recruitment of physicians to its medical group, expansion of its heart surgery program and addition of robot-ic surgery to its services. Employee and physician satisfaction have improved significantly and continue to increase since he joined the hospital. He was pre-viously CEO of hospitals in Louisiana, Florida and Alabama.

Sills is a graduate of Mississippi College in Clinton. River Region Health System Chief Operating Officer Greg Pearson will serve as Interim CEO of the hospital as members of the board, medical staff and administration identify a permanent candidate.

Doug Sills

Page 12: Mississippi Medical News June 2014

12 > JUNE 2014 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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PHONE NUMBER

WEB ADDRESS

8 0 0 -7 6 2 -2 4 2 6

w w w . b a l c h . c o m

FREE BACKGROUND INFORMATION AVAILABLE UPON REQUEST. No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers. Contacts: Scott E. Andress, Managing Partner, Jackson, MS, (601) 961-9900; Ricky J. Cox, Managing Partner, Gulfport, MS, (228) 864-9900.

Balch_MSMedNews_FullPG_Challenges_R.indd 1 2/25/14 12:24 PM


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