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PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER Benefitting Hospital Patients via Massage Therapy Baptist Healthplex’s nationally certified massage therapist adds Mayo Clinic designation for hospital-based massage therapy When Mayo Clinic comes to mind, a relaxing massage might not be at the forefront ... 4 The Case for Covering Low-Dose CT Lung Cancer Screening Proponents cite ROI of early detection, reduced mortality Perhaps it is only appropriate the Centers for Medicare & Medicaid Services is scheduled to announce its highly anticipated coverage decision for low-dose computed tomography (LDCT) lung cancer screening in November. ... 5 November 2014 >> $5 PROUDLY SERVING THE MAGNOLIA STATE Andrea Morris, MD PAGE 2 PHYSICIAN SPOTLIGHT ONLINE: MISSISSIPPI MEDICAL NEWS.COM Access, Incentives Key to Governor’s Healthcare Strategy Gov. Phil Bryant heads into final year of first term Baptist Memorial Breaks Ground on New $300 Million Hospital in Oxford Replacing existing facility offers a chance to plan for future needs BY LUCY SCHULTZE Baptist Memorial Health Care Corp. is starting from scratch in repositioning its Oxford hospital to better meet healthcare needs in north-central Mississippi. The Memphis, Tenn.-based corporation begins construction this fall on a new $300 million hospital to replace the current Bap- tist Memorial Hospital-North Mississippi (BMH-NM). The new hospital, slated for completion in December 2017, will retain the same total 217 beds as the existing one, but will provide more room for outpatient and emergency care as well as space for future expansion. “Oxford and Lafayette County is a fast-growing area for Mis- sissippi, between the growth of the University of Mississippi and the development of the town as a retirement community,” said William C. “Bill” Henning, CEO and administrator for BMH- NM. “The decision was made that we really need to replace the (CONTINUED ON PAGE 8) BY LUCY SCHULTZE Three years after Mississippians elected him their 64th governor, Phil Bryant is encouraged by the progress he’s seen toward connecting patients across the state with better access to healthcare. From boosting the number of new physicians in the state, to finding ways of attracting them to the neediest communities, Bryant can point to strides that stand to pay off in the years ahead. Likewise, the future will show the impact of new measures that apply economic-development in- centives to the healthcare industry. Mississippi Medical News asked him to outline the areas where he believes progress lies ahead for the state’s healthcare system. In your “Opportunity Mississippi” strategic plan released at the beginning (CONTINUED ON PAGE 10) 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 new Baptist Memorial Hospital North- Mississippi is slated to open at the end of 2017. The facility is being designed by architects Earl Swensson Associates Inc. and will be built by contractor Robins & Morton.
Transcript
Page 1: Mississippi Medical News November 2014

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

ON ROUNDS

PRINTED ON RECYCLED PAPER

Benefi tting Hospital Patients via Massage TherapyBaptist Healthplex’s nationally certifi ed massage therapist adds Mayo Clinic designation for hospital-based massage therapy

When Mayo Clinic comes to mind, a relaxing massage might not be at the forefront ... 4

The Case for Covering Low-Dose CT Lung Cancer ScreeningProponents cite ROI of early detection, reduced mortality

Perhaps it is only appropriate the Centers for Medicare & Medicaid Services is scheduled to announce its highly anticipated coverage decision for low-dose computed tomography (LDCT) lung cancer screening in November. ... 5

November 2014 >> $5

PROUDLY SERVING THE MAGNOLIA STATE

Andrea Morris, MD

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM

Access, Incentives Key to Governor’s Healthcare Strategy Gov. Phil Bryant heads into fi nal year of fi rst term

Baptist Memorial Breaks Ground on New $300 Million Hospital in OxfordReplacing existing facility offers a chance to plan for future needs

By LUCy SCHULTZE

Baptist Memorial Health Care Corp. is starting from scratch in repositioning its Oxford hospital to better meet healthcare needs in north-central Mississippi.

The Memphis, Tenn.-based corporation begins construction this fall on a new $300 million hospital to replace the current Bap-tist Memorial Hospital-North Mississippi (BMH-NM). The new hospital, slated for completion in December 2017, will retain the

same total 217 beds as the existing one, but will provide more room for outpatient and emergency care as well as space for future expansion.

“Oxford and Lafayette County is a fast-growing area for Mis-sissippi, between the growth of the University of Mississippi and the development of the town as a retirement community,” said William C. “Bill” Henning, CEO and administrator for BMH-NM. “The decision was made that we really need to replace the

(CONTINUED ON PAGE 8)

By LUCy SCHULTZE

Three years after Mississippians elected him their 64th governor, Phil Bryant is encouraged by the progress he’s seen toward connecting patients across the state with better access to healthcare.

From boosting the number of new physicians in the state, to fi nding ways of attracting them to the neediest communities, Bryant can point to strides that stand to pay off in the years ahead.

Likewise, the future will show the impact of new measures that apply economic-development in-centives to the healthcare industry.

Mississippi Medical News asked him to outline the areas where he believes progress lies ahead for the state’s healthcare system.

In your “Opportunity Mississippi” strategic plan released at the beginning

(CONTINUED ON PAGE 10)

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 new Baptist Memorial Hospital North-Mississippi is slated to open at the end of 2017. The facility is being designed by architects Earl Swensson Associates Inc. and will be built by contractor Robins & Morton.

After all, this is offi cially ‘National Lung Cancer Awareness’ month.

Page 2: Mississippi Medical News November 2014

2 > NOVEMBER 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

As one Jamaican child after another sought her care from a makeshift exam room in rural St. Ann Parish, Andrea Morris, MD, felt her life’s dream meet reality.

“After years of watching a medical team care for people on missions like this, now here I was doing it,” said Morris, for whom a weeklong mission to Jamaica in August 2013 was a landmark in life.

“There were so many children needing care, ranging from simple to complex, in an area of limited resources. I don’t think I’ve ex-perienced it like that before,” she said. “My dream and my hope is to be able to take part in missions like that more often — and to have the opportunity to do some of that work here at home as well.”

A pediatrician with BMG Internal Medicine & Pediatrics in Columbus, Mor-ris was born the United States to Jamaican parents. She returned often to her family’s home country over the years.

As she developed an interest in medi-cine during her youth, she had the chance to assist in medical missions during visits. Returning to Jamaica as a medical mis-sionary herself was a priority as soon as her medical training was completed.

“There’s a lot of glamour to Jamaica, and a lot of beauty and affluence, which I’ve been accustomed to for most of my life,” she said. “Seeing this side of it was an eye-opener to me. There were people who would walk 10 or 15 miles — some without shoes — to come see the Ameri-can doctor that had come to town.”

Morris was raised just outside New York City in New Rochelle, NY. But her frequent visits to Jamaica, with its slower pace and more rural lifestyle, helped pre-pare her for life in Mississippi. She came to the state in 2009, to complete a residency in pediatrics at the University of Missis-sippi Medical Center. She liked the area and chose to settle in Columbus, where she began her practice in 2012.

“I was looking for a place where I could help and be a part of enhancing ac-cess to medical care,” she said.

“When I was in Jackson, I would see a lot of patients who would come there from all the rural parts of Mississippi. While Co-lumbus is not as rural as a lot of places, it is a city that has made tremendous strides over many years.

“There still remain some limi-tations, but the commitment we have to our patients, in addition to a growing ability to provide com-prehensive healthcare, makes ac-cess to care something we handle well in the pediatric community. I am proud to have experienced that over the past two years here.”

Morris is part of a group of six pediatricians affiliated with Baptist Memorial Hospital-Golden Trian-gle. She sees patients in the clinic as well as caring for newborns and seeing patients in the hospital.

From her perspective, im-proving access for patients has meant not only the addition of more pediatricians to the area or providing a system where parents can connect with the practice when they have problems outside normal clinic hours, but also pro-viding education to the community

when necessary.“Our patients typically have a place

they can call to ask questions or seek ad-vice. Depending on the concern at hand, this sometimes means they can save them-selves an ER visit for non-urgent needs,” Morris said. “We do have an answering service, and in the event of a sick child at home or questions that just can’t wait till the morning, they can call and reach a ser-vice or a physician who can address their issue, whether it’s after clinic hours or over the weekend.

“I feel like that’s important — espe-cially in an area like this, where many of my patients come from an hour or some-times even two hours away.”

Morris’s career in medicine devel-oped through a surprising route: Her

experience as a concert violinist. In her youth, her family was part of a church that focused on volunteering and out-reach, and she often would visit patients in nursing homes and children’s hospitals and perform for them.

“Those environments granted me my first foot through the door when it came to medicine and caring for sick people,” she said.

By the time she was in high school, she had a growing desire to care for peo-ple through medicine. She took a job as a medical assistant at a local internal medi-cine and pediatric clinic to learn more about what the work was like.

When she arrived at the University of Massachusetts in Amherst, Morris opted for the premed track as a member of the Biological Sciences Talent Advancement Program and earned a bachelor of science degree in biology.

She went on to complete training as an EMT and earn a master’s of health administration degree from St. Joseph’s College in Standish, Maine. She returned to the Caribbean for medical school, com-pleting her medical degree at St. Mat-thews University School of Medicine in Grand Cayman.

Along the way, Morris found the demands of a career in medicine meant her musical pursuits would have to play second fiddle. Her prior experience as a professional violinist included performing all over the state of New York — including a couple of performances at Carnegie Hall and Lincoln Center — as well as perform-ing at weddings and as part of a touring string quartet.

“Violin was my past life, and I wouldn’t trade that experience for any-thing in the world,” she said. “I had the opportunity to travel to many places, and I also took trips to learn about musical cul-ture, so it was significant in my life.

“But as much as I love the violin, it’s very difficult to do both, and medicine is my number-one passion.”

Today, violin has become a hobby which she enjoys sharing with her son, Al-exander, 8, who also plays the instrument.

As her medical career goes forward, she plans to maintain her personal con-nection to Jamaica as well, with hopes of taking part in other international medical missions on a regular basis.

“What I found was that many of these children had had chronic medical problems for many years, but couldn’t be treated because they hadn’t had the means,” she said. “In addition to treating them and providing antibiotics and vari-ous medications, the organization I was part of also had the ability to find surgeons who would operate free of cost. It was truly rewarding to also be able to help our patients get the surgical corrections they required to improve their quality of life.”

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Editor’s note: This column is the third of a four-part series on healthcare leadership solutions.

Healthcare administrators and physi-cian leaders cannot afford the staggering price tag of the failure to address problem-atic physician behaviors.

Just one emotionally toxic physician (much less the estimated 3-6 percent of the typical medical staff who have such prob-lems) may cause significant damage to the reputation of the practice or hospital, cause patients and their families to take a lifetime of healthcare business elsewhere, destroy employee morale, increase the turnover of valuable team members, create com-munication problems that compromise patient outcomes, increase costly adverse events, and increase the probability of get-ting sued.

Patient satisfaction, word-of-mouth, and future healthcare choices.

When physicians behave disrespect-fully to their patients or patient families, these customers feel it intensely, and they never forget it. These experiences color

their entire perception of the physician, no matter the level of medical competence. Conversely, kindness, empathy, and con-cern in a time of crisis or ongoing care are also never forgotten!

When patients recommend a doctor, one of their most frequent bases of recom-mendation is “niceness,” not the treatment itself.

Dissatisfied patients and especially their upset family members liberally tell others about their experiences and feel-ings. Further, people make inquiries be-fore going to a certain physician, clinic, or hospital, and friends or web commentators quite happy to “advise.”

Additionally, unhappy patients don’t just rate their experience on patient satis-faction forms; they express their feelings “with their feet.” People exercise their choices about healthcare by changing pro-viders, practices, or hospitals. Consider the lifetime monetary value of a potential new patient’s healthcare and of the cumulative value of an exodus of patients. Pick a spe-cialty, and do the math.

Another cost embedded in patient satisfaction is its impact on patient sur-

veys of all kinds and in particular on the growing-in-importance Medicare Hospi-tal Consumer Assessments of Healthcare Providers and Systems (HCAHPS) survey. The implications for reimbursement are far-reaching. For several years, Medicare has been posting results of HCAHPS sur-vey on the Hospital Compare website to allow consumers to make fair and objective comparisons between hospitals. The age of using these scores in pay-for-performance initiatives is upon us.

Staff morale, turnover, and the impact on patient outcomes.

A major contributor to nurse satisfac-tion and the retention of good nurses is the quality of their relationships with physi-cians. According to Rosenstein’s research, the direct costs for recruiting and install-ing a new nurse can range from $60,000 to $100,000. Others estimate even higher figures when you add to recruitment such factors as:

• Staff and new hire time in orienta-tion;

• The investment in training to get the new person educated about specific

procedures and patient care in a new job setting;

• The disruption inherent to transi-tion, both for the new nurse and peers as they learn to work together and trust each other;

• The reactions of patients to new and sometimes inexperienced persons;

• The higher frequency of mistakes; and

• The interruptions in patient satisfac-tion as patients sense tension in the air.

Considering all of this, the sometimes-quoted turnover costs of 1 to 2-½ times the yearly salary seem quite credible. When a staff person is put down, mistreated, or harassed by a physician, the organization risks losing key talent and a great deal of money.

Additionally, when morale is low and staff stress is high, the patients bear the brunt of it.

A survey of more than 100 hospi-tals that tapped 4,500 respondents found that when staff members have high lev-els of stress and frustration, patient care

HEALTHCARE Leadership SolutionsBY BEVERLY SMALLWOOD, PHD

The Price of Not Nice: Part 3The high cost of negative physician behaviors

(CONTINUED ON PAGE 6)

Page 4: Mississippi Medical News November 2014

4 > NOVEMBER 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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By LyNNE JETER

When Mayo Clinic comes to mind, a relaxing massage might not be at the fore-front.

That’s not the case for Martha How-ell, LMT, membership and marketing co-ordinator for Baptist Healthplex-Jackson.

A licensed and nationally certified massage therapist, Howell recently com-pleted certification from Mayo Clinic in hospital-based massage therapy. The pres-tigious course, which included class work, hands-on training at Mayo, and a required case study, prepares massage therapists to provide services to hospitalized patients.

“Having the opportunity to work with the patients at Mayo was deeply moving,” said Howell. “Many of the patients had been hospitalized for months; two of the patients I saw had been there over a year. Through gentle massage, we were able to see significant reductions in their pain and anxiety levels.”

Mayo offers the certification course twice a year, but only accepts a dozen students per class. Howell’s class included eight people from a cross section of the United States, including Kansas, Cali-fornia, New York, Illinois, and two from Rochester, Minn., where Mayo is located. Howell was the only one from Mississippi

and the only Southerner. “We performed all massages in pa-

tient rooms and adapted them to needs and restrictions of the individual,” How-ell explained. “Massaging patients in the hospital is very different from massaging healthy clients. We had to work around IVs, ports, PICC lines, and wound vacs. There were times where we had to perform massage wearing an isolation mask, gown, and gloves.”

To qualify for the program, How-

ell had to complete an extensive applica-tion and get required immunizations. The prestigious internship at Mayo is not Howell’s first experience in advanced train-ing, however. In 2011, she participated in a month-long acupressure and Chinese medical manipulation internship at the Bei-jing Massage Hospital in Beijing, China. “I think Mayo looks for therapists who have sought extra training,” she noted.

The course started in February with online classes. In March, Howell partici-

pated in was a week of lectures on location at Mayo covering a range of topics, includ-ing medical note taking and reading, infec-tion control, aroma therapy, positioning around hospital equipment, recognition of hospital equipment, and identification of patients for massage therapy.

Back home, the online course work continued. Then, Howell’s class returned to Mayo in June for a week of hands-on training. Students were also required to do a case study due Aug. 1.

The most surprising aspect of Mayo training that Howell learned: there really aren’t obstacles to giving a massage in a hospital setting.

“Even if we only touch the feet or the hands, we can come in, dim the lights, help patients relax, and really listen,” she said.

At Mayo, Howell’s class saw patients recovering from cardiac, thoracic and general surgery, and those involved in pe-diatrics, orthopedics, oncology, palliative, hospice, breast surgery, pain management, and rehabilitation care.

According to Howell, hospital-based massage therapy is “super light, almost like acupressure.” Yet even though the massage itself is light, the benefits are weighty, she pointed out.

“We saw huge reductions in pain,” she pointed out. “On a pain scale of one to 10, we saw some eights drop down to twos and some fives to twos. We saw reduction in anxiety, and we were also able to help patients sleep. Some patients who hadn’t slept for days went to sleep during therapy, and then we just backed off quietly.”

Howell contracts with Baptist to pro-vide massage therapy services on weekends and after hours on a pay-for-fee basis. She’s provided massage therapy for hospitalized patients at Baptist in the mother/baby area and other specialties where patients requested therapy. “I ask for a physician’s order before I do therapy for hospitalized patients,” she emphasized.

Howell views her Mayo training as an-other tool in her repertoire.

“It’s changed the way I look at cli-ents,” she said. “And learning new tech-niques from others in the class itself was a great experience.”

Many people in the Jackson area have noted that Howell already has just the right touch. She’s been a finalist in the Jackson Free Press “Best of Jackson” awards since 2009 and won Best (Metro Area) Massage Therapist in 2010, 2012, 2013, and 2014.

Howell believes massage therapy for hospitalized patients is the wave of the fu-ture.

“It’s a way to enhance the quality of treatment and patient satisfaction,” she said. “I think it’s going to become more in-tegrated into hospital settings.”

Benefitting Hospital Patients via Massage TherapyBaptist Healthplex’s nationally certified massage therapist adds Mayo Clinic designation for hospital-based massage therapy

Martha Howell (center, holding banner) when selected as Baptist’s Caregiver of the Month last December.

Page 5: Mississippi Medical News November 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 NOVEMBER 2014 > 5

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

By CINDy SANDERS

Perhaps it is only appropriate the Centers for Medicare & Medicaid Ser-vices is scheduled to announce its highly anticipated coverage decision for low-dose computed tomography (LDCT) lung can-cer screening in November. After all, this is officially ‘National Lung Cancer Aware-ness’ month.

For proponents of using the diagnos-tic imaging study for early detection, the cost/benefit analysis is simple … LDCT saves lives in a cost efficient manner among a targeted, high-risk population. Medicare already covers broad-based screenings for colon, breast and prostate cancers. According to the American Can-cer Society Cancer Facts & Figures 2014, the combined estimated annual deaths from those three types of cancer is still sig-nificantly less than deaths from lung can-cer (120,220 vs. 159,260).

One of the most vocal supporters for extending coverage to Medicare ben-eficiaries is Ella A. Kazerooni, MD, MS, FACR, associate chair for Clinical Affairs and division director for Cardiothoracic Radiology at the University of Michigan.

“I firmly believe that screening for lung can-cer with CT saves lives,” she stated. An expert in the field, Kazerooni’s long list of credentials in-cludes serving as a trustee on the American Board of Radiology, chair of thoracic imaging for the American College of Radiology’s Com-mission on Body Imaging, chair of ACR’s Committee on Lung Cancer Screening, vice chair of the National Comprehensive Cancer Network’s Lung Cancer Screen-ing Panel, and past president of the Amer-ican Roentgen Ray Society.

“Medicare received two formal re-quests for a national coverage decision,” she explained of actions taken earlier this year precipitating the CMS determina-tion. “They statutorily have until Nov. 10 to post their draft coverage decision,” Ka-zerooni continued, noting a final decision was expected in February 2015 following a comment period.

The ScienceWhile CMS will complete the cover-

age decision process in a 12-month period, proponents say the science supporting CT scans for diagnosing lung cancer goes back several decades. Considering the current poor survival rates, this delay in integrat-ing the scientific research into routine practice has been particularly frustrating for providers.

Kazerooni said more than three-quarters of lung cancers are found in a late stage when the disease has spread, making surgical intervention ineffective or impossible. Patients are typically asymp-tomatic until the disease has progressed, which contributes to dismal survival rates. Currently, more than 90 percent of those diagnosed annually with lung cancer will die from the disease.

Research from the International Early Lung Cancer Acton Program (I-ELCAP), which was formed in 1992, has shown annual CT screening to be an effec-tive tool. In the original study, more than 1,000 high-risk, asymptomatic patients were screened. Of those who received a lung cancer diagnosis, more than 80 per-cent were at a clinical Stage 1.

Subsequently, findings from a much larger international pool were published

in several publications in 2006 after long-term follow-up of more than 31,000 as-ymptomatic study participants. While less than 2 percent of those screened received a lung cancer diagnosis, 86 percent were found in Stage 1 with an overall cure rate of 80 percent.

Similarly, the National Lung Screen-ing Trial (NLST), one of the largest and most expensive clinical trials ever under-taken in the United States, evaluated the impact of screening methods on surviv-ability. The trial, which ran from 2002-2010 and included more than 53,000 participants, compared outcomes when screening with standard chest x-ray vs. LDCT. The results published in 2011 in the New England Journal of Medicine demonstrated a 20 percent reduction in lung cancer mortality for those screened by LDCT.

In both arms of the trial, more than 94 percent of positive screening results turned out to be false positives upon further testing, which is one of the argu-ments against annual screening. It should be noted, however, that the false positive difference between LDCT and conven-

The Case for Covering Low-Dose CT Lung Cancer ScreeningProponents cite ROI of early detection, reduced mortality

Dr. Ella A. Kazerooni

(CONTINUED ON PAGE 6)

Page 6: Mississippi Medical News November 2014

6 > NOVEMBER 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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and outcomes are adversely affected. An atmosphere of emotional threat can exist because staff members don’t know what a disruptive physician will do next or re-spond to legitimate attempts at communi-cation regarding a patient care issue. The survey attributed poor patient outcomes to loss of focus and concentration, disrupted communication flow, diminished team col-laboration, and blocks in the information transfer necessary for effective patient care.

Adverse events.When physicians display habitual

anger and disrespectful behaviors, staff members are more reluctant to call them about patient issues or approach them to discuss a patient concern. Such com-munication issues have been found as a major contributor to a variety of adverse events, mistakes, and safety violations with patients. Fixed dollar per case reimburse-ment schedules, the refusal of third-party payers to reimburse for preventable ad-verse events, and possible financial penal-ties assessed (not to mention jeopardized patient outcomes) are all possible additions to the high price tag flowing from the dis-respectful attitudes and hostile behaviors of problem physicians.

In the hospital survey, a majority of respondents felt there were strong corre-lations between disruptive behaviors and the occurrence of adverse events (67 per-cent), the occurrence of medical errors (71 percent), compromises in patient safety (51 percent), compromises in quality (71 percent), and even patient mortality (27 percent). Most stated that they were aware of a specific adverse event that occurred because of disruptive physician behaviors.

When the Joint Commission ferreted a root cause analysis of sentinel events, they found that nearly 70 percent of such events could be traced to a communication problem. Further, the Joint Commission identified a strong association between disruptive behaviors and compromises in patient safety.

Most insurance companies no longer pay for additional expenses resulting from a selected group of adverse events, leaving the hospital at financial risk for the treat-ment of these conditions.

Liability and lawsuits. Lawsuits most often arise from real

or perceived adverse events, and often the physician’s emotional and interpersonal behaviors drive the pursuit of that lawsuit.

A strong, well-documented relation-ship exists between patient satisfaction, the quality of the patient-physician rela-tionship, and the likelihood of being sued. Contributing factors are poor provider communication, patient dissatisfaction, and physician incident reports.

In other words, if a patient has a warm, cordial relationship with their phy-sician, the likelihood of a lawsuit is signifi-cantly reduced. Even if an adverse event occurs, a patient who is enthusiastic about their relationship with the doctor is more likely to be willing to talk about it, excuse it, and work it out. People are highly un-likely to sue a doctor they “love.”

When lawsuits occur, even if the de-fendant “wins,” there are no winners. There are still lawyers to pay, costs of the malpractice proceedings, investigation expenses, and preparation charges. Ad-ditionally, one must take into account the opportunity costs related to staff time and energy as they are diverted for a significant amount of time from their primary respon-

sibilities. According to a New England Journal

of Medicine article, the average cost of a medical error-based claim is $521,000. A report on surgery malpractice traced 10 percent of paid surgery malpractice claims (with an average of $345,000 per claim) to poor communications among the surgery team.

Whew! The cumulative price tag is way too high to ignore this problem. So how can it be addressed? That’s the topic of Part 4 of this series.

Beverly Smallwood, PhD, is a psychologist with more than 30 years’ experience coaching physicians and executives, and also developing healthcare leadership teams. Request “The Price of Not Nice” white paper, or talk with Smallwood about leadership team needs by email via [email protected]

The Price of Not Nice: Part 3, continued from page 3

tional x-ray was less than 2 percent, yet decreased mortality with LDCT was 20 percent.

The available science led the United States Preventive Services Task Force (USPSTF) to assign a grade of B to lung cancer screening among high-risk patients —current or former heavy smokers, ages 55-80, with a smoking history of at least 30 pack-years. The USPSTF website defines the evidence behind a grade of B as being strong enough to recommend the service be provided.

The task force isn’t the only orga-nization to support LDCT screening for high-risk patients. In fact, Kazerooni said most every major clinical healthcare pro-fessional society, including the American Medical Association, has stepped up to voice support for CMS adopting cover-age.

“There’s overwhelming professional support,” Kazerooni said. “We also have a lot of support from the House and Sen-ate,” she added, noting congressional sup-port is bipartisan.

The DecisionThe irony, Kazerooni continued, is

the USPSTF recommendation led to a screening inclusion in the federally man-dated Affordable Care Act requiring third party payers cover LDCT for those at high risk of developing lung cancer. “It’s not a ‘recommended;’ it’s not a ‘they should;’ it’s a ‘must,’” Kazerooni said of the screening becoming a covered benefit beginning Jan. 1, 2015.

If CMS doesn’t reverse current pol-icy, then those who have received annual screenings for as much as a decade will abruptly lose the benefit when they hit 65 and qualify for Medicare coverage.

“The average age of lung cancer di-agnosis is 70 so to not offer lung cancer screening as they enter their peak years of risk would be a tragedy,” Kazerooni stated.

Among the issues being weighed by CMS are patient safety, frequency of test-ing, impact of false positive results, con-sistent quality across screening facilities, evidence-based data to identify eligible patients and inform follow-up and treat-

ment, and cost of screening in relation to improved outcomes.

Kazerooni noted CMS is undertaking the normal due diligence that goes into re-leasing a national coverage analysis deci-sion. She and colleagues across a number of medical specialties have provided infor-mation and parameters for the screening. For example, she noted, the American As-sociation of Physicists in Medicine has cre-ated specific exam protocols. The ACR, which is one of three bodies that accred-its CT facilities, has developed a practice standard for the screening. Proponents, she stressed, are specifically calling for low-dose, rather than standard dose, scans to improve the safety profile. Providers also agree smoking cessation counseling should be part of the overall professional intervention for all high-risk individuals who qualify for screening.

As for cost, Kazerooni said, “Low-dose CT screening is at least as cost ef-fective, if not more so, than breast cancer screening. When you’re talking about breast cancer screening, you’re talking about every woman of a certain age. Even though CT scans are more expensive, we’re targeting resources to a smaller, high-risk group.”

Bolstering that assertion, a study published in August in American Health and Drug Benefits found LDCT to be cost effective in the Medicare population. The researchers found implementing the screening cost less than $20,000 per life-year saved, which is less than the costs as-sociated with cervical and breast cancer screening.

Kazerooni is favorably encouraged CMS will follow suit with private payers and cover LDCT screenings for those with the necessary inclusion criteria who are not suffering from another medical condition that would significantly limit life expectancy. However, she added, she is interested to see what conditions CMS attaches to approval.

“It’s hard to believe they would do anything else but cover it,” she concluded of CMS. “There is a huge need for this, and we want to see it brought forward to benefit individual patients and the public at large.”

The Case for Covering Low-Dose CT, continued from page 5

Page 7: Mississippi Medical News November 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 NOVEMBER 2014 > 7

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association.® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

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YOU HAVEA PARTNERON YOURJOURNEY

By LyNNE JETER

True innovation concerning infor-mation technology (IT) in the practice of medicine lies in the manner it improves the care and quality of life of patients, em-phasizes Robert M. Wah, MD, president of the American Medical Association (AMA).

“Physicians must harness technology, not let technology harness us,” noted Wah, pointing to the fog of looming health IT, cloud computer and cyberse-curity issues facing the medical community. “With that prime di-rective in mind, we can now be open to new ideas, new techniques and new perspectives.” As part of his presidential agenda, Wah is making the rounds discussing how electronic health records (EHRs) are “about our patients, not tech-nology,” and focusing on not going high-tech for tech’s sake, yet also leveraging “an application of science that promotes well-being and advances tradition.”

Medical News spoke with Wah about

the movement toward patient-cen-tered electronic health record systems (EHR).

How will EHRs improve efficiency and cut costs?

Efficiency and cost-cutting are im-

portant, but the primary focus is improv-ing the care of patients using technology. Physicians are always looking for ways to take better care of patients, whether it’s a new technique, a new instrument in the OR, a new discovery from the life sciences industry, or in this case, a new technology that brings us better information to make better decisions to care for our patients. That’s where EHRs can help us in that regard.

Along with taking better care of our patients will come efficiency and cost-cutting. For example, through the use of EHRs, we’ve been able to cut down on prescribing problems by preventing a drug-drug reaction, or a drug-allergy reaction, or a duplication of medication.

How do EHRs impact the doctor-patient relationship now

versus your vision of that relationship

evolving?I always think people need to remem-

ber this is a technology, not the answer to everything. It’s another tool we can add to take better care of our patients. At the same time, we need to look for better ways to interface between man and machine,

so that the use of technology, which helps us take better care of our patients, doesn’t hinder us. What are your thoughts on technology taking focus away from patients, as providers pay attention to inputting data into the EHR system during patient visits?

We forget how much paper got in the way. There were probably times when a patient went into an office and thought, ‘gee, they’re writing the whole time, look-ing down at their pad.’ Now we’re more focused on when they’re looking at their iPad rather than a pad of paper. I’m not sure it’s much different. For some reason, patients seem to focus more on attention diverted to a machine. Pen and paper has always been there, too, and it wasn’t very efficient.

What are your thoughts on the per-ception that older physicians are reluctant to adopt EHRs?

There’s been a sentiment that doctors have been reluctant to embrace technol-ogy. I don’t think that’s true. Physicians will always embrace technology that helps them take better care of their patients. For example, physicians were among the first adopters of pagers, way back when pagers

Embracing Patient-Centered TechnologyAMA president discusses pitfalls, misperceptions and plentiful benefits of EHR systems

(CONTINUED ON PAGE 12)

Page 8: Mississippi Medical News November 2014

8 > NOVEMBER 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

existing hospital in light of that growth.”Henning said the move to start over

rather than renovate the existing facil-ity illustrates how much hospital operations have changed in the half-cen-tury since the existing hospital was built.

“The existing hos-pital really was designed for a time when people went to the hospital, and stayed in here a long time before getting discharged,” he said. “Today, so much more of the work is done on an outpatient basis or in-patient observation. The typical length of stay is much shorter, and many patients don’t even spend the night here.”

Campus DesignThe new facility is being built on a

150-acre site close to the original one. The site has been cleared and prepared, and a new access road has been laid.

At 680,000 square feet, the new six-story hospital will be nearly 60 percent bigger than the existing facility, including a 25,000-square-foot emergency depart-ment with 35 rooms. The ICU will be ex-panded from 20 to 24 beds.

Patient rooms in the hospital are de-signed to be 50 percent larger and more private than in the existing facility, while the new outpatient services areas are being designed with practical patient flow

in mind.“When you have more than 100 acres

to work with, it really gives you a chance to think through how patient flow needs to work for today’s patients and technol-ogy — and also, to design something that will be flexible as needs change down the road,” Henning said.

“While you may not know what healthcare is going to be like 15 or 20 years from now, you can design flexibility into the building to be able to take advan-tage of new procedures and technology in the future.”

In predicting the future, designers are anticipating that radiology will continue the dramatic evolution it’s seen in recent years. Likewise, history has shown a need for incremental expansions of the emer-gency room.

“Those departments are positioned on the outside perimeter of the building, with corridors set up to still allow good patient flow if those areas need to be ex-panded,” Henning said.

In the design, Baptist had a head start in basing the layout for the Oxford hospi-tal on that of its new Baptist NEA facility in Jonesboro, Ark. Representatives from Oxford had the chance to tour that facility and determine what aspects of the layout would work well back home.

Physician InputThe process of planning for the new

facility has included local medical staff

and physicians, as well as architects, engi-neers, equipment planners and healthcare consultants, Henning said.

Anesthesiologist Greg Thompson, MD, said local physicians were initially concerned about how much input they would have in the design process.

“After all, it’s the hospital’s money,” Thompson said. “But we’re the ones who work there, and from my perspective, it’s all about workflow and how we go about doing our daily tasks.”

Thompson said the process turned out to include “a lot of access” for physi-cians.

“I felt like they were open to sugges-tions,” said Thompson, who spoke up at meetings regarding floor plans for the sur-gery area.

“They saw what I was talking about in terms of how many steps someone was going to have to take between a hold-ing area and an operating room, and the distance patients would have to be rolled down the hallways,” he said. “They tweaked the plans based on our sugges-tions.”

Pathologist William M. “Bill” Poston, MD, said the process has allowed each de-partment to weigh in regarding how well the evolving design would meet its needs.

“In trying to position the laboratory for better patient flow and service, we started out on the basement level, and as the architects worked with everyone, we worked our way up to the first floor,”

Poston said. “They could see it really would make a difference from a functional standpoint.”

Poston said the medical community in Oxford is optimistic about potential new programs that the new facility could support. In the meantime, a smooth-flow-ing floor plan is enough to excite many.

“Physicians are looking forward to a design that will allow them to come and see patients in a very efficient manner,” Poston said. “As we all know, in meeting the new challenges of healthcare and re-imbursement, efficiency is important.”

Thompson said the medical commu-nity is also looking forward to the new hos-pital as a better expression of the quality of care offered inside.

“Right now, the wrapper’s a little old,” he noted. “There are still some things you’re going to have to go to a ter-tiary care center for, but we are modern-izing our care here in Oxford.

“I think having a big, new hospital will project that image to the Oxford com-munity and beyond: This care is as good as you’re going to get anywhere.”

Baptist Memorial Breaks Ground, continued from page 1

The announcement ad for Mississippi Retina Associates that ran in our August issue contained erroneous information concerning Dr. Jay Brown.

The announcement should have read:

Dr. Jay Brown, a native of Bay Springs, Mississippi, received his Bachelor of Arts degree in Biology from the University of Mississippi and completed his medical degree and Ophthalmol-ogy residency at the University of Mississippi School of Medi-cine, where he was presented with an Award for Excellence in Ophthalmology studies. His retina fellowship was completed at Louisiana State University in Baton Rouge, Louisiana, and he proudly served as the Chief of Ophthalmology at Mississippi Baptist Hospital from 2010-2012.

We r e g r e t a n y i n c o n v e n i e n c e f o r t h e w r o n g c o n t e n t o f t h i s a n n o u n c e m e n t .

CORRECTION!

JACKSON401 East Capitol St., Suite 600

Jackson, MS 39201P.O. Box 651

Jackson, MS 39205-0651PH. 601.968.5500 FAX 601.968.5593FAX 601.968.5593FAX

www.wisecarter.com

GULF COAST2781 C.T.Switzer, Sr. Drive,

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Hattiesburg, MS 39401P.O. Box 990

Hattiesburg, MS 39403-0990PH. 601.582.5551 FAX 601.582.5556FAX 601.582.5556FAX

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� CON� HIPAA� MEDICAL STAFF

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� GOVERNMENT RELATIONS

Our attorneys work hard every day in the ever-changing medical law environment. So, we’re up-to-date on all the latest rules, regulations and trends that affect the business side of health care. Call us today, and concentrate on your patients.

THERE WAS A TIME WHEN YOU ONLY HAD TO PRACTICE MEDICINE.

Expect results.

WCF MHA directory ad1.indd 1 3/10/09 3:05:11 PM

COMPLIANCE PROGRAMS

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REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.

Page 9: Mississippi Medical News November 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 NOVEMBER 2014 > 9

By LyNNE JETER

When Cherie Sibley was a teenager, she spent a great deal of time in the hospi-tal with her terminally ill grandfather.

“I always appreciated the nurses, the great job they did, and the difference they made with my grandfa-ther’s care and well-be-ing,” said Sibley, CEO since May 2013 of Life-Point’s 79-bed Clark Re-gional Medical Center in Winchester, Ky.

Sibley, whose back-ground is surgical ser-vices nursing, is one of many CEOs who has risen through the nursing ranks, a move that makes sense in the new patient-centered health para-digm.

“I speak the clinical language, under-stand the industry changes, and can pro-actively head off many issues at the pass,” she said. “Being able to understand qual-ity, patient safety, and the financial opera-tions of the industry is a strength clinical leaders possess.”

The HR AspectPam Belcher, vice president of human

resources and talent management for Brentwood, Tenn.-based LifePoint Hospitals, called the nursing-to-CEO path “possibly an emerging trend.” At the time of the interview, 11 percent of 47 LifePoint CEOs have CNO expe-rience; 18 percent of the company’s COOs were promoted from CNO positions. (At press time, the company has approximately 50 CEOs.)

“We’re certainly seeing more can-didates with nursing experience wanting to get into that executive hospital leader-ship role,” she said, adding how industry changes have also impacted the progres-sion. “We saw a shift in nursing from sim-ply a caregiver role that involved primarily caring for patients at bedside – turning and bathing them, for example – to that of a well-educated clinician with high expec-tations. The depth and breadth of their knowledge is amazing! As we changed the model of our hospitals to focus on how we were caring for patients, we put a greater responsibility on our lead clinician, which is mainly the CNO role. In addition, we began to ask them to manage the largest part of the facility – people, processes, equipment, and inventory – so their job has expanded significantly as healthcare has evolved.”

Steady Pace to CEO RoleSibley, a native of Bear Creek, a rural

community in northwest Alabama, began her career immediately following high school. She earned an associate’s degree

from the local community college and a nursing degree from the University of North Alabama while working at Lake-land Community Hospital in Haleyville, Ala. She had served as a nurse for more than 10 years when LifePoint acquired the hospital in 2002.

“As part of their evaluation process to assess talent, LifePoint talked to us about our roles and aspirations, while also shar-ing their succession planning and career development programs,” she said. “When I met with my leaders, rising to CEO was a goal. As part of my leadership develop-ment, they afforded me the opportunity to advance my education and then to pro-mote me when a position became avail-able.”

Sibley knew she needed business education before crossing over to the fi-nancial fold. After LifePoint relocated her to Selma, Ala., where she served as CNO of Vaughan Regional Medical Center, she earned an MBA with an emphasis in healthcare administration from nearby South University.

Sibley moved into the COO role at Vaughan Regional, and then to the same role at a larger hospital, the 250-bed Dan-ville Regional Medical Center in Dan-ville, Va. During her time there, Sibley successfully recruited nearly two dozen physicians to the hospital, significantly im-proved physician satisfaction, and helped implement the Duke Quality Oversight program. In 2008, LifePoint Hospitals awarded her the honorable Fleetwood Award for extraordinary leadership.

“One reason why CNOs can be so successful is the respect and trust obtained through nursing,” emphasized Sibley. “Nursing is the top trusted profession – over clergy and doctors! We always un-derstand the patient perspective because we’ve cared for them firsthand. And that trust spills over into other leadership posi-tions.”

Ahead of the CurveSusan Peach broke gender and age

barriers at Rockdale Medical Center in Conyers, Ga., when at the age of 38, she be-came the state’s young-est and first female hospital CEO. She also rose through the ranks of CNO to other C-suite roles.

“Early on, I received some grief from my board and a few local business leaders who were concerned whether I could make hard business decisions because I was a compassionate, empathetic nurse,” said Peach. “Some also wondered if I under-stood enough about business and finance to lead an organization as CEO. The first challenge wasn’t difficult to overcome be-cause I’ve made many hard choices and hard decisions with respect and compas-sion. On the business side, it’s all about

results. You can talk a good game, but you have to produce good results. I’ve been very fortunate … achieving wonderful fi-nancial results every time.”

Peach chuckled when recalling the steep financial learning curve needed in her first CNO role.

“I’d never done a budget,” admitted Peach, who earned a nursing degree from Clayton College. “When the CFO, back in the paper days, handed me a stack of spreadsheets, he said, ‘Here, I need this by Friday.’ I went home to my dad, a con-troller with Coca-Cola, and said, ‘You’re going to have to help me. I don’t have any clue how to do this.’ He looked me right in the eye and said, ‘I’ll help you one time, and then you best learn how to do it on your own.’ He was very strict. At that point, I decided to get my MBA so I’d know as much about business as I did about nursing and healthcare.”

Peach juggled raising a young fam-ily, managing a high-maintenance CNO role, while also earning an MBA from Georgia State University. “My husband, Jim, and my angel of a mother, made it all possible,” she said. “Jim and I have been married for 38 years and he’s always been so supportive of my career. My mother, bless her heart, never said no when I asked her to help with the kids.”

Since July 2012, Peach has been CEO of LifePoint’s HighPoint Health Sys-tem, overseeing more than 300 licensed beds on four campuses. Before that, she served as a CNO at LifePoint’s Hospi-tal Support Center, worked for Catholic Health Initiatives as senior vice president of performance management, and served in various “O” roles. Now, the recipient of Sumner County’s Impact Award for two consecutive years, and LifePoint’s prestigious 2013 CEO of the Year Award, makes a point of devoting time to mentor-ing rising stars, generally working concur-rently with four potential leaders.

“When I look back, I realize I was somewhat naïve to believe I could be the latest and greatest CEO at a young age,” joked the mother of two and grandmother of two. “The staff makes my job wonderful every day. I know my job is to get out of the way and make sure they have the tools and processes to do a good job.”

The Male CounterpartA couple of decades ago, if a man

dressed in scrubs walked into a hospital room, patients frequently assumed he was a doctor because the number of male nurses was so low. Nationwide, those gen-der numbers have improved. According to

From CNO to CEOLifePoint nurses are rising through the ranks to top leadership posts

Cherie Sibley

Pam Belcher

Susan Peach

(CONTINUED ON PAGE 12)

Page 10: Mississippi Medical News November 2014

10 > NOVEMBER 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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of this year, you named access to healthcare as a priority. How are efforts in that area evolving?

As the baby-boom generation is ac-cessing healthcare to a greater extent, the fi rst question is: Will we have enough phy-sicians? Our goal has been to have 1,000 new physicians in addition to those we already have in the state by 2025, which would get us off the bottom as the most medically underserved state in the nation. We’ve been working hard toward that goal.

The expansion of the School of Med-icine at the University of Mississippi is under construction now, and I was very proud to bring $10 million in Community Development Block Grant funding to start that process, with another $44 million from the Mississippi Legislature. The old School of Medicine was built in 1955, and it’s pretty obvious it’s time for an update.

Then, there’s the William Carey Uni-versity College of Osteopathic Medicine. It came with little fanfare but has had a tremendous impact. From the fi rst class of 91 new physicians, 33 are doing their residency in primary care. So between those two schools, I think we’re on the right track.

We’re also working with our medi-cal licensure board to make sure that if we have physicians coming from another state or country, we have a way to prop-erly manage them and make sure they are licensed without a great deal of delay.

Currently, there are two individuals who are responsible for gathering physicians’ background reviews and recommenda-tions, and we’re proposing legislation to increase those numbers so that we might fast-track the licensure of those physicians without losing any accountability.

How is the question of access being addressed for Mississippi’s most rural communities?

As we look at the ways rural com-munity hospitals might change into the future, we’re doing a lot of work with tele-medicine. Mississippi recently received an “A” from the American Telemedicine As-sociation for our ability to reimburse our physicians and providers that are utilizing telemedicine.

A lot of providers were concerned that this might be something that would infringe upon their practice — but we think it would enhance it. We might have a physician in Jackson or Tupelo that is as-sisting with a provider in one of the small community hospitals in a more complex healthcare challenge.

The Rural Physicians Scholarship Program is also a great opportunity for us. It allows us to help a physician who’s graduating and completing their resi-dency to help pay off the cost of going to medical school. In ’08-’09, we spent about $300,000 on that program for 10 scholar-ships — which was a very small amount in scholarships — and today, we’re spending

around $1.5 million to provide 53 schol-arships for rural physicians. We’ve also added rural dentists to that program now, so it’s moving along as we would like to see it.

Additionally, I’ve asked the legislature for several years to help cap the individual income tax on rural physicians, so that a doctor working in a rural, underserved area wouldn’t have to pay state income tax on more than $100,000 of his income. We can bring more doctors to rural areas if we can fi nancially incentivize them.

In addition to focusing on patient needs, how are you attending to the interests of physicians and hospitals?

We created a chamber of commerce for healthcare, the Mississippi Health Care Solutions Institute, chaired by Dr. Clay Hays and made up of represen-tatives within the healthcare industry. We’re looking at how to deal with the challenges of healthcare today — from access and affordability to reimbursement and managed care — and we’re involving physicians and hospitals before we make decisions.

We’ve worked hard to involve the Mississippi Hospital Association, and Tim

Moore, the president and CEO, has total access to the Governor’s Offi ce and the Division of Medicaid. It’s been very ben-efi cial.

In the past, I’ll have to admit, it’s been a very difficult relationship and there has sometimes been a great deal of confl ict. But that doesn’t exist today, and we’re working in cooperation to make sure as best we can that we’re reimbursing healthcare providers and hospitals to the greatest extent under the law.

Healthcare as an economic driver has also been a key aspect of your plan. What fruit have you seen so far in applying economic-development incentives like those traditionally used to attract manufacturers?

When I was fi rst elected in Decem-ber 2011, I traveled to Houston, Texas, and had the opportunity to see the Texas Medical Center. I was amazed at the sheer size and magnitude of that healthcare city in Houston. So we came back and began working on a program for Mississippi.

First, we have the Mississippi Health-care Corridor in Jackson, where we have UMC, St. Dominic’s, Baptist and the VA Medical Center all essentially touching each other’s borders. So we’ve asked them to begin to collaborate. It’s not easy get-ting hospitals to work together, but we be-lieve a collaborative effort to expand that medical corridor from Rankin County into Jackson is underway.

Not only are they beginning to work together on a Hope Cottage for cancer pa-tients and their families, but the ideas are as simple as having a combined laundry service. You’re able to turn to the private sector for that service and invest your dol-lars instead into healthcare and research-and-development. Those types of models are working well.

Additionally, we’ve used our ability at the Mississippi Home Corporation to in-centivize workforce housing developments within a medical zone that’s fi ve miles from any acute-care hospital that has at least 375 beds. Our idea has been to take a healthcare zone and incentivize it — just like we did with Toyota and Nissan — to grow the healthcare industry.

Every physician that comes into a community brings about $2 million of economic impact with them, so obviously that’s huge for a community. In addition to physicians, if you look at everything from the local pharmacists to manufac-turers of healthcare equipment and R&D — it’s a huge industry.

We call it ‘an industry of necessity.’ With the number of baby boomers who will be at the doorstep of healthcare pro-viders and hospitals, it’s not an industry we can choose to grow or not. It’s neces-sary that we have access to healthcare in the future, so that’s why we’re working to grow the industry today.”

Access, Incentives Key to Governor’s Healthcare Strategy, continued from page 1

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Page 11: Mississippi Medical News November 2014

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A little more than a year ago, the American Medical As-sociation announced $11 mil-lion in grants to 11 academic medical centers to fundamen-tally change the way physicians are educated and trained.

“There has been a univer-sal call to transform the teach-ing of medicine to shift the focus of education toward real-world practice and competency as-sessment, which is why the AMA launched the Accelerat-ing Change in Medical Educa-tion initiative,” AMA President Robert M. Wah said in a statement. “Over the last year, we have made significant progress in transforming curriculum at these medical schools that can and will help close the gaps that currently exist between how medical students are trained and the way healthcare is delivered in this country now and in the future.”

In late September, a consortium of thought leaders from the 11 academic cen-ters convened on the campus of Vander-bilt University School of Medicine in Nashville to discuss progress and barriers in implementing individual projects, offer insights and innovations, give and receive feedback on the conceptual model for the master adaptive learner, and share other lessons learned in the first year. Much of the meeting’s focus was centered on the master adaptive learner (MAL), which is the AMA consortium’s term for an expert, self-directed, self-regulated, lifelong work-place learner. Developing this type of skill is considered critical to prepare physicians for careers in a healthcare environment that is constantly changing and evolving.

During the two-day event, Susan Skochelak, MD, MPH, group vice presi-dent of Medical Education for the AMA, and Bonnie Miller, MD, senior associate dean for Health Sciences Education and associate vice chancellor for Health Affairs at Vanderbilt, hosted a media roundtable to discuss the transformative initiative.

Skochelak said it makes sense for the AMA to be at the forefront of such an am-bitious project. Upon being founded in 1847, the physician’s organization under-took two major tasks — to write the first code of professional ethics and to set the standards for medical education.

She added the AMA again took a lead role 100 years ago when there was a major movement to change medical edu-cation. Skochelak said the AMA published the standards of what medical education should look like and that became the basis for the Flexner Report.

“The Flexner Report really changed medical education to say it has to be sci-ence-based, and it has to be connected with knowledge generation,” she explained. “It made a great leap forward in the quality of medical education. But here we are a

century later, and our format for train-ing physicians remains almost identical to the structure that we described a hundred years ago.”

Skochelak added, “It’s not that the training is broken, it’s just that it hasn’t kept up with what’s going on in healthcare delivery today.”

She said the work being done as part of the Accelerating Change in Medical Education initiative is built on recom-mendations for change that have been well accepted for more than a decade by the medical education community. “We’re working in a great sense of consensus,” Skochelak noted. However, the fact that there has been broad agreement but little change points to impediments that must be addressed. “If it was easy, it would have al-ready been done.”

To address the barriers and make it possible to move forward, Skochelak said, “The AMA wanted to provide resources and leadership to schools that are really ready to make the change.” That decision led to the grant program now in place for the 11 lead schools in the initiative.

In choosing the academic medical centers, Skochelak said the AMA was looked for pro-grams that concentrated on key areas, including:

• Getting students into the real world environment early on so they understand healthcare systems in a way that isn’t cur-rently happening;

• Emphasizing important core concepts in medical school education like team-based care, patient safety and outcomes, patient-centered approaches to care, and population manage-ment; and

• Changing the way stu-dents progress through the educational system to provide more flexibility and in-dividualized learning.

Miller, a general surgeon by training, has been involved in shaping medical edu-cation at Vanderbilt for more than 15 years in an official capacity and even longer as a faculty member. She noted Vanderbilt had already undergone a major transformation to their traditional curriculum from 2004-2007. Yet, she added, it became clear that even more needed to be done to support continuous learning throughout a career.

“We came to the conclusion that in order to do that you really did have to start at the beginning … that we couldn’t put our learners through our programs as usual and then expect magically at the end of their training they would be expert lifelong learners if we didn’t start to build those habits from the start,” Miller said of the decision to rework Vanderbilt’s program-ming for a second time.

“Curriculum revision is hard work,” she continued. “It’s not just a matter of de-veloping new lesson plans. It really is a lot about culture change. We really felt that it

was important to go back to the drawing board and start something new right away.”

Miller continued, “One of the things we thought a lot about was the context of learning. We felt that all learners need to work so that you’re really rapidly applying what you’re learning in the workplace … and that all workers need to learn.”

That mantra became a foundational principle of Vanderbilt’s Curriculum 2.0. Miller added other tenets of the program-ming was that it should be team-based, interprofessional, modular to allow for dif-ferent entry and exit points, and include new content areas to help students understand the context of healthcare delivery, as well as what is happening on a molecular and ge-netic basis. The new curriculum rolled out last year with the incoming class of 2013.

During the recent consortium meet-ing, Vanderbilt and other participants shared their progress and discussed barri-ers to change. Skochelak said that unlike a research grant, where a recipient is given money and works on an individual project, the AMA initiative was designed to pool in-formation and work in collaboration.

“We told the schools if you receive grant monies, you will be part of a consor-tium of schools. Right from the beginning we’ll work together, and we’re going to share ideas because we want your projects to benefit from each other … and our ul-timate goal is to share this with all of the schools,” Skochelak said.

Over the next four years, the AMA will continue to track, gather data and report on the progress of the 11 medical schools and their collective work in order to identify and broadly disseminate best prac-tices to retool medical educational models across the country. Skochelak added the lessons learned would be shared with insti-tutions educating other health profession-als, as well.

The Transformation of Med EdAMA continues quest to accelerate change in physician training

Dr. Susan Skochelak at the podium addressing the consortium meeting at Vanderbilt.

Page 12: Mississippi Medical News November 2014

12 > NOVEMBER 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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were pretty complicated, when you had to turn a little radio to use a pager before it got really easy to use.

In fact, physicians, in their quest to embrace technology to help them better care for patients, have put up with some pretty complicated technology when it fi rst came out. Take cell phones, for ex-ample. When they fi rst came out, physi-cians probably embraced them earlier and faster than most of the rest of society. In the 1990s, my chairman at Harvard, a senior physician, foresaw the benefi t of computers when they were quite compli-cated. He taught himself to use a portable computer and lugged it around like a sew-ing machine, not like our little laptops. We used to call it a ‘luggable.’ It prob-ably weighed 20 pounds! He knew there was great promise in using computers in medicine. I don’t think there’s necessar-ily hesitancy on behalf of physicians to use technology, only when it gets in their way.

Last fall, the AMA surveyed practices about the most frustrating issues in medicine, and EHRs were high on the list.

At the time, the AMA planned to approach EHR vendors to discuss problems hindering physicians from caring for their patients. Could you give us an update on your fi ndings and AMA’s strategy going forward?

We’ve formed a group of physicians around the country, convened under the AMA umbrella, and asked them specifi c questions for EHR vendors. They’ve been working very diligently on it since the survey last fall, and they’re very close to completing a work product that would be along the lines of ideal attributes and issues that need to be addressed. We’re not trying to tell (vendors) what product to create. We’re going to tell them the attributes doctors want to see in ideal EHRs. We think it will help them in their design process. We’ll be going to the ven-dor community with what comes out of that work group and work with the ven-dor industry to fi nd ways to accelerate their ability to deliver on those features and functions that we think are necessary for the better use of that technology by our physicians.

Embracing Patient-Centered Technology, continued from page 7

AMA President Robert M. Wah, MDA board-certifi ed reproductive endocrinologist

and OB/GYN, Robert M. Wah, MD, president of the American Medical Association (AMA), made the transition from clinical medicine to health IT when he served on active duty as a captain in the U.S. Navy Medical Corps for nearly a quarter-century. During his service through two wars, Wah helped treat nearly 50,000 injured personnel, saw the mortality rate drop from 25 percent to 5 percent, and that marines who saw a medic within an hour of injury improve their chance of survival to 96 percent.

As the nation’s fi rst deputy coordinator in HHS’ Offi ce of the National Coordinator for Health Information Technology, with the goal of ensuring that every U.S. citizen has an electronic medical record (EMR) by 2020, Wah managed a portfolio of technology tools involved in the care of 10 million patients in 65 hospitals and 45 clinics.

With 17 years’ experience in AMA leadership roles, Wah practices medicine in McLean, Va., and teaches at the Walter Reed National Military Center in Bethesda, Md., and the National Institutes of Health.

MinorityNurse.com, male RNs now com-prise roughly 9 percent of the total nursing population; 7.6 percent of LPNs are men.

“As in any industry, I have to prove myself,” said Mark C. Holyoak, CEO of LifePoint’s 49-bed Castleview Hospital in Price, Utah. He previously served in COO and CNO posts. “In this case, I had to prove myself in the clinical arena that I was a competent, safe and compassionate nurse. In addition to those traits, I needed to demonstrate that I could lead others towards positive changes in the organiza-tion. From the nursing ranks, additional challenges were to gain fi nancial acumen, to demonstrate a knowledge and under-standing of the business.”

Even though the workforce is a gen-eration past being male-dominated, being male didn’t make it easier to rise to the top executive position, Holyoak noted.

“I don’t think it really made a differ-ence,” said Holyoak, a 15-year LifePoint employee. “Some of my counterparts may disagree, but I believe each one of us, re-gardless of gender, has the responsibility to prove ourselves and look for leadership growth opportunities. For me, I would hate not having the clinical knowledge, background and experience before mov-ing into this seat. I’m thankful I took this non-traditional road.”

Holyoak occasionally indulges in one of his favorite practices at Castleview: “I still throw my scrubs on periodically, walk the halls, and interact with patients. Being

involved in patient care keeps me in con-tact with the hospital staff and seriously helps regenerate my battery!”

Full CircleBelcher, the HR executive who joined

LifePoint in 2006, has enjoyed watching the collaborative leadership traits CNOs bring to the table.

“When I got here, and it came to the C-suite executives, the CNO was part of it, but the COO and CEO were the two stron-ger leaders in that group,” she noted. “It’s been fun for me to watch the CNO step up. We have some really good CFOs (without clinical experience) who approached us a few years ago and said for their jobs to be easier, and for the hospital to reach the or-ganization’s goals, they needed to partner more often with CNOs. Once we began to see those collaborations happen, and the value it brought to both of those critical po-sitions, we’ve encouraged it, and have put programs in place,” such as the LifePoint Learning Academy’s Leadership Develop-ment & Training Program, a 4-day event designed to develop and enhance leader-ship competency. There’s also a compo-nent, Finance for the Non-Financial, to help clinicians understand LifePoint’s spe-cifi c fi nancial expectations.

“I’ve never had a conversation with a CEO who felt threatened by the rise of the nurse ranks to C-suite levels,” said Belcher. “Our organization appreciates and recognizes talent in a unique way.”

From CNO to CEO, continued from page 9

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Page 13: Mississippi Medical News November 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 NOVEMBER 2014 > 13

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GrandRounds

Memorial Physician Clinics Welcomes Urologist Jacob Jorns, MD

Memorial Physician Clinics welcomes Jacob Jorns, MD, in the practice of Urol-ogy in Gulfport.

Dr. Jorns graduated Summa cum laude with his undergraduate degree from Louisiana Tech Uni-versity in Ruston, Louisi-ana. He earned his medi-cal doctorate at Louisiana State University Health Sciences Center in Shreveport, Louisiana. Dr. Jorns complet-ed his internship in General Surgery and residency in Urology at the Mayo Clinic Graduate School of Medicine in Jackson-ville, Florida.

Mississippi Named Best State to Practice Medicine by Physician’s Practice

For the second year in a row, Missis-sippi has been named the number one state in the nation to practice medicine by Physician’s Practice in their “Best States to Practice” rankings. In the creation of their rankings, Physician’s Practice took a look at the factors that can affect a medi-cal practice’s financial health.

Gov. Bryant said that the report by Physician’s Practice confirms what many doctors around the state of Mississippi al-ready know regarding their medical prac-tice. Just this year telehealth reimburse-ment legislation that has increased medi-cal provider compensation was passed and the benefits of medical tort reform over the past decade have kept malprac-tice insurance rates stable for physicians in Mississippi while the number of medical malpractice lawsuits has decreased.

According to the publication, the fac-tors taken into consider for the rankings included: cost of living, disciplinary ac-tions taken against physicians, tax burden per capita, Medicare’s Geographic Prac-tice Cost Index, physician density, and malpractice award payouts per capita.

Mayo Clinic, UMMC Expand Relationship

Mayo Clinic and the University of Mississippi Medical Center (UMMC) an-nounced that they have signed an agree-ment to broaden and deepen their col-laboration in clinical trials, other medical research and education. The agreement is a formal commitment to enhance the re-lationship that has been steadily building for the past 20 years.

An earlier memorandum of under-standing formed an institutional bond in 2010, designed to enhance and expand shared initiatives in translational research and training. A number of cooperative clinical research relationships have flour-ished between Mayo and UMMC since a first collaborative study was launched in 1995 in the Genetic Epidemiology Net-work of Arteriopathy (GENOA), with co-horts of non-Hispanic White Americans from Rochester, Minnesota, African-Amer-

icans from Jackson, Mississippi, and Mex-ican-Americans from Starr County, Texas.

Mayo’s and UMMC’s site principal investigators in GENOA, Stephen Turner, M.D., and Thomas Mosley, Ph.D., re-spectively, have continued to collaborate within GENOA, as well as in other genetic epidemiology-based research, seeking to better understand the differences in disease prevalence and progression be-tween different racial and ethnic groups.

Daniel W. Jones, M.D., chancellor of the University of Mississippi, believes the relationship with Mayo Clinic can be trans-formational for the University of Missis-sippi Medical Center across its missions of research, education and health care.

In addition to research into the ge-netic underpinnings of disease through epidemiological research, collaborative efforts between Mayo and UMMC include clinical research projects that look at ge-netic variations in treatment response.

Many of the current Mayo-UMMC collaborations have been developed un-der the auspices of Mayo’s Center for Clin-ical and Translational Science (CCaTS), for which UMMC’s James Wilson, M.D., serves as an external advisory committee member. These joint activities include en-abling UMMC investigators to access (cur-rently) 26 online training modules offered by Mayo Clinic; designation of Mayo as an elite “Vanguard Center” of the UMMC-affiliated Jackson Heart Study; and a num-ber of collaborative studies relating to kidney disease, uterine fibroids, and more.

Future collaborations are planned in graduate education and the mentor-ing and development of emerging clini-cal researchers, and conducting faculty exchanges. The organizations expect to leverage Mayo’s metabolomics core with UMMC’s lipidomics capabilities, share Mayo’s clinical research unit tools soft-ware, co-develop an Adult Congenital Heart Disease Clinic in Jackson, enhance UMMC’s Cardiac Electrophysiology De-vice Trials unit, and potentially develop a cooperative telemedicine program.

King’s Daughters Medical Center Named in Best Places to Work in Healthcare

King’s Daughters Medical Center an-nounces it has been named in the Modern Healthcare annual Best Places to Work in Healthcare recognizing employers for their outstanding performance in eco-nomic development, employee retention and satisfaction.

Modern Healthcare is the industry’s most trusted, credible and relied-upon news source. Modern Healthcare exam-ines the most pressing healthcare issues and provides executives with the informa-tion they need to make the most informed business decisions and lead their organi-zations to success. It’s for this reason Mod-ern Healthcare is deemed a “must-read publication” by the who’s who in health-care.

Dr. Jacob Jorns

Page 14: Mississippi Medical News November 2014

14 > NOVEMBER 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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GrandRounds

H E R S O U T H . C O M

L O V E ?N E E D A G I F T S H E W I L L

SRHS Opens Newly Renovated Southeast Tower at Singing River Hospital Singing River Health System (SRHS) celebrated its latest improvements to its world-class facilities with a building dedication and

ribbon-cutting ceremony at the newly renovated Southeast Tower at Singing River Hospital.The completely remodeled

facility houses ortho/neuro, sur-gery, urology, OB/GYN and pedi-atric patients at the hospital. The tower is three floors tall and fea-tures 15 rooms on the first floor and 16 rooms on both the second and third floors. The renovation project saw the complete interior demolition of the 1 Southeast, 2 Southeast and 3 Southeast floors at Singing River Hospital. Demoli-tion included removing the walls, flooring, ceiling, and all utilities, leaving only the original building structure of these areas. The reno-vated units are now equipped with the latest technologies in infection prevention, ergonomics and aes-thetics for modern healthcare. The rooms also feature computers that allow the clinical team to document the patient care in the room.

Construction began on the three-story building in March 2013 and took 18 months to complete, finishing in September 2014. A com-bination of local contractors including Fletcher Construction, Stewart Construction, Air Masters Mechanical and Moses Electric contributed to the project.

The new facility affirms the organization’s commitment to being nationally recognized for life-saving care. SRHS has been designated as a Blue Distinction Center + for Knee and Hip Replacement, Spine Surgery and Cardiac Care by Blue Cross Blue Shield of Mississippi. The stroke program has been named a Primary Stroke Center and a Get with the Guidelines award winner by the American Heart Association. The cardiac program has received the gold and silver level Mission: Lifeline awards from the American Heart Association.

Pictured (from left to right): Richard Lucas, SRHS Director of Communications; Mayor Jim Blevins, City of Pascagoula; Morris Strickland, SRHS Board of Trustees; Ira Polk, SRHS Board of Trustees; Dr. Randy Roth, SRHS Interim Chief Medical Officer; Michael Heidelberg, SRHS Board of Trustees President; Supervisor Melton Harris, Jackson County Board of Supervisors; Supervisor Mike Mangum, Jackson County Board of Supervisors; Kevin Holland, SRHS Chief Executive Officer.

Anderson Introduces Area’s Only Open MRI

Anderson now offers the area’s only High-Field Open Magnetic Resonance Im-aging System, providing a more comfort-able experience for patients and a broader range of clinical capabilities and features.

The inside of the open MRI provides a 270˚ unobstructed view, which minimizes anxiety and claustrophobia and maximizes a pleasant environment for the patient dur-ing the MR exam. The technology of the open MRI system combines unparalleled patient comfort with powerful technology and an ultra-fast workstation to make pa-tient exams as quick and smooth as pos-sible. Its imaging power is further boosted by an array of anatomically-specific, opti-mized receiver coils that allow advanced imaging applications ranging from vascu-lar to orthopedic to women’s health.

Page 15: Mississippi Medical News November 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 NOVEMBER 2014 > 15

Baptist Health Systems Names Bill Thompson, CPA, as Chief Financial Officer

Bill Thompson, CPA, has joined Bap-tist Health Systems as Chief Financial Offi-cer. His career spans almost 30 years with experience in healthcare management and finance.

Thompson comes to Baptist from the University of Mississippi Medical Cen-ter where he served as their Health System CFO. He also held positions as UMMC Health System’s Director of Fi-nance and Chief Accounting Officer.

A Canton, Miss. native, Thompson holds a Bachelor of Professional Accountan-cy degree from Mississippi State University and is a Certified Public Accountant. He is a member of the Healthcare Financial Man-agement Association, Mississippi Society of Certified Public Accountants and American Institute of Certified Public Accountants.

Roe named president/CEO of HPIC

Healthcare Providers Insurance Com-pany, RRG, (HPIC), sponsored by the Mis-sissippi Hospital Association (MHA), has an-nounced the appointment of Alasdair Roe to the posi-tion of president/chief ex-ecutive officer of HPI Com-pany (HPICO), which is the attorney-in-fact for HPIC. Previously, he served as chief operating officer. Retiring President/CEO Larry Bourne will serve as president emeritus and work closely with Alasdair through this transition at least through the end of 2014.

Roe holds a bachelor’s degree in Mar-keting from Florida State University and has over 20 years of experience in the insurance industry.

Thousands of Walkers to Attend Annual Metro Jackson Heart Walk

More than 3,000 area residents are ex-pected to join the Heart Walk on November 15, 2014 to raise funds to fight heart disease and stroke, America’s No. 1 and No. 4 kill-ers. The annual event activities begin at 8 a.m. with the walk starting at 9:15 a.m. at the Mississippi State Capitol.

The non-competitive three-mile walk and one-mile survivor route is free to the public and includes teams of employees from local companies, along with survivors of heart disease and stroke, and friends and family members of all ages. Hu Meena, President and CEO of C Spire, is chairman of this year’s Heart Walk.

The Heart Walk celebrates survivors of heart disease and stroke and lifestyle change heroes who are all taking steps to-ward a healthier lifestyle. The Heart Walk also focuses on raising funds to combat heart disease and stroke, the No. 1 and No. 4 leading killers, respectively, of American men and women. Proceeds will support research, education and community pro-grams of the American Heart Association.

For information on participating in the

Heart Walk, visit www.metrojacksonheart-walk.org to register.

Haigler named Chief Operating Officer at CMMC

Central Mississippi Medical Center (CMMC) Chief Executive Officer Charlotte W. Dupré is pleased to announce the addition of Tonda V. Haigler as Chief Operating Officer (COO).

Haigler comes to CMMC from Carolinas Hos-

pital System in Florence, S.C. where she served as COO, interim CEO, and assistant CEO, respectively. While at Carolinas Hospi-tal System, a 420-bed facility, Haigler man-aged physician clinics, imaging, radiation oncology, rehab services, the rehabilitation hospital, the transitional care unit, the detox unit, environmental services and engineer-ing.

Prior roles include assistant CEO and administrative specialist at North Okaloosa Medical Center in Crestview, Fla.; adminis-trative resident at Piedmont Healthcare in Altanta; community and corporate wellness

educator for Singing River Hospital in Gauti-er and roles of increasing responsibility for Saint Thomas Health Services in Nashville.

Haigler holds her MBA from Mississippi State University in Starkville and both her master’s degree in public health and admin-istration and bachelor’s of science degree from the University of Southern Mississippi in Hattiesburg.

A fellow in the American College of Healthcare Executives, Haigler has previ-ously served with Rotary, the March of Dimes executive committee, United Way board of directors and the Chamber of Commerce.

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Page 16: Mississippi Medical News November 2014

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