Mississippi Medical News October 2013

December 2009 >>

David Geer, MD

PAGE 3

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MHA Leadership Shift Sam Cameron retiring; Tim Moore takes top post after short stint leading NMMC

Sam Cameron is stepping down as the long-serving president and CEO of Mississippi Hospital Association (MHA).

Stepping up to lead MHA is Tim Moore, who had served ... 4

UMMC and Grenada Lake Med Make Deal New long-term partnership with public hospital nets mutual benefi ts; may signal similar structurings

In a long-term commitment to a North Mississippi county-owned hospital, University of Mississippi Medical Center (UMMC) leaders inked a deal to lease the 156-bed Grenada Lake Medical Center (GLMC) ... 5

Governor’s MissionHealthcare tops agenda at state Economic Development Summit

(CONTINUED ON PAGE 4)

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Spine Tingling TechnologyNewSouth NeuroSpine and Brett Farve among early adopters, promoters of Ortho Kinematics VMA technology

By LyNNE JETER

NewSouth NeuroSpine (NS2) in Flowood is the fi rst back and neck specialty practice in Mis-sissippi, and one of very few nationwide, to introduce innovative spine-imaging technology that provides previously unavailable views of the spine in motion, allowing neurosur-geons to pinpoint spinal irregularities more accurately.

Vertebral Motion Analysis (VMA) technology, developed by Oxford-based Ortho Kinematics Inc., uses fl uoroscopy to capture real-time images of the spine in motion. Approved by the FDA in 2011, VMA results are signifi cantly more ac-curate than typical MRI machines, while also reducing patient radiation exposure.

“It’s a very interesting diagnostic tool,” said NS2 neurosurgeon Jack Moriar-ity, MD, an investigator for Ortho Kinematics. “The controlled patient position-ing of the VMA system greatly reduces test variability and eliminates differences

As another show of his promise to make healthcare a priority, Gov. Phil Bryant certi-fi ed Health Care Zone Master Plans for a dozen Mississippi communities and unveiled new strategies to develop the state’s healthcare economy at the recent Governor’s Health Care Economic Development Summit.

Since detailing his vision for growing Mis-sissippi’s healthcare economy in a report last year, Bryant had discussed healthcare clustering strategies with other state leaders, announcing at the summit the inaugural communities that Mississippi Development Authority has certifi ed as Health Care Zone Master Plan Communi-ties.

“The cooperation of private sector leaders and Mississippi’s elected offi cials is producing great opportunities for this state,” Bryant told nearly 1,000 attendees at the Aug. 15 summit, which also touted the state’s rebuilding progress eight years post-Katrina. “Mississippi is unique in its approach to apply-ing healthcare zones and clustering to economic development.”

Last year, Bryant enhanced the Health Care Industry Zone Act to

spur healthcare development within fi ve miles of major acute care hospitals. Under the act, businesses such as laboratory testing facilities, medical supply distributors and biotechnology research facilities that either make a minimum investment of $10 million or create a mini-mum of 25 full-time, permanent jobs within the healthcare zone are eligible for certain tax incentives.

During the session, Bryant expanded the act to include healthcare investment in com-munities that developed a certifi ed healthcare master plan instead of meeting the original law’s acute care bed count.

“The communities that develop and adopt these master plans are setting solid groundwork for facilitating healthcare job creation,” Bryant continued. “These plans are valuable, proactive tools that will aid commu-nities, MDA and local economic development

practitioners as they work to attract the start-up or recruitment of a va-riety of private sector health-related industries.”

Gov. Phil Bryant

Dr. Jack Moriarity

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David Geer, MDPhysicianSpotlight

By LUCy SCHULTZE

Twenty-five years ago, David Geer, MD, brought his Yale medi-cal degree and Stanford training to a modest medical community in Mississippi.

He never looked back.“My main feeling about prac-

ticing medicine in Mississippi and heart surgery in Meridian is one of gratitude,” said Geer, who recently performed his 5,000th heart-surgery procedure at Anderson Regional Medical Center.

“I wish everybody could have the kind of work experience and life experience that I have had,” he said. “I feel blessed.”

For such a positive experience, Geer credits a supportive work en-vironment as well as his patients and staff.

“The work itself is very satisfy-ing, and we have a group of people who happen to get along extremely well,” said Geer, who practices as part of Anderson Cardiac Surgical Associates.

Within his trusted support staff are several nurses with whom he’s worked for 15 to 20 years.

“That’s pretty unusual these days,” he said. “People kind of come and go, so I’m very grateful to them.

“You work in different places, and sometimes people seem to really get along and hit it off. Other times, not so much. This is just that type of place where the people get along really well.”

It was relationships that led Geer to Mississippi as a young surgeon. During his residency at Stanford University, he became friends with Meridian native Jeff Hollingsworth, MD, whose grandfather had founded what is now Anderson Re-gional Medical Center as Anderson Infir-mary in the late 1920s.

“He was determined to come back to his hometown and start doing heart sur-gery in Meridian,” Geer said.

Hollingsworth didn’t get that chance. As the Meridian medical community was preparing to bring him on board, he was stricken with pancreatic cancer. He was able to set up Meridian’s first heart-sur-gery program before his death in 1986.

At Anderson Regional Medical Cen-ter, administrators were aware of the two men’s friendship and reached out to Geer to fill Hollingsworth’s place.

“As it happened, I was interested,” said Geer, who was practicing in Birming-ham, Ala., at the time. “I was at a place in my career when I was considering a career change anyway.”

Joining Geer in the move was his col-league Glenn Lau, MD, whom he met during a two-year stint in the U.S. Navy. Lau had invited Geer to practice in his hometown of Birmingham after their Navy service was over, and the two prac-

ticed there for a decade before coming to Meridian.

Life in the South was an adjustment for Geer, a native of Connecticut.

“It was a big shock, coming to Ala-bama first,” he said. “But it turned out that I loved the South. I love the people and the openness and the warmth.”

While Birmingham offered that cul-ture, too, the competitive nature of prac-ticing in a larger medical community wasn’t appealing to Geer. The way Me-

ridian needed him was.For some 15 years, Geer was

the only heart surgeon in Merid-ian and the surrounding referral area of east-central Mississippi and west-central Alabama. Lau, a gen-eral surgeon, provided assistance.

“It was very busy,” Geer said. “I didn’t have any time off to speak of, but I really loved the work.”

Geer was attracted to heart surgery during medical school as an emerging field that promised an exciting career. At Stanford in the early 1970s, Geer had the op-portunity to train under Norman Shumway, MD, a pioneer in the field of heart surgery and heart transplantation.

While Geer’s own surgi-cal practice has changed little since that time, the field itself has adapted with the rise of interven-tional cardiology.

“While we’re on call all the time, heart surgeries are mostly elective work now, due to the fact that a lot of heart attacks and coronary artery disease are treated initially by cardiologists with stents,” Geer said.

“A lot of the emergency work falls to them — which is fine with me. At my age, getting up in the middle of the night to op-erate — and we used to do quite a lot of that — has lost its appeal.”

At 70, Geer finds himself in a more

reasonable rhythm of work these days. He added partner Bryce Turnage, MD, about 10 years ago. Rush Foundation Hospital has also added its own heart surgeon in recent years, bringing Meridian’s total to three.

“We get along well, and there’s enough work for the three of us,” Geer said. “I’m not quite as busy as I once was, but that’s about right.”

While Geer was initially recruited by Anderson Regional Medical Center, he was also supported early on by Rush Foundation Hospital as well as Riley Hos-pital, which was absorbed by Anderson in 2011.

Over the years, his patient load has drawn from about a 75-mile radius around Meridian, from Philadelphia and Newton over to Livingston, Ala.

For Geer, serving his patients over the years has been its own reward.

“People try to over-complicate it, but there’s nothing complicated about how to succeed in medicine,” he said. “Just put patient care first, and you can’t go wrong. It works every time.”

As he continues doing what he loves, Geer has no plans to retire anytime soon. Outside of work, he enjoys reading and watching sports. He also spends time with his grandchildren, playing games and reading children’s books.

He and his wife, Charlie, a native of Meridian, have two grown sons, Bill and Jim.

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By LyNNE JETER

Sam Cameron is stepping down as the long-serving president and CEO of Mississippi Hospital Association (MHA).

Stepping up to lead MHA is Tim Moore, who had served for less than three months as president of North Mississippi Medi-cal Center (NMMC), a 650-bed regional refer-ral center that represents the largest, private, not-for-profit hospital in the state, and part of the na-tion’s largest rural hospi-tal system.

As MHA chief, the 48-year-old healthcare executive will lead a state or-ganization that represents more than 100 healthcare organizations, and will work closely with Gov. Phil Bryant and state lawmakers on industry issues.

“I’m looking forward to the chal-lenges and opportunities,” Moore told the Northeast Mississippi Daily Journal, “and we have plenty of both.” Serving in the state-wide post, he explained, will allow him to have a greater impact on Mississippi healthcare than heading a single hospital.

Cameron will remain president emer-itus of MHA until June, when he plans to fully retire.

Moore joined North Mississippi Health Services last April as vice president of community hospitals, where he worked

closely with facilities in Eupora, Iuka, Pontotoc and West Point, and across state lines in Hamilton, Ala.

The Forest native previously worked for Rush Health Systems in Meridian, where he had served as system vice presi-dent of regional operations since 2007. He had also worked with Greenwood-Leflore Hospital and, from 2003 to 2007, served as administrator of North Mississippi Medical Center-West Point.

When Moore was named as president and CEO of NMMC, North Mississippi Health System (NMHS) president and CEO John Heer emphasized his “servant leadership philosophy and relationship-based approach.”

Before his stint in West Point, Moore was assistant executive director and COO for Greenwood Leflore Hospital for four years. He previously worked with Rush Health System and other healthcare pro-viders in East Mississippi.

Moore earned an associate’s degree in radiological technology from Meridian Community College, a bachelor’s degree in industrial science from Mississippi State University, and in 2003, a master’s degree in healthcare management from the Uni-versity of New Orleans.

At the time he was named MHA president and CEO, he has been named chairman-elect of the MHA Board of Governors. Moore and his wife, Janice, have two sons, Matt, 28, and Ross, 22.

MHA Leadership Shift Sam Cameron retiring; Tim Moore takes top post after short stint leading NMMC

Tim Moore

in tests conducted by different radiologic technologists.”

Previously, NS2 neurosurgeons have relied on flexion extension films, where the patient is placed in a regular x-ray machine. Images are taken with patients in positions of extreme motion – extended fully, and also all the way forward.

“Then you eyeball it,” he explained. “It’s sometimes difficult to quantify the changes in the two.”

In fact, because patients are tradition-ally not placed in stressed gravitational po-sitions via x-ray, “many of them say they were “MRI’d” in the most comfortable position ... ‘when I don’t hurt.’ Usually, we can see the problem. But sometimes, we underestimate the degree of the prob-lem because they’re lying down. Some MRI scanners allow patients to be scanned when they’re sitting or flexing, but they’re not commonly available.”

Traditional x-rays require roughly 30 percent more radiation than the VMA alternative. The use of fluoroscopy in lieu of x-rays provides physicians with video consisting of hundreds of individual still images versus three still images of flexion, extension and center from the standard x-ray procedure to evaluate the lower spine. Image recognition software locates the vertebrae on each frame and plots the degree of spine bending for each level. A set of biomechanical measurements is overlaid on the video images to provide neurosurgeons with expansive data at a glance.

“You don’t realize how much your back is being exercised … from tying your shoes to getting out of bed … until you’re in back pain,” said NFL star Brett Favre, who has used the machine as a patient of Hattiesburg neurosurgeon David Lee, MD, of Southern Neurologic & Spinal Institute. “This piece of technology is im-pressive.”

Lee said the new diagnostic tool has prompted him to diagnose patient issues

differently. “Sometimes, it makes you alter the course of what you were going to do if you used an MRI or CT scan,” he said.

Also, VMA technology digitally marks boundaries of the vertebral bodies; the computer analyzes those boundaries to determine how much they angulate rela-tive to each other.

“It’s a much more robust way to do a flexion extension film,” said Moriarity.

Post-operatively, with VMA technol-ogy, neurosurgeons can tell immediately if mobility has improved in conjunction with pain relief, said Moriarity.

“VMA technology also helps with UMMC neurosurgery residents that ro-tate through our clinic,” he added. “I’d like to have those residents using the Ortho Kinematic films to answer some re-ally great research questions in the spine. For example, we do procedures that some people say might produce instability with a certain amount of bone removal. We don’t really have great evidence that those procedures do or don’t produce instabil-ity. This would be a great way to answer it: put the patient through this scan before surgery, and again three to six months post-surgery. Is the motion recognizably different? For example, does L-4/5 move differently now that we’ve done that pro-cedure?”

Even though Ortho Kinematics would likely prefer VMA technology to play a broader transformational role, per-haps replacing the MRI, Moriarity has doubts.

“That’ll be tricky since at its core, it’s an x-ray, even though it’s a video x-ray,” he said. “Still, you’re unable to see the disks, nerves or spinal cord. It’s still a bone-based study. I don’t see it replacing the MRI, but it’s certainly a better way to do what we’ve done for a long time.”

Most insurers cover VMA testing as a quantitative version of a flexion exten-sion film.

Spine Tingling, continued from page 1

How It WorksVertebral Motion Analysis

(VMA) technology uses a patented Motion Normalizer device, which provides powered passive trunk bending while the patient is standing and lying down. During the test, patients grip handlebars; the motion-normalizing technology guides them through a specified range of motion to capture a true picture of the spine’s ability to flex and bend. The 30-minute procedure is ideal for assessing patients with suspected instability of the lower lumbar spine in a weight-bearing or non weight-bearing posture.


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

By LyNNE JETER

In a long-term commitment to a North Mississippi county-owned hospital, University of Mississippi Medical Center (UMMC) leaders inked a deal to lease the 156-bed Grenada Lake Medical Center (GLMC).

The Mississippi Institutions of Higher Learning Board of Trustees approved the 20-year lease for $37.4 million – the total of the facility’s debt – on Aug. 15 to start Jan. 1 and includes three optional 10-year renewals for a total of 50 years. UMMC plans to use patient-care revenue to pay Grenada County nearly $2 million annu-ally to retire the facility’s debt.

After seeking proposals to alleviate the debt burden on the county hospital, the Grenada County Board of Supervi-sors voted last fall to consider negotiations with UMMC. Even though Gov. Phil Bry-ant had signed a law earlier this year that would allow UMMC to buy the hospital, both parties chose the lease option after prolonged negotiations.

“Collaboration will be key to success in healthcare in the future,” said James E. Keeton, MD, UMMC vice chancellor for Health Affairs and dean of the School of Medi-cine. “We’re honored the Board of Supervi-sors selected us to part-ner with Grenada Lake Medical Center and the strong care providers in the community.”

Garnering addi-tional rotation and residency slots for UMMC medical students and graduates sweetens the deal, said Keeton.

“We need more teaching venues so we can continue training more health professionals for Mississippi,” he said. “Grenada brings that important element to the table.”

Under the agreement, UMMC began managing the hospital Sept. 1, with the hospital paying the university $26,000 a month for four months. An executive steering committee will transition the facil-

ity and its operations to UMMC practice models and the GLMC’s workforce – 400 full-time and 50 part-time employees – to UMMC rolls.

At the start of the long-term lease, UMMC plans to contribute up to $12 million in working capital and refinance the hospital’s debt – $24.3 million in debt principal and $11.2 million in interest – from a variable interest rate to a fixed interest rate by mid-2015. UMMC also plans to finance future capital improve-ments, maintenance, insurance and utili-ties.

Also, to keep more Mississippians in Mississippi for patient care, UMMC hopes to steer more patients from North Mississippi to UMMC, instead of Mem-phis, Tenn.

“We can make it better,” Keeton said. “We can improve the admissions and number of patients.”

The new collaboration also provides opportunities to expand UMMC’s tele-medicine services, and to give the Gre-nada community access to sub-specialty

care in which there is a local void. Also, UMMC and GLMC adminis-

trators will work toward gaining the neces-sary licenses and certifications for various operations. The timing could change, depending on facilities issues and govern-mental approvals, according to UMMC.

The long-term deal with Grenada County Board of Supervisors may signal similar pacts on the horizon. UMMC also owns the Holmes County Hospital in Lex-ington, and elected local officials for other debt-burdened hospitals, such as those in Natchez and Starkville, are considering leasing or selling those properties. Keeton said UMMC is receptive to those options, adding “we’ll only go into an area if we’re asked.”

UMMC and Grenada Lake Med Make Deal New long-term partnership with public hospital nets mutual benefits; may signal similar structurings

Dr. James E. Keeton

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TUPELO – When Tommy Bozeman joined North Mississippi Health Services (NHMS) in 1975 to lead the hospital system’s informa-tion technology (IT) division, only a dozen or two folks represented IT.

Today, Bozeman leads a de-partment of 175 IT professionals. One-third are practicing clinicians; probably 50 are RNs. The very co-hesive group keeps electronic com-munication flowing between the fl agship 650-bed hospital in Tupelo, and community hospitals in Eupora, Iuka, Pontotoc and West Point, and also Hamilton, Ala. With ambula-tory clinics and long-term care facili-ties added in, the IT group supports approximately 150 buildings within a 75-mile radius.

The commemoration of NHMS’s 15th anniversary as a national healthcare IT leader, selected to the pres-tigious 2013 Most Wired Survey, comple-ments the system’s pick as one in four institutions nationwide selected as a 2012 Malcolm Baldrige Quality Award recipi-ent.

“The key to our IT success is the or-ganization, which has invested in health-

care information technology since the beginning,” said Bozeman, NMHS CIO. “Also, because we’ve been very thoughtful and diligent about the process, we haven’t had to rush out and fund a major pur-chase, as the federal government is push-ing hospitals to go electronic. We saw it 30 years ago. For example, we’re in the pro-cess of retiring our fi rst electronic medical

record system, initiated in 1983. It shows how we haven’t wasted money on bad IT decisions. That sets us apart.”

Interestingly, Medicare Provider Charts data relating to national/state averages show that NMHS Medicare charges for the Top 100 DRGs are 20 per-cent less than the Mississippi average, and 33 percent less than the national average.

“We truly have a very low cost struc-ture compared to others,” said Bozeman.

The NMHS integrated community health record (ICHR) contains real-time clinical information on more than 735,000 patients with more than 8.6 million epi-sodes of care since 1995. It includes sys-temwide EHRs, a corporate general accounting system, corporate billing and accounts receivable systems, and a data warehouse used for data mining. These systems are interfaced and provide com-prehensive and integrated information.

In 2009, NMHS earmarked $28 mil-lion to update its ICHR to the Allscripts Sunrise EHR system to benefi t from ad-vanced patient safety and quality tools. Be-cause of innovation and strong MIS clinical representation, NMHS remains an indus-try leader, one of few nationwide to meet all the meaningful use requirements early on.

“With the federal government’s push for physicians to adapt to and adopt the new stringent requirements for meaning-ful use, we’re asking physicians to inter-

act with systems more than ever, and we’re asking them to spend more time with these systems than in the past with paper records,” said Bozeman, noting the physician shortage exacerbates the challenge. “In a medically under-served state and region, our physicians work very hard with heavy patient loads, and we’re caught in the middle of trying to move the federal initia-tives forward while also being sensitive to the needs of our physicians not to overload them with increasing use of computers. Prior to the push to get them totally electronic, they received a lot of assistance from nurses and other healthcare professionals to help them through their day. That’s sort of been taken away from them to show mean-ingful use.”

In July, 74 percent of all orders system wide – not just medication or-ders – were placed electronically by

NMHS physicians, an astounding change from fi ve years ago, when it was close to 5 percent.

“A big challenge for us in IT is educat-ing and continuing to educate physicians as changes are made industry wide,” said Bozeman, noting that upon hire, NMHS provides 24 hours of dedicated basic com-puter training to each nurse and 16 hours to each physician. “Changes are made daily, based on input from physicians and others. If you went on a 2-month vacation, you might come back to a system that’s changed signifi cantly.”

The 2013 Most Wired Survey, spon-sored by McKesson Corp., AT&T, the College of Healthcare Information Man-agement Executives and the American Hospital Association, also covered new areas, such as big data analytics and patient-generated data. An emerging practice, big data analytics reviews large quantities of data to uncover patterns and correlations.

Other key fi ndings: • 71 percent of Most Wired hospitals,

including NMHS, have an electronic dis-ease registry to identify and manage gaps in care across a population.

• 66 percent of Most Wired hospitals share patient discharge data with affi liated hospitals. Thirty-seven percent do so with non-affi liated hospitals.

• 32 percent of Most Wired hospitals, including NMHS, conduct controlled ex-periments or scenario-planning to make better management decisions.

• 41 percent of Most Wired hospitals provide a patient portal or Web-based so-lution for patient-generated data. NMHS is in the process of rolling out a patient portal to clinics and hospitals system wide.

“We’ve had clinical staff embedded in technology for 25 years,” said Bozeman. “It gives us an advantage in that they re-ally understand medical processes and how nurses and doctors think and do their work as they’ve made rounds because they’ve been there.”

Most WiredNMHS marks 15th anniversary as national HIT leader

Tommy Bozeman


By DAVID A. WILLIAMS

Within the numerous parts of the Af-fordable Care Act, there are still many areas of implementation and enforcement that are unclear. In the confusion, hos-pitals may have missed or are in danger of missing important deadlines like the Community Health Needs Assessment (CHNA). Nonprofi t and dual status hospi-tals must submit a CHNA before the end of the fi scal 2012 year. Here’s an overview of what you need to know, along with tips on how to begin structuring your CHNA assessment to become a strategic tool you can use to better serve parts of your com-munity that fall through the cracks, as well as to set budgeting priorities for the next few years.

1. If you are a dual status hospital (a governmental organization that is by stat-ute not required to fi le a 990) and do not fi le a 990, you must still complete a Com-munity Health Needs Assessment before the end of the fi scal year. The penalties for not submitting are uncertain, but it seems logical to assume that revocation of a hos-pital’s tax exempt status could be at stake as well as a $50,000 penalty.

2. The fact that the IRS has not yet revealed its mechanism for dual status

hospitals to submit the assessment does not exempt nonprofi t and dual status hos-pitals from completing the CHNA.

3. The CHNA process takes several weeks from conceptualizing to staffi ng, information gathering to analysis, and re-port preparation. The report needs to in-clude an action plan for addressing areas in your community that are underserved and have disproportionately high health issues

4. Think strategically about the CHNA. Under the Affordable Care Act, a Community Health Needs Assessment is required to be completed every three years. Taking the time to put a good pro-cess in place gives you a solid template for conducting CHNAs going forward.

But the CHNA can actually be a very helpful strategic tool to take the tempera-ture of the community; fi nd out where you are having successes like a decrease in dia-betes, which lets you know your program is working. Or you could fi nd out infant mortality rate has risen, so a different ap-proach is needed to help the community in that area. By treating the CHNA as more than a compliance requirement, there is an opportunity to move more swiftly from a reactive status to a proactive status that can get ahead of serious health trends.

Addressing population health man-agement is a vital concern for hospitals. The reimbursement system for Medicare is shifting from a fee-for-service envi-ronment to an outcomes based delivery model. Other payors may adopt this ap-proach moving forward, therefore, status quo is not a strategy for hospitals. The CHNA is a great tool to aid in the culture shift required to move away from the re-imbursement platform that exists today.

Here are key process suggestions to get the CHNA process started at your hospital:

• Develop your supervisory team. Often the hospital administration, under direction from its board, is tasked with taking point on the CHNA. The fi rst priority is to develop a needs listing that identifi es both signs of wellness and areas of concern in the community you serve. Review existing programs with an eye for refocusing resources to meet the most critical needs.

• Develop your CHNA imple-mentation team. Include a broad rep-resentation of residents, agencies, and medical personnel that are knowledgeable about your community and will dedicate the time and effort to make the CHNA a success.

• Design the infrastructure nec-essary to manage the process, and to collect and analyze data. An evidence-based approach is necessary to meet com-pliance.

• Establish a plan for gathering primary and secondary data. Primary data on your community provides an op-portunity to identify health trends that need to be addressed. Methods used to collect primary data include postal surveys and web-based surveys, videography, ob-servation, focus groups, and face-to-face interviews. Secondary data is information used to prepare quantifi able benchmarks. Examples of secondary data include de-mographic data about the growth rate of the community population, family income trends, area employers, vital statistics about incidence rates, prevalence rates, mortality, morbidity, and outcomes. Good sources for secondary data include Cen-ters for Disease Control, State Depart-ment of Health, and U.S. Census Bureau.

• Set up a process to analyze the data. Prepare charts that include benchmarks that show how your community stacks up against state and national benchmarks in key areas of wellness and disease.

• Prepare a report that includes the

What You Need to Know NOW about the CHNA Deadline



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By LyNNE JETER ORLANDO – When leaders at

the Florida State University College of Medicine (FSU COM) began crunching numbers, they were pleasantly surprised to learn that roughly two of three medi-cal graduates are practicing medicine in-state, even if they completed residencies elsewhere.

“We were concerned it was a fluke and hoped the trend kept up,” said Michael Muszynski, MD, dean of the FSU COM Orlando regional campus, and associate dean of clini-cal research. “Five years later, it’s holding steady between 60 and 64 per-cent.”

State lawmakers approved the open-ing of the FSU COM in 2000, after the Board of Regents denied requests in the late 1990s, stating more doctors weren’t needed. The charter class graduated in 2005.

As of May, 82 of 135 FSU COM graduates who have completed residencies are practicing medicine in Florida (61 per-cent). Of those, 70 percent (57) are in-state primary care providers (PCPs) and 16 per-

cent (13) are practicing in rural, medically underserved areas of the state.

“The reasons why our statistics are much better than the standard 30/60 per-cent split – that is, 30 percent of graduates from traditional-based medical schools typically return to the state after complet-ing residency and 60 percent stay where they did their residency – is because of the foundation we laid with our mission state-ment, which was created by us from the very start,” said Muszynski. “We wanted the foundation firmly established so that whoever inherited the program from the pioneers who started the school wouldn’t be able to vary from the mission.”

First, FSU COM stacks the deck on the front end through a holistic applica-tion approach, focusing on applicants who want to live and practice medicine in Florida. Second, the college follows a community-based medical school model during students’ clinical years, where they connect one-on-one with physicians in the community.

And third, medical school faculty makes it fun and interesting to be a com-munity-based doctor with a mentoring system that maintains contact with stu-dents during school and afterward.

“We put a great deal of thought into how our approach might work,” said

Muszynski. “We knew we had to make an impression on medical students when they were making choices about their ca-reers. And it’s working. The only thing that surprised us was how well it’s worked. We would’ve been happy with a 40 to 50 percent return, but 60 to 65 percent is as-tounding.”

Deck Stacking Rather than reviewing only grades

and scholastic ability, the FSU COM ap-plication review board selects students with attributes that mirror the school’s mission.

“We quickly discovered that students who stated upfront their agreement with our mission had experience supporting that mission alignment,” said Muszynski. “For example, we noted that many appli-cants from smaller towns and smaller high schools were involved in a meaningful way with their community and seemed more likely to maintain that mission. We made no apologies for those identifying descriptors.”

For several years, FSU COM only accepted in-state applicants. Now, ap-proximately 5 percent of approved appli-cants cross state lines to attend. Still, the board remains very selective.

All factors considered equal between two applicants – one from a rural area and an urban applicant – the rural applicant may be get a slot above the urban appli-cant, said Muszynski.

“A student from a rural area is more likely to align with our mission just be-cause of their setting,” he explained. “But the rural applicant who didn’t do much extracurricular-wise, where the urban ap-plicant worked with the underserved, then it’s different.”

Middle GroundTo keep the in-state return mindset

strong, the FSU COM uses a community-based curriculum to place third and fourth year medical students in the field.

“Community-based curriculums have been talked down by some schools,” said Muszynski. “We contend its equal worthi-ness. We focus on producing physicians who can care for patients in community settings, and a community-based curricu-lum is central to the process.”

For example, FSU COM has a unique apprenticeship model. Students aren’t assigned to hospitals, wards or resi-dency teams. Instead, they’re assigned to a physician practicing in the community who has been trained to be an educator. That physician typically receives $2,000 a month on a contract basis. As a result of this model, the FSU COM has no full-

time faculty for years 3 and 4, with the ex-ception of the campus dean.

The approach also includes a ge-riatric rotation component to spark interest in caring for older patients. FSU COM has also established a strong student advisor network. Each student is assigned to a community advisor on an 8-to-1 ratio. Students are counseled not only about their careers, but also life in general, volunteerism, and the delicate yet very important work/life balance that perplexes many physicians. Advisors are overseen by a dean or associate dean, depending on the campus, on a 20-to-1 (students-to-dean) ratio.

“That low of a ratio in the U.S. rarely exists,” emphasized Muszynski.

Stage 3To further strengthen community ties

and the job placement network, Florida Hospital recently provided a $2 million gift to establish the Florida Hospital En-dowed Fund for Medical Education to help the FSU COM support its educa-tional mission.

“Our mission aligns strongly with Florida Hospital’s except that we’re not a faith-based school; we’re public,” said Muszynski. “These students are highly sought after, and relationships end up being life-long. We have 16 graduates al-ready practicing in Central Florida. You might think: only 16? But it’s impressive when you consider the number of gradu-ates during our ramp-up years between 2005 and 2010, and those who are just finishing 5-year residencies. We’ve now created a number of scholarships to en-courage students to return.”

Stacking the Deck Part 1COMs’ winning approach to retaining medical graduates

Dr. Michael Muszynski

health priorities identified by the CHNA. Share it with the community and prepare an action plan to address any healthcare gaps.

If you treat the CHNA as a check-the-box requirement, then you’ll have a nice statistics report you can file. But when done correctly and strategically, the CHNA truly does provide an oppor-tunity for hospitals to proactively budget resources for a multi-year plan that meets the specific health needs of the community of residents it serves.

What You Need to Know NOW about, continued from page 7

David A. Williams, CPA, MPH, FHFMA leads healthcare reimbursement and advisory services at HORNE LLP. For more than 25 years David has focused on the healthcare industry serving hospitals, outpatient centers, home healthcare agencies, skilled nursing facilities, assisted living centers, rural health clinics and mental rehabilitation centers. From offices across the Southeast, HORNE serves healthcare clients across the nation. Visit www.horne-llp.com for more information.



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By LyNNE JETER

An incisionless procedure fi rst per-formed in St. Louis at Washington Uni-versity’s 7th Annual GI Live Conference in July may very well represent a new gold standard for treating esophageal achala-sia.

“This is the closest we’ve gotten to the Holy Grail dream of incisionless surgery, where the patient goes to sleep, wakes up, feels no pain and has no side effects or complications,” said surgeon Michael Awad, MD, PhD, FACS, associate dean of medical student education, program director of general surgery, and director of the Washington Uni-versity Institute for Sur-gical Education. “We’re not totally there yet, but we’re very, very close.”

Awad and interven-tional gastroenterolo-gist Faris Murad, MD, assistant professor of medicine, and director of endoscopic ultrasound at Washing-ton University, performed the area’s fi rst POEM (Per Oral Endoscopic Myotomy) procedure on July 19, on a 54-year-old fe-male who awoke early the next morning

ready to go for a run. “We said, ‘no, you can’t do that yet,’” recalled Murad, with a laugh.

Immediately after completing the proce-dure, Murad and Awad could see how well the patient’s esophagus opened.

“Other than minor bleeding and some CO2 that leaked into her abdo-men, the case went great,” said Murad. “We’d practiced it and really understood the game plan.”

When checking on the patient post-operatively that evening and the next morning, Awad was pleased to learn the

patient had zero pain from the procedure. She only expressed slight discomfort from the postoperative barium swallow study and the IV in her arm.

“We wrote her (a script for) IV pain medication,” he said. “She didn’t use it once. We’d also written (a script) for Tyle-nol, but she didn’t take even one Tylenol. That’s almost unheard of after a proce-dure like this.”

Within a couple of days, the patient returned to her daily routine. “She’s no-ticed a huge difference,” said Murad. “We’re thrilled with her outcome so far.”

The Long PreparationMurad and Awad began preparing

for the introduction of the incisionless

procedure to St. Louis two years ago, when they fi rst heard about POEM being introduced in the United States. World-wide since 2010, some 1,400 POEM procedures have been performed. Nation-ally, there have been only 200 POEM cases, mostly at two locations. The largest POEM center in Portland, Ore., accounts for roughly half of them. Awad trained with Lee Swanstrom, MD, FACS, of The Oregon Clinic in Portland, who was the fi rst doctor to perform natural orifi ce surgery in the United States. The sec-ond largest center is Chicago; roughly 35 POEM procedures have been performed at NorthShore Hospital, and perhaps 25 cases at Northwestern Memorial Hospital.

“One of the fi rst times POEM came up in the U.S. was two years ago at a So-ciety of American Gastrointestinal and Endoscopic Surgery (SAGES) conference in San Diego,” said Murad. “I was pre-senting at the conference and had heard discussion about POEM, but it was the fi rst time I’d seen video and learned more about it. A consensus meeting discussing the best approach to POEM with prelimi-nary data and other details was very en-lightening. POEM has been slow to take hold in the U.S. because so much goes

A New Gold Standard?Washington University team performs fi rst incisionless procedure for treating esophageal achalasia in St. Louis

Current Gold Standard for Treating Esophageal Achalasia

The Heller myotomy is most commonly used to treat achalasia, a dysfunction of the lower esophageal sphincter (LES), which fails to relax properly, making passage to the stomach diffi cult for food and liquids. Initially performed by Ernest Heller in 1913, the procedure, now performed laparoscopically, involves cutting the LES muscles. The myotomy only cuts through the exterior esophagus muscle layers that are squeezing the muscle, leaving the inner mucosal layer intact.

Dr. Michael Awad

Dr. Faris Murad



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into it, and the procedure takes highly skilled people.”

In St. Louis, a collaborative approach was taken with minimally invasive surgery and interventional endoscopy. This col-laboration paired surgical experts in per-forming laparoscopic Heller myotomy, with interventional endoscopy and an esophagologist. Awad and Murad co-di-rected the start of the POEM program at Washington University.

Because the POEM procedure pairs specialists in surgery and GI, Murad and Awad began concentrated efforts to expe-dite bringing the POEM procedure to St.

Louis. “POEM is a convergence of disci-

plines, with both specialties focusing on the GI tract,” said Awad. “Traditionally, the approach to those disorders has come from different angles. GI approached it through use of medications and limited therapeutic maneuvers (injection of Botox and balloon dilation). On my end, we usually approach disease of the GI tract with keyhole surgery. We’ve been trying for years on a national level to make our procedures less invasive, and a huge jump was made 20 years ago with the advent of laparoscopic and minimally invasive sur-

gery. It was a huge advance toward less pain, faster recovery, and fewer complica-tions for patients.”

LagniappeDuring the preparation phase, Awad

and Murad connected with Haruhiro Inoue, MD, a professor at Showa Univer-sity Northern Yokohama Hospital and Di-gestive Disease Center in Japan, who has performed 423 POEM procedures. The timing worked well for Inoue (pronounced “in-you-way”) to keynote the July 19 St. Louis Live Endoscopy Conference and also proctor the first POEM case at Wash-

ington University. “It’s too early for us to know long-term outcomes, but right now they’re matching laparoscopic outcomes,” said Murad. “As our understanding of the procedure improves, it might lead to bet-ter long-term outcomes.”

Is the POEM procedure the new gold standard for esophagus achalasia?

“That’s the hope,” said Murad. “We don’t have quite enough evidence yet to say that, but it’s emerging, and very prom-ising. However, this particular procedure requires a great deal of technical expertise and a lot of specialized training. It won’t be done in all corners yet.”

A New Gold Standard? continued from page 9

POEM Procedure for Esophageal Achalasia

Symptoms: Weight loss, chest pain/heartburn, regurgitation.

Preoperative examination: Esophageal manometry, barium swallow study, blood test, and x-ray exam of chest and abdomen.

POEM surgical steps: 1. With the patient in the operating

room under general anesthesia, an endoscopy of the upper gastro-intestinal tract is performed to determine the length of the required incision of the muscle layer.

2. After the injection of a saline solution is made under the mucosa, a “mucosal incision is created which allows the endoscope to enter the submucosal space”.

3. A submucosal dissection is then performed down the esophagus to the top of the stomach. After creating the tunnel in the submucosa, the inner muscle layer is cut along its length.

4. The mucosal entry is closed by clips that will eventually fall off.

Possible postoperative symptoms: Fever up to 101 degrees, chest pain due to the muscle layer incision performed, and throat discomfort.

Day after surgery: A barium swallow study to confirm that the mucosal incision is tight and not leaking.

SOURCE: Showa University Northern Yokohama Hospital.

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Research Uncovers New Clues to the Causes of SchizophreniaGenome-wide study discovers new variants, pathways

Dr. Patrick Sullivan

By CINDy SANDERS

An insidious condition, schizophrenia is estimated to occur in about 1 percent of the population worldwide. Character-ized by a breakdown in thought processes, the mental illness has been described for centuries through accounts of individuals suffering from delusions, paranoia and hal-lucinations.

The chronic, debilitating disorder takes a heavy toll not only on affected indi-viduals but also on their families and society as a whole. An early onset disorder, many patients are first diagnosed dur-ing the late teens or early adult years and struggle throughout their lifetime to manage symptoms.

“It’s a horrible disor-der,” stated Patrick Sullivan, MD, director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine. “It’s a huge, huge public health problem, and it’s one where the scientific discussion has been dominated on partial information.” He added, “People have done the best they can with what informa-tion they have. We’ve been debating the cause of schizophrenia for the better part of a century now.”

On Aug. 25, Sullivan and colleagues helped move that conversation forward with the online publication of a new ge-nome-wide association study (GWAS) in the journal Nature Genetics. “This is the largest published study we’ve done in the field,” noted the lead author who also serves as a professor in the departments of Genetics and Psychiatry and UNC. Col-laborators in the study include co-authors from the Karolinska Institutet in Sweden, the Stanley Center for Psychiatric Re-search at the Broad Institute of MIT and Harvard, and the Mount Sinai School of Medicine in New York.

“We discovered there were 22 places in the genome, 13 of which to our knowl-edge had never been described before, and each is a clue about the cause of schizo-phrenia,” Sullivan said of identifying nearly two dozen locations in the human genome that are involved in the disorder, including one that has previously been im-plicated in bipolar disorder.

“If finding the causes of schizophrenia is like solving a jigsaw puzzle, then these new results give us the corners and some of the pieces on the edges,” he stated, adding the number of genetic variants probably numbers in the thousands. “These 22 are the tip of the iceberg.”

The study was based on a multi-stage analysis that began with a Swedish na-tional sample of 5,000 schizophrenia cases and 6,200 controls followed by a meta analysis of previous GWAS studies and then a replication of single nucleotide poly-morphisms (SNPs) in 168 genomic regions in independent samples for a total of more than 59,000 people included in the re-search. The results underscored two take-aways for Sullivan. The first, “We need to do more studies urgently. We’re actually quite encouraged and believe larger studies of this type will lead to more knowledge,” he said. The second, “The early results we have here certainly indicate two different biological processes are involved.”

The research uncovered two distinct pathways that might be associated with the disorder — a calcium channel and micro-RNA 137. Calling the calcium channel, which includes the genes CACNA1C and CACNB2, the ‘queen of the channels,’ Sullivan explained there are a number of FDA-approved calcium channel blockers on the market today that are used for a va-riety of conditions ranging from hyperten-sion and angina to migraines.

Stressing that it was much too early to draw conclusions, Sullivan

said the findings at least indi-cate the calcium channel might be an area that deserves further attention from those studying schizophrenia. Hypothetically, he continued, cal-

cium channel blockers might be found to have unexpected efficacy in schizo-phrenics. “That’s something that needs to be evaluated in a careful, rigorous way,” he said, again cautioning against jumping too far ahead.

The second pathway includes its namesake gene MIR137, which is a known regulator of neuronal development. Sullivan noted more than a dozen other genes are also known to be regulated by MIR137, as well.

Schizophrenia has long been known to have a strong genetic component. While it occurs in about 1 percent of the general population, the disorder is found in about 10 percent of people with a first-degree rel-ative diagnosed with schizophrenia. The National Institute of Mental Health notes the highest risk for developing the illness — 40 to 65 percent — occurs in an identi-

cal twin of an individual with schizophre-nia. Yet, most scientists believe genetics is only one component in developing the dis-order, which probably has environmental triggers, as well.

While Sullivan said each different approach to solving the enigma of schizo-phrenia is important, he noted the genetic approach offers a strong foundation for discovery. “We can measure the DNA part of people particularly well these days,” he said. “Our study is a step forward in under-standing the genetic basis of the disorder. This is really, truly nice progress.”

He added the new findings provide “a couple of good strides forward” even though an endpoint isn’t yet in sight. “But for researchers and scientists, it shows us a bunch of things we’ve never seen before … and that’s pretty cool.”

And Sullivan expects more information to be forthcoming. “What’s really exciting about this is that now we can use standard, off-the-shelf genomic technologies to help us fill in the missing pieces,” he said. “We now have a clear and obvious path to get a fairly complete understanding of the genetic part of schizophrenia. That wouldn’t have been possible five years ago.”

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The 12 Mississippi cities certifi ed as Health Care Zone Master Plan Communi-ties are:

• Batesville in Panola County • Belzoni in Humphreys County • Canton in Madison County • Hazelhurst in Copiah County • Holly Springs in Marshall County • Macon in Noxubee County • Morton in Scott County • Quitman in Clarke County • Waveland in Hancock County • West Point in Clay County • Winona in Montgomery County • Yazoo City in Yazoo County “Last fall, I traveled the state with the

Mississippi Economic Council after evaluat-ing the strengths and weaknesses in Missis-sippi’s healthcare economy,” said Bryant. “Together, we issued Blueprint Mississippi Health Care: An Economic Driver, a report that provides the framework to help us fur-ther develop our healthcare growth strate-gies.”

The report identifi ed ways to grow Mis-sissippi’s healthcare economy and benefi t the state in four key areas: workforce develop-ment, quality of life, business sustainability and the creation of economic wealth.

“Gov. Bryant’s focus on this importance of healthcare as an economic driver will play a vital role in positioning Mississippi for the future,” said Blake Wilson, president and CEO of the Mississippi Economic Council. “We have the opportunity through this sum-mit to develop a new pathway to progress for Mississippi as part of the Blueprint Mis-sissippi effort.”

Leaders around the state are continuing to foster a positive environment for health-care development, emphasized Bryant.

“We’re implementing many of the strat-egies outlined in the Blueprint healthcare report,” he said. “The clustering concept is taking root around the state as evidenced by these new master plan communities, and the Mississippi Health Care Solutions Institute, which I announced in my 2013 State of the State address, will work to promote Missis-sippi’s healthcare sector.”

For example, just fi ve days before the summit, Bryant had celebrated with offi cials from Crown Health Care Laundry Services Inc., a company that plans to locate laundry processing operations in the Marion County Industrial Building in Columbia. The proj-ect represents a company investment of $6 million and should create 150 jobs.

In January, Bryant marked signifi cant progress toward his goal of bringing more physicians to Mississippi and boosting the state’s healthcare economy when he helped break ground on a $63 million expansion to permit larger class sizes at the University of Mississippi School of Medicine. Last Octo-ber, he directed $10 million in grant fund-ing to the School of Medicine to launch the effort to help reach the goal of 1,000 new physicians in Mississippi by 2025. The new 151,000-square-foot facility will include new classrooms and laboratory space, allowing medical students to increase in number for each incoming class from 135 to 165. The bottom line: an economic impact of $1.7 bil-lion by 2025. Along the same timeline, the additional physicians trained should support

nearly 20,000 new jobs. Wilson called it “another world class

visionary move toward putting our state in the place of greatest opportunity.”

During the 2012 legislative session, Gov. Bryant signed into law House Bill 317 to establish more medical residency pro-grams throughout the state, a move that will allow more Mississippi-trained physicians to remain in the state. This session, Bryant will continue to pursue efforts to increase the number of physicians practicing in Missis-sippi’s most medically underserved commu-nities. The UMMC expansion is expected to create some 930 jobs during construction.

Bryant hopes other communities around the state will see the importance of developing a Health Care Zone Master Plan as part of a strategy for expanding healthcare investment, pointing out that healthcare in Mississippi “is not just about hospitals.”

“It’s about the factories that supply those hospitals with everything from medical equip-ment and high-tech machines to the basic goods and services necessary to make these vital and important institutions function,” he said. “Health Care Zone Master Plans will aid our Mississippi communities in growing this industry of necessity, and let the rest of the world know that Mississippi works!”

Governor’s Mission, continued from page 1

Health Care Zone Master Plans

Designed to be economic development tools for communities to follow and facilitate healthcare job creation and wealth, the economic growth strategy behind Health Care Zone Master Plans is patterned after the Mississippi Economic Council’s Blueprint Mississippi Health Care: An Economic Driver. This 275-page study provides a framework to evaluate Mississippi’s strengths and weaknesses regarding the state’s focus on healthcare from an economic development perspective. The study points out the benefi t of clustering and master planning which collectively drive economic development and job creation. Health Care Zone Master Plans will help communities, the Mississippi Development Authority, and local economic development practitioners facilitate the start-up or recruitment of pharmaceutical companies, biologic companies, biotechnology companies, diagnostic imaging companies, medical supply companies, medical equipment companies or medicine and related manufacturing companies or processing companies, medical service providers, medical product distribution companies, or lab testing facilities.


By LyNNE JETER

For many organizations, single sign-on (SSO) technology is simply a tool to increase effi ciency. But in the healthcare setting, it’s a difference-maker. Expedited access to patients’ health records allows caregivers to make quicker decisions about treatment options and medications.

As disparate systems continue to be pervasive, with records in multiple envi-ronments, an SSO tool easily allows users access to all systems by using just one login credential. SSO simplifi es user interac-tion, and when done properly, may act as a catalyst to improve workfl ow and docu-mentation.

“Virtually everything is digital and stored electronically,” said Dean Wiech, a na-tional leader in IAM (identity and access management) healthcare technology. “The real issue becomes making sure the appropriate peo-ple have access appropri-ate to their position or department in hospitals. For example, role-based access control – when a user is granted position into the network and ap-plications – allows staff to have the ability to see information appropriate to them. You don’t want a nurse in the maternity ward to have the ability to see what’s going on the respiratory fl oor.”

Single sign-on security has been a grave concern of CIOs, noted Wiech.

“An employee could walk away from a monitor and leave a session open that anyone else could walk up and see,” he explained. “There are some great tools on the market to fi x the issue; single sign-on is just a part of it.”

Wiech, also managing director of Tools4ever, a supplier of software and integrated consultancy services involving IAM, pointed to one solution: an enter-prise-level SSO that uses badge readers and Follow Me, a tool particularly helpful for physicians making their rounds. “They log into a terminal server and the session goes up so they can go from machine to machine without waiting for any applica-tion to open,” he said. “It remains open through the terminal service environ-

ment.”Time options for inactive screens to

automatically close a session range from 30 seconds to 1 minute, confi gurable to the hospital’s requirements.

“Since information began convert-ing to electronic, the ability to view it has become more widespread,” he said. “You may have 10 to 15 nurses on a fl oor, and

you run the risk of a digital fi le being ex-posed.”

In Orlando, for example, a low-level hospital clerk misused his newly discov-ered access to emergency room medical charts by routinely scanning them for au-tomobile accidents and pocketing money for every lead he gave a local attorney.

“For that reason, role-based access

control is another tool that ties into single sign-on,” said Wiech. “If proper controls had been put in place during that employ-ee’s hire, he never would’ve had access to the system. You really need an application that takes a look at different types of data elements needed, and confi gure and main-tain that person’s access to the network, data and applications appropriately.”

Simplifying SystemsSecuring SSOs

Dean Wiech




By CINDy SANDERS

If the workforce ain’t happy … ain’t nobody happy.

This spring the Lucian Leape Insti-tute at the National Patient Safety Foun-dation (NPSF) released a report, Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care, that underscored the fundamental importance the workplace environment plays on patient safety. The result of two roundtables on the topic, the report contends patient safety is inextri-cably linked to healthcare workers’ own sense of safety and well being since provid-ers who feel disrespected or threatened are more likely to make errors and less likely to follow institutional protocols.

Julianne Morath, RN, MS, president and CEO of the Hospital Quality Institute based in Sacramento, Calif., co-led the roundtables with former U.S. Treasury Secretary Paul O’Neill, now CEO of Alcoa. A

founding member of the Lucian Leape In-stitute, Morath was the inaugural recipient of the John M. Eisenberg Award for Life-time Achievement in Patient Safety from NPSF and is a noted author and speaker on the topic of safety and workforce im-provement.

Going into the roundtables, Morath said the working hypothesis was, “A work-force, no matter how committed and skilled, cannot create a culture of safety unless they themselves are free from harm and disrespect.”

This hypothesis was borne out during the discussions that included the experi-ences and opinions of frontline practitio-ners, leaders of healthcare organizations, scholars, and representatives of govern-ment agencies and healthcare professional societies. Morath said, “It became very evident through the course of the round-tables that we have a long way to go in healthcare workforce safety.”

When workers live in a constant state of risk, they become blind to that risk and resigned to their situation, Morath said. “It’s a dangerous place to be if you think this is as good as it’s going to get no matter

what you do,” she noted.When a workforce reaches this state,

Morath continued, the workers won’t speak up or speak out. Yet, the evidence clearly shows having a culture that allows for effective assertion … or a ‘stop-the-line conversation’ … is a prerequisite for pa-tient safety.

Morath, who served as chief quality and patient safety officer at Vanderbilt University Medical Center at the time of the roundtables, said her co-leader O’Neill has often made the statement that every person in a workforce should be able to answer affirmatively to three essential questions:

1. Am I treated with respect and dig-nity by everyone?

2. Do I have the support and training tools to do my job?

3. Am I recognized and thanked for my contributions?

Unfortunately, ‘no’ is too often the answer to those questions. “It was jarring to find not only was there a lack of respect … but even worse, there was a culture of disrespect in many of our healthcare or-ganizations that was tolerated,” she said of the group’s findings. “We have a some-what historic and toxic culture where the hierarchy has to do with positional titles and the number of degrees,” Morath added.

Vulnerabilities in the system include accepting emotional abuse, bullying and learning by humiliation as ‘normal,’ per-forming demanding tasks under severe time constraints due to the production and cost pressures that dominate today’s healthcare landscape, and having a higher rate of physical harm than such high-risk industries as mining, manufacturing and construction. This culture of fear and in-timidation takes away the joy and meaning from work that most healthcare employees chose for the very purpose of helping oth-ers and making a difference.

“While this report is concerning, it’s also hopeful,” said Morath, noting there were also examples of healthcare work-places that are getting it right … at least most of the time. New healthcare models that rely heavily on teamwork are also helping make cooperation part of the landscape. “It really requires an apprecia-tion and respect for everyone’s contribu-tion in a team to deliver high quality, safe care in this complex environment in which we work today,” she noted.

The report asserts joy and meaning

are created when the workforce feels val-ued, safe from harm and part of the so-lutions for change. The Mayo Clinic and Virginia Mason Medical Center are two examples that Morath said stood out for their culture of respect. She also said Hos-pital Corporation of America (HCA) has an exemplary employee safety and secu-rity initiative.

To create safe, supportive work en-vironments, healthcare facilities must be-come high-reliability organizations with a fundamental precondition that employees are their most valuable assets and that the health and well being of those employees is a non-negotiable priority. The report out-lined seven strategies to move the needle toward becoming this type of an effective organization.

1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

2. Adopt the explicit aim to eliminate harm to the workforce and to patients.

3. Commit to creating a high-reli-ability organization and demonstrate the discipline to achieve highly reliable per-formance.

4. Create a learning and improve-ment system.

5. Establish data capture, database and performance metrics for accountabil-ity and improvement.

6. Recognize and celebrate the work and accomplishments of the workforce regularly and with high visibility.

7. Support industry-wide research to design and conduct studies that will ex-plore issues and conditions in healthcare that are harming the workforce and pa-tients.

“It sounds deceptively simple, but it’s about and individual and collective commitment to continual learning, con-tinual improvement, and continual en-gagement,” said Morath. “When you start, you’re never finished. This is a com-mitment … a long term commitment.”

Happy, Safe Workforce Prerequisite for Patient SafetyReport Emphasizes Impact of Workplace Culture on Patient Outcomes

Julianne Morath

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.

Through the Eyes of the Workforce

To download the full report

and related materials, go online

to www.npsf.org. Click on

“About Us” and select the Lucian

Leape Institute at NPSF. From

there, choose the LLI Reports

and Statements link under

“Related Pages.”



Whitman B. Johnson III Named 2014 Best Lawyers® “Lawyer of the Year”

in Jackson-MS

Jackson, MS, United States -- Sun-day, August 18, 2013 -- Currie Johnson Griffin & Myers, P.A. attorney Whitman B. Johnson III was recently selected as 2014 “Lawyer of the Year” for Medical Malprac-tice Law - Defendants in the Jackson-MS area. This is the second year Mr. Johnson has been so honored, having also received the 2011 “Lawyer of the Year” designation by Best Lawyers in the field of medical de-fense practice. Only a single lawyer in each practice area and designated metropolitan area is honored as the “Lawyer of the Year,” making this acco-lade particularly significant. These lawyers are selected based on particularly impressive voting averages re-ceived during the peer-review assessments. Receiving this designation reflects the high level of respect a lawyer has earned among other leading lawyers in the same communities and the same prac-tice areas for their abilities, their professionalism, and their integrity. Since it was first published in 1983, Best Law-yers has become universally regarded as the definitive guide to legal excellence.

Whit Johnson was born in Philadel-phia, Pennsylvania, but grew up in Clarks-dale, Mississippi, in a doctor’s household. Mr. Johnson has been licensed to practice in the State of Mississippi since 1979. He specializes in trial work, with the focus of his practice for the past 30 years being the defense of physicians, hospitals, and other health care providers from claims of medi-cal negligence. Mr. Johnson is a frequent speaker to medical organizations, includ-ing the Mississippi State Medical Associa-tion, the Mississippi Medical and Surgical

Association, Medical Assurance Company of Missis-sippi, and various departments and groups within the University of Mississippi Medical Center system. He has also been published in the Journal of the Missis-sippi State Medical Association on both risk manage-ment and litigation issues. Mr. Johnson’s wife, George, is a pre-school librarian at Jackson Academy, and they are the proud parents of three children, all of whom are now grown and on their own. They have lived in Jack-son since Mr. Johnson’s graduation from law school in 1979 and are actively involved as parishioners at St. Richard’s Catholic Church.

Jackson Office: 1044 River Oaks Drive, Jackson • 601-969-1010

www.curriejohnson.com

GrandRoundsNew Physician Workforce Director Brings Passion, Vision

Dr. John R. Mitchell of Pontotoc has been named the new director of the Mis-sissippi Office of Physician Workforce, the organiza-tion whose duties include putting more primary care doctors to work in the state’s medically needy areas.

Mitchell, a family physician, hospitalist with North Mississippi Medical Center in Pontotoc and faculty member with the center’s Family Medicine Residency Pro-gram, takes over from workforce interim director Dr. Diane Beebe, professor and chair of the University of Mississippi Medical Center Department of Family Medicine.

A veteran of the Medical Corps of the U.S. Army and the Mississippi Army National Guard, Mitchell is a diplomate (board-certified specialist) of the Ameri-can Board of Family Medicine and re-cently served as chair of the physician workforce’s advisory board.

A graduate of the University of Mis-sissippi with a Bachelor of Science in pharmacy and the UMMC School of Medicine, he began his medical career as a pharmacist before practicing medi-cine in his hometown.

Dr. Mitchell brings to the office pas-sion and vision for improving health care access in Mississippi according to Bee-be.

Created on UMMC’s campus by state legislators in 2012, the Office of Physician Workforce is on a mission to reduce the shortage of primary care doc-tors in a state with the lowest per capita supply in the nation.

The office oversees the state’s phy-sician workforce development needs by nurturing the creation of family medicine residency programs, fostering the de-velopment of a physician workforce in all specialties where they are needed, evaluating the existing workforce, and establishing the state’s current and fu-ture workforce requirements.

To reach the national average, Mis-sissippi would have to add more than 1,300 primary care physicians, whose specialties include family medicine, in-ternal medicine, pediatrics and obstet-rics/gynecology.

His ideas for bringing change to the state include adding at least three medical residency training programs around Mississippi over the next three to five years, developing partnerships that would expand medical training op-portunities in rural areas, and building a strong relationship with the Mississippi Rural Physicians Scholarship Program, which cultivates rural college students desiring to return to their roots to prac-tice medicine.

Dr. James Matthews, Jr. Takes Role At Rush Wound Care And Hyperbaric Center

Dr. James C. Matthews, Jr., a gener-al surgeon who has prac-ticed with Rush Medical Group in Meridian for 40 years will now use his skills and expertise to serve as the Medical Director of Rush Foundation Hospi-tal’s Wound Care, Hyper-baric and Limb Salvage

Center according to an announcement made by the leadership of Rush Health Systems.

The hospital’s Wound Care, Hy-perbaric and Limb Salvage Center first opened in 1997.

Dr. Matthews, Jr., a native of Silas, AL received his medical degree from the Medical College of Alabama, now known as the University of Alabama School of Medicine and completed his surgical residency training at Lloyd Noland Hos-pital in Birmingham, AL. Dr. Matthews is

board certified by the American Board of Surgery and is a Fellow of the Southeast-ern Surgical Conference. Dr. Matthews and his wife Peggy are the parents of 6 children and 21 grandchildren. Dr. Mat-thews and his family are also musically talented and have performed at many local and regional events. Dr. Matthews is affectionately known as Meridian’s “Singing Surgeon.”

Dr. John R. Mitchell

Dr. James C. Matthews, Jr.


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Southern Eye Center is a state-of-the-art regional eye care and surgery center serving The Pine Belt since 1976.

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To schedule an appointment with one of our doctors, please call (601) 264-3937.

Dr. Griffith recently performed the first IntraLase-Enabled Keratoplasty (IEK) in the state of Mississippi and one of the first in the U.S. IEK is considered to be the greatest breakthrough in corneal transplant technology in over 50 years! Our corneal transplant patients now enjoy an unprecedented level of precision, more stability, quicker recovery and better results.

Dr. Griffith recently performed the first IntraLase-

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We’re proud of our team and their continued dedication to providing our patients with the latest advancements in eye care today!

Dr. Nelson was the first in the state of Mississippi and one of the first in the U.S. to perform Blade-Free Cataract removal and use the TECNIS® Toric Lens. The FDA approved the blade-free laser technology and the TECNIS® Toric Lens for correction of astigmatism along with cataract removal, providing patients better vision, quicker recovery and increased surgical accuracy.

Dr. Nelson was the first in the state of Mississippi

Kiper Nelson, M.D.Cataract/Implant, LASIK Surgeon

Kosko Receives Board Certification

John H. Kosko, M.D. of Southern Bone and Joint Specialists, P.A., a fellow-ship-trained orthopaedic foot and ankle surgeon, was awarded board certi-fication by the American Board of Orthopaedic Surgery.

Kosko, a Greenwood native, graduated summa cum laude in biological engineering from Mississippi State University. He re-ceived his doctor of medicine degree magna cum laude from the University of Mississippi School of Medicine. He completed an orthopaedic residency from the University of Mississippi Medi-cal Center. At UMC, he received the De-partment of Orthopedics OITE Award, Resident Research Award, Citizenship Award and Best Orthopaedic Teaching Resident. He completed a fellowship in foot and ankle reconstruction from Or-thoCarolina Foot and Ankle Institute in Charlotte, N.C.

Kosko was a visiting medical student to the University of Oxford and the Nuff-ield Orthopaedic Center in Oxford, Eng-land. He completed an AO Fellowship in Luzern, Switzerland.

Mississippi Academy of Family Physicians Elects Dr. Erin DeWitt as District Director

RIDGELAND - The Mississippi Academy of Family Physicians elected Erin DeWitt, M.D. of Dia-mondhead, MS as District 1 Director. Dr. DeWitt is an employed phyisican with HCA Physician Services – Garden Park Physician Group. She was installed during its recent annual scientific assembly at the Baytowne Conference Center in Destin, Fla.

As a board member of the MAFP, DeWitt will strive to serve the needs of its physician members, their patients and the public at large. During her two year term, she will act as a liaison between the MAFP and George, Greene, Hancock, Harrison, Jackson, Marion, Pearl River and Stone counties. To ensure all voices are represented, DeWitt will address is-sues facing her district during five board meetings a year and work to promote Family Medicine in Mississippi.

Dr. DeWitt, a Board Certified Family Physician, was born and raised in South

Mississippi and is proud to call this her lifelong home. She was Valedictorian of Pass Christian High School, and went on to graduate Magna Cum Laude from Spring Hill College in Mobile, AL. She received her medical degree from Uni-versity of Mississippi School of Medicine in 2003, and completed her residency in Family Medicine at North Mississippi Medical Center in Tupelo, MS, in 2006. She is currently employed by Garden Park Physician Services and has a full-service Family Medicine Practice in Dia-mondhead, MS.

She is an active member of the American Medical Association, Missis-sippi State Medical Association, Ameri-can Academy of Family Physicians, and Mississippi Academy of Family Physi-cians. She has served on the Board of Directors as Resident member of the Mississippi Academy of Family Physi-cians and recently attended the AAFP Conference of Special Constituencies as the delegate representing female family physicians in Mississippi.

Dr. John H. Kosko

Dr. Erin DeWitt

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Pulmonary Medicine Welcomes McCollum

Charles R. McCollum, III, MD, re-cently joined Hattiesburg Clinic Pulmo-nary Medicine.

McCollum earned his medical de-gree at the University of Mississippi School of Medicine in Jackson, Miss.,

where he also completed a residency in internal medicine and a fellowship in pul-monary and critical care medicine.

McCollum also holds a Juris Doctor degree from the University of Mississippi School of Law in Oxford, Miss.

He is board certifi ed by the Ameri-can Board of Internal Medicine in inter-

nal medicine and pulmonary medicine, and is a member of the American Col-lege of Chest Physicians.

McCollum joins Lewis W. Neese, MD; Charles J. Parkman, MD; Michael J. Raggio, MD, FCCP; Andrew H. Rogness, MD;Steven W. Stogner, MD; Hermes S. Velasquez, MD; and Walid G. Younis, MD.

SRHS Welcomes New Cardiologist to the Community

Singing River Health System, along with the Southern Mississippi Heart Cen-ter, welcomes Christopher Malozzi, DO, cardiologist, to the community.

Malozzi is a graduate of Philadelphia College of Osteopathic Medicine in Philadelphia. He complet-ed his Internship and Resi-dency in General Internal Medicine at The University of South Alabama Medical Center in Mobile. Dur-ing his time in residency, he was named Chief Resident in Internal Medicine and served as a member of the clinical teach-ing faculty. Malozzi then completed his Cardiology Fellowship at USA Medical Center, where he also served as Chief Cardiology Fellow. He is Board Certifi ed in Internal Medicine and Board Eligible in Cardiovascular Disease. Malozzi is now accepting new patients at Southern Mississippi Heart Center.

Mississippi Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Commu-nications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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Mississippi Medical News October 2013

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