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PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER Nursing Shortage Demands All- Levels Approach Expanding BSN opportunities a key advancement The word is out among young people that a career in nursing can mean a good salary, great job opportunities and the chance to advance in their field ... 3 Help Wanted: Older Physicians The 55-and-over group is more marketable than ever A decade ago, Tony Stajduhar recruited a well-experienced specialist from the Cleveland Clinic to a rural intermountain community. The physician was looking for a place where he could raise horses and enjoy the last phase of his career. The new job fit the bill ... 6 September 2014 >> $5 PROUDLY SERVING THE MAGNOLIA STATE Matt Cassell, MD PAGE 2 PHYSICIAN SPOTLIGHT ONLINE: MISSISSIPPI MEDICAL NEWS.COM High Colorectal Cancer Rates in Mississippi Linked to Lack of Screenings Colonoscopies unique in that they don’t just screen, but prevent cancer Tackling Health Challenges in Mississippi The Mannings team with UMMC to raise money for life-threatening diseases BY LYNNE JETER Just in time for the kickoff to a fresh football season, Ar- chie and Olivia Manning unveiled a new campaign aimed at tackling health challenges in Mississippi. The Mannings’ partnership with the University of Missis- sippi Medical Center (UMMC) involves raising money to focus on heart disease, kidney disease, hypertension, cancer, demen- tia and other chronic ailments common to Mississippians. “This is taking another step to do something to help the people in our home state,” said Archie Manning, patriarch of Mississippi’s First Family of Football, as recognized by state lawmakers in 2009. Last month, UMMC launched a public awareness campaign for the Manning Family Fund for a Healthier Mississippi, a long-term project that extends the philanthropic bond the family has already established with the medical center. This includes the Bank Plus-hosted Evening with the Mannings, a series of fundraising events from 2007 to 2011 that netted nearly $3 million to benefit Friends of Children’s (CONTINUED ON PAGE 4) BY BECKY GILLETTE A recent report by the Centers for Disease Control and Prevention (CDC) found a nationwide decline in colorectal cancer deaths with rates falling five to six percent in a few states. Mississippi was the only state that saw no real decline. In areas where screenings are up, death rates are down. But Mississippi has one of the lowest screening rates in the country. Colonoscopy screenings in Mississippi have in- creased in the past 15 years since Medicare approved screening for colorectal cancer, said Donald Page Bran- nan, MD, a gastroenterologist with Premier Medical Group and Premier Endoscopy Center of Jackson. “That has had a huge impact,” Brannan said. “But it is too early to tell if more people are getting screen- ing here in Mississippi because of the Affordable Care Act requirement that provides coverage for preventive health care. I’m not seeing an increase in screenings yet, perhaps due to my patient population. And there (CONTINUED ON PAGE 8) Increase web traffic Powerful branding opportunity Any metro market in the U.S. Preferred, certified brand-safe networks only Retargeting, landing pages, SEM services available [email protected] GUARANTEED CLICK-THROUGHS Get verified results (impressions and/or clicks) for (LOCAL) online advertising. Dr. Donald Page Brannan
Transcript
Page 1: Mississippi Medical News Sept 2014

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

ON ROUNDS

PRINTED ON RECYCLED PAPER

Nursing Shortage Demands All-Levels ApproachExpanding BSN opportunities a key advancement

The word is out among young people that a career in nursing can mean a good salary, great job opportunities and the chance to advance in their fi eld ... 3

Help Wanted: Older PhysiciansThe 55-and-over group is more marketable than ever

A decade ago, Tony Stajduhar recruited a well-experienced specialist from the Cleveland Clinic to a rural intermountain community. The physician was looking for a place where he could raise horses and enjoy the last phase of his career. The new job fi t the bill ... 6

September 2014 >> $5

PROUDLY SERVING THE MAGNOLIA STATE

Matt Cassell, MD

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM

High Colorectal Cancer Rates in Mississippi Linked to Lack of ScreeningsColonoscopies unique in that they don’t just screen, but prevent cancer

Tackling Health Challenges in MississippiThe Mannings team with UMMC to raise money for life-threatening diseases

By LyNNE JETER

Just in time for the kickoff to a fresh football season, Ar-chie and Olivia Manning unveiled a new campaign aimed at tackling health challenges in Mississippi.

The Mannings’ partnership with the University of Missis-sippi Medical Center (UMMC) involves raising money to focus on heart disease, kidney disease, hypertension, cancer, demen-tia and other chronic ailments common to Mississippians.

“This is taking another step to do something to help the people in our home state,” said Archie Manning, patriarch of Mississippi’s First Family of Football, as recognized by state lawmakers in 2009.

Last month, UMMC launched a public awareness campaign for the Manning Family Fund for a Healthier Mississippi, a long-term project that extends the philanthropic bond the family has already established with the medical center. This includes the Bank Plus-hosted Evening with the Mannings, a series of fundraising events from 2007 to 2011 that netted nearly $3 million to benefi t Friends of Children’s

(CONTINUED ON PAGE 4)

By BECKy GILLETTE

A recent report by the Centers for Disease Control and Prevention (CDC) found a nationwide decline in colorectal cancer deaths with rates falling fi ve to six percent in a few states. Mississippi was the only state that saw no real decline.

In areas where screenings are up, death rates are down. But Mississippi has one of the lowest screening rates in the country.

Colonoscopy screenings in Mississippi have in-

creased in the past 15 years since Medicare approved screening for colorectal cancer, said Donald Page Bran-nan, MD, a gastroenterologist with Premier Medical Group and Premier Endoscopy Center of Jackson.“That has had a huge impact,” Brannan said. “But it is too early to tell if more people are getting screen-ing here in Mississippi because of the Affordable Care Act requirement that provides coverage for preventive health care. I’m not seeing an increase in screenings yet, perhaps due to my patient population. And there

(CONTINUED ON PAGE 8)

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[email protected]

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

Dr. Donald Page Brannan

Page 2: Mississippi Medical News Sept 2014

2 > SEPTEMBER 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

It’s the sort of specialty in which a physician must learn quickly to guard against emo-tional attachment in every case. But for Matt Cassell, MD, the deep and lasting connection to patients and their families is exactly what drew him to medical oncol-ogy.

“There’s no question on-cology is one of the most emo-tionally draining things you can do on this planet,” said Cassell, now in his second year with Meridian Oncology Associates, PLLC.

“Hematology and oncol-ogy is a very patient-oriented practice, in that people take you into their family and depend upon you for moral support as well as medical treatment. Even more than the science of oncology, those relationships are what drew me in.”

Cassell brought that philosophy to Meridian when he joined the five-man, physician-owned practice in June 2013. The group is housed on the second floor of the Anderson Cancer Center and provides coverage at Anderson Regional Medical Center as well as Rush Foundation Hos-pital.

Previously, Cassell spent a year on the faculty of the University of Mississippi Medical Center’s Medical Oncology De-partment. He also helped provide cover-age for the Meridian group as a locum tenens physician during his fellowship and

faculty year.A native of Taylorsville, Cassell com-

pleted his undergraduate studies at Jones County Junior College and the Univer-sity of Southern Mississippi. He went on to UMMC, staying on for a residency in internal medicine and a fellowship in he-matology and oncology.

The move from Jackson to Meridian puts Cassell and his young family closer to his mother in Waynesboro and within 20 minutes of his wife’s family in De Kalb. He and his wife, Amanda, are raising a 2-year-old daughter and 6-month-old son.

“When this job opened up in Meridian, we took the opportunity to move closer to family while our kids were young,” Cassell said. “We hated to leave the Jackson area, and I have loved both jobs. Our choice to come to Meridian was a lifestyle deci-sion.”

The transition has brought a change of pace both in terms of the practice and the surrounding commu-nity.

“It has been differ-ent as far as getting used to smaller-town life, since we loved living in Flowood where everything is new and booming,” Cassell said. “But we love the family-oriented nature of Meridian and its slower pace. My commute is the same distance that it was in Jackson, but now it takes me 10 minutes instead of 40. That’s a whole hour every day that I gain back.”

Transitioning into private practice has also meant fuller days on the job. While being at UMMC meant allowing time for the research and academic as-pects of a medical faculty role, his current practice is packed with purely patient care.

“The academic setting did provide a slower pace,” Cassell said. “My wife joked that when I was at UMMC, she actually heard from me during the day.”

In Meridian, Cassell found his new group to be an easy fit, since the members share common values and seek a healthy work balance that supports quality of life.

He’s also appreciated the quality of the practice and the facility which houses it.

“This part of the state is lucky to have a center of this size and capability,” he said. “The Anderson Cancer Center is as good as any in the state, and the practice is very well-run and efficient.”

Cassell’s practice as part of Meridian Oncology Associates, PLLC, includes che-motherapy for cancer as well as treatment for blood conditions. As with most private-practice oncologists, the most common cancers he treats are those of the breast, lung and colon. At UMMC, he focused primarily on cancers of the bladder, pros-tate and kidney.

Cassell’s early interests had leaned toward surgery, but during his training he realized how much he preferred patient interaction to procedures.

“I found myself being drawn more to conversations with people, even more than the medical side,” he said. “I saw that in oncology and hematology, you see the patient so much, you almost become part of the their family.”

In the decade prior to his entering medical school, Cassell’s field advanced primarily in the area of supportive ther-apy, he said, with better controls for nau-sea helping to ease chemotherapy’s side affects for his patients. During his train-ing and early practice, key advances have included targeted therapy as well as che-motherapy that patients can receive in pill form rather than by IV.

“Every year, something new comes out,” Cassell said. “In the next five to 10 years, we’ll see a huge boost in the way we can manipulate people’s own immune system to target a cancer.”

While the advances are encouraging, Cassell doubts a “cure” for cancer will be found the way it may be for HIV.

“Cancer is not one thing; there are hundreds of different tumor types,” he said. “People always ask, ‘When will we cure cancer?’ But I think the first and fore-most goal is to get where we can manage it better and figure out ways to prevent it.”

Cassell is board certified in internal medicine and medical oncology. He is a member of the American Society of Clini-cal Oncology and serves as treasurer of the Mississippi Oncology Society.

Outside of his practice, Cassell spends most of his time with his young family, playing with his daughter, Hayden-Grace, while his wife tends to baby Luke Mat-thew. He and his wife also participate in endurance sports together, including Iron Man triathlons.

Matt Cassell, MDPhysicianSpotlight

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REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: [email protected] for information.

Page 3: Mississippi Medical News Sept 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 SEPTEMBER 2014 > 3

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

By LUCy SCHULTZE

The word is out among young people that a career in nursing can mean a good salary, great job opportunities and the chance to advance in their field.

But first, there must be enough room in nursing programs to train all those who are interested and qualified.

Adding more slots for students to en-roll in nursing programs has been a criti-cal step in improving Mississippi’s nursing shortage over the past decade, said Wanda Jones, RN, MS, executive director of the Mississippi Office of Nursing Workforce (MONW).

“Mississippi has some of the worst numbers in the country as far as health indicators,” she said. “Here, more than in any other state, we need to make sure we have an adequate number of appropri-ately trained nurses to care for our popula-tion.”

Belhaven University in Jackson is the latest to boost the number of slots avail-able for Mississippi’s nurses-in-training, with the opening of its School of Nursing this fall. The new program provides space for up to 40 BSN students in its inaugural year and will eventually grow to a total of 200 students.

“Belhaven’s School of Nursing pro-

vides a win-win situation for nursing and the state of Mississippi,” founding Dean of Nursing Barbara Johnson, PhD, said. “As changes in healthcare reform impact the demand for quality healthcare services, Belhaven’s nursing program is in a posi-tion to respond to the complexities and nuances of a diverse healthcare environ-ment.”

At the University of Southern Mis-sissippi, the College of Nursing is set to break ground this month on a new $31

million building that will allow the school to boost nursing enrollment from 550 to 800. Asbury Hall will also provide space to broaden community-based programs.

Such expansions at both private and public institutions follow several years of focused effort to increase the number of student slots at Mississippi’s public colleges and universities. That effort got underway during the early 2000s, as the state’s nurs-ing shortage reached a crisis point with nearly 10 percent of nursing jobs going

unfilled.“There was grave concern at that

time over whether we were going to be able to have enough nurses to care for our population,” Jones said. “We were already seeing the beginning of the baby boomers enter retirement – and at the same time, nurses from that generation were also be-ginning to retire.”

The central problem in expand-ing the capacity of Mississippi’s nursing schools was traced back to faculty salaries, Jones said. They were the lowest in the en-tire Southeast region of the United States.

Armed with MONW survey data about faculty vacancies and faculty retire-ment projections from the state’s nurs-ing schools, the MONW along with the Mississippi Nurses’ Association was able

Nursing Shortage Demands All-Levels ApproachExpanding BSN opportunities a key advancement

Nursing students get a tour of the Nursing Skills Lab in Belhaven University’s new School of Nursing facility. The nursing facility features state-of-the-art classrooms, a nursing computer lab, faculty offices and nursing skill labs. The Nursing Skills Lab was designed to mimic a hospital unit. Students will have the opportunity to provide care for “patients” with numerous needs. (From left to right) Glenda Lee, MSN, nursing faculty; Krista Shelton, Joshua Jones, and Bethany Savoy (all students); Tarshe Johnson, MSN, nursing faculty.

(CONTINUED ON PAGE 5)

Page 4: Mississippi Medical News Sept 2014

4 > SEPTEMBER 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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Hospital and the children’s clinics at Blair E. Batson Hospital for Children.

The Manning family’s connection with UMMC flourished several years ago, after Manning’s youngest son, Super Bowl-winning quarterback Eli Manning, visited pediatric patients at Batson Chil-dren’s Hospital. That journey sparked the fundraising activity that helped fi nance the relocation and improvement of the hospital’s pediatric clinics – renamed the Eli Manning Children’s Clinics.

“Eli called me and said, ‘Dad, this is what I want to do,’” Manning recollected. “That kind of jump-started what became a fun and successful happening, which raised a substantial amount of money for the clinics. As a parent, I was very proud of Eli and (his wife) Abby. Once it was completed, the most gratifying things were the letters and calls Olivia and I got from parents and doctors.”

During this time span, Archie and Olivia Manning developed a tight knit relationship with Dan Jones, MD, then UMMC vice chancellor and now Ole Miss chancellor. Referencing the new health initiative, Jones said the Manning family “is beyond gracious to lend their name and support for better health for Mississippians.”

The Mannings’ friendship with Jones grew to include Jones’ successor at UMMC, James Keeton, MD, now the medical center’s vice chancellor for health affairs. Keeton and Manning concocted the idea for evolving the Manning Fam-ily Fund.

“The Manning name has been syn-onymous with football, but it’s also be-come synonymous with helping others,” Keeton noted. “Our state has huge health needs but limited resources. We couldn’t ask for a better partner in our mission to achieve a healthier Mississippi than the Manning family.”

Mississippi consistently faces myriad health issues, including high rates for obe-sity, physical inactivity, diabetes, infec-tious disease, and low birth weight.

“We’re very familiar with Mississippi and its needs,” said Manning, a native of Drew. “I lost my dad a long, long time ago, and then my mom, but I still have friends in Drew.”

In the 1960s, Manning was a star quarterback at the University of Missis-sippi and later with the NFL’s Houston Oilers, Minnesota Vikings, and most no-tably, the New Orleans Saints. The couple met on campus, married and moved to the Garden District of New Orleans, where they raised three sons – Cooper, Peyton and Eli.

A star high school quarterback with a promising college football career at Ole Miss, Cooper Manning was diagnosed with spinal stenosis at the age of 18. Turn-ing to a business career, he’s now a part-ner in a New Orleans energy investment fi rm.

Peyton Manning, a former Tennes-see Volunteers standout who led the In-dianapolis Colts to a Super Bowl victory in 2006 and now plays for the Denver Broncos, is considered perhaps the NFL’s greatest quarterback.

Eli Manning, a former Ole Miss standout, led the New York Giants to a Super Bowl win in 2008 and 2012 and re-mains their star quarterback.

“Olivia still has family in Philadel-phia,” said Manning, of his wife’s home-town. The Ole Miss Women’s Council for Philanthropy honored Olivia Manning in 2011 with its Legacy Award. “We have a lot of friends in small towns in Missis-sippi and know what’s going on. This is just recognizing the needs we should all be concerned about, the overall health of Mississippians.”

Tackling Health, continued from page 1

Making the “Most Wired” ListFour Mississippi medical centers were recently named to Hospitals & Health

Networks magazine’s 2014 “Most Wired” healthcare facilities: the University of Mississippi Medical Center (UMMC) and St. Dominic Hospital, both in Jackson, North Mississippi Health Services in Tupelo, and Magnolia Regional Health in Corinth, the latter of which was also recognized among the state’s “Most Improved” facilities.

UMMC received its “Most Wired” honor for the second consecutive time.

“I’m proud that UMMC has been recognized for two years in a row,” said David Chou, CIO of UMMC’s Department of Information Systems. “We’re just getting started with the utilization of our technology portfolio to streamline operation effi ciencies. The team has done a great job shifting their mindset from traditional IT to now providing business value for the organization.”

Donations to the Manning Family Fund for a Healthier Mississippi may be made online at www.manningsforhealth.org or mailed to Sara Merrick, Offi ce of Development, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. For more information, contact Merrick at (601) 984-2302.

Page 5: Mississippi Medical News Sept 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 SEPTEMBER 2014 > 5

By COLLIER GRAHAM

Beginning April 1, 2013 in connec-tion with the federal budget sequestra-tion, CMS was required to withhold 2 percent of fi nal Medicare payments in-cluding Medicare payments to Medicare Advantage (MA) plans. Many MA plans automatically passed on to providers the 2 percent cut in reimbursements even though there was no statutory or con-tractual justifi cation. Depending on the language of the MA provider agreement, these hospitals may be entitled to recovery

of potentially wrongfully withheld reim-bursements. Whether a hospital is entitled to recoup the 2 percent cut from an MA plan will largely depend on the specifi c reimbursement provisions of the MA pro-vider. If the contract references Medicare allowable rates, fee schedules, or a per-centage thereof, and there are otherwise no express provisions allowing the MA plan to unilaterally change reimbursement payments, then it is likely that the MA plan did not have authority to unilaterally cut reimbursements by 2 percent.

In recent follow up guidance (issued

in April of this year), CMS made clear that while the Medicare sequestration did apply to fi nal payments, it did not alter the Medicare allowable rates and fee schedules enforceable in MA provider agreements. Moreover, CMS has cau-tioned there is no statutory or regulatory mandate for MA plans to automatically force the 2 percent sequestration cuts on providers and that MA plans must follow the terms of individual provider contracts in determining whether withholding 2 percent of reimbursements is permitted. “Prompt payment” provisions required to be included in MA provider contracts may subject MA plans to penalty interest cal-culated from the date an underpayment was made.

The “sequestration reduction

amount” for each affected claim submit-ted by a provider should be identifi ed on the explanation of remittance providers received from the MA plan. Thus, a hos-pital should be able to identify whether it was subject to application of a 2 percent reimbursement cut and calculate the amount of the potential underpayment.

The process to recover wrongly with-held reimbursements may be subject to the terms of the provider contracts. These may include requirements to exhaust ad-ministrative appeals and/or arbitration in lieu of litigation.

Potential Recovery from Medicare Advantage Plans of Wrongfully Withheld Reimbursement Due to Federal Budget Sequestration

Collier Graham and George Ritter of Wise Carter are working with providers who are in the process of determining whether to seek recovery of underpayments related to sequestration. They can be reached at [email protected] and [email protected], respectively.

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to demonstrate the problem to the Mis-sissippi Legislature. State leaders passed signifi cant raises for nursing faculty mem-bers in 2006 and 2007 that helped fi ll the faculty vacancies and create new positions. Hospitals and other enti-ties also stepped in to fund more faculty posi-tions.

“We were able to turn this around from a nursing vacancy of 10 percent to as low as nearly 4 percent, by fi ll-ing the faculty vacancies and also increasing faculty positions,” Jones said. “As a result, we doubled our nursing student graduates in about eight years.”

Along the way, the MONW also helped the state’s schools of nursing bet-ter understand some of the reasons why students who enrolled in their programs didn’t fi nish them. Through two grant-funded studies, “Barriers to Completing Nursing Education,” completed in 2002 and 2004, the MONW was able to show that alongside academic struggles, nursing students were being sidelined by personal,

fi nancial, social and health issues. Stu-dents who were attending nursing school while working 40-hours-per-week jobs also tended to struggle.

“It really helped our schools of nurs-ing to have scientifi c information that showed what some of those barriers are that keep their students from being suc-cessful,” Jones said. “Many schools have since added to their staff a ‘student navi-gator’ who works with students to resolve those issues so that they can be successful.”

Looking ahead, the MONW is pre-paring to undertake a new study on bar-riers to success for nursing students. Another growing focus is encouraging and equipping nurses and nursing students to advance as far as they can within their chosen fi eld.

Currently, Jones said, only about one-third of Mississippi nurses hold a BSN de-gree or higher.

“Certainly, we cannot begin to take care of our patients in this state without the nurses who come out of two-year pro-grams,” she said. “We see that as an entry point, and we want to convey that we ex-pect those nurses to continue their educa-tion and work toward their baccalaureate degrees.”

With an increasing number of pa-tients accessing the healthcare system today, nurses are needed to staff not only patient-care roles, but also specialty prac-tices, faculty and leadership positions.

“We want to accelerate the nurses’ educational pathway, so that those who are interested will be able to fi ll those higher-level professions,” Jones said.

Likewise, she said, equipping nurses to take part in healthcare innovation is also a key goal for the horizon.

“We have bountiful data on patient safety and quality, and we know how im-portant it is for nurses who are at the bed-side to determine where there might be some gaps in meeting patient quality and safety needs,” she said. “Nurses are well-positioned to come up with ideas to resolve those issues.”

Wanda Jones, RN, MS

Nursing Shortage, continued from page 3

Vacancy rates for RN hospital nursing positions

2012 — 4.9 percent2011 — 4.3 percent2010 — 4.3 percent2009 — 5 percent2008 — 6.4 percent2007 — 9.1 percent2006 — 9.6 percent2005 — 7.9 percent

Source: Mississippi Offi ce of Nursing Workforce

Number of nursing students in Mississippi public BSN programs

2013 — 1,7802012 — 1,7182011 — 1,7052010 — 1,5292009 — 1,4512008 — 1,2392007 — 1,2712006 — 1,3302005 — 1,292

Source: Mississippi Institutions of Higher Learning

Online Event CalendarTo submit or view local events visit the Mississippi Medical News website.

mississippimedicalnews.com

Page 6: Mississippi Medical News Sept 2014

6 > SEPTEMBER 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

Belhaven Building1200 North State Street, Suite 300, Jackson, Mississippi 39202

601-981-4091 • www.msretina.com

Committed to your visual health.

Missisippi Retina Associates is Pleased to Welcome

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 Ophthalmology residency at the University of Mississippi School of Medicine, 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.

Jay Brown, M.D.Ophthalmology

Diseases and Surgery Of The Retina And Vitreous

By LyNNE JETER

A decade ago, Tony Stajduhar re-cruited a well-experienced specialist from the Cleveland Clinic to a rural in-termountain community. The physician was looking for a place where he could raise horses and enjoy the last phase of his career. The new job fit the bill.

“On my latest visit to the community, I was happy to see that he’s still there work-ing full-time and is an integral part of the program and community,” said Stajduhar, president of Jackson & Coker, a national permanent physician placement firm, based near Atlanta.

Older physicians, overwhelmed by federal mandates complicating the prac-tice of medicine and considering retire-ment as their only option, may be much more marketable than originally con-sidered in the post-Affordable Care Act (ACA) era.

For starters, the supply/demand curve is in their favor. According to the American Medical Association (AMA), nearly 1 million physicians practice medi-cine in the United States. Roughly 36 percent are 55 years or older. Of those physicians, pulmonologists and psychia-trists comprise two of the largest percent-age categories.

A frightening statistic: up to 76 per-cent of pulmonologists and critical care specialists are in that age group.

“Older physicians are very mar-ketable,” said Stajduhar. “Even though clearly, nobody should be discriminating … in a perfect world, hospital administra-tors would like to bring in doctors fresh out of residency, who could work there for 25 to 30 years. That’s utopia. In the real world, we know that when doctors com-plete their residency programs, more than half of them leave within three years after making their first (placement) decision. That’s a huge percentage! Just because they’re young doesn’t mean they’ll stay.”

On the other hand, practitioners in their fifties, for example, who are consid-ering making a change realize it’s prob-ably their last career move and are more motivated to make it permanent, said Stajduhar.

“Then it’s just a matter of asking: ‘how long are you willing to practice?’ Perhaps they’re 59, and say they want to work as long as their health holds out. When they’re upfront with the hiring cli-ent, you have a very marketable physi-cian.”

Surprisingly, hospital administrators rarely ask if qualified candidates are tech-savvy, noted Stajduhar, which quells one worry among older physicians.

“It doesn’t seem to be a concern at this point,” he said. “The older recruit may move into a hospital system that makes it fairly easy for them to adapt.

For example, they may assign a nurse or nurse practitioner to the physician, who can plug notes into an electronic medi-cal record (EMR) system as the physician tends to the patient.”

After the ACA kicked in, most phy-sicians with 25 or 30 years under their belt considered retiring. Unfortunately, it was signed into law less than 18 months after the stock market crash of September 2008, when many physicians watched in dismay as their retirement funds withered.

“Many would’ve retired then, if they could have,” said Stajduhar. “The ACA, out of the gate, scared the heck out of older physicians. If there’s a significant contin-ued uptick in the economy, I wouldn’t be surprised to see the retirement rate of that age group accelerate over the next five or six years. But then we’ll have a huge problem with specialties being in critical shortage areas.”

If that happens, older physicians who opt not to retire sooner will be in even more demand, particularly if they’re open to moving to a different location, which melds with another emerging physician employment trend: The best jobs aren’t necessarily in rural areas, defined as a population of 40,000 or less.

“We probably have more primary care needs in urban areas than ever be-fore,” said Stajduhar, noting the greatest demand is internal medicine. “Yet we still have many unmet needs in rural areas, especially those areas we know are very rural. Older physicians have more oppor-tunities than perhaps they realize.”

The passage of time since the ACA took effect has also softened the attitudes of older physicians, adding to their mar-ketability.

“Physicians, as a rule, have been fiercely independent,” said Stajduhar. “They didn’t want people telling them how to practice medicine from a hospital level. When it became imminently clear that we’d have a different industry in five to 10 years, that revelation became the impetus of the dramatic change in the hiring process. Now those physicians are seeing the benefits of being employed by a hospital or health system, perhaps in an-other location. They’re in an age group where most are empty nesters, and being confined to a school district or a place to settle down isn’t holding them back. Only caring for aging parents may play a role in their ability to relocate.”

An employment contract for the older physician is a win-win for both par-ties.

“Administrators know the move is probably the doctor’s last hurrah,” he said. “That’s where they’ll retire. Then at a minimum, the client will have six or seven years from a good, experienced physician with a great track record on staff.”

Help Wanted: Older PhysiciansThe 55-and-over group is more marketable than ever

Page 7: Mississippi Medical News Sept 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 SEPTEMBER 2014 > 7

To learn more, visit healthcare.goarmy.com/y941 or call 1-888-550-ARMY.

By LyNNE JETER

“Uncertainty prevails” was a com-mon theme in the recently released Jackson Healthcare study on the Af-fordable Care Act’s (ACA) impact on physicians and practices.

“We found that a significantly larger number of phy-sicians desire to be employees (versus inde-pendent contractors) in the post-ACA world,” said Sheri Sorrell, man-ager of market research for Jackson Healthcare, a national healthcare recruitment fi rm based near Atlanta. “They know a salary is constant, even when reimbursements decline. Plus, they know someone else will navigate the complexities of the ACA.”

Jackson Healthcare’s “Physician Practice Trends 2014,” a national study with nearly 2,000 physicians representing all 50 states and medical-surgical specialties, revealed some rap-idly changing statistics that are shaping physicians’ decisions to ink an employ-ment deal with a hospital or healthcare system.

The happiness factor. Physicians whose income decreased in the last year are more likely to be age 45 to 64, own their medical practice, work more than eight hours a day, be dissatisfi ed with their career, and discourage young people from entering the medical fi eld. Because of the ACA roll-out, they say they’ve lost patients, and remaining patients often delay treatments because of higher out-of-pocket costs.

The “never-known-indepen-dence” physicians. Satisfi ed physi-cians are more likely to be between the ages of 25 and 44, work eight hours a day, be employed, have chosen employ-ment for lifestyle reasons, and have a greater number of patients with private insurance. “Younger physicians are most likely to have never been in private prac-tice,” noted Sorrell. “They started out employed and remain employed.”

The impact of higher deduct-ibles. As a result of higher deductibles resulting from effects of the ACA law, patients are seeking routine care less frequently and postponing certain pro-cedures. The trend attributed to 12 percent of physicians’ responses to the most prevalent effects the rollout of the ACA has had on their practices. The higher deductible has made insurance the equivalent of self-pay. “In reality,” one physician wrote, “patients don’t have insurance until they’ve met their deduct-ibles.”

The insurance cancellation aspect. Insurance policy cancellations

led to 23 percent of physicians saying they’ve lost patients since the ACA im-plementation; another 15 percent lost patients because their practice could no longer accept their insurance plans.

Quality of life and fi nancial reasons are only a part of the reason why older physicians, especially primary care pro-viders (PCPs), are approaching hospi-tals, with the keys to their practice in hand.

“The majority of acquisitions are ini-tiated by physicians,” emphasized Sorrell. “It’s not necessarily the hospitals going after the practices. It’s the practice physi-cians knocking on the hospital door.”

Fortunately, practice acquisitions are mutually benefi cial for practice phy-sicians and hospitals and health systems, the latter of which are welcoming the op-portunity to buy PCP practices as they’re forming and growing Accountable Care Organizations (ACOs).

The answer to which party has the upper hand depends on the geographic location of the practice.

“They’re hedging their bets,” added Sorrell. “They’ve done the math. They know what they need to keep up with the ACA compliance. They see it’s too much to deal with. They realize they’re better off accepting a salary, putting in their eight hours a day, and going home.”

Despite the awkward position of practice physicians approaching hospi-

tals and health systems about a deal, they have a considerable amount of leverage, especially in larger metropolitan areas, Sorrell pointed out.

“They’re offering the practice on their terms,” she explained, “and can say, ‘if you don’t take it, I’m going down the street to offer it to your competitor.’”

A striking study statistic as a positive benefi t to physicians of selling their prac-tice: The number of physicians taking call dropped from 77 percent in 2012 to 55 percent in 2014.

“Basically, it’s a result of employ-ment,” Sorrell said. “It’s interesting be-cause physicians, especially older doctors, tend to complain a little bit about the work ethic of younger folks, who want to work eight hours a day and not take call. Those same physicians are making a shift in that percentage by at least limiting on-call time in their contracts.”

Sorrell said study statistics align with broader trends seen in other Jackson Healthcare and industry research.

“We’ve been tracking the trend to-ward employment in various ways, with studies on physician practice acquisitions, why physicians decided to sell their prac-tice, or why they want to get out of private practice,” she said. “We’ve also been tak-ing a look at what happens when physi-cians become employed. These are trends we’ll continue to watch.”

Shifting Toward EmploymentMore PCPs are becoming hospital employees, according to ACA impact study on physicians and their practices

Sheri Sorrell

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Page 8: Mississippi Medical News Sept 2014

8 > SEPTEMBER 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

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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LIVE HEALTHY

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is just not as much public awareness and political advocacy with colorectal can-cer that we have seen with other types of cancer. For example, breast cancer is un-surpassed in the oncological world in the efforts brought to publicizing the need for screening.”

Brannan said knowledge about the genetics of colon cancer has really ex-ploded over the past decade and has be-come a quite complex subject. Genetic syndromes are believed to account for about 10-15 percent of colon cancers. Lynch syndrome (hereditary nonpolyposis colorectal cancer or HNPCC) results of a lifetime risk of colon cancer of about 70 percent. Those people should be screened at an earlier age and more often.

“Some people are likely being screened too often for colorectal neopla-sia, and others are not getting screened frequently enough,” Brannan said. “That could be improved by clinicians getting a detailed family history regarding colon can-cer/HNPCC related cancers. Classically, the Lynch syndrome has been defi ned by the 3:2:1 rule, and that rule is three fam-ily members representing two generations, with one younger than 50 at the age of diagnosis. Such a history should prompt appropriately aggressive screening, and re-ferral to a genetic specialist as this has rel-evance not just for them, but their family members, including offspring, as well.”

The gene defect(s) for Lynch fall in the category of mutations in mis-

match repair genes (MMR). MMR genes serve a ‘proof reader’ function to detect errors during cell replication.“In other words we are always at risk for mistakes during the DNA copying phase of cell replication and these molecular proof readers exist within us to fi nd errors and correct them during cell replication,” Lynch said. “That is why the MMR muta-tions are relevant not just to colon cancer, but to a variety of cancers - colon cancer just being the most common. Those other cancers include uterine, ureteral, stomach, small bowel, and bile duct cancers.”

Better equipment has improved colo-noscopies. Brannan likens the improve-ment in colonoscopy equipment in the past 25 years to the major strides seen

with digital cameras.“There has been great improvement

in terms of the resolution, as well as the ability to examine the tissue both in white lights, as well as narrow band imaging that helps highlight certain features and allows subtle tumors to stand out from the back-ground,” he said.

Advances have also been made in im-proving patient preparation to make sure patients are cleaned out well. Giving pa-tients split doses of potent laxatives, one at night and one in the morning, does a better job.

Also important is quality improve-ment.

“The skill of the operator matters,” Brannan said. “Like other things in medi-

cine, someone who does this procedure all the time is going to be more skilled than someone who does it once in a while. Non-specialists sometimes perform colonosco-pies; not all are done by a board-certifi ed gastroenterologist. We now compile our own GI adenoma detection rates. This has been written about a lot in our literature. Even among experienced practitioners, there is quite a variation in the adenoma detection rate. I have found it useful for us to keep track of that data and I expect someday this will be information required by insurers.”

Another thing healthcare practitio-ners may want to know before referring a patient for a colonoscopy is the physician’s record for perforations. Brannan does about 1,200 colonoscopies per year, and has done about 23,000 over his career. He has only had one perforation.

“There are practitioners who have had several a year,” Brannan said. “Ac-cording to the statistics, this only happens on average to one or two people among a thousand colonoscopies. It is a very safe test in the right hands. And this is not just a screening test. We are removing pre-cancerous tumors every day, often several a day.”

The only way to make a dent in colorectal cancer rates is to do screening of people who are pre-symptomatic.

“Your symptoms are apt to occur only when the disease is advanced,” said Christopher Lahr, MD, who is an associ-ate professor of surgery at the University of Mississippi Medical Center and a spe-cialist in colorectal surgery, usually sees patients when the disease has advanced enough to cause symptoms.

“Colon cancer is more or less pre-ventable by removing polyps before they turn into cancer,” Lahr said. “It takes many years to go from a polyp to a can-cer stage, in most cases. But many people are afraid of a colonoscopy because they think afterwards they will have to wear a colostomy bag. Healthcare providers need to dispel this myth because this is the best screening test.

“The Fecal Occult Blood Test is pretty inaccurate and has a high rate of false positives. If it is positive, cancer is there only 20 percent of the time. If it is negative, it doesn’t tell you much at all.”

Lahr has recently taken his second course on doing colon surgery with the da Vinci® Surgical System. Lahr said studies have not shown a dramatic difference with the robot surgery for colon cancer regard-ing fewer complications and less hospital time.

“If things go well, patients should be able to go home sooner sometimes,” Lahr said. “This is popular with the public.”

High Colorectal Cancer Rates in Mississippi, continued from page 1

TO LEARN MORE: Go online to http://fi ghtcolorectalcancer.org/

Page 9: Mississippi Medical News Sept 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 SEPTEMBER 2014 > 9

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Baptist welcomes new OB/GYN to staff

Baptist Memorial Hospital-Golden Tri-angle welcomes new OB/GYN Clay Hud-son MD to its medical staff. Dr. Hudson practices at Co-lumbus OBGYN Specialty Center.

Dr. Hudson received his bachelor’s degree in molecular biology from Mill-saps College in Jackson, Miss. He is also a graduate of the University of Tennessee College of Medicine in Mem-phis. Dr. Hudson completed his internship and residency in obstetrics and gynecology at the University of Mississippi Medical Cen-ter in Jackson. He comes to Columbus from Tupelo where he was in private practice.

Dr. Hudson is a member of several professional organizations including the Mississippi State Medical Association, the American College of Obstetricians and Gy-necologists and the American Board of Ob-stetricians and Gynecologists. He is board certified by the American Board of Obstet-rics and Gynecology.

HORNE LLP’s Healthcare Delivery Institute Graduates Class from the Advanced Training Program

The Healthcare Delivery Institute at HORNE LLP recently announced the gradu-ates of its Advanced Training Program in Healthcare Delivery Improvement. The ATP trains students, who fill roles in their health care organization ranging from clinicians to CFOs, in both the theory and methodology of continuous quality improvement in the health care environment. The program is a sister-program to Dr. Brent James’ interna-tionally recognized Advanced Training Pro-gram at Intermountain Healthcare.

An unprecedented focus on quality, unsustainable costs and current legislation has created highly disruptive changes in our country’s health care system. As a result, health care providers will be directly im-pacted, according to HDI Director Thomas Prewitt, MD.

Graduates of the 2014 ATP were: from the University Mississippi Medical Center Mechelle Keeton, Mike Baumann, Patrick Robbins, Patrick Bergin, Rana El Feghaly, Cyrillo Araujo, Jessylen Age, Amanda Breazeale and Ashley Moore Hardy; Dr. Christopher Cummins (Magnolia State Family Medicine); Marcella McKay (Missis-sippi Hospital Association); Alasdair Roe (Healthcare Providers Insurance Company); Dr. Billy Long (Jackson GI Associates and Endoscopy Center); and from HORNE Jim Wadlington, Julie Martin, Bruce Walt, Rob Ainsworth and Brandon Jones.

Faculty included nationally recog-nized presenters Tom Burton, Senior Vice President Product Development and Co-Founder at Health Catalyst; Carter Dredge, Director of Healthcare Transformation at Intermountain Healthcare; Andre Delbecq, D.B.A., J. Thomas and Kathleen L. McCar-thy University Professor at Santa Clara Uni-versity; and Larry Grandia, Health Catalyst Board Member.

The Advanced Training Program reg-istration is open for the fall 2014 and win-ter 2015 terms. Details about the program, including exact dates and tuition fees are available at www.connect.horne-llp.com/hdiatp.

Hattiesburg Clinic ENT Offering New Procedure

Hattiesburg Clinic Ear, Nose & Throat (ENT) is now offering balloon sinus dilation, a new in-office procedure used to treat si-nusitis.

Balloon sinus dilation is a treatment op-

tion for patients who suffer from recurrent or persistent sinusitis. This minimally invasive treatment uses a small balloon to expand the sinus cavity and create an opening for sinus drainage in order to provide immedi-ate relief.

To find out if this balloon sinus dilation procedure is right for you, visit www.hatties-burgclinic.com/ear-nose-throat.

Newly Crowned Miss Mississippi Visits Children’s Hospital

2014 Miss Mississippi Jasmine Mur-ray brightened the days of Batson Chil-

dren’s Hospital patients this morning dur-ing her first media appearance since being crowned Saturday night in Vicksburg. She was joined by Miss Mississippi’s Outstand-ing Teen Grace Munro of Ocean Springs. This was the Columbus native’s third visit to Batson in recent years.

Batson is a member hospital of Chil-dren’s Miracle Network Hospitals, which is the official platform of the Miss America Organization. The CMNH partnership with the pageant extends to women competing at the local, state and national levels.

GrandRounds

Dr. Clay Hudson

Page 10: Mississippi Medical News Sept 2014

10 > SEPTEMBER 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

SVMIC Receives RatingState Volunteer Mutual Insurance

Company (SVMIC) has again received an “A” (Excellent) financial strength rating from A.M. Best Company. SVMIC has maintained an “A” or better rating for more than 30 years.

The A.M. Best Company is the old-est, most experienced rating agency in the world and has been reporting on the finan-cial condition of insurance companies since 1899. The Best’s Financial Strength Rating is an independent opinion of an insurer’s fi-nancial strength and ability to meet its insur-ance obligations.

Founded in 1975, SVMIC is one of the largest and most successful insurance com-panies of its kind, insuring physicians and surgeons in Tennessee, Arkansas, Kentucky, Virginia, Alabama, Mississippi, and Georgia.

SRH Recognized with MORA Awards

Singing River Hospital was awarded with Hospital Excellence and awarded the Best Pre-Donor Management award at the inaugural Spero Awards presented by Do-nate Life Mississippi / Mississippi Organ Re-covery Agency in Jackson. The awards cer-emony recognized hospital partners, medi-cal professionals, corporate partners and donor ambassadors that work with MORA to promote organ, eye and tissue donation to ultimately save and enhance lives.

SRH was selected as a Hospital Excel-lence winner for identifying 100 percent of potential donors, and the Best Pre-Donor Management award is related to the num-ber of eligible donor patients who progress to consenting for donation

Singing River Hospital is dedicated to notifying MORA early in the referral process and provides off-site electronic medical record access to streamline the evaluation process. SRH demonstrates the importance of maintaining organ viability by supporting blood pressure and oxygenation, giving the family time to make an informed decision about organ and tissue donation. This is evi-denced by SRH having a 100 percent organ donation conversion rate in 2013.

Hattiesburg Clinic Connections Welcomes English

Lauren M. English, PA-C, recently joined Hattiesburg Clinic Connections as a physician assistant.

She received her Bachelor of Science from Mississippi State University in Starkville, Miss., and her Master of Physician Assistant Studies from Mississippi College in Clinton, Miss.

English is board certified by the Na-tional Commission on Certification of Physi-cian Assistants. Her professional affiliations include the American Academy of Physician Assistants and the Mississippi Academy of Physician Assistants.

Page 11: Mississippi Medical News Sept 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 SEPTEMBER 2014 > 11

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Mississippi Organizations Come Together to Improve the Health of Mississippi Babies

Several Mississippi organizations are joining forces to make a difference for Mis-sissippi babies.

The Mississippi State Department of Health, March of Dimes, Mississippi Hos-pital Association, Blue Cross & Blue Shield of Mississippi, the Mississippi Division of Medicaid, the Mississippi Chapter of the American Academy of Pediatrics, the Missis-sippi Section of the American Congress of Obstetricians & Gynecologists, and others are committed to reducing the frequency of early term delivery without medical reason.

According to State Health Officer Dr. Mary Currier, rushing labor and birth before a baby is fully developed can be extremely risky. This initiative is an important step for the best outcome for mom and baby.

Earlier this year, the March of Dimes, with support from the Mississippi State Department of Health, Mississippi Hospital Association and the Mississippi Section of the American Congress of Obstetricians & Gynecologists, urged Mississippi hospitals to wait until 39 weeks of pregnancy for any elective delivery through its Banner Pro-gram. The nationally recognized program acknowledges hospitals that develop and implement a written policy and reduce their early elective delivery rate to five percent or lower. So far, 36 Mississippi hospitals have made the pledge and 10 of those hospitals have qualified for the banner distinction.

Now, Blue Cross & Blue Shield of Mis-sissippi is taking the next step by imple-menting medical policy that clearly defines best-practice standards for medically neces-sary early term delivery of babies. The medi-cal policy was developed in partnership with its Network Providers to support the prac-tice of evidence-based medicine. Effective January 1, 2015, Blue Cross & Blue Shield of Mississippi will only provide benefits for the early term delivery of babies when there is a medical necessity based on the medical policy. This policy will not apply to pregnan-cies and deliveries when labor occurs natu-rally prior to 39 weeks.

While Blue Cross & Blue Shield of Mis-sissippi has taken the lead in best-practice policy for elective early-term deliveries, Mississippi Medicaid officials indicate they are also in the process of reviewing policy around elective deliveries prior to the ex-pectant due date.

State Health Officer Dr. Mary Currier said that early elective deliveries that are not medically necessary increase the risk of infant harm and even death. Many of Missis-sippi’s delivering hospitals have voluntarily reduced their early elective delivery rates choosing to wait the full term 39 weeks as is recommended by the American College of Obstetricians and Gynecologists. This combined with this new Blue Cross & Blue Shield of Mississippi policy is a huge step to ensuring healthy babies and healthy moms.

Research shows that the last weeks of pregnancy are essential for the full develop-ment of important organs, the brain, lungs and liver, and babies born before 39 weeks are more likely to have vision or hearing problems after birth. Early elective delivery is also linked to infant illnesses and other lasting health impacts with no benefit to the mother or infant.

GrandRounds

Page 12: Mississippi Medical News Sept 2014

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