AUGUST 2017 • VOLUME 11, NUMBER 4 OBGyn News PROMOTING EXCELLENCE IN WOMEN’S HEALTHCARE in GEORGIA in this issue Maternal Healthcare Disappearing in Rural Georgia .......... 1 President’s Column .......... 2 Fight Against PCOS .......... 4 Editor’s Column ......... 5 Profile on Dawn Mandeville .......... 6 Profile on Tameeka L. Walker .......... 7 Stay Vigilant Against The Zika Virus .......... 9 Meet Chris Tice .......... 9 AIM Bundles ........ 10 News from Around the State ...... 11 Administrative Office 2925 Premiere Parkway, Suite 100 Duluth, GA 30097 Telephone: 770 904-0719 Fax: 770 904-5251 www.gaobgyn.org Georgia Obstetrical and Gynecological Society, Inc. Continued on page 7 J oy Baker’s patients travel 40 miles on average to see her. Some pull up in their own cars, but if they’re too poor to own one, they might hitch rides with friends or on the Medicaid van, which must be scheduled three days in advance and also can run early or late. In that case, they wait for a quick opening in Dr. Baker’s day so she can fit them in. They pass the time in the waiting room, staring at their phones or flipping through issues of Pregnancy & Newborn magazine. Her patients come to her for the most fundamental of reasons: She’s one of only two OB/GYNs in a swath of rural Georgia that spans eight counties and 2,714 square miles. Baker works out of the Upson Regional Medical Center in Thomaston, about halfway between Macon and Columbus. We hear a lot about safety net hospitals, but Baker is a safety net doctor. Half of Georgia’s 159 counties—79, to be precise—do not have a single obstetric provider. Rural hospitals are closing. In Georgia a pregnant woman has a greater chance of dying before she delivers, or in the weeks after, than in any other state in America. So Baker’s practice here in Upson County, where nearly a quarter of the residents live below the poverty line, represents a kind of miracle—but a precarious one. “What’s going on today? Not doing so good, huh?” Baker hovers above her patient’s hospital bed on the second floor of Upson Regional, a look of concern on her face. Abigail Williams is 28 years old and 27 weeks pregnant, and she was admitted last night. It’s a little after nine o’clock in the morning, but it’s clear Williams has been up for a while. Dark circles ring her eyes, bits of hair escape from a bun and spill onto her cotton hospital gown, and her brow crinkles with worry. A large gallstone is lodged in her bile duct, causing her severe abdominal pain. She also can’t keep anything down, and that has Baker worried, considering Williams also has some coronary risk factors, including tachycardia, when the heart beats too rapidly. “We need to keep your electrolytes steady, your blood sugar steady,” Baker says. “We don’t want your heartbeat to become erratic.” This is the seventh time Williams has been hospitalized during her pregnancy, and she reminds the doctor that she has two other kids at home, including a one-year-old who requires a feeding tube. “Here’s the deal,” says Baker. “The [surgeon] is probably going to recommend that you try medication first because he’ll be worried about the baby. But I would not try it for long. You need to speak up for yourself on this.” Williams asks if she can request surgery to remove the stone now, rather than risk yet another hospital stay if medication doesn’t help. “Absolutely,” Baker says. “You are the patient, and it’s your decision.” Before she leaves the room, she reminds Williams, “Part of my job is looking out for not just the baby but for you, the mom. Because if you’re not well, the baby’s not going to be well, either.” Later Williams tells me that Baker is the first doctor she’s had that really takes the time to listen to her and explain things. “I’m just glad to have her.” Baker has been at the hospital since 7:30 a.m., and by lunchtime she will have also performed a laparoscopic surgery, delivered a baby via C-section, induced labor for a pregnant patient who was past her due date, and checked in on a mom who delivered the day before. In the afternoon, Baker heads to her office across the street from the hospital, where she has a full slate of high-risk pregnant patients who come in regularly to videochat with a specialist in Atlanta. Baker introduced telemedicine for her high-risk patients in March, after the hospital was awarded a grant. Up until then, the women had to travel to Columbus, Macon, or Atlanta to see a Georgia Obstetrical and Gynecological Society, Inc. In Much of Rural Georgia, Maternal Healthcare is Disappearing Meet Dr. Joy Baker, one ofjust two OB/GYNs serving 8 counties and 2,714 square miles By Jennifer Rainey Marquez Photography by Melissa Golden
Transcript
AUGUST 2017 • VOLUME 11, NUMBER 4
OBGyn NewsPROMOTING EXCELLENCE IN WOMEN’S HEALTHCARE in GEORGIA
in this issue Maternal Healthcare Disappearing in Rural Georgia ..........1
President’s Column ..........2
Fight Against PCOS ..........4
Editor’s Column .........5
ProfileonDawnMandeville ..........6
ProfileonTameekaL.Walker ..........7
Stay Vigilant Against TheZikaVirus ..........9
Meet Chris Tice ..........9
AIM Bundles ........ 10
News from Around the State ...... 11
Administrative Office2925PremiereParkway,Suite100
Duluth, GA 30097Telephone: 770 904-0719
Fax: 770 904-5251www.gaobgyn.org
Georgia Obstetrical and Gynecological Society, Inc.
Continued on page 7
JoyBaker’spatientstravel40milesonaveragetoseeher.Somepullupin their own cars, but if they’re too
poor to own one, they might hitch rides withfriendsorontheMedicaidvan,whichmustbescheduledthreedaysinadvanceand also can run early or late. In that case,theywaitforaquickopeninginDr.Baker’sdaysoshecanfitthemin.Theypass the time in the waiting room, staring attheirphonesorflippingthroughissuesof Pregnancy & Newborn magazine. Her patients come to her for the most fundamental of reasons: She’s one of only two OB/GYNs in a swath of rural Georgia that spans eight counties and 2,714 square miles. BakerworksoutoftheUpsonRegionalMedical Center in Thomaston, about halfway between Macon and Columbus. We hear a lotaboutsafetynethospitals,butBakerisa safety net doctor. Half of Georgia’s 159 counties—79,tobeprecise—donothaveasingleobstetricprovider.Ruralhospitalsareclosing. In Georgia a pregnant woman has a greaterchanceofdyingbeforeshedelivers,orintheweeksafter,thaninanyotherstateinAmerica.SoBaker’spracticeherein Upson County, where nearly a quarter of theresidentslivebelowthepovertyline,
representsakindofmiracle—butaprecarious one.
“What’s going on today? Not doing so good, huh?” Bakerhoversaboveherpatient’shospitalbedonthesecondfloorofUpsonRegional,alookofconcernonher face. Abigail Williams is 28 years oldand27weekspregnant,andshewas admitted last night. It’s a little after nineo’clockinthemorning,butit’sclearWilliamshasbeenupforawhile.Darkcircles ring her eyes, bits of hair escape from a bun and spill onto her cotton hospital gown, andherbrowcrinkleswithworry.Alargegallstone is lodged in her bile duct, causing hersevereabdominalpain.Shealsocan’tkeepanythingdown,andthathasBakerworried, considering Williams also has some coronaryriskfactors,includingtachycardia,when the heart beats too rapidly. “We need tokeepyourelectrolytessteady,yourbloodsugarsteady,”Bakersays.“Wedon’twantyour heartbeat to become erratic.” ThisistheseventhtimeWilliamshasbeenhospitalized during her pregnancy, and she reminds the doctor that she has two other kidsathome,includingaone-year-oldwhorequires a feeding tube. “Here’s the deal,” saysBaker.“The[surgeon]isprobablygoingtorecommendthatyoutrymedicationfirstbecause he’ll be worried about the baby. But I would not try it for long. You need tospeakupforyourselfonthis.”Williamsasksifshecanrequestsurgerytoremovethestonenow,ratherthanriskyetanotherhospital stay if medication doesn’t help. “Absolutely,”Bakersays.“Youarethepatient,andit’syourdecision.”Beforesheleavestheroom, she reminds Williams, “Part of my job islookingoutfornotjustthebabybutforyou, the mom. Because if you’re not well, the baby’s not going to be well, either.” LaterWilliamstellsmethatBakeristhefirstdoctorshe’shadthatreallytakesthetime to listen to her and explain things. “I’mjustgladtohaveher.” Bakerhasbeenatthehospitalsince7:30a.m.,andbylunchtimeshewillhavealsoperformedalaparoscopicsurgery,deliveredababyviaC-section,inducedlaborfora
pregnant patient who was past her due date,andcheckedinonamomwhodeliveredthedaybefore.Intheafternoon,Bakerheadstoherofficeacrossthestreetfrom the hospital, where she has a full slate ofhigh-riskpregnantpatientswhocomeinregularlytovideochatwithaspecialistinAtlanta.Bakerintroducedtelemedicineforherhigh-riskpatientsinMarch,afterthe hospital was awarded a grant. Up untilthen,thewomenhadtotraveltoColumbus, Macon, or Atlanta to see a
Georgia Obstetrical and Gynecological Society, Inc.
In Much of Rural Georgia, Maternal Healthcare is DisappearingMeetDr.JoyBaker,oneofjusttwoOB/GYNs serving8countiesand2,714squaremilesBy Jennifer Rainey MarquezPhotography by Melissa Golden
President’s ColumnThe Pursuit of Better Care
Cyril O. Spann, MDGOGS PresidentDecatur, Georgia
In light of the continued healthcare debate in Washington, I wanted to takethisopportunitytoprovideyou
food for thought on issues that concern thehealthcareofwomen.Aboveall,Iam reminded that we must continue to beoutspokenadvocatesforourpatientsand our specialty. During July, I signed two letters as GOGS President that were sent to U.S. Senators JohnnyIsaksonandDavidPerdue. These lettersaskedthat they oppose allversionsofthe Better Care Reconciliation Act of 2017 (BCRA). The bills that were introduced wereanemicinadvancingwomen’shealthcare and proposed policies that would place a woman’s access to care in serious jeopardy. Our position is that these measures would drastically reduce access and quality of healthcare for thousands of women in Georgia. Thebottomline,though,isthatlackofaccess to medical care for any segment ofsocietywilleventuallyeffectthehealthcare of all—insured and uninsured. Ultimately, emergency rooms will burst attheseams,theworkforcewillbelessproductive,andtheentirepopulationwilleventuallysufferfromevenworsehealthoutcomes than we experience today. While our current healthcare system isexpensivegivenourhealthoutcomes,theproposalsinCongresshaveonlyfocused on reducing cost by reducing what insurers are required to pay for and who they are required to insure. The authorsofBCRAciteever-risingcostsas one reason to reduce funding for Medicaid. These authors are correct. At presstime,theLegislativeBranchhasstruggled to gain a majority consensus on a healthcare proposal, and the future is uncertain. Healthcare expenditures now approximate more than 17% of the GDP. Is this amount too high to maintainthehealthandpreservationof our society? Our national debt is now approaching $20 trillion. Funding healthcare for all will increase this debt. Allotherfirstworldcountrieshavefoundawaytoprovidehealthcarefortheirpopulations while spending less than we do – what will our solution be that doesn’t hurt our economy?
Ourletterproposedseveralwaystocontrol costs, including bundling and quality measures. This, I opine, will fall shortofthekindofcostcontrolweneedtosustainahigh-quality,financiallyviablehealth system. Increasing taxes is a potential solution, but is an unsatisfactory andsuffocatingalternativeformost.Iwouldliketoseeaninvestmentbythe
U.S. population in the healthcare system. Tax credits and/or bonds could be offered to thosewhoinvestin infrastructure projects such as hospitals and medical research development.Theirinvestmentswould be secure because our
economy is the most robust in the world. As for Georgia, rural hospitals still struggletosurvive.Theinfrastructureandfinancingrequiredtorunafullycapablehospitalismassive.Qualifiednursing,socialservices,appropriately staffed ICUs, and fullystockedbloodbanksarebutafewof the necessary servicestoprovidesafe,comprehensiveobstetrical care for women. When smaller counties in criticallyunderservedareascannotprovidehealthcare to their populations, we mustadvocateforrobust transportation systems so patients get appropriate care. Lookingbackovertheyears,everyelectionisconsidered the most critical and that era, the most critical. That’s probably the way it should be. Let’s continue to do the right thing for our patients by not settling for anything less than the highest quality of reproductivehealthand women’s care.
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IthasbeenanhonorservingastheSocietyPresidentthisyear.Thankyouforentrusting our organization to me. We will miss Ms. Cota. The society grew by leaps andboundswithherasourexecutivedirector. Mr. Thompson, our new executivedirector,isenergetic,eager,andhastonsofideas.Ilookforwardtoseeingyou at the Annual Meeting and to your future engagement with the Society.
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Remember September: Joining Forces in the Fight Against PCOS
Workingtogether,wehaveahistoricopportunitytoimproveoutcomes for hundreds
of thousands of women and girls throughout Georgia and millions across thecountrylivingwithpolycysticovarysyndrome. PCOS is a serious genetic, hormonal,metabolicandreproductivedisorderthataffectsover10percentofwomen in the United States.1 As OBGyns, you are often thefirstphysicians whohaveconnected the dotsofvarioussymptoms, givenaPCOSdiagnosisandprovidedatreatmentplan.Youhavewitnessedthe range of emotions that follow the words,“YouhavePCOS.”WhileaPCOSdiagnosis often brings about a sense of relief for some, it is also potentially the beginning of a rollercoaster of emotions, experiences and health challenges. The mental health struggles that accompany PCOS are often a complicating factor in treatmentandoverallqualityoflife.
Infertility—and Much More As a hormonal condition, PCOS can haveaprofoundeffectonreproductiveand gynecological issues. PCOS is theleadingcauseofanovulatoryinfertility.2Evenwheninfertilityisovercome,PCOSisassociatedwithincreasedriskofgestationaldiabetes,preeclampsia,pretermdelivery,miscarriage and perinatal death.3 PCOS affects far more than fertility andpregnancy.Unchecked,PCOScanlead to a number of life-threatening related conditions including heart disease,hypertension,strokeand
diabetes. In fact, more than 50 percent of women with PCOS will become prediabetic or diabetic by age 40.4 WomenwithPCOShavethreetimeshigherriskofdevelopingendometrialcancer and may also be at higher riskforothercancers.5Moreover,theconditionhasasignificantimpactonhealthcare expenditures, with costs exceeding $4.3 billion during PCOS
patients’ reproductiveyears.6 With more than 50 percent of women and girls with PCOS going undiagnosed
or misdiagnosed,7andagenerallackof awareness and education about the condition, there is an urgent need to worktogethertomakePCOSapublic-health priority.
The Opportunity—Joining the Fight PCOS Challenge has grown to become theworld’slargestpatientadvocacyorganization worldwide, supporting more than 43,000 women and girls with PCOS. Through our PCOS Awareness Symposia, we now educate more than 1,000 patientsandhealthcareproviderseachyearandrecentlyworkedwithCongresstointroducethefirstPCOScenteredlegislation (H.Res. 495) in the U.S. House ofRepresentatives.However,weneedyourhelp.Wehavesurveyedmorethan43,000women, and it is clear that there are major education and practice gaps related to diagnosis; nutrition, obesity and weight management counseling; cardiometabolic riskeducationanddiseasemanagement;fertilitymanagementandreproductivehealth;hairandskintreatment;mentalhealth;andintegrativecare.Themessage
isclearthatallstakeholdersneedtoworktogethertoimproveoutcomesforPCOSpatients. So, what can you do as obstetricians, gynecologists and healthcare leaders? Plenty.First,getinvolvedbyjoiningwithustoadvancethecauseforwomen and girls with PCOS. • Support the PCOS Resolution in theU.S.HouseofRepresentatives(H.Res.495):LendyourvoicebycallingyourRepresentativestosupport our Congressional resolution designating September as PCOS Awareness Month. Let us use this monthtorecognizetheseverityofPCOS and educate women, girls, healthcare professionals and the general public about its effects and urge medical researchers to deepen their understanding of PCOS.
•JoinusforPCOSAwarenessWeekend2017 at Georgia Tech in Atlanta: - Gather with clinicians, researchers
and patients at the Southern Regional PCOS Awareness Symposium on September 16 to discuss the latest updatesaboutthecondition,improvecompetenceinthePCOSfield,andaddress education and practice gaps.
- Join the Bolt for PCOS 5K Run/WalkonSeptember17aseitheraparticipant,bringyourentireofficeas a team, or sponsor to raise PCOS awareness, and support funding for research, education and support programs–as well as promote exerciseinafunandeffectiveway.
Asphysicians,yourvoicesareauthoritativeandrespectedamidthemyriad health messages and messengers thatwomenandgirlsnavigateastheylearnwhytheymayhavetroubleconceivingorfindthemselvesprediabetic. Remember September to maketheinvisiblevisible—helpraise
Continued on page 9
Sasha OtteyFounder and Executive Director
Al Sermons, MDEditor
Atlanta, GA
Editor’s ColumnTheYearAtAGlance...NoFakeNews!!!
When we left the annual meeting last year, our nation was in the midst of a tumultuous
presidential election, the results of whichhaveintensifiedtheturbulencein our capital and left many Americans in a state of uncertainty. Six months into the new presidency, America still waits for order to be restored and for thedeliveryonpromisesmadetotheAmerican people by the newly elected leader.Divisioninournation’scapitalwill do little to soothe the anger and fear felt by the American citizenry. As leaders in our profession, we feel most intensely the need to remain focused and retain the order that is necessarytogrowandnourishpositiveoutcomes for mothers, children, and families that depend on us to “do no harm”andmakethedailydecisionsthat support their well-being. The uncertainty in our nation does not equate to uncertainty in our practice ofmedicine.So,wemoveforwardwithfocus and purposefulness to continue ourgoodwork. As we prepare for the upcoming 66th Annual Meeting, the Society looksforwardtoshowcasingournewExecutiveDirector,DanielThompson,whoistaskedwithleadingustothenextlevelinourprofession.PatCotamakesalateralmovetoheadtheSociety’s foundation, and as she does, wethankherforthemanyyearsofservice,todate.Eveninthemidstofuncertaintimesinournation,wehavemuchtocelebrateathome! I am pleased to recognize Dr. Tom Price as newly appointed Secretary of Health and Human Resources. The fact that he is a fellow colleague from Georgiamayprovefavorableforus,as he formulates new policy for much-needed changes in our healthcare system. Also, our own Dr. Brenda Fitzgerald, a past president of the
Society,movesfromCommissionerofthestateofGeorgiatoserveasDirectorof the Centers for Disease Control and Prevention(CDC). TheSocietycontinuestodevoteitselftoimprovingthehealthcareofmothers and babies throughout our state. We are acutely aware that the maternal mortality rate in Georgia is desperatelyinneedofimprovement.Evenaswereporttheclosureofonlyone hospital OB unit this past year and celebrate the opening of a new unitinHallCounty,underservedareasof Georgia still remain a problem. Telemedicinecontinuestomakeinroadsintoprovidinghigh-riskmaternitycaretocertainareasofthestate.However,it cannot replace much needed hands-on expertise in rural Georgia. As it has in years past, the upcoming annual meeting will offer a plethora of relevanttopics,and continue toprovidea wealth of professional developmentopportunities. Topics range from information regarding heart disease in women to what’s new in STI treatment. Experts will address minimallyinvasiveGYNsurgeryandGYN cancers. Presenters will share knowledgeofprimaryCesareansection rates and postpartum care. Also,participantsareinvitedtoshare
breakfastwiththeattorneys.Theycontinuetheirattemptstokeepusfreeof litigation, while our U.S. senators
ponderoverlegislation(e.g.HR1215)to support medical liability reform. As uncertainty is slowly replaced by focus and order among our nation’s leaders, we can be sure of the need to continue our own personal growth andprofessionaldevelopment.Theannual meeting is a prime opportunity todojustthat!Iencourageyoutojoinme and our peers at the Ritz Carlton on Amelia Island as we combine professionaldevelopmentwithfun!Come and attend the sessions to learn newthingsandvalidateold,sharedknowledge.Then,takethetimetorelax, recharge and enjoy the fun of oneofFlorida’sfinestbeaches.Welookforward to seeing you at Amelia Island for our 66th Annual Meeting. It just might be the best meeting of the year!
Dr. Shelley Dunson-Allen raised $964.38 for the Foundation at an event she hosted this Spring.
Awesome job! We are grateful for all our members’ contributions totheimprovementofwomen’shealth. To learn more about the GeorgiaOBGynFoundation,visitwww.gaobgyn.org/foundation/.
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OBGyn NEWS, August 2017 OBGyn NEWS, August 2017
Dr.DawnMandevilleObstetrics & Gynecology
Atlanta Gynecology & Obstetrics
I had been treating a wonderful couple for their twin pregnancy. Twin B had somemildgrowthissues,butoverall
everythingwasprogressingwell.Thenlate in the third trimester, an ultrasound showed Twin B’s growth was still lagging atatimewhenthebabyshouldhavebeen gaining more weight. We scheduled a C-section for the following day. On the morning of the surgery, I met the patient and her husband as they cameintothelaboranddeliveryunit,then left to do my rounds while the mom was being prepared for the OR. When the nurse called to say they were ready for me, she mentioned that they’d had troublefindingaheartbeatforTwinB,butthattheyfinallygotit. OnceIscrubbedin,Ilookedaroundtheroom just as the pediatrician/neonatology staffwasarriving,astheydoroutinelyforthedeliveryoftwins.IannouncedthatIwasmakingtheincision,andTwinAcameout crying and squirming in my hands. Then I turned my attention to Twin B. This time there was no squirming, no cry, no breath. My heart started to race,andIquicklycutthecordand
handed the limp, motionless baby to the pediatric/neonatology staff. AsIdeliveredtheplacentasandbegantoclosetheincision,Ikeptglancinginthe direction of Twin B. The staff was huddled around the baby, and I saw they weremovingmorequicklythantheywould for a normal newborn. I caught the eye of the attending neonatologist, whoshookherhead.Ifeltsick. The dad accompanied the pediatric staff and the babies to the NICU, and thenthemomwenttotherecoveryroom.Aftermakingsuremomwasstable,IrushedovertotheNICU.BythetimeIgotthere,thedadalreadyknew:Thebabydidn’tmakeit.Wedecidedtogototherecoveryroomtogethertotellthemom.Whenwebothwalkedin,sheknewsomethingwaswrong. ItoldherthatTwinAwasdoingverywell, but Twin B, the smaller one, did notmakeit.Itriedmybestnottocry.Atthispoint,itlookedasthoughtheyneededtimealonetogether.Iwalkedovertothecallroomandbrokedown. The next day, I went to see the family and once again express my grief and
ThefirsttimeIdeliveredtwinsbutonlyonesurvived There was no squirming, no cry, no breath. My heart started to race.
senseofhelplessness.Themomlookedat Twin A, swaddled in her arms, and I’ll neverforgetwhatshesaid:“Thankyoufor bringing this baby into the world safely. But our other baby will be coming home with us, too—right here.” She placed her handoverherheart,andrepeated,“Wewill bring this baby home, too.” — As told to Jennifer Rainey Marquez
This article originally appeared in Atlanta Magazine’s July 2017 issue.
In Much of Rural Georgia, Maternal Healthcare is Disappearing Continued from page 1
perinatologist, a doctor who specializes in themanagementofhigh-riskpregnancies. “That’s an hour away, and if you’re relying onaMedicaidvan,oryou’vegototherkidsathomethatyoucan’tleavealone,you’renotalwaysgoingtomakeit,”Bakersays.Now patients can undergo an ultrasound atherofficeinThomaston,andtheimagesare sent electronically to a specialist at Piedmont Hospital in Atlanta. It’s one of a numberofnewprogramsthatBakerhasimplementedsincearriving.“Thereareopportunities out there,” she says, “but as a ruralphysicianyougottalookfor’em.WhocanItalkto?WhocanIgoto?Whocanhelp me get what I need for this patient?” Baker’spathtoThomastonwasnotplanned.Shewasn’tevensupposedtobean OB/GYN. Growing up in LaGrange and Jonesboro, she wanted to be a surgeon. It wasn’tuntilherfinalyearofmedicalschoolatMorehouse,whileworkinginthetraumaand surgical ICU at Atlanta Medical Center, that she began to reconsider her path. “A man was brought in with a gunshot wound,andhiskidneywasbeyondrepair,”shesays.“Theattendingjusttookitoutand tossed it onto a surgical table.” As the traumateamworkedonthepatient,Bakercouldn’tstopglancingoveratthemangledorgan. She thought, I don’t want to see people killing and hurting each other for the rest of my life.
BakerdidherOB/GYNresidencyatMorehouse and then found a job at a hospital in Columbus, Georgia. She preferred the lifestyle of a smaller city. “In Atlanta,becauseofthetraffic,prettymucheverypracticewantsyoutoremainatthehospital while you’re on call, which might be for 24 hours at a stretch,” she says. ShetraveledtoThomaston occasionally as a locum tenens, or fill-in,physician.Atthe time, the practice didnothaveafull-time OB/GYN, and temporary doctors rotated in and out frequently. “One day Icalledtocheckonapatient, and I got to talkingwithoneofthenurses,”saysBaker.“Shetoldme,‘IwishwecouldhaveanicedoctorlikeyouhereinThomaston.’”Baker,whose Columbus hospital was planning layoffs, inquired about the job. Upson’s struggle to recruit a new OB/GYNisrepresentativeofthatfacedbyrural hospitals across the country. As more and more Americans shun economically depressed small towns in search of greater opportunity in cities, it has become harder toconvincedoctors—nomatterwhattheirspecialty—to go into rural communities.
BakersaysthatwhilesomeofhermedicalschoolclassmatestookjobsinplaceslikeMacon or Columbus, most chose to remain in the metro Atlanta area. When she came on board in 2015, Upson had been without a permanent OB/GYN for 18 months. (Soon after they hired a second physician, who commutes from Gwinnett County.)
“Ultimately fewer peoplewanttolivein rural areas in general, whether they’re doctors or not,” says Shelley Spires, president of the Georgia Rural Health Care Association. Thus, while the entire state of Georgia faces a
physician shortage, the problem is especially criticaloutsideoflarge,orevenmidsize,metropolitan areas. Of the state’s 108 rural counties,93aredesignatedasworkforceshortage areas in terms of primary care. Compounding the issue, salaries at small ruralhospitalscanbelesscompetitivethanatlargemetropolitanones,makingrecruitmentmore challenging. This article originally appeared in full in Atlanta Magazine’s July 2017 issue. Read the full story at http://www.atlantamagazine.com/issue/july-2017/.
Dr.TameekaLawWalkerMaternal and Fetal Medicine, Georgia
Perinatal Consultants
I n 2005 I was the most senior resident oncallfortheweekendatahospitalin Baltimore. We’d had a busy day,
andIwasfinallygettingachancetositdown.ThenIreceivedanurgentpagefrom a nurse. They didn’t want to see an intern; they wanted me. Iarrivedinthehospital room to findapregnantwoman writhing in pain. She was about37weeksalong, and the nurses hadn’t beenabletofinda heartbeat for the baby. I tried to calm her down so Icouldperformanultrasoundtofigureout what was going on. On the screen, I immediately saw something odd. The babywasawkwardlypositioned,anditsheart rate was super low, 50-something beats per minute compared to the usual 120s to 160s. I realized we had to deliverherrightaway.
I gathered the surgical team together andgotherbacktotheoperatingroomasquicklyaspossible;thisprocedureneeded to happen within 10 minutes or less. The patient had undergone two priorC-sections,soweknewthesurgery
would be a bit difficultbecauseof all the existing scar tissue. I made a verticalincisiondown her belly, and then I saw it—the baby. It wasn’t inside the uterus or behind any layers of muscle. Her uterus had
ripped apart, and the baby was just rightthere,floatinginherabdomen.I made the incision and saw its face, justlike,“Hello.”Iwastakenaback.Wedidn’thavetodeliverthebaby;itjustcame out. The pediatrician immediately got to workresuscitatingthebaby.Atthe
same time, the mother was bleeding a lot internally because her uterus had completely torn open. We were able to stop the bleeding and sew up the uterus,savingit.Bothmomandbabymadeitthroughjustfine,whichisprettyincredible.Ionlyknowofoneothercase where this happened, and both the mother and the baby died. —As told to Christine Van Dusen This article originally appeared in Atlanta Magazine’s July 2017 issue.
Obstetric Care Missing In Some CommunitiesSomepregnantwomeninGeorgiaarehavingtodrivemiles
—eventodifferentcounties—justtogetbasicobstetriccarebecausetherearen’tanyproviderswheretheylive. GiovannaDrpicofCBS46satdownwithDr.CathyBonkinDecatur to discuss the dire situation.
Viewthevideoathttp://www.cbs46.com/clip/13551374/obstetric-care-missing-in-some-communities Read more at http://www.cbs46.com/clip/13551374/obstetric-care-missing-in-some-communities#ixzz4pNmhT3ud
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OBGyn NEWS, August 2017 OBGyn NEWS, August 2017
Provider FAQ — Availity Web Portal pregnancy notification and HEDIS® attestation
https://providers.amerigroup.com
1. What is the purpose of this new process? Asyouknow,AmerigroupCommunityCareofferspregnantwomenseveralservicesandbenefitsthroughtheTakingCareofBabyandMe® program. It is our goal toensureallpregnantwomenareidentifiedearlyintheirpregnancysotheycantakefulladvantageoftheeducation,support,resourcesandincentivesAmerigroupprovidesthroughouttheprenatalandpostpartumperiod.
Thisnew,user-friendlyworkflowwillgeneratetimely
information that will help you, your patients and AmerigroupimprovebirthoutcomeswithearlyinterventionandwillensurecompliancewithHEDISbenchmarks.
2. When will the new pregnancy-related questions
display? WhenanOB/GYNofficeconductsaneligibilityandbenefitsinquiryforaGeorgiaFamiliesmember15-44yearsofageintheAvailityWebPortal,thesystemwilldisplaypregnancy-relatedquestions.Iftheofficeconfirmsthepatientispregnant,aMaternity HEDIS Attestation Form will be generated. If the patient is not pregnant,thedesiredeligibilityandbenefitsinformationwill display, and no further action is required.
3. Does the Maternity HEDIS Attestation Form
replace the need for an OB global authorization? ResponsesprovidedintheAvailitypregnancynotificationsystem do not replace the need to submit a request for OB global authorization. A request for OB global authorization can be submitted by phone or fax as well asonlinethroughthesecureproviderself-servicewebsitethatcanbeaccessedthroughtheAvailityWebPortal.
4. Does the Maternity HEDIS Attestation Form
replace the need for any state-required notification of pregnancy? This process does not replace the need to submit state-requirednotificationofpregnancyformsorhealthriskassessments.
5. How should our office reply when a patient
presents as a transfer from another OB provider? You should answer the pertinent pregnancy questions and complete the Maternity HEDIS Attestation Form asusual.Eventhoughthefirstprenatalvisitquestiontypicallyrelatestoprenatalcareinthefirsttrimesterorwithin 42 days of plan enrollment, you can simply enter thedateyoufirstprovidedprenatalcareforthepatient.
6. If a patient transfers out of our practice during her
prenatal course, how should our office complete the Maternity HEDIS Attestation Form? ItisalrighttoleavetheHEDISattestationinapendingstatusasitprovidesAmerigroupwithpertinentprenatal
care information up to the point that the patient transfers out of the practice. The form will remain in place until it is automatically retired 19 months later.
7. If we have confirmed the patient is pregnant but she suffers an early miscarriage or chooses to end the pregnancy, how should our office communicate this important information? In this situation, you should select the option on the Maternity HEDIS Attestation Form that states “this pregnancyendedorthebabydeliveredpriorto20weeks.”Thisactionwillallowtheofficetocloseoutand submit the Maternity HEDIS Attestation Form for this pregnancy.
8. Do I have to answer all the questions on the
Maternity HEDIS Attestation Form all at once? No,theworkflowisdesignedsoyoumayenterandsaveinformationasitbecomesavailableduringthepregnancy.Afterthedeliveryandpostpartumvisitdatesareentered,youwillbegiventheoptiontocomplete and submit the attestation. Until then, you maysavetheinformationyouenterandcontinueonwithothertasks.
9. Is there an easy way for me to obtain a list of all
patients for whom I need to enter prenatal or postpartum visit dates? Yourorganizationwillreceivetwonotificationstocomplete the Maternity HEDIS Attestation Form. • In order to prompt you to complete the form and
enterthefirstprenatalvisitdate,thefirstnotificationis posted at the time the form is created.
• Inordertoalertyoutoschedulethepostpartumvisit(if not already done) and to enter the postpartum visitdate,thesecondnotificationisposted14daysprior to the estimated due date.
Youmayaccesstheworkqueueatanytimebygoing
to Payer Spaces. Next, select the payer title from the list. Then select Amerigroup HEDIS Attestation for Maternity.
10. How can I get additional help, support or training?
• Availityoffersintegratedhelpandon-demandtraining demonstrations (select Help and search using thekeyword“maternity”).
• You can launch training demonstrations from associated help topics as well as the HEDIS attestationformaternityworkqueue.
Would-Be And Expectant Moms Urged To Stay Vigilant AgainstTheZikaVirus
The AP (6/29, Neergaard) reports that women who are attemptingtoconceiveorwhoarealreadypregnantneed tostayvigilantagainsttheZikavirusdespitetherecent
drop-off in new cases. Expectant mothers “still are being urged nottotraveltoacountryorareawithevenafewreportedcasesofZika,becausetheconsequencescanbedisastrousfor a fetus’ brain.” The AP quotes acting CDC Director Dr. Anne Schuchat,whosaid,“Zikahasn’tgoneaway.”Sheadded,“Wecan’taffordtobecomplacent.”What’smore,“thiskindofvirus‘almost certainly is not going to disappear completely,” Dr. Anthony Fauci, Director of NIH’s National Institute of Allergy and Infectious Diseases, recently told Congress.
Meet Chris Tice, CNMMaternalMortalityReviewCoordinator
Hello everyone, IamsoveryexcitedtobetakingoverastheMaternalMortalityReviewCoordinatorforthestateofGeorgia!IamsoluckytohavehadDebbieSibleytohavepavedthewayforthisposition in our state. She brought a wealthofperinatalknowledgetotheposition,andIamgratefultohave
had her mentor me this spring as she was getting ready to begin the newest chapter of her life in retirement. My goal is to help greatly decrease the number of maternal mortality cases thatwehavehereinGeorgia.Nofamily or child should lose a mother in pregnancy or during the crucial year afterpregnancyends.Itrulybelievethatwecanimprovematernaloutcomesin our state, and am excited to be a part of the process of abstracting these cases, reporting on them, and helping to coordinate the Maternal MortalityReviewCommittee.IhavebeenaCertifiedNurseMidwifeinthestate of Georgia for 20 years, and I believethisbackgroundreallyhelps
me to understand the natural process ofpregnancy,uncoveringlargerphysiological health problems of the mother,andthepotentialfordifficultcircumstances.Ihaveworkedinprivatepractice, a large HMO setting, and havealsotaughtperinatalnursingandwomen’s health during this time span. Allthewhile,mylovefortheamazingprocess of pregnancy has grown, and Iwanttohelpeverypregnantwomanand family in Georgia now, and all of thoseinthefuture.IamthankfulthatwehaveawonderfulpartnerintheDepartment of Public Health to help uscarryonthisenormousandveryimportanttask,andIlookforwardtoworkingwithallofyou.
awareness about PCOS so that girls and women get the care theyneed.Thankyouforyourleadershipandsupport!
About Sasha Ottey, MHA, MT (ASCP) SashaOtteyisFounderandExecutiveDirectorofPCOSChallenge:TheNationalPolycysticOvarySyndromeAssociation. PCOS Challenge is the world’s leading support andpatientadvocacyorganizationadvancingthecausefor women and girls with PCOS. Sasha is a Clinical and Research Microbiologist. Prior to founding PCOS Challenge, Sasha was a contract research microbiologist at the National Institutes of Health (NIH). For more information, visitPCOSChallenge.org._______________1 Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. (2016) The prevalence
and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016 Dec;31(12):2841-2855. Epub 2016 Sep 22. https://www.ncbi.nlm.nih.gov/pubmed/27664216
2 Balen AH, Rutherford AJ. (2007) Managing anovulatory infertility and polycystic ovary syndrome BMJ. 2007 Sep 29; 335(7621): 663–666. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1995495/
3 Does PCOS affect Pregnancy? https://www.nichd.nih.gov/health/topics/PCOS/more_information/FAQs/Pages/pregnancy.aspx
4, 5 Centers for Disease Control and Prevention. PCOS and Diabetes, Heart Disease, Stroke...https://www.cdc.gov/diabetes/library/spotlights/pcos.html
6AzzizR,MarinC,HoqL,BadamgaravE,SongP.(2005)Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab. 2005 Aug;90(8):4650-8. Epub 2005 Jun 8.
7MarchWA,MooreVM,WillsonKJ,PhillipsDI,NormanRJ,DaviesMJ.(2010)The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod (2010) 25 (2): 544-551. DOI: https://doi.org/10.1093/humrep/dep399
Joining Forces in the Fight Against PCOS Continued from page 4
Maternal Mortality Review Process
MaternalDeath
•
CheckMarkonDeathCertificate
•Mandatory Reporting
Identification•
ICO-10/0-code•
DataLinkages
CasesSelected
forAbstraction
Reviewby
Committee
CommitteeRecommen-
dations
ActionableItems
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OBGyn NEWS, August 2017 OBGyn NEWS, August 2017
News from Around the State
Deal announces launch of Words2Reading Gov.NathanDeal,inconjunctionwiththeGovernor’sOfficeofStudentAchievement(GOSA),hasannouncedthe launch of the Words2Reading website, words2reading.com, a webtool,usableonmobiledevices,with curated resources for families, caregiversandteacherstohelpdevelopandsharpenearlychildhoodlanguageandliteracyskillsforchildrenuptoage8. “Stronglanguageandreadingskillslaythefoundationfor a student’s long-term academic success,” said Deal. “Words2Reading promotes increased engagement in childhoodeducationbyputtingeffectivelearningresourcesin the hands of families and early educators anywhere inthestate.Bymakingtheseresourcesreadilyavailableforfamilies,caregiversandeducators,wearefurtherinvestinginGeorgia’sgreatestresource,themindsofouryoungest learners, for generations to come.” W2RpartnerprogramReady4KGAisanevidence-basedtext messaging program for parents of newborns and children ages1to5.Eachweek,Ready4KGAsubscribersreceivefunfacts and easy tips to boost early learning. Parents can sign upfortheseage-specificmessagesatnocost.
Top free menstrual cycle tracking apps for patients As of September 2015, the number of health apps in the US Apple iTunes and Google Play stores exceeded 165,000, with approximately 7% focused on women’s health and pregnancy. One area in which an app may enhancepatientcareisinmenstrualcycletracking. Thisyear,Dr.PaulaCastanoandherteamidentifiedandevaluatedfreemenstrualcycletrackingapps.Theaccuracy of each app was determined by menstrual cycle predictionsbasedonaveragecyclelengthsofatleast3previouscycles,ovulationpredictedat13to15dayspriortothestartofthenextcycle,andqualificationthattheapplication contained no misinformation. Thetop3recommendedmenstrualcycletrackingapps from Dr. Castano and colleagues’ study, in terms of accuracyandeaseofuse,areClue,Glow,andPinkPadPeriodTrackerPro. Study published in OBG Management’s July 2017 issue.
J. Patrick O’Neal named Commissioner J. Patrick O’Neal, MD, was appointed Commissioner of the Georgia Department of Public HealthbyGovernorNathanDealonJuly7,2017,tofillavacancycreated by the appointment of Brenda Fitzgerald, M.D. as director of the Centers for Disease ControlandPrevention. In addition to his role of commissioner, Dr. O’Neal servesastheDirectorofHealthProtection for the Georgia Department of Public Health (DPH), and for 29 years prior, he practiced emergency medicine at DeKalb Medical Center in Decatur.
InhisfinalsevenyearsatDekalbMedicalCenter,heservedastheRegionalMedicalDirectorforEMSthroughoutGreaterAtlantaandformerlyservedasDirectoroftheOutpatient Clinic at the Medical Center of Central Georgia. HeservedasaflightsurgeoninVietnamin1970-71.
QualityImprovementInitiatives for Maternal Care in Georgia
A 2010 report by Amnesty International listed Georgia at the bottom of the United
Stateswithastaterankof50foritsmaternal mortality rate. To address this,theMaternalMortalityReviewCommitteewasestablishedtoreviewmaternal deaths of women who were pregnant within one year of death. The2012casereviewdeterminedthat the leading causes of death were hemorrhage, hypertension, and cardiac in origin, and that there areopportunitiesforpreventionandqualityimprovement,includingequippinghospitalproviderstoaccelerate recognition and treatment ofconditionsthatleadtoseveremorbidities and mortalities.
TheAllianceforInnovationonMaternal Health (AIM) is a national partnershipofprovider,publichealthandadvocacyorganizations.AIMalignsnational,state,andhospitalleveleffortstoimprovematernalhealthand safety and is poised nationally to reduceseverematernalmorbidityby100,000eventsandmaternalmortalityby 1,000 deaths by 2018. With funding receivedfromtheHealthResourceServicesAdministration,AIMprovidesevidencebasedfrontlineresourcesforbirthfacilitiesandprovider/publichealth teams to adapt and implement a series of action steps (safety bundles) onhighriskmaternalconditions. AIMisadatadrivenqualityimprovementinitiative.TheAIMteamhasdevelopedmetricsformeasuring safety bundle adoption and maternal outcomes within hospitals implementing the safety bundles. De-identifiedoutcome,structureandprocess data reported to the AIM data
centerisbenchmarkedwithothersimilarhospitalswithinstatesandnetworksandreportedbacktotheparticipatinghospitals and states. Hospitals and states are able to utilize this data to identifysuccessesandweaknesseswithimplementation of AIM safety bundles. Safety bundles are standardized evidence-informedprocessestoreducevariationinhospitalmaternalcare.Theyaredevelopedbymultidisciplinaryworkgroupsofexpertsinthefieldrepresenting each of our Alliance partners and specialty organizations. TheAIMteamdevelops,identifiesandprovidesanincreasingnumberof resources for hospitals and state teams to implement the Maternal Safety Bundles. These include online, interactiveandbrieflearningmodulesforstaffeducation;checklists;workplans;directlinkstotoolkitsandotherpublished resources. The AIM website (www.safehealthcareforeverywoman)has many resources and guidance, assistance with data management, and a help center. AIM is in the process ofdevelopingadditionalresourcestoconnect and assist participants. All resources are open access and can be shared freely. Additionally, AIM supports participants by offering Part IVmaintenanceofcertificationforphysicians and will soon be offering CEUsfornurses.AIMisdevelopingan award program for participating hospitals and supporting reduction of liability protection costs. To join AIM, states and hospital systems must be able to display the abilitytoprovidecurrenthospitaladministrativedataquarterlytotheAIMdata center; identify champions among nursing, public health and physicians to provideleadership;andhaveastrongperinatal committee and/or maternal mortalityreview. The Georgia Department of Public
Health (DPH), in collaboration with Georgia Perinatal QualityCollaborative(GaPQC),GeorgiaOB/GYN Society (GOGS), Georgia Chapter of American Academy of Pediatrics (Ga AAP), Georgia Hospital Association (GHA), the Regional Perinatal Centers (RPC), and members of the Maternal Mortality
Current AIM States and Hospital Networks
Oklahoma New Jersey North Carolina
Louisiana Illinois Utah
Maryland Florida California
Michigan Mississippi
AIM Networks Aim Countries Trinity Health care Malawi
Premier No. Mariana Islands
Nat. Perinatal Info Center
ReviewCommittee(MMRC),hastakenthefirststepstomakeGeorgiaanAIMState.Thecollaborationwillworktoincrease the use of AIM safety bundles anddevelopadatasharingprocesstocollect,analyze,andvalidateperinataldata.ToaddressfindingsoftheMMRCCaseReview,thefirsttwobundlestoberolled out in Georgia will be Obstetric HemorrhageandSevereHypertension/Preeclampsia. Georgia DPH and our partners hope for the support of our providersaswemoveforwardineffortstoimprovematernaloutcomesin our state. For more information please contact Diane Durrence, [email protected].
THE ALLIANCE
• American College of Obstetricians and Gynecologists
• American College of Nurse Midwives
• American Academy of Family Practitioners
• American Society of Healthcare Risk Management
•AssociationofMaternalandChild Health Programs
•AssociationofStateandTerritorialHealthOfficers
•AssociationofWomen’sHealth,Obstetric and Neonatal Nurses
• March of Dimes•NationalPerinatalInformation
Center•NursePractitionersforWomen’s
Health•Premier,Inc.• Society for Maternal Fetal
Medicine• Society for Obstetric Anesthesia
and Perinatology
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OBGyn NEWS, August 2017 OBGyn NEWS, August 2017
Georgia Obstetrical and Gynecological Society, Inc.
AdministrativeOffice
2925PremiereParkwaySuite 100
Duluth, Georgia 30097
Telephone: 770 904-0719Fax: 770 904-5251
If you would like to send a letter to the editor, please send it to
Medicaid Payment IncreasesGoodnews!ThecoalitionofprimarycarephysiciansassociationsinGeorgia(familyphysicians,OBGyn,Internists,pediatricians,osteopaths)receivedwordfromtheGeorgiaDepartment of Community Health that the Medicaid rate increases that went into effect on July 1 are now part of the Georgia state “base budget” going forward. This means that the funding that was secured for the increased rates will remain in each state budget in future years, sowedon’thavetogobackeachyearandasktheGeneralAssemblytoincludetheincreasedamount.
