Louisiana Medical News Nov 2013

By TED GRIGGS

Sometime in the next decade or so, defending a medical malpractice claim, or proving one, may become a much simpler affair, one that doesn’t involve years of litigation and cadres of expert witnesses.

“You say to the plaintiff, ‘You can win your case if you can prove the doctor did not comply with a clinical practice guideline,’” said Dr. Jeff White, who chairs the Louisiana State Medical Council on Socioeconomics. “Or you say to the doctor, ‘You can defend your case. We’ll let you off this time if you can prove that you complied with the practice guidelines.’”

White was one of several speakers at the Medical Society’s 2013 Picture of Health event.

“The standard of care is now defi ned as what a reasonable physician would do under the same circumstances,” White said.

Typically, experts are called to testify about what’s rea-sonable, and not surprisingly, their opinion on reason-able varies widely.

However, those experts could be taken out of the picture through “safe harbor” legislation. Basically, these laws state that following evidence-based practice guidelines creates a safe harbor against lawsuits for fail-ing to do more.

“To be effective, a safe harbor guideline must be narrowly conceived in design, scope and implementa-

tion,” White said. “It must also have the force of law. The guideline cannot just be evidence of the standard of care. It must be the stan-dard of care.”

White said doing more because physicians fear lawsuits may be a major reason for the spiraling cost of healthcare.

It’s diffi cult to pin down the cost of “defensive medicine,” White

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Liability Reforms and Standard of Care Could Reduce Costs

Dr. Michael LaneKarate Chop Doc

As a kid growing up in Brooklyn, New York, Michael Lane dabbled in martial arts. “You watch Bruce Lee and you think you want to do Kung Fu,” he recalled. But, instead of Kung Fu, he trained in Shotokan Karate starting 11 years ago. He now holds a second degree black belt ... page 3

Feds Close “Loophole” in Fair Labor Standards ActHome Health Care Companions and Minimum Wage/Overtime

The White House approved federal regulations on September 17 that require home health workers to be paid at least minimum wage as well as overtime. This may affect close to two million home care workers ... page 4

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Dr. Jeff White

REIMBURSEMENT

Gaining Perspective on the Reimbursement Landscape: Glass Half Empty … or Half Full

By cINDy SANDERS

To see something in a different light often requires a shift in perspective. David A. Williams, CPA, MPH, FHFMA, leader of healthcare reimbursement and advi-sory services for HORNE LLP, believes this certainly holds true for practices and facilities facing ever-increasing budget pressures.

Glass Half EmptyWilliams, a partner in HORNE’s Ridgeland, Miss. offi ce, noted for

many healthcare providers, any incremental increase in revenue is eaten up by rising costs — from increased wages to higher prices for supplies to

2 • NOVEMBER 2013 Louisiana Medical News

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Louisiana Medical News NOVEMBER 2013 • 3

By LISA HANcHEy

As a kid growing up in Brooklyn, New York, Michael Lane dabbled in mar-tial arts. “You watch Bruce Lee and you think you want to do Kung Fu,” he re-called. But, instead of Kung Fu, he trained in Shotokan Karate starting 11 years ago. He now holds a second degree black belt. “It is one of the open-hand forms of ka-rate,” he explained. “It’s an Okinawan martial art, one of the older ones.”

Today, Lane and his 16-year-old son, Mike, spar in the sport together. “It teaches you a lot of discipline,” he said. “It’s actually quite good for coordination and strengthening without having to nec-essarily involve a lot of weights.”

Lane hails from a family of healthcare professionals. His father was a maxillofa-cial surgeon; his mother was director of the dialysis unit at the VA and his brother is a dentist. But, his medical interest sparked after his mother sustained an injury where she almost lost her arm.

For his education, Lane followed in his parents’ footsteps by choosing Ten-nessee State University’s undergraduate school. As an added bonus, his brother attended college there at the same time. Lane then returned to his home state for medical school at the State University of New York Downstate Medical Center in Brooklyn.

During his third year of medical school, he decided to focus on physical medicine and rehabilitation. He attained his specialty training at The Institute for Rehabilitation and Research for Baylor College of Medicine in Houston. “It was based on the varied types of cases you see ranging from the sport-related patient to the spinal cord and brain injuries,” he ex-plained. “So, it was pretty diverse.”

After completing his studies, a head-hunter recruited him to Lake Charles. Since 2010, he has practiced as a phys-iatrist for Orthopaedic Specialists, a part of Memorial Medical Group. “It’s pretty challenging,” he said. “I see a pretty wide variety of medical diagnoses and cases.” He also frequently performs electric diag-nostic testing, including nerve conduction and electromyography studies.

In his personal time, Lane enjoys practicing karate with Mike and spend-ing time with his younger boys, Maxwell, age 12, and Malcolm, 10. Like their dad and older brother, the younger guys enjoy sports – Maxwell plays baseball while Malcolm prefers basketball.

After a long day at work, Lane gets his kicks from karate. He practices at least fi ve times a week. “If you ascribe to what the philosophy and principles of what ka-rate are, it actually calms you down,” he said with a laugh. “It gives you calmness. It should create an inner peace.”

Lane’s other passion is motorcycling.

From the age of 15, he has been rid-ing bikes. His current ride is a Triumph Rocket III. “I mainly ride on the week-ends,” he said.

The eclectic doc also has an extensive music collection. He particularly enjoys listening to jazz and Brazilian/Portu-guese-infl uenced artists.

In his day job, Lane aspires to grow his practice so that local patients can get

the full range of medical care offered in larger cities. “Ultimately, we’d like to be able to provide services that people are overlooking,” he said. “A lot of times, peo-ple go to Houston for lack of knowledge of what’s right here in Lake Charles. We are providing many of the needs that people are seeking. But, they just don’t necessar-ily have an idea that these things exist, and that they are here right at Memorial.”

Physician Spotlight

Dr. Michael LaneKarate Chop Doc

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By BARBARA MccONNELL

The White House approved federal regulations on September 17 that require home health workers to be paid at least minimum wage as well as overtime. This may affect close to two million home care workers now, and that number is expected to climb exponentially because the num-ber of Americans over age 65, by far the biggest user of their services, is expected to double in the next 20 years.

These workers had previously been omitted from wage protections be-cause they were included in an informal arrangements/‘babysitting’ exemption from the law in the 1970’s.

The law itself is the Fair Labor Standards Act (FLSA) that was passed by Congress in 1938, regulated by the Department of Labor and covers the minimum hourly wage, overtime pay, re-cordkeeping and child labor. Overtime is defined as: anyone working over 40 hours a week. They must be paid time and a half for additional hours, the exception being salaried workers, usually of the profes-sional or managerial class.

President Obama first proposed them two years ago, but there are differing opin-ions about their overall effect.

Kevin Troutman, an employment attorney with Fisher & Phillips, LLC in their New Orleans and Houston offices, had a background in hospital human resources for 17 years before going to law school. He pointed out the differences between home health workers and explained the impact of the changes.

“There is the medically trained and licensed home health care aide who is al-ready covered under the FLSA regs and is subject to minimum wage and overtime, and usually spends one to two hours with each client and perhaps sees 20-40 clients in a week. Whereas a ‘direct care’ home health worker/companion/attendant spends long hours, 60-80 hours a week, with one or two primarily elderly clients providing companionship services with fellowship and protection,” Troutman advised.

This direct personal care may involve reading to the person, help with dressing, bathing, some meal prep, light housekeep-ing, medicine reminders, watching televi-son, and hours overnight which are known as the activities of daily living (ADL).

“There are unintended consequences to this law change, and it will affect home

health agencies, individual families who directly hire the workers, and some as-sisted living facilites-depending on the definition or test of what is your ‘home,’” he said.

Home health companies and families are going to have to decide if they want to keep the one to two folks they have in their homes now and pay the overtime, or hire many different care-givers who each work 40 hours or less.

“And the workers themselves may have to sign on with more than one agency to make up the time if their hours are re-duced elsewhere,” Troutman surmised.

These people have to be screened for criminal and drug backgrounds, trained on CPR and when to call 911. Finding out if they are honest, agreeable, reliable, and won’t take advantage of their usually elderly and/or disabled charges, are all part of the oversight services provided by home health agencies. Additional workers of this caliber may be hard to find. Plus, the costs of vetting additional workers and paying overtime will have to passed on to those they serve.

“The one to two people the client has gotten used to and trusts and has estab-lished a good routine with is difficult to duplicate,” Troutman added.

He feels that though most compa-nies are already paying these workers minimum wage if not above, an obvious consequence is that some businesses will be unable to shoulder the additional costs and will go out of business.

Cyd Begnaud, owner of Alternative Health Care Specialist, Inc. who employs only home companion or direct service workers (DSW) providing non-complex tasks for disabled, usually older, Medicaid recipients, said this federal employment ruling “would not only affect the entire industry of home health care, but would have a detrimental effect on my services as a whole.”

She stated that it is not the hourly minimum wage rate that will be the prob-lem, because she has been paying higher than that for quite sometime and believes most other companies do the same, but that it would be the overtime aspect that would be the deal changer.

In fact, she characterizes the employ-ment compensation law change as a train wreck, and that it has the ability to put her company out of business as well as many others if it is indeed strictly enforced by its kick off date of January 2015.

Minimum wage remains at $7.25 an hour.

Feds Close “Loophole” in Fair Labor Standards ActHome Health Care Companions and Minimum Wage/Overtime

Kevin Troutman


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By TED GRIGGS

More than 1,600 physicians in Gulf South Quality Network will take part in a Blue Cross and Blue Shield of Louisiana program designed to improve outcomes for patients with chronic diseases.

Under the first year of the Quality Blue Primary Care program, Gulf South will manage care for somewhere be-tween 40,000 and 60,000 people covered through Blue Cross, said Bill Bopp, presi-dent of the physician network. Gulf South will be paid somewhere between $400 and $500 per member per month, or $200 to $300 million in medical premiums.

Blue Cross will first identify the pa-tients in that group who have one of more chronic diseases, such as diabetes, coronary artery disease, hypertension and chronic kidney disease.

“That’s your 25 percent of your mem-bership that’s spending 75 percent of the (healthcare) dollars,” Bopp said.

Gulf South will then work with its primary care physicians and provide the infrastructure to help them better manage those patients. So when patients come in,

Gulf South will be able to identify whether they have had their A1c levels tested, if they’re taking their medications, and if they’ve recently seen a podiatrist or oph-thalmologist for feet and eye exams.

“All those types of things so we’re making sure that that chronic disease state is not falling into a worse condition,” Bopp said. “And hopefully we’re helping them be compliant so their lifestyle is getting better.”

Blue Cross developed Quality Blue to better support physicians in the network and transform the relationship among primary care physicians, the insurer and patients. The idea is to change an episode-driven, physician delivery care model to a more coordinated, team care delivery model. The program was designed to give providers the tools and resources they need to focus on improving care quality for their total patient population, not just those actively seeking treatment.

Gulf South is the largest clinically in-tegrated physician network in Louisiana. The network’s physicians represent East Jefferson General Hospital, West Jefferson Medical Center, Slidell Memorial Hospi-

tal, Tulane University Medical Center, Tulane/Lakeside Hospital and Lakeview Regional Medical Center.

Blue Cross will attribute a medical budget – the anticipated spending for 2014 – to the patients under Gulf South physicians’ care. Gulf South expects its ability to work with its physicians and hospital leadership will provide better outcomes for those patients when they need care, and those improved outcomes should result in lower healthcare spending levels than the current level.

If that happens, Gulf South will share in a percentage of those savings with Blue Cross, Bopp said. And Gulf South will take those savings and reward its physi-cians, based on their performance.

The percentage Gulf South receives is set on a sliding scale.

“The better we do, the more we get,” Bopp said.

Eventually, Gulf South hopes to achieve a global payment system where the network manages the full continuum of care for patients. But in order to do that, Gulf South needs to establish a true part-nership with its physicians.

That’s where some Accountable Care Organizations have run into problems, Bopp said. ACOs that are driven by one side, rather than physicians and hospital management working together.

Bopp said he doesn’t think that will be an issue with Gulf South.

The network’s partners, who include for-profit, nonprofit and service district hospitals, have been incredibly support-ive, he said. The reason the partners have been successful is that everyone is focused on a couple of questions:

“How do we improve patient care, and how do we become the high-quality, low-cost network to the marketplace?”

Gulf South hopes to demonstrate it can do both through the Quality Blue pro-gram, Bopp said. If the network succeeds, Gulf South will make itself more attractive than the options in the community.

This will allow Gulf South to go into employers’ offices and discuss the physi-cian network’s advantages. Gulf South will be able to show a company how the network can provide a higher level of care for employees, and how the network can

Physician Network, Blue Cross Partner in Quality Program

REIMBURSEMENT



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hikes in rent and utilities. He pointed out that for hospitals,

the largest revenue stream is for inpatient stays, and the largest single payer is Medi-care, which can represent from the low 40s to the high 60s in terms of percentage of patients. “There has been a market bas-ket update, but for the last couple of years, it’s been less than 2 percent,” he said.

Williams noted the government puts in the full market basket update but then begins reducing the rate by look-ing at adjustments tied to value-based purchasing, readmission rates and acquired conditions, in addition to other factors. “Normally you’re seeing very minimal increases. It’s caused a flattening of revenue per pa-tient,” he said. Then, Williams continued, after payment increases are netted out, “Medicare is subject to a 2 percent reduc-tion to fulfill the sequestration order.”

He added that Medicaid, which typi-cally covers anywhere from 5-15 percent of patients … or higher depending on lo-cation and a hospital’s safety net status, is not currently subjected to sequestra-tion. Yet, he said, hospitals are faced with mounting concerns about Medicaid ex-pansion, uncompensated care, and cuts to disproportionate share hospital payments.

For hospitals in states that didn’t opt to expand Medicaid rolls, administrators are worried about rising levels of uncom-pensated care for those that fall into the gap in the Affordable Care Act between traditional Medicaid eligibility and quali-fying for federal subsidies on the health-care exchange. Even for providers who are in states that did expand Medicaid, Williams said uncertainty still exists about how reimbursement will actually net out.

Traditionally, Medicaid has reim-bursed providers at a set match rate for

direct patient services and a 50 percent rate for the administrative portion of the episode of care. Although the ACA Med-icaid expansion plan covers 100 percent of patient services for three years and then rolls down incrementally to 90 percent over subsequent years, the administrative match remains at 50 percent so the state does incur additional cost by expanding rolls. Additionally, Williams said certain provisions of the ACA require mandatory changes for states regardless of expansion, including: welcome mat population or those who were eligible for Medicaid but had not enrolled previously, foster chil-dren expansion to age 26, expanded eligi-bility for children, primary care physician fee increase, and health insurer fee. In Mississippi, a non-expansion state, the es-timated amount of the mandatory changes is between a $272 - $436 million increase in spending. With this amount of growth, the state is not expected to increase the reimbursement rate for a full episode of care.

Medicare DSH payments also are causing administrators to lose sleep at night. Initially, the ACA plan called for a 75 percent reduction in Medicare DSH payments. However, Williams said part of the final regulation that went into effect Oct. 1 of this year moderated that number a bit by moving to an empirical DSH pay-ment for uncompensated costs … a com-plex, calculated cut that softens the blow some by looking at a hospital’s relative share of Medicaid inpatient utilization as a proxy for uncompensated patients.

Williams said that for one hospital in the Mississippi Delta, the original Medi-care DSH reduction would have meant a loss of $5.6 million. “But,” he continued, “because of the additional payment to fund the uncompensated cost, it was ac-tually a reduction of $2 million.” While that is still a significant loss, “It could have been worse,” Williams noted.

Still, he continued, “You’re faced with the fact your revenue isn’t growing as fast as your expenses. It’s very concern-ing to most every healthcare organization around.”

Glass Half FullSo if revenue isn’t going up, the logi-

cal place to increase margins is to decrease costs. Yet, healthcare providers want to make sure they provide the best care pos-sible without sacrificing a patient’s well being simply to save a few dollars.

“A lot of people equate higher quality with higher cost, but that’s not necessar-ily true,” Williams pointed out. In fact, he said, doing the right thing in the right way is often significantly more cost efficient.

“A major cost in providing care to pa-tients is variation in the clinical process of care,” Williams said. He added it is easy to find real world examples of this type of variation where one hospital’s cost for an average hip replacement is $45,000, yet another one might have an average cost of $22,000. “What’s the disconnect?” he asked of the two cost scenarios. “A lack of standardization of using evidence-based protocols,” he answered.

By using data available through elec-tronic health records coupled with a part-nership with technology company Health Catalyst, Williams said HORNE is able to mine the available information to look at clinical pathways and search out deviation from standard protocols that adds to the cost of care. He was quick to add that the technology doesn’t seek to stop physicians from exercising their medical judgment but does highlight where there are outliers when it comes to following clinical proto-cols. “Best practices and evidence-based medicine say that these are the best proto-cols out there,” he pointed out.

Following those protocols not only saves money, but also should optimize quality. With increased transparency, pay-

ers and patients will have access to infor-mation regarding those positive outcomes and lower costs, which could ultimately drive volume.

A Foot in Both BoatsAdministrators and chief financial

officers are caught between the fee-for-service and value-based payment worlds right now. Williams said they are trying to keep their heads above water in the current payment system … and now re-imbursement experts want them to shift their focus to population management. Although making the move is understand-ably frustrating, Williams believes it is also the best option to ultimately improve the bottom line.

“There has to be a change in cul-ture from what it’s been in the past,” he noted. “We tell them, ‘Let’s prepare for it by being the most efficient, effective deliv-erer of care and eliminating patient waste.’ That puts you in a competitive advantage over those providers that have a higher cost structure.”

It is a different mindset, Williams continued, to stop attacking reimburse-ment from the top and instead improve revenue by cutting costs. “If you deliver high quality at a lower cost, then your margins are going to be greater. We see opportunities,” he concluded.

Gaining Perspective on the Reimbursement Landscape, continued from page 1

REIMBURSEMENT

David A. Williams

do that in a more cost-efficient manner.Gulf South began working with phy-

sicians and hospital management about two years ago to improve quality out-comes. Each of the hospitals in the net-work formed a local quality outcomes chapter. Gulf South evaluates about 200 quality measures, determining which phy-sicians and/or medical staffs have better outcomes than their colleagues.

“So we’re starting to move toward best practices, and we can then share those best practices with the other physi-cians,” Bopp said.

So if, for example, one local chapter has lower readmission rates than the oth-ers, Gulf South can look to see what that chapter is doing differently and examine other chapters’ clinical pathways for ways to improve.

The physician network provides data back to the physicians to evaluate and the infrastructure to make it easier for the doctors to look at that data, Bopp said. The physicians and hospitals can look at the data and at current medical trends.

“We’re strictly the support unit for all these physicians and hospitals to help them understand how they’re performing in the marketplace,” Bopp said.

Physician Network, continued from page 5


Stepping Up to Leadership

by LSMS President Vincent A. Culotta, Jr., MD

LSMS President Vincent A. Culotta, Jr., MD

LSMS Making Louisiana a Better Place to Practice Medicine Since 1878

The Louisiana State Medical Society is pleased to announce an unparalleled opportunity for medical staff lead-ers in Louisiana. We encourage you to attend the “Stepping Up to Leadership” program, which teaches physicians the skills and expertise they need to successfully lead a medical staff.

What to Expect

The conference engages physicians with interactive, hands-on learn-ing modalities, focusing on small-group sessions featuring video vignettes and real-life case studies. “Stepping Up to Leadership”’s outstanding faculty - including keynote speaker and past AMA president Nancy Dickey, MD; Community Health System’s Barbara Paul, MD; the Univer-sity of California at San Diego’s David Bazzo, MD; and many others - will address important topics from a practical perspec-tive, including the “how-tos” of leading a staff, credentialing and privileging, assessing the needs of the organization, using CME effectively, resolving on-call issues, improving communication skills, using data to improve quality, le-gal considerations, and managing disruptive or impaired colleagues. We encourage you to bring your entire MEC to this program.

“Stepping Up to Leadership” was developed by the Institute for Medical Quality and the PACE Program at the UC San Diego,

in cooperation with the Health Sciences Center at Texas A&M University. Additionally, the program has been endorsed by the Texas Medical Association, the Texas Hospital Association, the New Mexico Osteopathic Medical Association, the Nebraska Medical Association, the Medical Society of Virginia, the Medical Society of the District of Columbia, and the Maryland State Medical Society.

Registration

With the help of a one-time grant from The Physicians Foundation, this outstanding two-and-a-half day program is available at one-third of its normal cost, with prices starting as low as $595.

To register, visit http://physician-leadership.org

In addition to the educational components, the program allows time for networking with col-leagues in desirable locations. The “Stepping Up to Leadership” will be held in San Antonio in No-vember, followed by sessions in San Diego on March 6-8, 2014 and Washington, D.C. on May 8-10, 2014.

Become an LSMS Member

To find out how you can become a member of the LSMS, visithttp://www.lsms.org/site/join and fill out an online application. You can also find out more about what products and services we of-fer to our membership.

facebook.com/LSMS

By LyNNE JETER

TAMPA, FLA. – Mimi Guarneri, MD, FACC, and fellow founding members of the American Board of Integrative Medi-cine (ABIOM) spent the lingering days of summer putting the final touches on a new board certification examination for a spe-cialty that’s garnering national attention.

“Creation of integrative medicine as a specialty by the American Board of Physi-cian Specialties (ABPS) guarantees excel-lence in the field and assures consumers of healthcare the practitioner they’re seeing has reached a high standard of practice,” said Guarneri, board-certified in cardiology, internal medicine, nuclear medicine and ho-listic medicine.

Tampa, Fla.-based ABPS, the first multi-specialty certifying body to offer phy-sician certification in integrative medicine, is the official certifying body of the American Association of Physician Specialists (AAPS) and one of three national certifying organi-zations of MDs and DOs. The ABPS has led industry response to trends in urgent care, disaster medicine, hospital medicine and family medicine obstetrics.

Andrew Weil, MD, said the forma-tion of ABOIM – one of 18 ABPS boards – marks an important milestone in the devel-opment in the field of integrative medicine.

“Finally, there’s a way for qualified physicians to present themselves as experts in offering competent integrative care to patients,” said Weil, who helped establish integrative medicine as a specialty.

Of the other two national certify-ing organizations, the American Board of Medical Specialties (ABMS) represents the largest national organization certifying MDs and DOs. The American Osteopathic As-sociation Bureau of Osteopathic Specialists (AOABOS) certifies DOs only.

“Integrative medicine focuses on get-ting to the underlying cause of disease and implementing personalized programs that help people achieve optimal health,” said Guarneri. “In conventional medicine, we’re taught to make a diagnosis and prescribe a treatment. In integrative medicine, we look for the underlying cause of the problem or health challenge. For example, in conven-tional medicine, we may diagnose diabetes and prescribe a medication. In integrative medicine, we look at what a person is eat-

ing (to determine if) they’re deficient in mi-cronutrients linked to diabetes. If they’re physically fit, are they exposed to toxins? Are they under stress? All of these can cause diabetes. We may prescribe medicine, but we also look to correct the underlying cause. We treat the whole person – body, mind and spirit – and we look at an individual’s rela-tionships to family, community and planet.”

ABOIM and the Consortium of Academic Health Centers for Integra-tive Medicine define integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.”

Guarneri, founder of the Scripps Cen-ter for Integrative Medicine in La Jolla, Calif., and president of the American Board of Integrative Holistic Medicine (ABIHM), pointed out that as a cardiologist, her goal is to also reverse the patient’s health chal-lenges.

“Integrative medicine provides me the tools that weren’t available in my conven-tional medical training,” she said. “As a cardiologist, I’m well versed in the role of medication, surgery and stenting for treat-ment of cardiovascular disease. But, it’s my training in integrative medicine that’s taught me the principles of nutrition, the evidenced-based use of natural supplements, and the role of the mind-body connection. Integrative medicine allows me to complete the circle of care.”

Eudene Harry, MD, medical director of Oasis Wellness & Rejuvenation Center in Orlando, Fla., was thrilled to learn about the new board certification in integrative medicine.

“It’s very good that integrative medi-cine is being acknowledged as a specialty,” said Harry. “The message is: let’s not be ex-clusive. Let’s be inclusive. Let’s look at all ev-idence-based material and treat it equally.”

Harry, who specializes in both holistic and emergency medicine, said integrative medicine allows “more focus on informa-tion-gathering.”

“That’s going to be helpful,” she said. “Medications don’t address the issue that’s driving the patient to the doctor’s office.”

Integrative Medicine Goes MainstreamABIOM finalizes board certification exam for emerging specialty

Integrative Medicine Board Certification 4-1-1 ABOIM certification is available to both allopathic and osteopathic

physicians in the United States and Canada who are practicing integrative medicine and have completed a residency training program approved by the Accreditation Council of Graduate Medical Education (ACGME), American Osteopathic Association (AOA), Royal College of Physicians and Surgeons of Canada (RCPSC), or College of Family Physicians of Canada (CFPC).

Complete eligibility requirements are available online.Qualified physicians interested in becoming board certified in integrative

medicine may submit an application by Dec. 1; the initial exam will take place next May. Applications are available online at www.aapsus.org and may be obtained by contacting the ABPS Certification Department at (813) 433-2277.


Connrmed speakers: Gregory D. Frost and Clay J. Countryman from Breazeale, Sachse & Wilson, L.L.P. and Tony Brooks from Horne LLP.

By LyNNE JETER

NEW ORLEANS – When Marga Massey, MD, FACS, joined New Orleans’ St. Charles Surgical Hospital in 2009, the nation’s only hospital specifi cally devoted to the comprehensive treatment of lymph-edema (LE) and breast reconstruction, she was among select specialists worldwide to perform Vascularized Lymph Node Transfer (VLNT), a complex microsur-gery that brings relief to LE patients.

“It’s an ingenious approach to lymph-edema,” said Massey, an internationally recognized oncologic reconstruction sur-geon who practices with The Center for Restorative Breast Surgery in New Or-leans, and is the founder of the Dr. Marga Practice Group, with clinics in Chicago, Charleston, SC, Salt Lake City, Utah, and New Orleans.

Three years ago, Massey co-founded the National Institute of Lymphology, a consortium of academic practitioners de-voted to valid clinical outcomes research in the fi eld of LE, with Scott Sullivan, MD, FACS, co-founder of The Center for Restorative Breast Surgery and the St. Charles Surgical Hospital.

“It’s been the holy grail of reconstruc-tive microsurgery to fi nd out what the answer to the puzzle is, to fi x (LE),” said Sullivan. Until VLNT, “there hasn’t been anything that’s worked defi nitively over the last 20 to 25 years.”

LE is a debilitating condition of local-ized fl uid retention prompted by a com-promised lymphatic system, which can occur immediately following cancer treat-ment or infection, or many years later. It affects more than 5 million Americans

and is most frequently seen after cancer treatments such as lymph node dissection and/or radiation therapy. Recently, the National Cancer Institute established that nearly half of node positive breast cancer patients with lymph node removal and ra-diation therapy develop lifestyle-limiting arm and/or trunk LE. The chronic prob-lem results in pain, decreased mobility, recurrent soft tissue infections, and some-times permanent disability. In many cases, LE causes chronic wounds and ulcers and breakdown of the skin.

Until VLNT, only conservative treat-ments such as massaging or compressing the affected area were available to LE pa-tients.

“It’s not a medical problem that many people talk about, mainly because these patients start hiding,” said Massey. “They start wearing large clothes. They don’t leave their house.”

LE is not only a physical problem; it’s an emotional problem, said Massey.

“Many of these patients have diffi -culty with depression and they lose them-selves in this disorder,” she said.

Because VLNT, the only surgical treatment for LE, is so new to the United States, with sparse surgical teams trained

to perform the complex microsurgery, many physicians aren’t yet aware of the medical breakthrough.

“Most of us are very cautious about offering new surgical interventions for patients,” said Massey. “Actually, our pa-tients fueled this (by) their sense of relief of this pressure and their ability to do more things in their lives and not be connected to a pump, and not necessarily have to go to their lymphedema therapist as often. They get their life back.”

Massey trained under Corinne Becker, MD, a Paris surgeon who’s per-formed more than 4,000 lymph node transfers worldwide in the treatment of both upper- and lower-extremity LE over the last two decades. Several years ago, Becker performed VLNT at Roper St. Francis in Charleston, SC, where Massey also performs the procedure.

Simply put, VLNT moves lymph nodes from one area of the body to an-other that’s affected by a blockage in the lymphatic vessels, relieving sufferers’ pain and discomfort and allowing them to re-sume their daily activities. Most insurers cover the procedure.

More specifi cally, the fi rst step of the demanding operation requires returning

to the site at which nodes were taken with-out damaging nerves. Because scarring is usually evident from previous surgeries, the surgeon must locate a small artery and vein in the location to transfer and set it into. Then tissue must be harvested from another part of the body without causing LE in that location. Those lymph nodes must be attached to a small vein. Because the artery in the vein typically measures approximately 8.8 millimeters, surgeons operate under a microscope to reattach the artery and veins.

Because the operation is only one key component for VLNT to be successful, the LE therapy team works in tandem with the surgical team. For example, immedi-ately before and after surgery, a trained LE therapist decongests and massages the affected limb without overwhelming the lymph nodes.

A physical therapist from Boulder, Co. who attended one of Massey’s semi-nars to educate the physical therapy com-munity about VLNT, discounted negative discussion about VLNT “taking a healthy node (and) cause LE somewhere else.”

“And while that’s very true, it’s the selection of the nodes from the donor site that’s crucial,” she said. “When treating axillary lymphedema, (Dr. Massey) uses a few nodes from the lower lateral aspect of the abdomen, not the groin. Using groin nodes will cause LE of the lower extrem-ity. But the nodes she uses are ones al-ready being removed by the DIEP (deep inferior epigastric perforator) procedure, when that fat is transferred to the breast. And none of the DIEP patients have lymphedema of the leg.”

A bonus for female LE patients un-dergoing VNLT, if it can be described as such, is “a tummy tuck along with your breast reconstruction,” said Massey.

Massey pointed out the signifi cant need for oncology patient education about LE.

“Lymphedema needs to be part of their education before surgery,” she said. “It may be a little much for them to take it all in, but if they have a basic educa-tional process should this condition de-velop years after their surgery, there are places to learn more about it and doctors who are very interested in taking care of lymphedema patients.”

A graduate of Duke Medical School, Massey has served as a visiting professor at Zagazig University in Egypt, and per-formed the fi rst DIEP fl ap breast recon-struction in their facility. She’s a research collaborator in one of the fi rst microsurgi-cal programs to seek a WHO Collabora-tion Center designation for the study of the surgical treatment of LE.

Relief for LymphedemaMarga Massey, MD, brings VLNT to Louisiana for lymphedema patients; initiates national campaign for validating clinical outcomes research for painful disorder

Because VLNT, the only surgical treatment for lymphedema is so new to the United States, with sparse surgical teams trained to perform the complex microsurgery, many physicians aren’t yet aware of the medical breakthrough.


Physicians’ health Foundation oF louisiana

Providing ass istance with the ident i f icat ion, t reatment, and monitoring of physicians who suffer from a physical or mental condition, in order to promote patient safety and to ensure the continued availabil ity of sk il led physicians

888-743-5747 www.phfl.org

By LINDA RODRIGUE AND LyN SAVOIE

Because the increasing prevalence of technology, mobile devices in the work-place and online health records, as well as the risk of making patient information more public, HIPAA, or the Health Insur-ance Portability and Accountability Act, recently instituted new safeguards and re-strictions. HIPAA was established in 1996 to safeguard protected health information.

In 2009, the United States Congress signed the Health Information Technology for Economic and Clinical Health Act into law to promote the proper use of health information technologies. The HITECH Act works to ensure healthcare providers learn the proper methods and are given the resources to transmit Electronic Health Records of patients.

The new “Final Rule,” effective on March 26, 2013, through the HITECH Act added several changes to the privacy and security policies in HIPAA. Of the many additions and regulations enacted by this new rule, three carry the most weight: new Business Associate Agreements; new breach notification rules and enforcement; and new notice of privacy practices re-quirements.

A business associate, as it pertains to the new rule, is any person or entity who creates, receives, maintains or transmits protected health information (PHI) for a covered function or activity, or provides other work that requires them to use or disclose PHI. Under new regulations, this now includes subcontractors, requiring covered entities to make new agreements with their business associates and the busi-ness associates to make agreements with their subcontractors.

Simply speaking, anyone who touches medical records may need to sign a new agreement. There’s a single exception – if a business associate agreement was made prior to March 26, 2013, the contracts can be used until they expire or on Sept. 23,

2014, whichever comes first.New, stricter rules addressing breach

notification have gone into effect, transfer-ring the burden of proof to covered enti-ties and business associates. Previously, covered entities were not presumed to have breached unless a significant risk was present. Now, all entities have to prove there was no compromise of PHI based on a thorough risk assessment. Three ex-ceptions to breaches have also been main-tained – an entity is not held accountable if an in-house use was unintentional; if PHI was disclosed to an unauthorized person under the assumption they won’t retain the information, or if one authorized per-son inadvertently discloses the information to another authorized person in-house.

Finally, healthcare privacy has evolved dramatically since HIPAA was first signed into effect, and updated regu-lations require entities to address these changes. Staffs should be retrained on PHI, how to use a mobile device in the work environment and protecting shared data. Regulations also strongly recom-mend entities preemptively address the use of social media. Health care provid-ers must also give a notice explaining to the patient how they can use and share their health information and how they can exercise their health privacy rights; the notice must explain how they use and disclose PHI, as well as the fact that the en-tity must get a patient’s permission before using their health records for various uses or disclosures.

The task of staying compliant with HIPAA policy changes is evolving as quickly as the medical field itself, and the rise of mobile technology has only served to increase complications. But becoming and staying compliant should be a huge priority for businesses and individuals, to prevent significant public perception and financial losses.

The Evolution of HIPAA Compliance

Linda Rodrigue is a partner with Kean Miller, LLP in Baton Rouge. Lyn Savoie is an associate at the same location.

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Health Law Symposium

24th Annual Louisiana Society of Hospital Attorneys

The Health Law Symposium is the most comprehensive program for healthcare law practitioners featuring materials on important health law topics from leading experts. Come participate in the sessions, join in on the Q&A with the dynamic faculty, and network with colleagues to discuss the most relevant issues facing healthcare law practitioners.

November 6-7, 2013 Louisiana Hospital Association

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Visit www.LHAonline.org or call (225) 928-0026 for more information.

By cINDy SANDERS

What if a simple blood test could pro-vide information that your patient had a significantly elevated risk of developing diabetes within the next decade? What might that mean from the standpoint of early intervention and prevention? While it’s much too soon for this type of clinical application, researchers at the Vander-bilt Heart and Vascular Institute (VHVI) and Massachusetts General Hospital have identified a novel biomarker that lends it-self to such intriguing questions.

Led by Thomas J. Wang, MD, di-rector of the Division of Cardiovascular

Medicine at Vanderbilt and physician-in-chief for VHVI, the team recently published results of their discovery of elevated 2-aminoad-ipic acid (2-AAA) as a precursor to diabetes in The Journal of Clinical Investigation. Tapping into the rich data source of the Framingham Heart Study, which is now following its third generation of participants, the Wang research team studied blood samples gath-ered more than a decade ago from 188 in-dividuals who ultimately developed type

2 diabetes and 188 who did not develop diabetes.

Using these blood samples, the in-vestigators were able to compare levels of metabolites to see if there were any differ-ences between the group that went on to develop diabetes and the group who did not. Wang noted newer technology now makes it possible to profile hundreds of metabolites at one time.

“One of the things that really lit up when we looked at the people who devel-oped diabetes was 2-aminoadipic acid,” he said. “Having elevated levels of 2-AAA predicted risk above and beyond their blood sugar at baseline, their body weight, or other characteristics that put them at risk.” Wang added there doesn’t appear to be a specific threshold of risk at this point … the higher the levels of 2-AAA, the higher the risk of developing diabetes. In fact, those in the top quartile of 2-AAA concentrations had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared to those in the lowest quartile.

Interestingly, the researchers found 2-AAA might not be just a passive marker. As part of the same study, the team con-ducted mouse model testing and discov-ered giving 2-AAA to the mice actually

altered the way the animals metabolized glucose.

“It suggests the molecules might be playing a direct role in how the body pro-cesses glucose rather than being an inno-cent bystander in the process,” Wang said. He added that elevated levels of 2-AAA don’t necessarily mean the molecule is bad for the body. Instead, it could be a defense mechanism where the body is producing higher levels to fight risk from another, as yet unknown, source.

Figuring out the metabolite’s exact role in the functioning of pancreatic cells is one area for future research. If, indeed, 2-AAA turns out to be a defense mecha-nism to stave off diabetes, the good news is that the metabolite could be given to humans in the form of nutritional supple-ments. On the other hand, if 2-AAA turns out to be harmful to the body’s glucose regulation system, further research could reveal methods to lower the metabolite’s presence.

Wang was quick to say the next step is to conduct additional research to mea-sure 2-AAA in other human populations outside of the Framingham study through both retrospective and prospective stud-ies. More in depth animal model studies

Early Warning System: Researchers Identify Diabetes Risk Biomarker

Dr. Thomas J. Wang

DIABETES



Frank Courmier, MDPulmonology/Critical Care

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We know you want more options when it comes to your healthcare. Lourdes Physician Group welcomes one of our newest doctors, Frank Courmier, MD, who will bring his pulmonology and critical care expertise to the Acadiana community. Dr. Courmier completed his Fellowship training at Scott & White Memorial Hospital at Texas A&M Health Science Center in Temple, Texas. He is board certified and has joined the practice of long-time Lafayette physician, Dr. Richard H. Fei.

Now accepting new patients

Even More Specialized Care to AcadianaWe’re Proud to Offer

By LyNNE JETER

As another dismal economic year draws to a close, addiction and substance abuse clinics are gearing up for an influx of patients.

“We say in our business that the drinking season begins at Thanksgiving and ends on Super Bowl Sunday,” said Percy Menzies, M. Pharm., founder of Assisted Re-covery Centers of Amer-ica (ARCA), based in St. Louis, Mo. “We opened in February and just re-cently had to turn away patients for the first time. It’s that busy. We’re also dealing with a huge iatrogenic epidemic of addiction to prescription pain drugs. For the first time, more people have died of drug overdose than automobile accidents. Heroin has become the cheap ‘generic’ form of opi-oid pain killers.”

Despite the revolving door headlines about celebrities frequenting rehab clin-ics, addiction medicine remains one of the most underfunded diseases in the United States. According to a 2012 report pub-lished by The National Center on Addic-tion and Substance Abuse at Columbia University (CASA Columbia), “Addiction Medicine: Closing the Gap between Sci-ence and Practice,” 15.9 percent (40.3 million) of Americans have the disease of addiction. That’s more than heart condi-tions (27 million), diabetes (25.8 million) or cancer (19.4 million). Even though one in five deaths is attributable to tobacco, al-cohol and other drug use, the U.S. spent $107 billion to treat heart conditions, $86.6 billion to treat cancer, and $43.8 billion to treat diabetes in 2010. But only $28 billion was spent on addiction treat-ment.

Another eye-opening statistic: Of every dollar spent by federal, state and local governments on risky substance use and addiction, 95.6 cents pay for conse-quences; only 1.9 cents go to prevention and treatment.

Genetic predisposition, structural/functional brain vulnerabilities, psycho-logical and environmental influences are clear risk factors for addiction, as is the age of first use. Ninety-seven percent of addiction cases start with substance abuse before the age of 21, while the brain is still developing. As a result of all risk factors, one-third of the population over the age of 12 is susceptible to substance abuse.

“This clearly articulates the monu-mental challenge ahead of us,” said Menzies, who left an executive role with DuPont Pharmaceuticals to open ARCA’s first integrated outpatient clinic in 2001, and in early 2013, a 25-bed residential substance abuse clinic. He’s on a cam-paign to move addiction into the main-stream of medicine.

“For too long,” he said, “we’ve been

on the outside of the margins.”

Addiction Medicine ChallengesVarious factors keep addiction and

substance abuse programs in the shad-ows of medicine: the professional stigma that makes it difficult to recruit healthcare providers, the social stigma that pervades society and the field of addiction medicine, misconceptions among other healthcare providers, and the often unbalanced mix of medications and treatment.

“When I give talks to medical school students, and ask who wants to specialize in addiction medicine, not one hand goes up,” said Menzies, noting that of 985,375 active physicians nationwide, only 1,200 are practicing addiction medicine spe-

cialists and 355 are practicing addiction psychiatrists. “They don’t see it as a very lucrative business.”

The report also noted a significant differential in requirements for addiction counselors by state. Only one state has a minimum requirement of a master’s de-gree, six states require an undergraduate degree, and 10 states require an associ-ate’s degree. Fourteen states require only a high school degree or GED equivalent, six states have no minimum degree require-ments, and 14 states don’t require any licensure or certification. Only 10 states mandate a physician as a medical director or staff member of residential treatment programs.

“The majority of people who work in

addiction treatment are in recovery and lost everything to their addiction and want to give back to society,” he said. “Part of the challenge is that they come with their own baggage. Being in recovery doesn’t make them an expert. That’s one of the major obstacles we face in this field.”

Menzies, who is not in recovery, recalled how his relatives – many are healthcare professionals – questioned his decision to move into addiction medicine.

“Others ask me if my practice failed, because they believe no self-respecting healthcare professional would go into this field voluntarily,” he said, with a chuckle.

The social stigma of the disease exac-erbates misconceptions of addiction.

Managing AddictionsAddiction medicine professionals prepare for ‘busy season’

Dr. Percy Menzies



said. The estimates are all over the place.The Institute of Medicine estimates

that 27 percent of the $2.5 trillion the United States spends each year on health-care goes for unnecessary care.

This includes overuse, or treatment that goes beyond evidence-based levels; and discretionary use, care the patient could do without but the doctor chooses to provide.

In 2002, the U.S. Department of Health and Human Services estimated de-fensive medicine costs at $60 billion to $108 billion a year. In 2009, the Congressional Budget Office estimated defensive medi-cine cost around $11 billion a year.

“The conventional wisdom on defen-sive medicine is that it’s a fraction of total healthcare spending,” White said. “The conventional wisdom says it makes more sense to reform the system and get rid of the incentives for overuse, and that some federal healthcare reform could reduce medical professional liability costs.”

However, when physicians have a much different viewpoint about defensive medicine, that upends conventional wis-dom.

Jackson Healthcare’s 2011 survey of 3,000 physicians estimated the cost of defen-sive medicine at $650 billion to $850 billion, or one-fourth to one-third of all healthcare spending. The survey asked physicians if they had practiced defensive medicine in the last year; 92 percent said yes.

A Rand Corp. analysis of nearly 41,000 physicians covered by one insurer found that in a 40-year career, the average physician spends about 50 months with an unresolved malpractice claim.

Concern over defensive medicine and rapidly rising costs have prompted health-care experts, physicians and politicians to call for malpractice reforms. The proposed solutions include capping non-economic damage awards.

“A 2010 study done for the Medicare Payment Advisory Committee looked at

malpractice reforms’ impact on every area, from malpractice claims frequency and costs and defensive medicine to health-care providers’ liability costs and quality of care,” White said.

The study found reforms had little effect on those areas, with one exception: capping noneconomic damages.

In addition to the predictable benefits, such as lower malpractice awards and med-ical professional liability premiums, cap-ping noneconomic damages correlated to a reduction in the cost of defensive medicine, a reduction in overall spending on health-care and a modest increase in the number of physicians in states with these caps.

So, is there a “silver bullet” for mal-practice reform?

“I’m not sure. But we can make the case if there is one; the only evidence we have right now is noneconomic damages,” White said.

“When the Rand Corp. completes its review of the HHS demonstration projects

for malpractice reform, physicians and the country will have a better idea of what works best,” he said.

Meanwhile, as if physicians didn’t have enough to worry about with the Af-fordable Care Act, the American Medical Association is suggesting that the new regu-latory structures could actually create new causes of action for malpractice lawsuits according to White. The AMA-backed Standard of Care Protection Act of 2013 has been introduced in the U.S. House of Representatives, and Georgia has actually passed a version.

The proposed law would protect phy-sicians and other healthcare providers from liability lawsuits resulting from national care and practice standards or guidelines detailed in the ACA.

The AMA says doctors shouldn’t have to worry about new causes of action or li-ability exposure in an age of developing and implementing new ways to improve the quality and efficiency of care.

Liability Reforms and Standard of Care Could Reduce Costs, continued from page 1

“If you go to your physician and say, ‘doc, I’m drinking too much,’ he’s likely to say ‘stop drinking’ and maybe advise you to go to AA,” he said. “If you go to a psy-chiatrist and say, ‘I’m drinking too much,’ he’s likely to say, ‘you’re depressed. Let me give you an anti-depressant.’ If you go to your pastor and say, ‘I’m into drugs and alcohol,’ he may say, ‘you should come to church more often.’ My goal is to treat addiction like any other chronic medical condition, such as diabetes or asthma, through the right combination of medi-cations, counseling, behavioral therapies, and psychiatric care.”

Drug Intervention ChallengesIronically, drug and alcohol treat-

ment has a dark and checkered history, noted Menzies.

“Highly dangerous and addicting drugs were touted as ‘cures.’ This has re-sulted in a very unhealthy segmentation of treatment,” he explained. “Only a small percentage of alcoholics are treated with medications, but addiction to opioids is predominantly treated with addicting and abusable drugs like methadone and buprenorphine, which adds to the stigma and deters many physicians from getting into this field.”

Nearly 35 years ago, the federal government developed naltrexone as the first non-addicting medication to prevent detoxed heroin addicts from relapsing, added Menzies.

“DuPont introduced this medication in 1984; in 1994, the same medication was approved for the treatment of alco-

holism,” he said. “Naltrexone faced op-position from many treatment providers and the practical challenge of medication compliance.” Vivitrol, a monthly injection of naltrexone, was introduced in 2006 but has yet to gain significant use.

“It’s an amazing medication to pre-vent relapse to alcohol or opioid use, but there’s so much opposition to it,” he said. “It gives patients a fighting chance of not relapsing when they return home to the familiar environment of past drug and al-cohol use. The true test of any treatment program is how well patients do when they return home. Vivitrol is a potent tool to keep patients engaged in long-term treatment.”

Improving the EnvironmentIn 1956, the American Medical As-

sociation (AMA) referred to alcoholism as an illness that should be treated within the medical profession. In 1989, the AMA adopted a policy naming addiction as a disease. Yet less than 6 percent of referrals to publically-funded addiction treatment emanates from healthcare providers.

Addressing the education, training and accountability gap is paramount to moving addiction medicine into the main-stream. Among the report’s next-step rec-ommendations, improved screening and assessment tools need to be developed, national accreditation standards for all ad-diction treatment facilities and programs that reflect evidence-based care need to be established, addiction medicine work-force needs to be expanded, addiction treatment facilities should be licensed as healthcare providers, and research and data collection to improve and track prog-ress and search for a cure needs a financial shot in the arm.

“The stigma of addiction,” said Men-zies, “can only be removed with better outcomes.”

Managing Addictions, continued from page 11

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SOLUTIONS

By LyNNE JETER

Editor’s note: The Solutions series is a new feature of Medical News, focusing on innovative answers to the growing chasm between the number of medical graduates and residency slots.

TAMPA, FLA. – While the gap be-tween medical graduates and the number of residency slots nationwide continues to challenge industry leaders, the University of South Florida (USF) Health Morsani College of Medicine (COM) is bucking the trend. Within the next couple of years, the number of residency slots will nearly double to 1,400.

“We have one of the nation’s largest distributive residency programs, with 730 USF residents at seven sites, and a pro-posal to add another 700 residents,” for-mer USF Health CEO Stephen Klasko, MD, also former dean of the Morsani COM, said before he left the school in Au-gust to become the first executive selected to head both Thomas Jefferson University and the TJUH System in his home state of Pennsylvania. Klasko significantly contrib-uted to the medical school infrastructure expansion, allowing meaningful strategic growth of the residency program.

The ambitious plan fits the distribu-tive model, allowing USF Health Morsani COM the ability to sponsor or participate in residency programs as “civilians,” ex-plained Charles Paidas, MD, vice dean for clinical affairs and GME for the USF Health Morsani COM.

“We’re offering a shopping list of educational and research initiatives that are required for GME certification,” said Paidas, noting that Naples Community Hospital in Naples, located more than 150 miles away, represents the school’s most recent affiliate addition, and that a pact for other affiliations is in the works.

When Paidas, the plan’s architect, be-came associate dean for GME in 2009 after five years with the school, the residency program faced governance and operation issues that required improved oversight. He assembled a strategic committee that allowed the school to garner impeccable institutional review commendations from the Accreditation Council for Graduate Medical Education (ACGME). In 2011, he was promoted to his current post.

At the suggestion of USF medical students, Paidas also brought together As-sociation of American Medical Colleges (AAMC) executives, GME leaders and medical school deans to the USF Health

GME Summit last year. The well attended event “begs the

issue of a replay this year,” he said. “Our goal was to characterize the state of GME in Florida. For example, the average num-ber of residents per 100,000 population in the U.S. is 35.9. Florida’s at 17.5. That’s a raw data point that tells you we need to double the workforce. That translates to 2,900 residency slots in the state.”

Boosting the number of residency slots also improves the chances of keeping new doctors in Florida.

“Florida had nearly a 59.6 percent retention rate of residents who com-plete their training and stay here,” noted Paidas. “The mantra around the country is: wherever you do your residency – not where you attended medical school – is likely where you’ll practice. USF pushes that to 68 percent.”

Of 128 total first-year resident slots, USF Health Morsani College of Medicine placed medical graduates in the following specialties, according to the National Resi-dent Match Program:

Dermatology: 4

Emergency Medicine: 10

Family Medicine: 8

Internal Medicine: 29

Medical-Preliminary/Ophthalmology: 1

Neurological Surgery: 2

Neurology: 5

Obstetrics-Gynecology: 5

Orthopedic Surgery: 4

Otolaryngology: 3

Pathology: 4

Pediatrics: 15

Physical Medicine & Rehabilitation: 2

Plastic Surgery (integrated) 3

Psychiatry: 8

Radiology-Diagnostic: 8

Radiation Oncology: 1

General Surgery: 6

Surgery-Preliminary: 2

Surgery-Preliminary/Urology: 3

Vascular Surgery: 2

Medicine-Pediatrics: 3

“This past year, we matched all 128 first-year slots in the first round of Match,” said Paidas. “We haven’t done that in 20 years!”

Doubling Residency Slots USF Health Morsani COM hosts one of the nation’s largest distributive residency programs; maintains high retention rate of new doctors


are also in the pipeline. “A lot of the effort will be focused on trying to understand the biologic effect of 2-AAA in developing dia-betes,” he said of the work going forward.

However, Wang said the current re-search results at least raise the possibility that somewhere in the future knowing how high a person’s circulating 2-AAA levels are could impact clinical practice by allowing providers to adopt a more ag-gressive intervention posture among those at highest risk, whether that be through exercise, weight loss or pharmacologic measures. It is conceivable that 2-AAA might be the type of red fl ag for diabetes that high cholesterol is for heart disease.

“Understanding why diabetes occurs and how it might be prevented is a very intense area of investigation because of the serious consequences of having the disease,” Wang said. “Down the road, this might be one part of the armamen-tarium of tests that could be considered. If this were proven useful in further studies and could be used clinically, it would be an easy test to administer.”

As for the impact of the fi ndings right now, Wang added, “In 2013, it highlights a specifi c pathway that might be related to diabetes risk that we previously didn’t know about.”

Considering the prevalence of type 2 diabetes and growing obesity epidemic in the United States, that is an important lead for researchers working to develop strategies to interrupt the disease progres-sion and stop risk from becoming a reality.



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13271 ANG_LA Medical News_7.4375x5.5.indd 1 9/24/13 10:56 AM

Lafayette General Health announces affi liation agreement with Bunkie General Hospital

LAFAYETTE – Lafayette General Health (LGH) and Bunkie General Hospi-tal (BGH) are proud to announce their re-cent clinical affi liation in order to provide the highest quality of care to the residents of Avoyelles Parish. The goal of the part-nership is to expand patient services in BGH’s service area, with both organiza-tions working cooperatively to provide “best practice” medical care.

“As health care has evolved with more advanced equipment and highly special-ized care, hospitals realize that they can-not work alone and be successful,” said President and CEO of LGH, David L. Cal-lecod, FACHE. “Within LGH, our goal is to establish relationships with area hospi-tals and health care providers to improve patient outcomes. By sharing informa-tion and resources between our facili-ties, we can reduce variation in how care is delivered. Studies show that treating patients – whether at BGH or at another LGH hospital – according to best practice guidelines, improves the overall quality of medical care.”

Under the arrangement, LGH and BGH hospital leaders will consult and cor-respond on medical and technical issues. This affi liation facilitates more optimiza-tion of patient information technology and assists providers across the systems.

BGH CEO Linda Deville says the market for health care services is get-ting more complex, particularly for rural hospitals. “Increases in competition and diminishing resources require us to de-velop strategies to compete effectively. We can do this through service integra-tion with a large, well-known institution

like LGH,” she says.Both CEO’s agree that a closer rela-

tionship between hospitals will benefi t patients most. LGH will work with BGH to provide employee and medical staff edu-cation and boost primary and specialty physician needs in Avoyelles Parish.

Deville says the assistance of LGH will permit BGH to remain an independent, critical access care hospital while improv-ing hospital performance and employee morale. BGH is not selling or leasing any part of its 25-licensed bed critical access hospital to LGH. “Ultimately, BGH will continue to be able to provide the high-est quality and most cost-effective pa-tient services available,” she says.

Oleana Lamendola, MD, Joins Baton Rouge General Physicians

BATON ROUGE- Oleana Lamendola, MD, has joined Baton Rouge General Physicians.

A Louisiana native, Dr. Lamendola is a graduate of Louisiana State University Health Sciences Center in New Orleans. She complet-ed her residency in internal medicine at Earl K. Long Medical Center in Baton Rouge, and completed her fellowship in gastroenterology and hepa-tology at the University of South Florida in Tampa. Dr. Lamendola is a member of the American College of Gastroenterology.

Dr. Lamendola joins Drs. Shaban Fa-ruqui, Paul McNeely and Alan Sonsky at Baton Rouge General Gastroenterology Center located at 6615 Perkins Road in Baton Rouge.

Dr. Oleana Lamendola

Early Warning, continued from page 10


01MK5518 10/13

In the News

Ochsner COO Named To Modern Healthcare’s ‘Up & Comers’ List

NEW ORLEANS – Beth Walker, Chief Operating Offi cer of Ochsner Medical Center, was recently named to Modern Healthcare’s 2013 “Up & Comers” list. Only 12 people in the country were named to this list which honors rising young stars in the healthcare manage-ment fi eld.

Walker began her ca-reer at Ochsner in 2002 as an administra-tive fellow. Over the past 11 years, she has served in various roles, from manager of internal medicine to vice president of operations for women’s and children’s ser-vices

Walker is profi led in the September 23, 2013 issue of Modern Healthcare and on ModernHealthcare.com. The list fea-tures men and women under age 40 who have made signifi cant contributions in healthcare administration, management or policy.

Lake Charles Physician Appointed to National Medical Advisory Panel

LAKE CHARLES- Timothy Gilbert, M.D., local endocrinologist with the En-docrinology Center of SWLA, an affi liate of Imperial Health, is one of six physicians from across the United States selected to serve on a National Advi-sory and Education Panel focused on instructing En-docrinologists and other medical professionals re-garding the utilization of insulin pumps/artifi cial pancreas, continuous glu-cose sensors and other diabetes related technology. The project is sponsored by the Medtronic Diabetes Division, the world leader in insulin pump therapy and related technology.

Gilbert, a Lake Charles native and McNeese State University graduate, spe-cializes in the treatment of endocrine dis-eases and disorders. Dr. Gilbert received his Doctor of Medicine at Louisiana State University School of Medicine in New Or-leans, Louisiana. He went on to complete a residency in Internal Medicine at LSU Health Science Center in Baton Rouge, Louisiana, followed by an Endocrinology and Metabolism fellowship at Ochsner Health Systems in New Orleans, Louisi-ana

Dr. Gilbert has been in private prac-tice for 7 years and currently manages over 500 insulin pump patients.

Dr. Paul Rachal Louisiana Family Practice Doctor of the Year

BATON ROUGE– Our Lady of the Lake Physician Group congratulates Dr. Paul Rachal for his selection by the Loui-siana Academy of Family Practice as Loui-siana Family Practice Doctor of the Year.

The Louisiana Academy of Family Physicians (LAFP) recognized Dr. Rachal as its 2013 LAFP Family Physician of the Year during the annual Awards and Instal-lation Ceremony held in New Orleans, LA in August. This award recognizes Dr. Rachal’s years of service to his patients, his dedication to Family Medicine and his

contributions to developing and improv-ing the profession for future physicians and their patients. Letters of endorse-ment were received from patients, col-leagues and friends who have known Dr. Rachal for numerous years, where he has been delivering health care to the State of Louisiana.

Dr. Rachal received his medical de-gree from Louisiana State Medical School in New Orleans. He completed a Family Practice residency at Earl K. Long Medi-cal Center in Baton Rouge and Ochsner Clinic of Baton Rouge. Dr. Rachal is a preceptor for Tulane University Medical

students as well as Our Lady of the Lake College Physician Assistant students. He is a member of the Louisiana Academy of Family Physicians and the American Academy of Family Physicians. He prac-tices at Our Lady of the Lake Physician Group Family Practice of New Roads.

With more than 300 healthcare pro-viders, Our Lady of the Lake Physician Group is one of the area’s largest physi-cian networks covering more than 40 lo-cations. For more information about Our Lady of the Lake Physician Group, visit ololphysiciangroup.com.

Beth Walker

Dr. Timothy Gilbert

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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Louisiana Medical News Nov 2013