Louisiana Medical News November 2014

SOUTH LOUISIANA EDITION

yOUR PRIMARy SOURCE FOR PROFESSIONAL HEALTHCARE NEWS

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On Rounds

Read Louisiana Medical News online at www.louisianamedicalnews.com

NOVEMBER 2014 / $5

Providers Push for Budget Protection

Dr. Susan ConwayA dog’s life

While training as a reproductive endocrinologist in Vermont, Dr. Susan Conway became the third owner of a yellow Labrador Retriever, Jake ... page 3

Hospitals Drive Local, State EconomiesLouisiana’s 207 hospitals help drive the state’s economy, employing more than 98,000 people and generating an economic impact of nearly $30 billion ... page 4

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

When Cherie Sibley was a teenager, she spent a great deal of time in the hospital with her terminally ill grandfather ... page 5

Physician Spotlight

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By CINDy SANDERS

A little more than a year ago, the American Medical Association an-nounced $11 million in grants to 11 academic medical centers to fundamen-tally change the way physicians are educated and trained.

“There has been a universal call to transform the teaching of medicine to shift the focus of education toward real-world practice and competency assessment, which is why the AMA launched the Accelerating Change in Medical Education initiative,” AMA President Robert M. Wah said in a statement. “Over the last year, we have made signifi cant progress in trans-forming curriculum at these medical schools that can and will help close the gaps that currently exist between how medical students are trained and the

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


By TED GRIGGS

Roughly three years ago, amid yet another state budget crisis and the ac-companying Medicaid funding cuts, members of the Louisiana Hos-pital Association began talking about fi nding a long-term funding solu-tion for the program.

The conversation eventually boiled down to two questions, LHA President and Chief Executive Offi cer Paul Salles said. Is there anything the industry can do to help stabilize Medicaid funding? And how do hospitals continue to provide the services nec-essary to people in the Medicaid program as well as those without insurance?

The result of those conversations can be found on the Nov. 4 ballot in proposed Constitutional Amend-ments No. 1 and No. 2.

The fi rst sets a minimum level for Medicaid payments to nursing homes, pharmacies and facilities that serve the disabled. The second allows hospitals to pool their money and use it to draw down federal Medicaid dollars. It would also pre-vent the government from making cuts targeted specifi cally to hospitals.

“What we’re trying to do with the constitutional amendment is take the fi rst step in setting up a structure similar to what 40 other states have

done,” Salles said.Louisiana is one of 10 states that

doesn’t use provider assessments to stabilize Medicaid rates for hospitals, according to the LHA.

HEALTH EDUCATION

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

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By LISA HANCHEy

While training as a reproductive en-docrinologist in Vermont, Dr. Susan Con-way became the third owner of a yellow Labrador Retriever, Jake. “He had come from a breeder who was known for beauti-ful but very active dogs,” she recalled. At the time, she had a Dachshund, Peanut, who was paraplegic and confi ned to a dog-gie wheelchair. “They basically got me through my medical training,” she said.

Reared in suburban Los Angeles, Calif., Conway relocated with her family to Virginia, where she obtained a degree in medical technology at the Medical Col-lege of Virginia. Afterwards, she went to graduate school at Emory University in Atlanta where she completed two cur-rent master’s degrees in public health with a concentration in infectious disease epidemiology and medical science with a concentration in clinical microbiol-ogy. Then, she decided to go to medical school. “When I was going through medi-cal school, I thought I would either do infectious disease epidemiology or go into reproductive endocrinology and infertility, because I thought my skill set would help me be valuable in either situation,” she explained. “And the only decision-making point for me then was whether or not I was going to like the operating room.”

During her third year at Emory’s School of Medicine, her fi rst rotation was in internal medicine with an attending in-fectious disease specialist. “I ended up in-troducing him to the woman he married,” she recalled. Her last rotation in obstet-rics/gynecology cinched her career path. “My fi rst day, I knew,” she said. For OB/GYN residency training, Conway went to the University of New Mexico in Albu-querque, followed by fellowship training at the University of Vermont College of Medicine in reproductive endocrinology. During her fellowship, she met Dr. John Storment, who was a year ahead of her. “We kind of bonded then,” she recalled.

Following her fellowship, Conway re-turned to Albuquerque to practice. A year later, Peanut passed away at age 16. “It was Jake and me for the longest time,” she said.

After practicing in Seattle for a few years, Conway returned to Atlanta. Once Jake died in 2007, Conway tried to live a dog-free lifestyle. “I hated it,” she recalled. “I didn’t like going home in the evening.”

Conway decided to adopt a three-year-old Lab through the Atlanta Dog Squad (ADS), a retriever rescue agency. “I called him Scout, and he was awesome,” she said. “I’ll never get that lucky again. He was one of those really naturally well-behaved dogs. He never barked. Ever. All he wanted to do was chase that tennis ball.”

Two years later, Scout succumbed to

a spinal tumor. “It was devastating,” she recalled. “After Jake died, I went three months without a dog. After Scout died, I went two weeks.”

Conway returned to ADS and came back with Molly, a Feist. “She’s been the hardest dog I’ve ever had,” she said.

At that point, Conway became a volunteer for ADS. “I felt like because it had been so rewarding with both Jake and Scout as part of the rescue adoption process, I needed to give something back,” she explained.

Over the last two years, Conway upped her involvement with ADS, pick-ing up dogs at different shelters, process-ing adoption applications and performing home visits. She adopted a companion for Molly, a yellow Lab/Beagle mix named Hannah. Eventually, Conway became involved in dog foster parenting, adding two smaller dogs – Petey, a Chihuahua/French Bulldog mix, and Kenzie, a Chi-huahua/Jack Russell Terrier mix.

Since training in Vermont, Conway had kept in touch with Storment, who practices at FertilityAnswers in Lafayette, La. On June 2, she moved to Louisiana to join Storment’s group. “It’s been really nice to work with somebody I respect, and who has a very similar treatment philoso-phy,” she said. “It’s been a really good fi t. We are both open to new ideas and in-novations in this fi eld, but we are also very practical-minded. It’s about providing good care that’s individualized, evidence-based and safe. And that’s what’s impor-tant to me.”

At FertilityAnswers, Conway special-izes in the diagnosis and treatment of in-fertility and female reproductive disorders, including in vitro fertilization, intrauterine insemination, tubal reversal surgery, uter-ine fi broids and endometriosis. “I’m doing general infertility, ranging in anything from diagnosis up to cutting-edge fertility treatments,” she explained.

When relocating to Lafayette, Conway temporarily left the smaller canines with another foster dog parent in Atlanta. “I joked that Petey and Kenzie were at Miss Jen’s Summer Camp for Wayward Waifs,” she recalled with a laugh. The dogs were reunited when Conway found a home in

Lafayette a couple of months later.Now that Conway and her pack are

settled in, she indulges in other hobbies in-cluding gardening, cooking, knitting and documentary watching, and is a Harry Potter afi cionado. But, she intends to stay focused on dog rescue and foster parent-ing. “It is important to consider a rescue dog, whether it is from a group that fo-cuses on particular breeds/types or from shelters,” she said. “The vast majority of these dogs have been discarded as though they are trash through no fault of their own. Their problems are usually human in origin, ranging from someone losing their home or becoming ill or even to an unwillingness to train a dog once it has passed its ‘cute puppy phase’ and is now a young, energetic adult. Each dog has a distinct personality and it has been so gratifying to help them fi nd homes. I think there is a role for purebred dogs selected and purchased from a reputable breeder who is careful with placement. Too often, however, dogs are bred to make ‘cute pup-pies’ who sell well to often cavalier own-ers – then end up in rescue. I got involved because I couldn’t stand to not help.”

Physician Spotlight

Dr. Susan ConwayA dog’s life

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By TED GRIGGS

Louisiana’s 207 hospitals help drive the state’s economy, employing more than 98,000 people and generating an economic impact of nearly $30 billion.

Those figures are included in a Loui-siana Hospital Association-funded report, Hospitals and the Louisi-ana Economy, 2014. The report, authored by LSU economist James Rich-ardson, is the fourth the LHA has published since 2007.

“Hospitals really play a dual role, not only pro-viding critical services to the community, but they are also important to the employment base of the community and important to the economic viability of a community,” said Paul Salles, LHA president and chief ex-ecutive officer.

Hospitals account for roughly 35 per-cent of the state’s healthcare jobs but more than 42 percent of the total healthcare sec-tor payroll, the report shows.

Nationwide, hospitals employ nearly 5.6 million people and support nearly $2.5 trillion in economic activity, according to the American Hospital Association.

Salles said the LHA is using its most recent report to help bolster support for a state constitutional amendment that will help protect hospitals from Medicaid fund-ing cuts. Under the amendment, the state would not be allowed to make budget cuts specifically targeting hospitals. In addition, hospitals could pool their money and use it to draw down federal Medicaid dollars.

For every 38 cents Louisiana spends on the Medicaid program, the state gets approximately 62 cents from the federal government, according to the report. Med-icaid-related hospital expenditures create and support more than 48,000 jobs, and generate more than $137.5 million in state tax collections and $117.8 million in local tax collections.

However, the state’s reliance on Med-icaid funding leaves Louisiana’s hospitals vulnerable to budget cuts. According to Richardson’s report, if Louisiana reduces its direct expenditures for Medicaid by $150 million, the state would lose an ad-ditional $245 million of federal dollars.

The overall result is a reduction of $395 million in state funds; a loss of ap-proximately 8,144 jobs statewide; and a reduction in personal earnings of $329 million, the report says. In addition, over-all business transactions would plummet by $800 million.

Salles said the continual budget cuts – hospitals have seen $260 million in Medicaid payment cuts since 2009 – hurt hospitals, workers, patients and the state’s economy.

The LHA and its members are cam-paigning to get voters to support Constitu-tional Amendment 2 in the Nov. 4 election. The hospitals are pitching the amendment as a move to protect vital healthcare ser-vices and jobs.

Critics say the amendment will further restrict the state’s ability to balance its bud-get by leaving only higher education fund-ing unprotected by the Constitution.

The report also includes the results of the 2014 LHA Annual Hospital Survey about the effects of current market condi-tions on hospitals.

Of the members surveyed, 80 percent had seen an increase in emergency room vis-its for uninsured patients, while 75 percent had seen lower patient account collections.

In order to cope, hospitals have made or are considering cost-cutting moves, the report shows.

Sixty percent of the hospitals surveyed have reduced patient services while 33 per-cent are considering doing so, the report says. Some 31 percent have eliminated va-cant positions and 35 percent are consider-ing it.

In addition, 13 percent have reduced community benefit programs and 16 per-cent are considering doing so, the report says. Meanwhile, 9 percent halted con-struction, equipment purchases and other projects while 20 percent of the hospitals surveyed are considering those steps.

Salles said the economic report is an important reminder to voters of the services that community hospitals provide, as well as their importance to the community from an economic perspective.

For example, in 2012 and 2013, the state’s hospitals undertook an average of $870 million worth of capital projects, the report shows. This level of capital spending created or supported close to 15,000 jobs, personal earnings of $583 million, and state and local tax collections of $78 million.

The state’s hospitals annual direct spending is estimated at $14.1 billion, the report shows. These expenditures create and support 294,548 jobs in Louisiana, with personal earnings of almost $12 billion per year and state and local tax collections of approximately $1.6 billion per year

Basically, hospitals also create a lot of high-paying jobs and employ well-educated workforces, Salles said. Both those things are vital to communities, and the impact is especially strong in the state’s rural areas.

In rural communities, hospitals are usually one of the top two or three employ-ers, Salles said.

Louisiana’s 35 rural parishes make up the second-largest healthcare market in terms of employees, the report shows.

The rural parishes also have about 18,000 hospital employees, or about 18 per-cent of all hospital workers in Louisiana. The hospital payroll in the rural parishes make up about 16 percent of the statewide payroll.

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By LyNNE JETER

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

“I always appreciated the nurses, the great job they did, and the difference they made with my grandfather’s care and well-being,” said Sibley, CEO since May 2013 of LifePoint’s 79-bed Clark Regional Medical Center in Win-chester, Ky.

Sibley, whose back-ground is surgical services nursing, is one of many CEOs who has risen through the nursing ranks, a move that makes sense in the new patient-cen-tered health paradigm.

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

The HR AspectPam Belcher, vice president of human

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

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

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

community in northwest Alabama, began

her career immediately following high school. She earned an associate’s degree from the local community college and a nursing degree from the University of North Alabama while working at Lake-land Community Hospital in Haleyville, Ala. She had served as a nurse for more than 10 years when LifePoint acquired the hospital in 2002.

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

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

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

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

Ahead of the CurveSusan Peach broke gender and age

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

“Early on, I received some grief from my board and a few local business leaders who were concerned whether I could make hard business decisions because I was a compassionate, empathetic nurse,” said Peach. “Some also wondered if I under-stood enough about business and finance

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way healthcare is delivered in this country now and in the future.”

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

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

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

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

“The Flexner Report really changed medical education to say it has to be science-based, and it has to be connected with knowl-edge generation,” she explained. “It made a great leap forward in the quality of medical education. But here we are a century later, and our format for training physicians re-mains almost identical to the structure that we described a hundred years ago.”

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

She said the work being done as part

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

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

In choosing the academic medi-cal centers, Skochelak said the AMA was looked for programs that concentrated on key areas, including:

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

• Emphasizing important core con-cepts in medical school education like

team-based care, patient safety and out-comes, patient-centered approaches to care, and population management; and

• Changing the way students progress through the educational system to provide more flexibility and individualized learning.

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

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

“Curriculum revision is hard work,” she continued. “It’s not just a matter of de-veloping new lesson plans. It really is a lot about culture change. We really felt that it was important to go back to the draw-ing board and start something new right away.”

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

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

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

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

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

The Transformation of Med Ed, continued from page 1

Snapshot of Grant ProjectsIndiana University School of Medicine is working to create a virtual health care system (vHS) and a teaching electronic

medical record (tEMR) to teach clinical decision-making and ensure competencies in system, team, and population-based healthcare skills.

Mayo Medical School is creating an innovative educational model based on the science of healthcare delivery to prepare students to practice within patient-centered, community-oriented, science-driven collaborative care teams to deliver high-value care. The curriculum’s experiential learning program focuses on how interprofessional teams, patients, communities, public health resources and healthcare delivery systems impact care, outcomes and cost.

NYU School of Medicine is launching the NYU by the Numbers Curriculum, which is a flexible three-year, individualized, technology-enabled blended curriculum to improve care coordination and quality improvement.

Oregon Health & Science University School of Medicine is implementing a learner-centered, competency-based curriculum that enables medical students to advance through individualized learning plans as they meet pre-determined milestones. A portfolio-based system will track milestone achievement and clinical experiences, allowing some students to complete medical school in less than four years.

Penn State College of Medicine has collaborated with Penn State Hershey Health System leaders to design educational experiences that align medical education with health system needs. The Systems Navigation Curriculum (SyNC) prepares students to work throughout the continuum of care. During school, students are embedded in clinical sites across central Pennsylvania as patient navigators to help them better understand patient and health system issues.

The Brody School of Medicine at East Carolina University is implementing a new core curriculum in patient safety for all medical students that features integration with other health-related disciplines to foster interprofessional skills to prepare students to lead healthcare teams for a systems-based approach.

The Warren Alpert Medical School of Brown University is establishing a dual MD/MS degree program to create a new type of physician leader with expertise in population health. The master’s degree program, which includes nine courses, emphasizes teamwork and leadership, population science and behavioral and social medicine and includes two courses being introduced to all students on health disparities and epidemiology/biostatistics.

University of California, Davis School of Medicine is working in partnership with Kaiser Permanente and UC Davis’ residency program to create a three-year medical school pathway called the Accelerated Competency-based Education in Primary Care (ACE-PC). Those enrolled in ACE-PC will simultaneously be considered for acceptance into local primary care residencies.

University of California, San Francisco School of Medicine is crafting the three-phase UCSF Bridges Curriculum, which seeks to create physicians who learn to work expertly in interprofessional teams to continuously improve the safety, quality and value of healthcare.

University of Michigan Medical School’s innovative curriculum includes a two-year foundational “trunk” consisting of integrated scientific and clinical experiences followed by flexible professional development “branches,” which are development tracks to cultivate advanced skill sets within clinical domains at a student’s own pace.

Vanderbilt University School of Medicine has launched Curriculum 2.0 to create master adaptive learners who are embedded in the healthcare workplace during their undergraduate medical education. Students will also use their own competency-based performance data to complete self-assessments and devise individualized objectives to hone self-directed learning skills.

Dr. Bonnie Miller


Legislative AffairsBY CINDY BISHOP

Office of State Register Publishes Emergency RulesThe Office of the State Register has

published several emergency rules with an effective date of October 2014. Here are a few of the new emergency rules. These can be found on the Louisiana Division of Administration website.

DECLARATION OF EMERGENCY Department of Health and Hospitals Bureau of Health Services Financing Pharmacy Benefits Management Program Methods of Payment

The Department of Health and Hospitals, Bureau of Health Services Fi-nancing hereby rescinds the provisions of the November 1, 2012 Emergency Rule which revised the reimbursement meth-odology for pharmacy services covered under the Medical Assistance Program as authorized by R.S. 36:254. This Emer-gency Rule was adopted on October 19, 2012 and published in the November 20, 2012 edition of the Louisiana Register. This Emergency Rule is promulgated in accor-dance with the provisions of the Admin-istrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, which-

ever occurs first. The Department of Health and Hospitals, Bureau of Health Services Financing provides coverage and reimbursement for prescription drugs to Medicaid eligible recipients enrolled in the Medicaid Program. The department promulgated an Emergency Rule which amended the provisions of the Septem-ber 5, 2012 Emergency Rule to further revise the provisions governing the meth-ods of payment for prescription drugs and the dispensing fee (Louisiana Register, Volume 38, Number 11). Upon further consideration and consultation with the U.S. Department of Health and Human Services, Centers for Medicaid and Medi-care Services (CMS) on the correspond-ing Medicaid State Plan Amendment, the department has determined that it is necessary to rescind the provisions of the November 1, 2012 Emergency Rule governing the reimbursement methodol-ogy for services rendered in the Pharmacy Benefits Management Program, and to re-turn to the reimbursement rates in effect on September 5, 2012 which is consistent with the currently approved Medicaid State Plan. Effective October 1, 2014, the Department of Health and Hospitals, Bureau of Health Services Financing re-scinds the Emergency Rule governing

pharmacy services which appeared in the November 20, 2013 edition of the Louisi-ana Register on pages 2725-2728. Interested persons may submit written comments to J. Ruth Kennedy, Bureau of Health Ser-vices Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030 or by email to [email protected]. Ms. Kennedy is responsible for responding to all inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for re-view by interested parties at parish Med-icaid offices. Kathy H. Kliebert, Secretary

DECLARATION OF EMERGENCY Department of Health and Hospitals Medical Transportation Program Non-Emergency Medical Transportation (LAC 50:XXVII:Chapter 5)

The Department of Health and Hos-pitals, Bureau of Health Services Financ-ing repeals and replaces the provisions of the October 20, 1994 Rule governing Non-emergency medical transportation, and amends LAC 50:XXVII.Chapter 5 in the Medical Assistance Program as au-thorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency Rule is promulgated in accor-dance with the provisions of the Admin-

istrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maxi-mum period allowed under the Act or until adoption of the final Rule, whichever oc-curs first. The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing adopted pro-visions governing non-emergency medical transportation (NEMT) (Louisiana Register, Volume 20, Number 10). The department has now determined that it is necessary to repeal the October 20, 1994 Rule in order to revise the provisions governing NEMT services, and to ensure that these provi-sions are appropriately promulgated in a codified format for inclusion in the Loui-siana Administrative Code. This Emergency Rule will also amend the provisions gov-erning the reimbursement methodology for NEMT services to replace the monthly payment of capitated rates with a monthly per trip payment methodology.

This action is being taken to promote the health and welfare of Medicaid re-cipients by ensuring continued access to non-emergency medical transportation services. It is estimated that implementa-tion of this Emergency Rule will have no programmatic costs for state fiscal year 2014-15.



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Checkmate Strategies and Louisiana Medical News, LLC. For more information, readers

may contact Cindy Bishop at 225.923.1599 or P.O. Box 80053, BR, LA 70598, or send email to [email protected]. Our website is www.

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Effective October 1, 2014, the De-partment of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing the reimbursement methodology for non-emergency medi-cal transportation. The department will solicit intrastate transportation through a nonprofi t provider. (The full rule can be found at the Offi ce of the State Regis-ter tab on the Division of Administration website)

DECLARATION OF EMERGENCYDepartment of Health and HospitalsBureau of Health Services FinancingInpatient Hospital ServicesNon-Rural, Non-State HospitalsChildren’s Specialty Hospitals Reimbursements

The Department of Health and Hos-pitals, Bureau of Health Services Financ-ing amends LAC 50:V.967 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency

Rule is promulgated in accordance with the provisions of the Administrative Pro-cedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the fi nal Rule, whichever occurs fi rst. Due to a budgetary shortfall in SFY 2013, the Department of Health and Hospitals, Bureau of Health Services Financing, amended the provisions governing the re-imbursement methodology for inpatient hospital services to reduce the reimburse-ment rates paid to non-rural, nonstate hospitals, including children’s specialty hospitals

(Louisiana Register, Volume 40, Num-ber 2). The department has now deter-mined that it is necessary to amend the provisions governing the reimbursement methodology for inpatient hospital services rendered by children’s specialty hospitals to revise the reimbursement methodology and establish outlier payment provisions. This action is being taken to promote the health and welfare of Medicaid recipients by maintaining access to neonatal and

pediatric intensive care unit services and encouraging the continued participation of hospitals in the Medicaid Program. It is estimated that implementation of this Emergency Rule will increase expendi-tures in the Medicaid Program by approx-imately $2,535,283 for state fi scal year 2014-2015. Effective October 4, 2014, the Department of Health and Hospitals, Bu-reau of Health Services Financing amends the provisions governing the reimburse-ment methodology for inpatient hospital services rendered by children’s specialty hospitals. (The full rule can be found at the Offi ce of the State Register tab on the Division of Administration website)

Offi ce of State Register, continued from page 7

A Kaiser Family Foundation report shows that during the 2013 and 2014 fi scal years, provider assessment programs were part of Medicaid fi nancing for:

• Nursing facilities in 44 states, including Louisiana;

• Managed care in 12 states, including Louisiana; and

• Other services, such as pharmacies, in 13 states, including Louisiana.

Still, critics – the list includes Gov. Bobby Jindal and AARP – say the amend-ments leave Louisiana with only one target when cuts are needed to balance the bud-get: higher education. Critics also question the wisdom of protecting hospitals and nursing homes when a number of studies have shown patients favor the less costly options of home-health and hospice care.

In its guide to the proposed amend-ments, the Public Affairs Research Coun-cil of Louisiana says the hospital fi nancing system could be created by state law. This would allow the governor and Legislature more fl exibility to tweak the law if neces-sary.

But Salles said the LHA sought con-stitutional protection for just that reason. The hospitals wanted to avoid the sort of tweaking other states have seen, tweaks that have diluted the impact the indus-try expected when setting up the funding structures.

Louisiana hospitals’ pooled fund-ing could only be used for hospital- and healthcare-related purposes, he said. The special fund’s dollars would not be swept into the state’s general fund to fi ll budget

shortfalls elsewhere.“If you talk to a few

of the other states that set up these sorts of funding structures, they would say, ‘Yeah, we did this as an industry with great positive intentions … but over the years our state has sort of whittled away and essentially supplanted that funding,’” Salles said.

Salles said the LHA doesn’t agree with those who say Amendment No. 2 will leave the state’s public colleges more vul-nerable to funding cuts.

“First of all, this isn’t about going after anybody’s existing funding. This is about creating a system to create an opportunity

for additional (Medicaid) funding,” Salles said.

Medicaid dollars are a critical part of hospitals’ revenue. The LHA’s Hospitals and the Louisiana Economy, 2014 report, shows that 18 percent of hospitals’ net rev-enue came from Medicaid.

In Louisiana, for every 38 cents the state contributes, the federal government provides 62 cents. Medicaid-related hos-pital expenditures create and support more than 48,000 jobs and over $137.5 million of state tax collections and $117.8 million of local tax collections.

The LHA believes that allowing the industry to create a system that can help solve some of its own funding shortfalls and budget issues will provide the Legislature with more fl exibility in the budgeting pro-cess, he said.

The LHA says community hospitals have seen their Medicaid reimbursement rates slashed by a cumulative 26 percent, or more than $260 million a year, since 2009.

Hospitals’ base rates for treating Med-icaid patients are roughly 60 percent of the actual cost to provide the care, the LHA says.

The cuts to Medicaid, taken each of the last fi ve years, have produced “a great deal of uncertainty” for hospitals when it comes to planning and operating the facili-ties.

If this fi nancial situation continues, community hospitals may have to close their Emergency Departments or even shut down entirely, Salles said. Other healthcare providers could have to elimi-nate needed services or reduce them.

Those are frightening possibilities for any community, he said.

Providers Push for Budget Protection, continued from page 1

Paul Salles

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to lead an organization as CEO. The first challenge wasn’t difficult to overcome be-cause I’ve made many hard choices and hard decisions with respect and compas-sion. On the business side, it’s all about results. You can talk a good game, but you have to produce good results. I’ve been very fortunate … achieving wonderful fi-nancial results every time.”

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

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

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

help with the kids.”Since July 2012, Peach has been CEO

of LifePoint’s HighPoint Health System, overseeing more than 300 licensed beds on four campuses. Before that, she served as a CNO at LifePoint’s Hospital Support Center, worked for Catholic Health Ini-tiatives as senior vice president of perfor-mance management, and served in various “O” roles. Now, the recipient of Sumner County’s Impact Award for two consecu-tive years, and LifePoint’s prestigious 2013 CEO of the Year Award, makes a point of devoting time to mentoring rising stars, generally working concurrently with four potential leaders.

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

The Male CounterpartA couple of decades ago, if a man

dressed in scrubs walked into a hospi-tal room, patients frequently assumed he was a doctor because the number of male nurses was so low. Nationwide, those gen-der numbers have improved. According to MinorityNurse.com, male RNs now com-prise roughly 9 percent of the total nursing population; 7.6 percent of LPNs are men.

“As in any industry, I have to prove

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

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

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

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

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

Full CircleBelcher, the HR executive who joined

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

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

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

From CNO to CEO, continued from page 5

Mark C. Holyoak


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Breast And Cervical Health Program Awarded Record $2 Million Grant

NEW ORLEANS- The Louisiana Breast and Cervical Health Program (LBCHP), which performs breast and cervical cancer screenings including mammograms and Pap tests at no cost to low-income, uninsured and underin-sured women across the state, was re-cently awarded the maximum amount for 2014-2015. LBCHP’s exceptional performance in providing these screen-ings was one reason that the Centers for Disease Control and Prevention (CDC) not only continued the grant for the program, which has been in existence since 2002, but increased it.

“The CDC has always thought LB-CHP has done a great job,” said LBCHP Director Nannozi Ssenkoloto. “And this year, the CDC felt they had additional money to give.”

That added budget is a boon to the state, as Louisiana ranks second high-est in breast cancer and fourth in cer-vical cancer death rates. Those fi gures are even starker when one considers that Louisiana women have a lower in-cidence or occurrence of breast cancer in the fi rst place. People not getting screened - or being unable to afford screenings - is one reason Louisiana’s death rates are so high.

“This additional money will allow LBCHP to screen more women than we ever have before. We’d like to reach as many as 14,000 women this year or ap-proximately 14 percent of the eligible population,” said Ssenkoloto.

LBCHP eligibility is based on age, income and insurance status. Women whose household incomes who are at or below 200 percent of the 2014 Fed-eral Poverty Level are eligible, which translates into an annual income of, for example, under $23,340 for a single person, $47,700 for a family of four, etc. Cervical cancer screenings are per-formed for women between the ages of 21 and 64, while mammography screen-ings are done for women between the ages of 50 and 64. In addition, women in their 40s can qualify for a clinical breast exam, while women of any age who exhibit symptoms or have physical fi ndings that suggest breast cancer can qualify for LBCHP.

LBCHP does not provide treatment services, but once a woman is diag-nosed, its patient navigation team can help enroll the patient in Medicaid or in a program under the Affordable Care Act.

For more information on LBCHP, go to www.lbchp.org or call 888-599-1073.

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.


In the News

We all know chronic illness is destroying lives. And crippling the healthcare system. That’s why Blue Cross has created Quality Blue Primary Care, a program that rewards doctors for getting better health results for our Blue Cross members. Especially those with chronic health issues.

Our Quality Blue Primary Care program offers primary care practices in our network access to technology, tools and services to help them focus on what they do best: treating patients. Plus, providers and clinics enrolled in the program are paid a monthly care management fee—on top of their usual fee-for-service amount.

Patients benefit. Providers benefit. And together, we create a healthier, more affordable healthcare system for all of us.

For more information on Quality Blue Primary Care:Call 800.376.7765Email [email protected] Visit www.bcbsla.com/qbpc

Dr. David CarmoucheExecutive Vice President of External Operations & Chief Medical Officer

Blue Cross and Blue Shield of Louisiana

We invite our network primary care doctors in Family Medicine, Internal Medicine or General Practice to learn more about Quality Blue Primary Care.

Introducing A New Introducing A New Primary Care Program Primary Care Program

That Rewards That Rewards Doctors and Patients Patients

for Better Health.for Better Health.

01MK5620 06/14 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.

Bradley Mabry

Michael Smith

Peoples Health Appoints Michael Smith to New Orleans Executive Director

METAIRIE – Peoples Health has an-nounced the appointment of Michael Smith to executive direc-tor of the New Orleans re-gion. Smith is responsible for the overall operations of the region for Peoples Health, a Medicare Ad-vantage company serv-ing a 23-parish area that includes New Orleans and Baton Rouge. He works to optimize health outcomes for plan members and further relationships with network pro-viders. In efforts to improve business performance, Smith organizes and leads multidisciplinary staff to facilitate a team-oriented atmosphere. He also works in partnership with the market medical di-rector to implement company initiatives and evaluate the effi ciency and effec-tiveness of current operations.

With an extensive background in healthcare operations and managed care, Smith brings over 20 years of expe-rience to his position at Peoples Health. In his most recent position as vice presi-dent of operations at Sacred Heart Hospital of Pensacola, Smith served as the senior leader responsible for clini-cal operations within various areas, in-cluding radiology, laboratory, inpatient and outpatient pharmacy, inpatient and outpatient rehab, neurodiagnostics and bariatric clinic services. In addition, he facilitated multiple expansion projects, such as the openings of Sacred Heart Cancer Center, Sacred Heart Hospital on the Gulf, and Sacred Heart master facility and campus plan. Throughout his career at Sacred Heart Hospital, he also served as vice president of man-aged care and support services, vice president of managed care services, and administrative director of managed care. He also served as director of network development at United Healthcare of Louisiana and Mississippi, where he was responsible for the management of pro-vider network development, provider contracting and relations, and creden-tialing functions.

Smith earned a Bachelor of Sci-ence in fi nance from Loyola University New Orleans and a Master of Science in healthcare management from Troy Uni-versity in Alabama.

New Chief Executive Offi cer Announced by Dauterive Hospital

NEW IBERIA- Dauterive Hospital, a full service acute care hospital serv-ing New Iberia and the surrounding re-gion has announced the selection of a new Chief Executive Offi cer follow-ing a nationwide search spanning several months. Bradley Mabry, a Louisi-ana native and most re-cent Chief Operating Of-fi cer with Clinton Memorial Hospital Re-gional Health System in Ohio has been selected for the leadership position.

Mabry’s selection was announced by Dan Rissing, Chief Executive Offi cer of Progressive Acute Care, the parent cor-poration based in Mandeville, Louisiana which owns Dauterive Hospital. Rissing was joined by Dauterive Chairman of the Board Gilbert “Doc” Thomas and Chief of Medical Staff Dr. Mike Alvarez in mak-ing the announcement.

“We are most excited to have Brad return home to Louisiana with his fam-ily including his newborn daughter. His family now joins the family of physicians, Board of Directors, nurses, employee associates, and volunteers as we con-

tinue the legacy of Dr. Henry Dauterive in serving our patients.” Rissing stated that Mabry will begin his service as CEO November 10, 2014 with his fi rst mis-sion being to meet and get to know the Dauterive Hospital physicians and em-ployees as well as the people of New Iberia and the area cities and towns. “Brad is a people person in addition to his extensive healthcare experience and knowledge,” Rissing commented. Mabry has been in the medical fi eld in leader-ship positions including his most recent Chief Operating Offi cer role for more than a decade. He has served with Life-

Point Hospitals, Inc. in medical centers in Nevada, Texas and Opelousas, Loui-siana. He also served as Administrative Resident at Heart Hospital of Lafayette while pursuing and earning his Masters of Business Administration in Healthcare Administration from the University of Louisiana in Lafayette. He holds a Bache-lor of Science in Economics degree from Louisiana State University. He is also a Graduate of the Performance Leader-ship Academy of the Healthcare Advi-sory Board and has a strong background in market and business development in the healthcare fi eld.

Documents

Louisiana Medical News November 2014