Mississippi Medical News December 2013

December 2009 >>

D. Kyle Ball, MD

PAGE 3

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Deducing DiabetesDiabetes Foundation of Mississippi and TrialNet team up at Camp Kandu to detect children with potential type 1 diabetes

When Kenyada and DeJuan Gilbert set out last year for Camp Kandu in Florence, it was with the knowledge that their son Deuce, 6, would have a chance to swim, climb trees and otherwise cut loose in the camaraderie of children who, like himself, have diabetes ... 4

Securing Isotopes for Diagnostic ImagingZevacor unveils nation’s fi rst 70 MeV commercial cyclotron dedicated to radiopharmaceuticals for medical use

INDIANAPOLIS, Ind. – Zevacor is changing the way hospitals do business when it comes to securing isotopes for diagnostic imaging ... 5

Osteopathic Infl uenceMississippi strengthens opportunities for DO residency slots, PCP population

(CONTINUED ON PAGE 10)

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Establishing a Preoperative Cognitive Baseline for Elderly PatientsSpecialists discuss how preoperative cognitive testing would lift the question mark over the possible link between surgery and anesthesia and dementia

By LyNNE JETER

Mississippi physicians are among geriat-ric specialists weighing in on how preoperative cognitive testing mitigates the controversy on whether elderly patients undergoing anesthe-

sia for surgery may suffer from postoperative cognitive dysfunction (POCD), leading to early onset dementia, or delirium, a temporary state of confusion.

Preoperative cognitive testing is rarely

By LyNNE JETER

Editor’s note: This article is the second in a series about closing the gap between medical graduates outpacing residency opportunities na-tionwide and in Mississippi. The lead article, “Incentiv-izing Medical Professionals: Mississippi leaders increasing residency slots, growing MD population,” was published in the August edition focusing solely on ACGME accredited positions.

Osteopathic graduate medical educa-tion positions strengthen the state’s num-ber of residency slots in the race to provide as many residency opportunities for the increasing num-ber of medical graduates in Mississippi.

In fact, some internship and residency positions at the University of Mississippi Medical Center (UMMC) are dually accredited by both the American Council on Graduate Medi-cal Education (ACGME) and American Osteopathic Association (AOA).

In Decatur, the East Central Health Network provides 18 funded positions, and in Jackson, the University of Pikeville-Kentucky College of Osteopathic Medicine (UP-KYCOM) and UMMC provide

2 > DECEMBER 2013 m i s s i s s i p p i m e d i c a l n e w s . c o m

U.S. News & World Report ranked Memorial Hospital at Gulfport as the #1 hospital in Mississippi. Memorial received the designation as the state’s top hospital because it was the only facility in the state to earn national recognition in any of the adult specialties studied by U.S. News. Memorial also had the most specialties of any hospital in the state to be designated as “High-Performing.” Memorial was ranked 42nd nationally in Diabetes and Endocrinology care, and Memorial’s Gastroenterology and GI Surgery, Geriatrics, Nephrology, Neurology and Neurosurgery, Pulmonology and Urology specialties were rated “High-Performing.” More details are available at http://health.usnews.com/best-hospitals/area/ms.

How a Hospital Is ChosenIn order to determine hospital rankings, U.S. News sifts through data

from a variety of sources on nearly 5,000 hospitals in the nation and surveyed nearly 10,000 specialists. Factors that were considered included patient survival, safety, volume, advanced technologies, physician and

diagnostic services availability, and nurse staffing. Categories were weighed to determine rankings. An annual survey that asks physicians to name hospitals they consider the best in their specialty for difficult cases was also taken into account.

Memorial’s ScoreMemorial’s top marks are the result of a true team

effort. When examining the data for each specialty, Memorial also stood out for the availability of advanced technologies and access to key patient services. Each of the seven recognized specialties relied on these technologies and services as they achieved their high rankings. Technologies such as robotic surgery, stereotactic radiosurgery, PET/CT scanners, diagnostic radioisotope services, and image-guided radiation therapy enhanced the hospital’s standing as an excellent healthcare facility. Also factored into the report were

Memorial’s Intensive Care Units staffed by intensivists, Hospitalist program staffed by internal medicine physicians, hyperbarics medicine, general and vascular surgery services, anesthesia services, and a Level II Trauma Center. Memorial’s nursing staff received the highest ranking score in all high performing specialty categories evaluated by U.S. News.

Why is Memorial Hospital at Gulfport ranked Mississippi’s BEST hospital?

Memorial Ranked Best Hospital in Mississippi

http://health.usnews.com/best-hospitals/area/ms

Diabetes & Endocrinology · Gastroenterology & GI Surgery · Geriatrics Nephrology · Neurology & Neurosurgery · Pulmonology · Urology

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Our staff works tirelessly to provide top quality healthcare, and we are very proud of their efforts that make us nationally recognized as the best hospital in the state of Mississippi. —Gary G. Marchand, MPH Memorial President and CEO

m i s s i s s i p p i m e d i c a l n e w s . c o m DECEMBER 2013 > 3

D. Kyle Ball, MDPhysicianSpotlight

By LUCy SCHULTZE

For patients who come to the Jackson office of OB/GYN D. Kyle Ball, MD, the photos and articles on the walls are like an invitation to connect with what’s impor-tant to him.

Pictures of his family members decorate his hallway and exam rooms, alongside images and articles from his ex-cursions around the world as a hunter of big game.

“Everybody that comes to see me knows what I do,” said Ball, who plans at least one or two hunting trips each year.

“For most women in Mississippi, their husbands or sons or family members hunt,” he said. “There’s always a com-mon theme that gives us something to talk about right off the bat.”

And while the mountains of New Zealand or the savannas of Zimbabwe may seem a world away, the experiences he’s had in such remote places are present with him day-to-day.

“In those times when I’m just re-ally worn out and stressed out, I sit down and close my eyes and go to one of those places,” Ball said.

“You can really zone out and think back to when you were sitting on that mountain in the Yukon — just you and your professional hunter and the great open spaces. I draw a lot of peace from it. It helps me to regroup real quick and get back to work.”

Sharing a practice with his older brother, G. Christopher Ball, MD, pro-vides the opportunity to cover for each other in order to take time off for such adventures.

“He and his wife like to travel, so I’ll cover a week or two while they go, and he does the same for me and my wife,” he said. “We get plenty of time to go see the world. It’s just a matter of making time

and planning far enough in advance.”For Ball, the opportunity for broad

travel balances out a choice to spend his life and career in his hometown.

A native of Jackson, he graduated from Jackson Preparatory School and played football at Mississippi State Uni-versity. He earned a medical degree from the University of Mississippi Medical Cen-ter and went on to complete a four-year residency at Tulane University and Char-ity Hospital in New Orleans.

Ball returned to Jackson in 1988 to join a group practice that included his father, his brother and three other physi-cians.

“I had looked around while I was in residency training, and really found there are some other nice places in the country,” he said. “But it wasn’t home.”

Since his wife, Maury, was also from Jackson, coming home seemed like the best fit. Settling into the practice was a positive transition.

“We always collaborated, and I can’t

remember there ever being a cross word,” Ball said. “We were all headed in the same direction, which was trying to do what was best for the patient. If that’s the case, you can have little disagreements, but the main issues are going to be resolved in the patient’s best interest.”

While his father, George Ball, MD, retired in 1998, Ball still takes advantage of his experience and consults him on in-teresting cases. His youngest brother, Jeff, also followed in their father’s footsteps and practices as an OB/GYN in Jackson, Tenn.

“I never heard our father say any-thing like, ‘This is what you need to do,’” Ball recalled. “He just let us all make our own decisions in our own time, and we all seemed to gravitate toward what we knew.

“Growing up, my dad always came home tired — but with a smile on his face. I always thought, ‘He must really love what he does.’ And for me, as well, I still enjoy going to work each morning.”

Ball’s growing-up years in Mississippi included hunting for white-tail deer, quail and dove. But hunting bigger game was always a dream.

Beginning in 1990, he started travel-ing to hunt out outside of his home state. His travels have since taken him all over the world, including five trips to Africa.

In February, he’ll make his third trip to New Zealand to hunt red stag and Rocky Mountain elk.

Over the years, his wife has joined him on hunting expeditions — she killed her first big-game animal, a Gold Medal red stag, on their 30th wedding anniversary in 2010 — and has made room for nearly two dozen mounted heads in their home’s lodge-style family room.

The collection includes life-size mounts of a Dall sheep from the Yukon, a

leopard from Zimbabwe and a Himalayan tahr from New Zealand.

“The neighborhood children come by all the time, and my wife enjoys letting them see the collection,” Ball said.

“We’ve also had a lot of people come in who are not hunters, and heard a lot of comments about how appreciative they are of how the room looks and how artis-tically it’s presented. That makes you feel like you got it right.”

While bringing trophies home is al-ways a thrill, Ball values most of all their connection to memories of his travels and the people he meets along the way.

“I like going places that few people have gone,” he said. “I have found some of the nicest people in the world in some of the most remote, most deprived condi-tions.

“The farther back into Africa you go, you meet tribesmen who have never re-ally seen a motorized car or a pair of bin-oculars. It’s interesting to meet people like that, and to find out that, to them, family and just getting by every day are the big-gest issues.

“They have a simple outlook on life. It’s pretty refreshing coming from this world of stress and anxiety where we live.”

Ball and his wife are the parents of three grown children, each of whom is pursuing a medical career.

Daughter Sara Martin Robertson is a chief resident in anesthesiology at the University of Arkansas in Little Rock and will pursue a fellowship in pediatric anes-thesiology. Middle son George earned a PhD in clinical psychology in Chicago and is completing an internship in marriage and family counseling, while younger son John is a second-year medical student at UMMC in Jackson.

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When Kenyada and DeJuan Gilbert set out last year for Camp Kandu in Flor-ence, it was with the knowledge that their son Deuce, 6, would have a chance to swim, climb trees and otherwise cut loose in the camaraderie of children who, like himself, have diabetes.

The Gilberts didn’t know that, thanks to a federally funded study at the camp, they’d find out that Deuce’s little brother, Tre, 4, was also at risk for type 1 diabetes.

“Tre had just come along for the ride,” said his mother, Kenyada Gilbert, an RN who recently relocated from Crystal Springs to Fort Leavenworth, Kansas. “But when they mentioned they’d be doing the testing, we decided we should do it while we were there.”

Researchers with Type 1 Diabetes Tri-alNet, begun in 1994 as a prevention study, can predict the disease by testing for anti-bodies to pancreatic cells that make insulin, which controls blood sugar.

People eligible for antibody testing are ages 1 to 45, with an immediate fam-ily member who has type 1 diabetes. The eligibility broadens to those 20 and younger who have a cousin, uncle, aunt, niece, nephew, grandparent or half-sibling with

the disease. Della Matheson, a University of

Miami research nurse who administered the test at the Nov. 9-10 session at Camp Kandu, called TrialNet volunteers provid-ing blood samples to be studied “heroes.”

“They’re helping pioneer the use of medications that could switch off the im-mune system’s attack on the pancreas,” she

said. Early experiments with immunosup-

pressants that researchers thought might stop the disease proved unsuccessful, Matheson noted, adding that more pre-cisely targeted drugs are “providing hope that we’re moving in the right direction.”

The TrialNet study hadn’t topped the Gilberts’ agenda that weekend at camp, which is free for children with diabetes. In-stead, those children were absorbed in ac-tivities like theatrical improvisation games, karate, and making up “blood sugar” bal-lads around the campfire.

Separately, diabetes educators dis-cussed with the Gilberts and other parents the complex calculus of insulin pump op-eration.

“They have so much to do at Kandu, and we were getting so much information, talking to parents and having so much fun that we lost track of time,” said Gilbert. “The people with the study were headed out the door when we finally got to them.”

She didn’t want to miss the opportu-nity.

“I wanted to partake of everything that Camp Kandu offered, and that was part of it,” she continued. “My thought was, Tre has to be tested. And we wanted to be tested, too, to know whether Deuce’s diabetes came from either side of our family. You don’t want to play a blame game, but at the same time you do want to know how and why this happened.”

After a pause, she said: “I’m a nurse. I love medicine. I’m a research junkie. I wanted to be part of the testing because the answer would not only help my chil-dren, but it would also help somebody else’s child.”

Both Gilbert parents tested negative, yet Tre had pancreatic antibodies.

“I remember it verbatim, like it was yesterday,” said Gilbert. “They send you a transcript and a letter that your child has tested positive for diabetes. He had two of the antibodies they were specifically look-ing for. They didn’t give us a percentage,

but they said it was very likely he would get diabetes.”

Tre was enrolled by TrialNet in a dou-ble-blind study of an immunosuppressant that might delay the onset of diabetes. So far, he has remained healthy.

Not everyone who tests positive is eli-gible for the highly experimental therapy. But advance warning, combined with free and confidential monitoring offered by TrialNet, may be beneficial to the health of those at risk for type 1 diabetes, Matheson said.

“By following children who have anti-bodies, we’re able to see when their blood glucoses begin to deteriorate,” she said. “We don’t have to wait for the onset of symptoms.”

Intervention before the start of keto-acidosis—a potentially deadly breakdown of fat cells—and other metabolic changes may help insulin-producing cells survive longer, Matheson said, adding that early, well-managed glucose control can lead to fewer long-term complications like eye and kidney damage.

As more people are tested, results will become more accurate, Matheson said.

“We need more data to get better pre-dictive ability,” she said. “One of the prob-lems we have is that people aren’t sure they want to know.”

For families like the Gilberts who al-ready have a child with diabetes, finding out another child is at risk can be upsetting.

“We offer to test your family members and follow them,” Matheson said. “Some are going to take you up on it, but others may need time to normalize life with their existing child with diabetes. Then they begin to feel like knowing is a good thing, that maybe they can do more if they know.’ ”

Gilbert urges other parents with type 1 diabetes in the family not to hesitate to have their children tested.

“Don’t think about it—just do it,” she said. “You may be fearful, but given the choice between knowing and not knowing, maybe finding your child on the floor and

Deducing DiabetesDiabetes Foundation of Mississippi and TrialNet team up at Camp Kandu to detect children with potential type 1 diabetes

Tre Gilbert with Brittany Purnell.



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By LyNNE JETER

INDIANAPOLIS, Ind. – Zevacor is changing the way hospitals do busi-ness when it comes to securing isotopes for diagnostic imaging. That’s very good news in light of the looming international isotope shortage, and represents part of a larger strategy to provide hospitals nation-wide with a reliable and steady stream of radiopharmaceuticals critical to patient care.

Zevacor, an independently owned healthcare firm established in 2012 to manufacture and distribute PET and SPECT radiopharmaceuticals, is the first private non-government entity with the only 70 MeV commercial cyclotron in the United States strictly dedicated to making radiopharmaceuticals for medical use.

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“In the past, the supply of medical iso-topes hasn’t been continuous, making it difficult to offer these diagnostics and therapeutics. This investment will allow us to provide year-round production of medically necessary isotopes for patients.” Zevacor’s 70 MeV cyclotron is expected to be operational by the end of 2016, around

the time North America’s only reactor will cease operations. The Canadian reactor, built in the 1950s, produces technedium 99, an isotope needed for diagnostic imag-ing and therapies within oncology, neurol-ogy and cardiology. The Canadian government plans to take the reactor offline in 2016.

“That one is near-est the U.S.,” explained Zehner. “There are reactors in Poland, Bel-gium, South Africa, Aus-tralia, and a few other places. However, on the North American continent, the demand for this isotope puts pressure on the system. We have very short expiration drugs, so shipping them long distance isn’t conducive to a viable supply line. The (U.S. Department of En-

Securing Isotopes for Diagnostic ImagingZevacor unveils nation’s first 70 MeV commercial cyclotron dedicated to radiopharmaceuticals for medical use


A cyclotron at the world’s only installed and operational 70 MeV system, located in Nantes, France.

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six funded positions, all in family medicine/osteopathic manipulative treatment. A ma-jority of the 60 percent of UP-KYCOM graduates who are primary care providers (PCPs) serve in rural Appalachia healthcare clinics.

In Corinth, Magnolia Regional Health Center provides 26 funded positions – 20 internal medicine slots and six cardiology fellowships.

“Since we’re a rural underserved com-munity, we have the ability to further add to our CMS cap space and have plans to add future GME training programs,” said David Pizzimenti, DO, medical education and internal medicine program director at Magnolia Regional. “We’ve enjoyed tre-mendous success in training medical stu-dents and physicians, which hopefully will help to alleviate the physician workforce shortage in our region. Our program is a great model for what a rural community-based hospital can do to proactively recruit and retain physicians.”

Unfortunately, residency positions in Tupelo (noted in the August edition) are now closed.

“I believe that we defi nitely need to increase graduate medical education pro-grams, whether allopathic (MD) or osteo-pathic (DO),” said Flowood obstetrician/gynecologist W. Ashley Hood, DO, presi-dent of the Mississippi Osteopathic Medi-cal Association (MOMA).

William Carey University College of Osteopathic Medicine in Hattiesburg is

helping attain that goal, with 108 new matricu-lants this fall, and total enrollment of 505. The new school, which has af-fi liation agreements with 45 hospitals in the Gulf South and more than 600 practicing physicians, will graduate its fi rst class of medical students as DOs in 2014.

The Bigger PictureNationwide, a recently released study

by the American Association of Colleges of Osteopathic Medicine (AACOM) re-fl ects the rise in new student enrollment at osteopathic medical colleges. DOs take an extra 200 hours of training in osteo-pathic manipulative medicine, focusing on patient-centered care with less medication. The steep increase is good news for a so-ciety needing more PCPs, especially with a majority of DOs pursuing primary care medicine. The PCP shortage is projected to be greater than any other specialty – more than 50,000 in 2025 – and the total physi-cian shortage across specializations is pro-jected to top 100,000, according to reports.

According to the AACOM, new stu-dent enrollment at osteopathic medical col-leges grew by 11.1 percent this year, with one in fi ve U.S. medical students training to become an osteopathic physician.

AACOM, established in 1898, attri-butes the rapid fi rst-year student growth

in part to three new colleges of osteopathic medicine that opened this year to help mitigate the national physician workforce shortage. The trend is expected to continue as new campuses are developed and estab-lished colleges continue to expand with increased class sizes. Several additional colleges are in the planning stages.

“Because large numbers of new os-teopathic physicians become primary care physicians, often in rural and underserved areas, it’s evident the osteopathic medi-cal profession will help the nation allevi-ate a primary care physician crisis,” said AACOM CEO Stephen C. Shannon, DO, MPH. “And colleges of osteopathic medi-cine are expanding and increasing to meet this demand.”

Among the key fi ndings from AA-COM’s enrollment report:

Enrollment of fi rst-year osteopathic medical students has grown by 11.1 per-cent over last year’s number to a total of 6,449.

This spring, 4,726 students graduated from osteopathic medical schools, repre-senting an increase of more than 50 per-cent over the number of new osteopathic physicians who graduated a decade ago.

The United States has 30 colleges of osteopathic medicine at 40 locations in 28 states, including Mississippi with the ad-vent of William Carey University College of Osteopathic Medicine, with several ad-ditional colleges of osteopathic medicine in the planning stages.

Three colleges of osteopathic medicine enrolled fi rst classes this year:

• Alabama College of Osteopathic Medicine in Dothan, Ala.,

• Campbell University School of Os-teopathic Medicine in Buies Creek, NC, and

• Marian University College of Osteo-pathic Medicine in Indianapolis, Ind.

Schools with signifi cant growth this year are:

• Pacific Northwest University of Health Sciences College of Osteopathic Medicine (PNWU-COM) in Yakima, Wash., and

• University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine.

The number of students who applied to osteopathic medical schools hit record numbers at 16,454, an increase of more than 1,500 over last year’s applicant pool.

Osteopathic Infl uence, continued from page 1

Dr. W. Ashley Hood

not knowing why, there’s no question. This is a crystal ball you can look into and see the probability of this thing happening and start learning what to do.”

For example, if she’d known Deuce was at risk for diabetes, Gilbert wouldn’t have allowed him to take the steroid prednisone—notorious for raising blood sugar—for a chronic cough. “That seemed to switch it on,” she pointed out.

Even though he was diagnosed at a young age, Deuce has adapted remarkably.

“Since the age of four, he’s been checking his own blood sugar, which in-volves fi nger sticks,” his mother explained. “He got his pump last year and immedi-ately learned to program it and account for the amount of carbohydrates he was eating. We explore different approaches together and try them together, but I don’t try to control what he does because his research has to come from his own curiosity.”

That curiosity is piqued at Camp Kandu.

“There’s a game called Find the Carbs, where they put out models of food—a child may fi nd a potato, for instance, or an apple—and they try to teach them what is in their diet,” said Gilbert. “It lets them know, ‘This is what I have to count to administer my insulin.’ It puts them in charge.”

Camp Kandu is about empowerment, said Mary Fortune, executive vice president of the Diabetes Foundation of Mississippi (DFM).

“We want children with diabetes to live full, independent lives in which they control diabetes and diabetes does not con-trol them,” she said.

Camp Kandu also breaks down barri-ers for children with diabetes.

“Deuce talks about it all the time,” said Gilbert. “The kids are able to meet and play team sports. And several times

a day, the staff will stop the games and say, ‘Everybody sit down and check your sugar!’ And they all sit down and test their blood sugar together. It gives them a sense of belonging. The camp does a lot for their self-esteem.”

It’s about not being alone with diabe-tes, said Gilbert.

“Camp Kandu is heaven-sent because it’s where your child can fi gure out there’s somebody out there just like them,” she said. “It’s a place to heal their spirit. It lets them know they can do this.”

In Tre’s case, the TrialNet testing at Camp Kandu and subsequent preventive therapy may be keeping diabetes at bay, said Fortune.

Deducing Diabetes, continued from page 4

Making Every Penny Count

The Diabetes Foundation of Mississippi (DFM) offers Camp Kandu free for children with diabetes and their families, the only one of its kind in the state.

“Every dollar we raise stays in the state and is spent helping every child, every adult and every family touched by diabetes,” said Mary Fortune, DFM executive vice president. “We save lives every day.”

To support the DFM mission or for information on diabetes, contact DFM at (601) 957-7878 or (877) DFM-CURE or visit www.msdiabetes.org or DFM on Facebook.

For more information on TrialNet, call (800) 425-8361 or visit www.diabetestrialnet.org.


By CINDy SANDERS

If being quite specific while leaving plenty of room for interpre-tation was an art form, the Centers for Medicare and Medicaid Services surely would have achieved ‘master class’ sta-tus by now. The two-midnight rule, the recent compliance mandate that went into effect on Oct. 1, is an example of this dichotomy and has left physicians and hospital administrators scrambling to un-derstand what it means for patients … and the bottom line.

Boiled down, the new rule sets “two midnights” as a benchmark for inpatient admission, but there are excep-tions. Meant to clarify the difference be-tween appropriate observation status and inpatient admission, the IPPS final rule caused enough confusion that CMS offered a three-month amnesty period, which is set to expire at the end of 2013. During this last quarter of the year, hospitals will not face financial penalties even if deemed out of compliance with the rule.

Instead, the federal agency has used this time period for a “probe and educate” program where Medicare Audit Con-tractors (MACs) have focused reviews on claims that are for stays of less than “two midnights” after admission and have of-

fered feedback and education to providers about compliance and missteps. During this period, the Recovery Audit Contractors (RACs) have not conducted medical neces-sity reviews. At year’s end, CMS has said it will assess the findings to see if additional guidance is needed.

Brian Contos, executive director over-seeing the clinical research and insights pro-grams at The Advisory Board Company, recently spoke with Medical News to shed a little light on the confusing and contro-versial rule.

The Backstory“There are probably two storylines be-

hind why they have implemented the two-midnight rule,” Contos said of CMS. “On

the one hand, they’re instituting this policy to address concerns surround-ing extended observation stays.” He continued, “I think the other reason is the simple fact that there are a tre-mendous number of very short stay inpatient admissions.”

Looking to the first motivat-ing factor, Contos said, “Between

2006 and 2011, there was a dramatic increase in observation stays … a 65 percent increase.” In addition, he contin-

ued, there was a 176 percent increase for those kept in observation for an extended period — 48 hours or longer. As for the sec-ond issue, Contos said, “Of the roughly 15 million Medicare admissions in 2012, about 2 million of those were admitted with a one-day stay.”

Since the cost to Medicare is far greater under Part A than under Part B (outpatient or observation status), the federal payer has a vested interest in how patients are classi-fied, but CMS made it clear the goal is nei-ther to keep patients in observation limbo when inpatient admission is warranted nor to pay Part A rates when services could be rendered in a more cost effective manner.

Contos said, “From CMS’ perspective, there’s a yin and yang here … we don’t want a really long observation period nor do we want to pay for these really short in-patient stays.” He said it’s all about finding equilibrium.

Going forward, one-night inpatient stays will probably serve as a red flag for auditors to dig deeper to ascertain whether Part A reimbursement was appropriate. While two midnights is the benchmark for inpatient status, there certainly are excep-tions. First and foremost, any procedure that appears on the inpatient-only list is ex-empt from the rule. Second, there are other conceivable situations where a patient could have reasonably been expected to meet the benchmark but only stayed one night, in-cluding self-discharge against medical ad-vice, death, or transfer. However, Cantos stressed the documentation must clearly show that the physician admitted the indi-vidual to inpatient status with an anticipa-tion that the patient’s condition warranted a stay of at least two midnights.

In addition to the marked increase in observation cases, Cantos said the issue of post-acute care was another catalyst for the rule. For Medicare to pick up the tab for a stay in a skilled nursing facility or rehab unit, a patient has to stay in the acute care

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facility for three days, and observation days don’t count. Pressure has been mount-ing on CMS … both by patient advocacy groups and through legal challenges … to ‘do something.’ A report based on Medi-care data from 2012 and released this July by the Office of Inspector General found there were more than 600,000 hospi-tal stays last year that lasted at least three nights but didn’t qualify for inpatient pay-ment … which means those stays would not have satisfied the three-day rule if needed.

Contos noted, “I would say the three-day rule is universally hated. Hospitals and advocacy groups want time in observation to count if a patient ultimately is admitted.” While CMS did not opt for that route, the two-midnight rule could be seen as a step to-ward ensuring a more timely determination of whether or not a patient should be admitted.

The Problem for Hospitals“It’s a judgment call at the end of the

day,” Contos said of whether or not a physi-cian admits a patient.

Therein lies part of the problem for hospitals … the two-midnight rule is spe-cific in that it is a judgment call and simul-taneously very loose because, by its very nature, a judgment has many shades of gray, which could leave the soundness of the decision open to interpretation … per-haps by an auditor.

Although CMS actually expects about 400,000 observation cases to become inpa-tient and 360,000 inpatient cases to move out, many hospitals don’t believe the rule will help the bottom line. First, the inpa-tient payment rate is being adjusted down slightly to achieve budget neutrality. The other concern is that for some hospitals, the number of inpatients gained from extended observation will be considerably less than the number lost from shorter stays, which will negatively impact margins that are al-ready extremely tight.

“I don’t think we can assume what happens in one hospital will happen in all. It will be institution by institution. Every hospital is going to look differently,” Can-tos said.

Certain service lines will probably be disproportionately impacted. For example, about one-third of hypertension cases and approximately 40 percent of Medicare chest pain cases result in a one-day admis-sion. Presumably, those patients will wind up as observation patients in the future. Cantos encouraged hospital administrators to work closely with their analytics team to get a better sense of the anticipated effect of the rule on their specific hospital.

Exacerbating the financial concern is the increased out-of-pocket burden on patients. Moving from Part A inpatient to Part B observation status typically means the patient will shoulder more of the costs, adding strain to the collection process and potentially increasing the hospital’s bad debt ratio.

So what is to keep a hospital from skewing the numbers in their favor … keep-ing short stays longer and admitting more observation patients? Cantos said some hos-pitals certainly might opt to roll the dice, but there are inherent risks in this plan.

First, demanding a patient be admit-ted contrary to a doctor’s medical opinion is never optimal. “Physician judgment should really be held almost sacred,” Cantos said. “There is nothing more disruptive to hospi-tal/physician relationships than for a hospi-tal administrator to tell a physician how to assess or judge a particular patient’s care.”

Cantos continued, “This is something that starts with a physician’s medical judg-ment, and I don’t think most hospitals want to dictatorially stipulate how physicians must practice.”

The second risk is that a hospital could ultimately wind up taking an even bigger hit to the bottom line. Although CMS offers a rebilling process to move claims incorrectly filed as Part A to Part B, hospitals only have one year to do so. By the time an auditor comes in to review inpatient claims, there is a good chance many would be past the one-year mark. In those cases, a claim deemed inappropriate by the auditor wouldn’t be eligible for rebilling. Instead, the hospital would be liable to CMS for the full amount of those claims plus any fines.

Prepping for Post-AmnestyWith the grace period granted by

CMS rapidly coming to an end, Cantos offered four observations about steps hos-pital administrators could take to optimize compliance.

First, there should be an emphasis on physician education. “You don’t want to dictate, but you do want to make sure ev-eryone understands the rule and documen-tation requirements,” Cantos said.

In the eyes of CMS, he added, ‘admit’ and ‘admit to inpatient care’ are different. No one wants to lose out on reimbursement because of incorrect terminology. Hospitals also don’t want to present RAC auditors with widely divergent case documentation. “As a hospital, you do want to try to estab-lish some norms here so it’s not a total crap-shoot if audited,” Cantos said. “If you’re all over the map, it becomes really difficult to right-size your program.”

The second recommendation is for hos-pitals to look at the processes in place to as-sess and reassess observation cases. “There’s a timing element,” Cantos pointed out. While it’s critically important to document how, when and why a decision was made to admit to inpatient status, it’s also impor-tant to expedite that process. “It’s something every hospital is going to have to push on — timely decision-making,” he said.

Cantos said hospitals also should re-view their internal auditing process. “Like-wise, you want to develop a self-review process to identify cases that were inappro-priately admitted so you can rebill under Part B within the one-year filing window,” he noted.

The fourth item is to make sure that in addition to educating staff about the two-midnight rule, hospitals also remember to explain it to patients. “It’s very important the patients understand that just being in a bed in a hospital doesn’t mean you are ad-mitted. Patients pay more out-of-pocket for Part B so they must understand the nuances about payment for inpatient and observa-tion,” Cantos stated.

Two-Night Minimum, continued from page 7


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 Technol-ogy 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 Elec-tronic 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 Agree-ments; new breach notifi cation rules and enforcement; and new notice of privacy practices requirements.

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 fi rst.

New, stricter rules addressing breach notifi cation 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 signifi cant 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 person inadvertently discloses the information to another authorized person in-house.

Finally, healthcare privacy has evolved dramatically since HIPAA was fi rst signed into effect, and updated reg-ulations 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 entity must get a patient’s permission be-fore 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 fi eld 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 signifi cant public perception and fi nancial 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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done, with some anesthesiologists saying it takes too much time and health insurance won’t cover it.

“Patients are often cleared for surgery from a medical, cardiac, or pulmonary standpoint,” said neurologist Ronald L. Schwartz, MD, CPI, director of the Neu-rological Research Center at Hattiesburg Clinic in South Mississippi. “However, surgical clearance from a neuro-cognitive standpoint is rarely requested or per-formed. Overall effectiveness of such procedures hasn’t been systematically studied.”

A mental status exam to evaluate dif-ferent areas of the brain can be quickly given by the physician who’s performing the pre-operative clinical evaluation of a patient, said Mariana Dangiolo, MD, as-sistant professor of family medicine, di-rector of geriatrics at the UCF College of Medicine, and a geriatrician for UCF Pegasus Health in Orlando, who includes it as a routine part of physical exams with geriatric patients.

“Other cognitive baseline tests, es-pecially comprehensive ones, may take several hours,” she said. “Those typically aren’t covered by insurers, and aren’t usu-ally what you need to establish a baseline status. Something simple, such as asking patient and/or family about patient’s daily level of functioning before surgery, can certainly provide a lot of information.”

Research NotesA recent Duke clinical study published

in the Journal of Anesthesiology confirms earlier findings from an important 1998 Lancet publication, showing significant numbers of elderly patients experiencing changes in higher order brain function after anesthesia and surgery.

At discharge from the hospital, signs of POCD were present in roughly one in three patients.

At the 3-month mark, 12.7 percent of patients over the age of 50 still showed cognitive impairment.

Elderly patients are at risk of POCD, but the study doesn’t specify whether it’s due to anesthesia, surgery, or post-surgery recovery aspects, such as pain, pain medi-cation, other medications, infection, in-flammation, sleep disruption.

Post-operative confusion is often tran-sient and not necessarily a precursor to a dementia syndrome, noted Schwartz.

“However, POCD is distinct from a post-operative delirium, which may rep-resent a precursor to dementia or, more commonly, represents a symptom of an underlying dementia – such as Alzheimer’s – that wasn’t adequately recognized pre-operatively,” he explained.

A study by French doctors released earlier this year at a European Society of Anesthesiology congress in Barcelona, Spain, said general anesthesia for the el-derly boosts the risks of dementia by more than a third.

Researchers led by Francois Sztark at the University of Bordeaux in France analyzed data from a long-term study into

cognitive decline covering 9,300 elders in three French cities. The volunteers – aver-age age 75 – were interviewed when they were recruited into the study and then two, four, seven and 10 years post-surgery.

The data showed a link between the onset of dementia and a general anesthetic that had been administered two or three years earlier.

Some experiments suggest that vari-ous anesthetics inflame neural tissues, caus-ing protein plaques and tangles to develop that are precursors of Alzheimer’s disease.

“Clinically, it’s not uncommon for pa-tients to be diagnosed with Alzheimer’s as the ultimate etiology for a post-operative delirium,” noted Schwartz. “If Alzheimer’s pathology exists, anesthesia may trigger a decline as being potentially neurotoxic to neurons hindered by amyloid and, perhaps more likely, tau pathology.”

Another recent study examining the incidence of POCD after major non life-threatening procedures shows how certain risk factors have been identified and dem-onstrated a number of correlates and risk factors, even though much remains to be clarified about the true incidence, etiology, prevention, and treatment.

In the study of 200 patients age 60 and older undergoing hip surgery, postop-erative delirium was a strong independent predictor of the development of subsequent cognitive impairment, subjective memory decline, and the need for long-term care.

Interestingly, the correlation with the development of POCD isn’t shown whether the patients had regional or gen-eral anesthesia.

Several theories have been posed to anesthesiologists regarding the possible link between dementia and anesthesia and surgery in patients 85 and older:

In the traditional view, anesthetic agents are rapidly metabolized and/or ex-creted from the body, and therefore are un-likely to cause neurologic injury long term. Also, certain anesthetic agents appear to protect, not injure, the brain. Recent re-search challenges the belief that a well-done anesthetic and complication-free surgical procedure is totally neurologically benign.

Researchers suggest that, in patients who develop POCD, limited brain “re-serve” has been somehow “unmasked” by anesthesia and surgery, or that anesthe-sia and surgery somehow accelerates the aging process in the brain. Inflammation might be the culprit. Previous research has shown signs of inflammation in cerebro-spinal fluid after surgery, but it’s not clear whether this is the cause or the result of POCD.

A significant limitation of POCD stud-ies is exclusion of a standardized preopera-tive neurological examination, in addition to the neuropsychological testing, making it very difficult to separate the relationship between surgery and anesthesia and sub-sequent cognitive decline and death from the cognitive decline and death that occur among older adults without surgery.

“The unmasking comment seems rel-evant, but precise etiology remains elusive as many of the theories of anesthesia tox-icity have been shown mostly in animal

studies,” said Schwartz. “There have been some recent studies evaluating CSF A-Beta/tau ratios pre and post-operatively, which suggested an adverse effect on these biomarkers. There may be other inflam-matory biomarkers that are effected in conjunction with the above.”

The bottom line: “It’s reasonable to be cautious, especially with elective pro-cedures, but association between anesthe-sia and long-term dementia -- permanent damage – hasn’t been established,” said Schwartz.

David Richardson, MD, head of the geriatric psychiatry unit at St. Dominic’s Behavioral Health Services in Jackson, usually sees patients post-operatively who present with the onset of dementia symp-toms.

“A traumatic event like surgery may loosen their hold,” he said. “I’m wondering if maybe rather than (a possible link between surgery and anesthesia and) dementia, if de-mentia may be already present.”

Difference Makers “We (healthcare providers) can pre-

vent a lot of confusion in the hospital not only with the preoperative cognitive eval-uation, but also with some very simple modifications in postoperative care,” said Dangiolo. “For example, we know hospitals can be very noisy, yet the patient needs to maintain uninterrupted sleep while there. Nurses go into the room every two hours or so, along with other interruptions such as blood tests that hinder a patient’s rest.”

The unfamiliar environment also breeds confusion for some patients, Dan-giolo said.

“Having family photos, a clock, or other items from home to orient the pa-tient will help,” she said. “Keeping the lights on from 7 a.m. to 7 p.m. will help regulate the sleep cycle.”

Many times, physicians busy making their rounds may forget to ask patients whether they wear glasses or use hearing aids, resulting in perceived patient confu-sion.

“Also, anything that restrains pa-tient activity in the hospital, such as being connected to an IV or catheter, adds to confusion,” she said. “If the patient has a catheter, it should be removed as soon as possible. Otherwise, it could lead to infec-tion, which could lead to confusion and more.”

Pain affects patients in a way that cre-ates temporary confusion, and unnecessary guests create an environment not condu-cive to rest, Dangiolo said.

“Elderly people take an average of six prescription drugs or more, plus over-the-counter drugs and supplements,” she said, noting that all medications should be carefully reviewed, with special atten-tion to those that affect the brain such as sedatives, antidepressants, hypnotics and antispasmodics.

“When you combine all these ele-ments, it’s easy to see how elderly patients could become confused,” she said. “These simple modifications after surgery can make a big difference in the assessment of a patient’s postoperative cognitive state.”

Establishing a Preoperative Cognitive Baseline, continued from page 1


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Case Study: ICD-10 Conversion ChartWise comprehensive CADCDI software program significantly enhances documentation efficiency while also optimizing reimbursements for busy Atlanta-area health system

Maria Mann

By LyNNE JETER

LAWRENCEVILLE, GA. — When leaders at Gwinnett Hospital System were tasked with implementing a program for ICD-10, they were concerned about tight-ened Medicare reimbursement standards and projected losses in productivity associ-ated with conversion from ICD-9.

The Lawrenceville, Ga.-based market leader, with 38 percent market share in Gwinnett and Barrow counties, had been using the same software tool since 2004. Even though Gwinnett Hospital System had developed a clinical documentation improvement (CDI) program that ranked in the top 5 percent nationally for clinical quality, the software could no longer sup-port the needs of its 553 beds, 800 affili-ated physicians and 4,100 employees.

“Our system required a tool that would streamline workflow by automat-ing manual processes,” said Maria Mann, RN, BSN, clinical documentation integrity manager and for Gwin-nett Hospital System, who was tasked with re-searching and selecting a new Computer-Assisted CDI (CACDI) provider. “We also needed a plat-form capable of provid-ing advance metrics and more efficient reporting. We were looking for a state-of-the-art software solution designed to handle pres-ent and future documentation challenges associated with reimbursement, (CMS’s) RAC (Recovery Audit Contractors) audits and the ICD-9 to ICD-10 conversion.”

The most salient attribute the health system required from their CACDI soft-ware to move the program forward was a user-friendly interface and an overall easy-to-use platform. An impactful, com-prehensive CACDI program could signifi-cantly enhance a coder’s documentation efficiency while ultimately impacting the organizations’ bottom line through op-timized reimbursements. Also, coders

needed to be able to query physicians electronically for speed, efficiency and ac-curate recordkeeping, noted Mann.

“We didn’t have the time or resources to execute extensive training with physi-cians, and needed to make certain any advanced features contained within the software would improve efficiency for the hospital systems’ CDI and IT staff,” she explained.

Mann invited the top vendors in the field to make a presentation demonstrat-ing the value and functionality of their software to integrate into their CDI pro-gram.

“Once we reached the point of work-ing through each software solution’s user functionality and integrative capabilities, it became readily apparent that there are no other tools on the market today offering what ChartWise:CDI does,” said Mann. “We were searching for the most user-friendly solution and that’s what drew us in, but ChartWise’s advanced reporting capabilities were extraordinary. We also found that the ChartWise software would help facilitate our transition from ICD-9 to ICD-10 and that their solution would

streamline our workflow while increasing productivity.”

In the first five months of implement-ing ChartWise’s CDI application, Gwin-nett Hopsital System, reported significant results. In January, the month preceding implementation of ChartWise’s software solution, the CDI staff engaged in a total

of 774 initial chart reviews searching for further documentation that could alter the severity of illness/risk of mortality or DRG (diagnosis related group) codes, along with 439 follow-up reviews to see if the physician had answered their clarifica-tion query. In March, the first full month after assimilating the new CDI program, the same team was able to complete 1,445 initial reviews and 1,850 follow ups, an increase of 87 percent and 321 percent, respectively.

Gwinnett Hospital System also re-ported a substantial increase in phy-sician response rate after integrating ChartWise:CDI software. Last year, the average response rate was 75 per-cent. From February to May, with ChartWise:CDI implemented, the aver-age physician response rate rose to 86.8 percent. Mann attributes the increase to the quality and content of the queries, along with the ability to easily respond to a query.

“The entire process has been an over-whelming success,” said Mann. “From the easy-to-use interface, to the reporting ca-pabilities, to the electronic query function-ality, the transition has been seamless.”

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By CINDy SANDERS

Whether in the context of discussing defensive medicine or the latest diagnostic technology, there seems to be a pervasive belief that increasing overutilization of medical imaging is a key driver of health-care spending. Yet, those within the field point to recent studies that find a flaw in that line of thinking … within the Medi-care population, utilization rates are actu-ally in decline.

A study conducted by the Harvey L. Neiman Health Policy Institute and pub-lished this summer in the Journal of the American College of Ra-diology found the num-ber of physician visits by patients age 65 or older that resulted in an imag-ing exam has consistently trended downward over the past decade from 12.8 percent in 2003 to 10.6 percent in 2011. Using Medical Expenditure Panel Sur-vey (MEPS) data in addition to Medicare claims data, the researchers also said that annual spending on imaging for the senior population grew from $294 per enrollee in 2003 to $418 per enrollee by 2006 but had declined to $390 per enrollee by 2011.

Richard Duszak, Jr., MD, FACR, chief medical officer and senior research fellow at the Neiman Health Policy Insti-tute, which is part of the research arm of the American College of Radiology, noted a major concern for those in the profes-sion is that outdated information could be used to inform healthcare policy with a direct impact on patients and providers. “We’re in an interesting time where there is immense scrutiny on our health delivery system,” he said. “We really need good, credible information driving policy deci-sions.”

Duszak, a board-certified radiologist, noted that at some point the mantra that imaging utilization was continually spiral-ing upward “didn’t match what we in the trenches saw.” He added imaging studies were rapidly growing until 2006, “Then it plateaued and has, in fact, declined.” Duszak added he isn’t suggesting imaging utilization shouldn’t continue to be moni-tored but that similar scrutiny should ac-crue to other Medicare service lines that are now growing at a faster rate.

“Like any tool … like any technology … like any discipline, how good imaging is — how useful it is — really depends upon how it is utilized. I think there are some appropriate areas where we can reduce in-judicious use of imaging, but,” he stressed, “we should not be throwing the baby out with the bathwater in the process.”

The medical discipline has already taken a number of financial hits. The Def-icit Reduction Act of 2005 significantly

decreased financial reimbursement for di-agnostic imaging. Sequestration, bundled payments and other changes to reimburse-ment models and formulas also threaten to further erode the financial viability of the field. In this most recent research, the study’s authors wrote, “A failure to understand changes in utilization that may accompany these potential payment reductions could ultimately produce ad-verse effects on patient care regardless of whether the intended cost containment goals are realized.”

Duszak pointed out the field of radiol-ogy has seen incredible technological and diagnostic advancements that have helped physicians accurately pinpoint health is-sues and improve outcomes. He said the downstream effect must also be considered when determining appropriate imaging utilization levels.

He said looking solely at the front-end savings is a bit like only watching the first part of a movie without regard to how the story ends. “The hero did great. He saved money … but what happens in the next scene? Did that money really get saved, or are there other unforeseen costs as a result of the hero’s actions in scene one?” Duszak questioned.

It’s a topic Duszak explored in a brief he authored for the Neiman Health Policy Institute last fall. “Lawmakers, regulators and medical professionals are making medical imaging policy decisions without fully understanding or examining their downstream effects, which may include an increase in hospital stays, associated costs and other adverse events,” he wrote. “We need to examine imaging, as it relates to a patient’s overall continuum of care, to ensure that decision-makers don’t create imaging cost reduction policies which par-adoxically raise overall costs, create barri-ers to care and ultimately harm patients.”

Getting a better handle on the bearing imaging has on the overall cost of care is an area where Duszak said more research is critically needed. What impact does im-aging play in catching cancers early when treatment is most effective? Did skipping a diagnostic study result in a patient staying extra days in the hospital while providers tried to determine the source of illness? “We need more research in this space to answer these questions definitively,” he said.

Ultimately, Duszak said, everyone’s goals should align — find out where imag-ing is most beneficial and push for more of it … determine where it isn’t as helpful and push for less. “We need to continue a sophisticated analysis to determine appro-priate usage,” he concluded.

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ergy) is making efforts to correct that by investing money in grants to spur activity. Our project indirectly addresses the prob-lem by offering a better option.”

Zehner pointed out the large-scale machines producing these isotopes domes-tically aren’t dedicated to medical use; the “part-time” supply won’t keep pace with long-term demand.

“No single cyclotron operates year-round to produce these generators,” he said. “We’ll be the fi rst group to provide a very stable supply of these isotopes to image patients. If you have PET scanner, you’ll be able to count on the fact it’ll be available.”

He also noted that other companies with cyclotrons producing medical iso-topes don’t have the capacity – limited in horsepower by 30 MeV, for example – to make certain ones.

“The long-term Zevacor business plan is to change the way hospitals do business by giving them an opportunity to create a profi t stream for their hospi-tals through investment in a smaller-scale cyclotron that will allow them to produce necessary isotopes onsite and supply both short- and long- life nuclear medicines to hospitals within a three-hour radius,” said Zehner.

Zevacor is part of a purchasing group, UPPI (United Pharmacy Partners Inc.), a chain of independent pharmacies that’s in talks with various healthcare facilities to

establish local markets. “In today’s healthcare environment,

everyone’s striving to provide the same or better outcomes with lower overall cost,” said Zehner. “Even though PET is more expensive upfront, it eliminates multiple unnecessary tests compared to the information it provides.”

Securing Isotopes, continued from page 5

Zevacor Molecular’s EVP John Zehner has experience as a nuclear pharmacist, radiation safety offi cer and cyclotron operator for drug manufacturing, and extensive regulatory affairs knowledge collaborating with the Nuclear Regulatory Commission (NRC), Food and Drug Administration (FDA), Department of Transportation (DOT) and various state pharmacy boards. In 1995, the Purdue alum led the effort to acquire Eastern Isotopes from three nuclear pharmacies in Washington, DC. The emerging company became one of the world’s largest producers of Positron-emitting radioisotopes, IBA Molecular. Also, Zehner has a patent involving the automation of nuclear medicine products.

Meridian Physician Releases First Novel

Is it ever possible to get a second chance? Dr. Keith Miller thinks he has found the secret to craft-ing a second chance for himself. One that will al-low him to recapture a lifetime of sweet memo-ries he selfi shly walked away from.

In his fi rst novel, Me-ridian gynecologist Dr. Freddy Grant creates a rich group of characters – the handsome former high school football star who is now a driven, successful research physician, his loving young wife and new baby. But lack of moral character leads him away from his commitments.

Dr. Grant says he was fi rst inspired to write the novel when he returned to watch a high school football game the year after his son Doug graduated. He loved watching his son play football and thoroughly enjoyed all the experiences of parenting his two children, Doug and Emily Joy. As he looked into the stands and saw a couple watching their son play that night, he noticed the intensity of love and concern on their faces. He then began to wonder, “What if I had never experienced it? What would my life be like if I hadn’t been a part of my children’s lives?”

With that thought in mind, Dr. Grant

set about starting his novel, a work that took him almost ten years to complete. With support from his wife, Linda, chil-dren Doug and Emily Joy and close friends who encouraged him, Running Back was fi nally published.

The novel starts in the northeast but quickly moves to Gulf Shores, then Me-ridian. Dr. Grant describes his work as fi c-tional drama with a bit of science fi ction. Readers will enjoy the pace of the book as well as the familiarity of the characters and places in East Mississippi and West Alabama.

A native of York, Alabama, Dr. Grant has practiced OB/GYN in Meridian since 1988. He now limits his practice to gy-necology. He says that growing up and working in an area where family ties are so strong he couldn’t imagine what his life would have been like if he hadn’t been a father ( and now a grandfather).

Running Back has its own Facebook page and is available for sale on Ama-zon.com.

St. Dominic’s First in Nation to Enroll Patient in Clinical Study to Evaluate New High Blood Pressure Reduction Procedure

St. Dominic’s has announced that the fi rst patient has been enrolled in the EnligHTN IV trial, a clinical study evalu-ating a new procedure for patients with drug-resistant high blood pressure. St.

Dominic’s is one of the fi rst hospitals in the country to participate in this ground-breaking research.

The ability to reduce blood pressure is important because the risk of cardio-vascular death is cut in half with every 20 point decrease in blood pressure.

The new procedure, called Renal Sympathetic Denervation, is one of the hottest topics at cardiovascular confer-ences around the world, according to Gray Bennett, M.D., Interventional Car-diologist at St. Dominic Hospital. It’s a minimally invasive procedure that can lower blood pressure by levels that over time will signifi cantly reduce the risk of heart attacks and strokes. That’s not what this trial is designed to show but ulti-mately that is where it is headed he said.

Renal denervation is a minimally in-vasive therapy that may provide a lasting reduction in blood pressure for patients with hypertension who are resistant to medications. It is a specialized ablation procedure that targets nerves along the renal arteries leading to the kidneys.

During the procedure, tiny scars are created on the renal artery walls to inten-tionally disrupt nerve signals thought to cause high blood pressure. This inten-tional disruption of the nerves may infl u-ence a decrease in systolic and diastolic blood pressure.

Sponsored by St. Jude Medical, the EnligHTN IV study is a randomized,

single-blind, controlled, multi-center trial to demonstrate the safety and effective-ness of the next-generation EnligHTN™ Renal Denervation System in reducing systolic blood pressure when measured in an offi ce setting. The study will enroll approximately 590 patients between the ages of 18 and 80 with an offi ce systolic blood pressure of 160 mmHg or greater, who are taking three or more antihyper-tensive medications including a diuretic. Study patients will be enrolled at up to 80 sites in the U.S. and Canada.

Biloxi Regional Medical Center Earns “Top Performer on Key Quality Measures®” Recognition

Biloxi Regional Medical Center was named Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of health care or-ganizations in America, for the 3rd year in a row. Biloxi Regional Medical Center was recognized by The Joint Commis-sion for exemplary performance in using evidence-based clinical processes that are shown to improve care for certain conditions. The clinical processes fo-cus on care for heart attack, pneumonia, surgery, children’s asthma, stroke and venous thromboembolism, as well as inpatient psychiatric services. New this year is a category for immunization for pneumonia and infl uenza.

Dr. Freddy Grant


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GrandRoundsRiver Oaks Hospital receives prestigious awards for spine surgeries

River Oaks Hospital is among the top 10 percent of U.S. hospitals for spine surgery, a ranking that places the Flowood hospital in the category of America’s Best 100 Hospitals, according to a new report from Healthgrades, the leading provider of information to help consumers make an informed decision about a physician or hospital.

For the 12th consecutive year, Riv-er Oaks Hospital’s orthopedic services program received a 5 Star Award from Healthgrades. Additionally, the hospi-tal received a Spine Surgery Excellence Award and 5 Star Award for spinal fusion surgery.

The findings are part of American Hospital Quality Outcomes 2013: Health-grades Report to the Nation, which eval-uates the performance of approximately 4,500 hospitals nationwide across nearly 30 of the most common conditions and procedures. Healthgrades bases its ob-jective measures solely on clinical perfor-mance.

Healthgrades independently mea-sures hospitals based on data that hospitals submit to the federal govern-ment. No hospital can opt in or out of the analysis, and no hospital pays to be measured.

Folse named medical advisorSouthern Bone and Joint’s Dr. Susi

Folse has been named medical advi-sor for the University of Southern Mississippi School of Human Perfor-mance and Recreation Ki-nesiotherapy program.

Folse received her athletic training degree from the University of Southern Mississippi. She received her medical degree from the Louisiana State University Medical Center and also com-pleted her internship and residency in physical medicine and rehabilitation at LSU. Folse is a member of the Southern Medical Association and Association of Physical Medicine and Rehabilitation.

Southern Bone and Joint Special-ists Rehabilitation facility will be a clinical rotation site for the program. Julie Falla, OT and Quin Sirmon, PT will be instruc-tors.

Dr. Aaron Shirley receives national medical school award

Dr. Aaron Shirley, who broke a racial barrier at the University of Mississippi Medical Center in 1965 and is one of the state’s civil rights icons, received the 2013 Herbert W. Nickens Award from the Association of American Medical Colleges.

Honored for his life-time of service in support of diversity in medical ed-ucation and the elimina-tion of health disparities, Shirley received the award at a black-tie gala at the AAMC’s annual meeting in Philadelphia, Pa.

Originally from Gluckstadt, Shirley completed medical school and an in-ternship in Tennessee before entering private practice in Vicksburg. He set his sights on a pediatric residency out of state, but was invited to apply for a train-ing slot at UMMC by then chair of pe-diatrics, Dr. Blair E. Batson. After much prayerful consideration, he accepted, becoming the first African-American res-ident — and the first black learner in any program — at UMMC in 1965.

He went on to serve as a clinical in-structor in the Department of Pediatrics for more than 40 years.

Memorial Hospital First Choice Among Consumers for Seven Years in a Row

For the seventh consecutive year, National Research Corporation (NRC) has recognized Memorial Hospital at Gulf-port among the nation’s top hospitals as a 2013/14 Consumer Choice Award win-ner. NRC has honored hospitals whose healthcare consumers have rated as hav-ing the best quality and image nation-ally. Memorial was selected as having the highest quality, best image/reputation, best doctors and best nurses.

Memorial Hospital was also recently ranked as the #1 hospital in Mississippi by U.S. News & World Report for be-ing the only facility in the state to earn national recognition in any of the adult specialties studied by U.S. News. Me-morial also had the most specialties of any hospital in the state to be desig-nated as “High Performing” and ranked 42nd nationally in Diabetes and Endocri-nology care.

SRHS Welcomes Provider to the Neuroscience Center

The Board of Trustees of Singing River Health System has recently welcomed a new member to the Pain Man-agement team within the Neuroscience Center.

Dr. Michael Cos-grove, MD, received his medical degree from the Jefferson Medical College in Philadelphia. He performed a residen-cy at Maine Medical Center in Portland, Maine. He also performed a fellowship at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Cosgrove is board cer-tified in Anesthesiology and board certi-fied in Pain Management.

He will be practicing with the Neu-roscience Center in Ocean Springs

Dr. Susi Folse

Dr. Aaron Shirley

Dr. Michael Coscrove

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Mississippi Medical News December 2013