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Identity as a Risk FactorHeart disease and the feminine mystique Despite the fact that heart disease is the number one killer of women in America and stroke the leading cause of disability, women often don’t identify with the very real dangers the disease holds for their gender, according to Robert Wood Johnson Foundation Clinical Scholar Lisa Rosenbaum, MD. ... 4

Staffi ng Trends on the MoveHORNE LLP’s 2013 staff salary study shows increased demand for NPs and other non-physician providers

This month, Medical News looks at two diverse physician practices, one a large multispecialty practice, and one that steadfastly remains a solo practice ... 6

May 2014 >> $5

PROUDLY SERVING THE MAGNOLIA STATE

William Scot Bell, MD, JD, MMM

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:MISSISSIPPIMEDICALNEWS.COMNEWS.COM

Best ER Care in SoutheastEmergency Medicine Report Card scores Mississippi higher than neighbors, room for improvement

Lifesaving Gifts UMMC transplantation team continues setting records; state lawmakers aid program by removing periodic review from Mississippi Uniform Anatomical Gift Act

BY LYNNE JETER

With a new liver transplantation program in place since last March fol-lowing a 22-year absence, and a pan-creas transplantation program startup in December, the University of Mis-sissippi Medical Center (UMMC) is poised to break more transplantation records in 2014.

“We’re going full steam,” said Christopher Anderson, MD, associate professor of transplant surgery and divi-sion chief of transplant and hepatobiliary surgery at UMMC.

“In the fi rst 12 months of the liver trans-plantation program being open, we completed 25 liver transplants, 18 in the 2013 calendar year, and 25 March-to-March. Since we

opened the pancreas transplant program com-plementary to the kidney transplant program, representing that last piece of the abdominal program, we’ve completed four simultane-ous pancreas-kidney transplants. All total, we completed 104 kidney transplants in the last calendar year, another record for our insti-tution. We’re pleased with our progress, and more importantly, providing the very best quality care for our patients.”

Legislative BoostLegislation passed in the most recent leg-

islative session includes removing the periodic review of the Mississippi Uniform Anatomical Gift Act

(UAGA) while also paving the way for the Mississippi Organ Re-covery Agency (MORA) to boost the number of organ donors and

(CONTINUED ON PAGE 8)

By Mississippi Medical News STAff

Mississippi’s emergency care environment outranked all other Southeastern states and placed 26th out of 51 overall, according to a re-port from the American College of Emergency Physicians (ACEP). In the recently released report, the state received an overall C minus, a score based on 136 measures in fi ve categories, including access to emer-gency care, disaster preparedness and medical liability environment. “As the state’s only academic medical center, UMMC is a major driver of Mississippi’s emergency environment in terms of care, preparedness, assets and services, and setting the bar for the profession statewide,” said Alan Jones, MD, professor and chair of emergency medicine at UMMC. “We take tremendous pride in the work we do and recognize there’s obviously still

(CONTINUED ON PAGE 9)

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opened the pancreas transplant program com-

completed 104 kidney transplants in the last calendar year, another record for our insti-tution. We’re pleased with our progress, and more importantly, providing the very best quality care for our patients.”

islative session includes removing the periodic

“In the fi rst 12 months of the liver trans-review of the Mississippi Uniform Anatomical Gift Act

(UAGA) while also paving the way for the Mississippi Organ Re-

islative session includes removing the periodic review of the Mississippi Uniform Anatomical Gift Act

2 > MAY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

By LUCy SCHULTZE

From electronic health records to the ever-shifting horizon of reimbursement, healthcare organizations do well to weigh every issue from the perspective of care providers.

Adding a physician’s voice to the ex-ecutive leadership team at Anderson Re-gional Medical Center in Meridian was the goal in bringing William Scot Bell, MD, JD, MMM, aboard as chief medical officer.

“With all the changes and cutbacks in healthcare, we’re trying to provide the highest value to our patients through a combination of quality and cost,” said Bell, who joined Anderson in January as its first CMO.

“I think the hospital felt like it was the right time to bring in some physician lead-ership to help navigate through all this,” he said.

A board certified internist, Bell has lived in Meridian since 1998. He comes to Anderson from Rush Health Systems, where he developed the hospitalist pro-gram before taking on additional admin-istrative duties as chief medical officer. His move to Anderson will allow him to focus more fully on an administrative role.

“I may continue to do some clini-cal work, but it will be limited,” he said. “Practicing allows me to relate to the phy-sicians and keep up my skills, and I can say I understand how all these changes are affecting physicians in their day-to-day

practice. I think it gives me some level of credibility.”

Among key efforts in which Bell is already becoming involved is the imple-mentation of the electronic health record system at Anderson, which is currently in the design-and-build stage. The system is slated to go live in April 2015.

Meanwhile, Bell is getting settled in his role as a liaison between the adminis-tration and medical staff.

“Traditionally, there’s always fric-tion between the administration in a hos-pital and the medical staff, just because they have different perspectives,” he said.

“Physicians tend to look at individual pa-tients and advocate for their needs, while hospitals are in the position of having to look at patients in the plural and how we can provide the best care overall.

“It is imperative that physicians and hospitals not only align to achieve shared goals and outcomes, but become true part-ners, as respected equals, relying on each other for mutual assistance, support and cooperation to achieve high-quality, highly reliable, safe, cost-effective patient care.

“I don’t think it’s good enough to just survive, we must remain relevant and strive for excellence. The goal is coming to a bal-ance where we’re treating each patient the best we can, but not to the extent that we’re taking some service or care away from other patients in the population.”

For Bell, stepping into a full-time administrative role comes after some 25 years in medical practice.

He spent seven years in a general internal medicine practice in Southaven, where he found he enjoyed his hospital rounds far more than seeing patients in an office setting. He came to Meridian for the chance to start the hospitalist program at Rush, which today employs six full-time physicians.

A native of Memphis, Bell holds an undergraduate degree in biological en-gineering from Mississippi State Univer-sity and a medical degree from Louisiana State University School of Medicine in Shreveport.

He completed his internship and resi-dency in internal medicine through Bap-tist Memorial Hospital in Memphis, where he stayed on for an additional year as an attending physician and clinical instructor.

Bell holds certifications from the American Board of Internal Medicine and the American Board of Quality As-surance and Utilization Review Physicians Inc. He is a Certified Physician Executive by the Certifying Commission in Medical Management; a distinguished fellow of the American College of Medical Quality; and a fellow of the American College of Physicians and the American Institute for Healthcare Quality.

Over his years of practice, Bell be-came attracted to the administrative side of medicine for the opportunity to make a difference in a broader way.

“I started thinking that maybe there was more I could do to improve the qual-ity of healthcare, beyond just one-on-one patient care,” Bell said, adding that health policy issues should be a matter of interest for all physicians.

“I think it’s very important for physi-cians to become more active in leadership, especially in hospitals, now that everyone is struggling because of the changes in reimbursement, the regulatory environ-ment, and healthcare delivery,” he said.

“Physicians may not be able to con-trol the shifting winds and the changing current in the healthcare environment, but we can adjust the sail and the rudder to guide the ship to our destination.”

Bell returned to school to earn a mas-ter’s degree in medical management from Tulane University, then took the further step of enrolling in law school at South-ern Methodist University in Dallas. From 2005-08, he spent the weekdays in Dallas and flew back to Meridian each weekend to cover shifts as a hospitalist.

“A lot of people say they don’t know how I did that,” Bell said. “But for me, it was actually a good break. I enjoyed prac-ticing medicine, and I worked taking care of patients on weekends. Then by Sunday night or Monday morning, it was a nice change to catch a plane to Dallas and con-centrate on something completely differ-ent. I enjoyed the challenge.”

Bell felt prepared when, after finish-ing his law degree, he had the opportunity to step into a part-time role as chief medi-cal officer for Rush. In transitioning now to Anderson, he appreciated the chance for a lifestyle change that came with fo-cusing on administrative rather than clini-cal work — instead of trying to squeeze in both.

“I’m still trying to figure out what to do with my free time, since I’ve never had a lot,” he said.

A father of five, Bell returns to Dal-las at least one weekend a month to spend time with his children, who range in age from 12 to 23. He also has two stepdaugh-ters with wife Jennifer in Meridian.

William Scot Bell, MD, JD, MMMPhysicianSpotlight

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By KAREN OTT MAyER

It’s time to clear the air about chronic obstructive pulmonary disease (COPD). For the first time, the COPD Foundation gathered state-specific data that reveals Mississippi has one of the highest rates of COPD in America, with 7.9 percent of residents having COPD.

“We estimate about 40 per-cent of the U.S. population is either undiagnosed or misdiagnosed, so we’re looking at potentially even greater num-bers. For instance, in Mississippi that could mean as much as 15 per-cent of the state has COPD,” said Craig Kephart, the ex-ecutive director of the COPD Foun-dation.

This year, however, the COPD Foundation promises to offer Mississip-pians real opportunities to participate in educational and research initiatives, be-ginning with the 2014 implementation of the Patient-Centered Outcomes Research Institute (PCORI) grant designed to de-velop and expand a health data network, enrolling 100,000 people with COPD.

“The highest inci-dence is in the South, particularly in Missis-sippi, Alabama, Ken-tucky, and Oklahoma. Likewise, we see COPD in the industrialized area of the Midwest such as Ohio, Michigan and In-diana,” said Kephart.

An umbrella term, COPD encom-passes a wide range of progressive lung diseases such as bronchitis, asthma, and emphysema. While no cure exists, it is treatable and preventable. “We can ac-tually slow the progression of the disease through pulmonary rehabilitation and ex-ercise,” said Kephart.

According to Kephart, several misperceptions exist about COPD. While smoking is definitely a high-risk factor and Southerners smoke at higher rates than other regions, 25 percent of those diagnosed with COPD never smoked. A huge disparity exists in race as well, with COPD affecting whites two times more than blacks. Seventy percent of those di-agnosed fall under age 65; COPD isn’t a disease of the aging.

“Another myth is it’s an old white man’s disease; one and a half times more

women die of COPD than men,” said Kephart.

Kephart encourages individuals and families to get involved, especially

because COPD can be highly stigma-tized. “In 2014, we launched a new

online community where people can get info, share, and talk to each other. The employer tool kit can be embedded into any well-ness program.” With so many potentially undi-agnosed patients, screen-ing programs remain a

critical component, and the COPD Founda-

tion offers a simple 5-question online

risk assessment.A team led by the

COPD Foundation, in collaboration with the

COPD Outcomes-based Network for Clinical Ef-

fectiveness and Research Translation (CONCERT)

and the COPDGene research networks has been approved for a

funding award by the Patient-Centered Outcomes Research Institute (PCORI) to develop and expand a health data net-work that will be part of PCORNET: The National Patient-Centered Clinical Research Network.

“We hope to begin enrolling people with COPD into this registry by June,” said Kephart. Enrolled patients will rep-resent the spectrum of COPD disease se-verity—most with multiple morbidities, across diverse geographic regions, broad age and socio- economic ranges, both gen-ders, and all racial and ethnic.

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By CINDy SANDERS

Despite the fact that heart disease is the number one killer of women in America and stroke the leading cause of disability, women often don’t identify with the very real dangers the disease holds for their gender, according to Robert Wood Johnson Foundation Clinical Scholar Lisa Rosenbaum, MD.

“We all know men drop dead of heart attacks … we don’t think of women drop-ping dead of a heart attack,” the Univer-sity of Pennsylvania cardiologist noted of the masculine attributes often attached to heart disease.

Furthermore, women tend to fear other diseases, nota-bly breast cancer, more than heart disease. The HealthyWomen 2010 survey, in partner-ship with the National Stroke Association and the American College of Emergency Physi-cians, found that women believe breast cancer is five times more prevalent than stroke, and 40 percent of those surveyed were ‘only somewhat’ or ‘not at all’ concerned about experiencing

a stroke. Yet, stroke is significantly more prevalent in women than in men, and stroke kills twice as many women as breast cancer each year.

“There’s a certain sort of female soli-darity around breast cancer,” Rosenbaum stated. In a perspective piece published earlier this year in the New England Journal of Medicine, Rosenbaum wrote about an encounter with a middle-age woman with high blood pressure and hyperlipidemia. When Rosenbaum asked the new patient what was the number one killer for women, she noted the patient “answered in a way that sticks with me: ‘I know the right an-swer is heart disease,’ she said, eyeing me as if facing an irresistible temptation, ‘but I’m still going to say breast cancer.’”

Rosenbaum is quick to say breast cancer is a valid concern, but the emo-tions linked to the disease go beyond just the facts. She pointed to the controversy surrounding mammography as a clash be-tween data and identity at the social level. Despite a recommendation from the U.S. Preventive Services Task Force to de-crease mammography frequency for most women under age 50 based on decades of data, Rosenbaum wrote, “So intense was the outrage over these evidence-based rec-ommendations that a provision was added

to the Affordable Care Act specifying that insurers were to base coverage decisions on the previous screening guidelines.”

No matter where you stand on mam-mography, most healthcare professionals are united in agreeing lifestyle modifica-tions and appropriate use of medications have been proven to prevent heart disease and save lives. However, Rosenbaum con-tends that facts alone aren’t enough. In-stead, she said the healthcare community needs to find a way to tap into the emo-tional aspects of heart disease as success-fully as has been done with breast cancer.

In the her perspective piece, Rosen-baum wrote that although the first decade of educational campaigns such as Go Red for Women “led to a near doubling of women’s knowledge about heart disease, in the past few years, such efforts have failed to reap further gains.”

She told Medical News, “Our default in medicine is to give people facts, and then we don’t know what to do when we hit the wall. We know how to disseminate facts … we don’t know how to change feelings.”

Complicating the issue with heart disease is that in so many cases it is pre-ventable, and therefore comes with built-in guilt. Risk factors, which have been well publicized, include smoking, obesity,

high blood pressure, high cholesterol, and sedentary lifestyle. “All of these are em-bedded with a sense of not taking care of yourself,” Rosenbaum said. “You should have done something differently.”

Conversely, breast cancer is imbued with a sense of having a terrible disease visited upon a victim, which is true. Also, because breast cancer kills more women at a younger age than heart disease, there are multiple media images of beautiful, strong heroines fighting and surviving … or suc-cumbing … to a disease that attacks a body part that is so uniquely feminine. Rosen-baum pointed out Angelina Jolie’s message about breast cancer resonated with women across the nation who saw the actress as a lovely, brave, fierce role model.

Again, she stated, it isn’t ‘bad’ that breast cancer has pushed its way to the front of female consciousness. It’s smart … and perhaps it’s the type of message the field of cardiology should consider to reach more women.

However, Rosenbaum said it isn’t fair to ask healthcare providers to try to change identity beliefs in a brief office visit. In-stead, she said the subject requires research regarding social values and group identity. Ultimately, Rosenbaum added, cultural messaging will likely come from a variety of sources including media outlets.

Today, she said, “Our biggest chal-lenge is translating what we know into better health of our population. The next phase of evidence based-medicine should be as much about figuring out how to communicate that evidence to our pa-tients … to do that we have much to learn from the methodological approaches of the social sciences.”

Rosenbaum added the starting point to address women’s perceptions of heart disease should be to conduct focus groups to evaluate where emotional beliefs cur-rently stand and assess the impact of fram-ing messaging in different ways. “This is decades worth of work,” she stressed, “to ultimately understand not just how they feel and where those feelings come from, but to evaluate whether there are ap-propriate interventions that help women adopt more heart-healthy behaviors.”

While heart disease might have a de-cidedly masculine feel, there’s no reason why research can’t point to ways to soften the message and appeal on an emotional level to women, as well. After all, women are often identified with their capacity to love … the trick will be finding the right words to help a woman celebrate her big heart while being cognizant of the dangers that come with having an enlarged one.

Identity as a Risk FactorHeart disease and the feminine mystique

Dr. Lisa Rosenbaum

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By Mississippi Medical News STAff

TUPELO—This summer, when pediatric endocrinologist Jessica Sparks Lilley, MD, is slated to give birth to her second baby, a pediatric cardiologist will join the University of Mississippi Medi-cal Center (UMMC). Both positions will further strengthen the state’s pediatric of-ferings.

Lilley, a faculty member at UMMC and Batson Children’s Hospital in Jack-son, has established a practice in Tupelo in affiliation with North Mississippi Medi-cal Center (NMMC) to provide care to children with diabetes and other endo-crine conditions such as disorders related to growth and puberty. Her arrival in Tu-pelo is part of an effort to provide more convenient access to subspecialty care in rural areas and without easy access to the state’s only children’s hospital.

“Our mission at Children’s of Mis-sissippi is to touch the lives of children throughout our state, so we’ve been look-ing for ways to have a greater presence in areas like Tupelo,” said Rick Barr, MD, the Suzan B. Thames Professor and Chair

of Pediatrics at UMMC. “North Missis-sippi Medical Center has welcomed us and paved the way to bring in subspecial-ists like Dr. Lilley so general pediatricians in that area of Mississippi can have a go-to person locally to meet the needs of these

children.”Ellen Friloux, NMMC administra-

tor for Women and Children’s Services, is ecstatic to have Lilley, a Belmont native from Tishomingo County, seeing patients in the East Tower of NMMC.

“She’s very interested in not only treating children with diabetes, but also educating the community on how we can help parents and others nurture kids to a healthy lifestyle,” said Friloux, noting that Lilley joined UMMC last July as an assis-tant professor, after completing a fellow-ship in pediatric endocrinology at Monroe Carell Jr. Children’s Hospital at Vander-bilt University in Nashville. Lilley earned her medical degree from the Vanderbilt University School of Medicine and com-pleted her residency in pediatrics at Chil-dren’s Hospital of Philadelphia, Pa.

Lilley, who has had specific training in the management of cholesterol disor-ders in children, is the author or coauthor of five published articles and two more accepted for publication. She has coau-thored two medical textbook chapters and five abstracts.

Among her honors: American Heart

Association Epidemiology Tahoe Fellow-ship, 2010 Children’s Hospital of Philadel-phia Pediatric House Staff Humanitarian Award and, last summer, Women in En-docrinology’s Young Investigator Award.

In 2011, she won the Pennsylvania Academy of Dermatology Outstanding Service Award, which stemmed from her advocacy work on sun safety in children following her own melanoma diagnosis – she is now a five-year survivor.

Lilley’s awareness of childhood en-docrine problems took shape at a young age, living near young relatives with Type 1 diabetes, who had to drive long distances to see a pediatric endocrinologist.

“Witnessing that really stuck with me, and having the opportunity to partner with my home state’s only children’s hos-pital and the nation’s largest rural hospital was a dream come true,” she said.

Lilley’s professional affiliations in-clude the American Academy of Pe-diatrics, Pediatric Endocrine Society, American Heart Association and National Lipid Academy.

Lilley and her husband, a Methodist minister, have a daughter.

NMMC-UMMC Collaboration Nets Pediatric EndocrinologistPediatric cardiologist also joining Batson Children’s Hospital

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By LyNNE JETER

The 2013 HORNE Medical Office Staff Salary Survey, a fundamental an-nual industry tool to gauge and project salary and benefit trends among medical office staff, reflects a boost in demand for nurse practitioners (NPs), with a startling 68 percent jump in the addition of non-physician providers to practices and hos-pitals from 2009 to 2013.

Based on the context of the Afford-able Care Act (ACA) and shrinking reim-bursements, industry leaders anticipated the spike in demand of non-physician roles, but perhaps not to the extent reported, said Katherine G. Watts, CPA, CHC, partner in charge of healthcare for HORNE LLP, publisher of the annual survey since 2009.

“In practices and hospitals across the na-tion, revenue isn’t growing as fast as your expenses, and surviving as an institution is going to require a different mindset going forward,” said Watts. “However, under-standing industry averages and trends in compensation is a requirement today.”

The ACA’s pervasive mix of new reg-ulations, incentives and reimbursement plans has prodded hospital and practice leaders to scrutinize their staffing priori-ties with an eye toward finding more cost-effective ways to provide high quality care for non-acute patients. Non-physician provider services are emerging as part of the puzzle piece to reach this goal, with the additional benefit of helping to fill gaps in areas where there’s a shortage of physi-cians, said Watts.

The Rise of NPsThe demand for NPs, who are trained

to care for underserved populations, pro-vide disease management patient edu-cation, and help patients make the best lifestyle choices, has pushed average salary rates to nearly $90,000 in 2013, up from $82,727 in 2009, according to the survey.

Strong advocacy efforts at the state level have spurred approximately 170,000 NPs nationwide to hold varying degrees of prescriptive privilege in all 50 states. Con-sidered licensed independent contractors, NPs are trained to order and interpret diagnostic tests. Some states allow NPs to practice independently without physician involvement.

“The focus NPs have on overall pa-

tient health makes them valued members of the interdisciplinary teams supported by Human Health and Services grants, authorized by the ACA to promote pri-mary care services,” said Watts. “Al-though there’s been some pushback from the American Medical Association on NPs leading these interdisciplinary teams in place of physicians, more than half of NPs already identify themselves as the team leader in primary patient care, according to a 2013 Nurse Practitioner Survey. As hospitals grapple not only with shrinking reimbursement, but also changes that link reimbursement to quality and cost-effec-tive care, NPs are uniquely positioned to help with their specialized training in dis-ease management and wellness.”

For the first time, NPs made the top 20 list of most recruited specialties, coming in tenth, followed by physician assistants (PAs) at No. 12, resulting in a combined 164 percent increase in search requests for both positions over the last two calendar years.

Support PostsAccording to the 2013 survey, both

non-physician and physician providers require an average of 5.3 support staff members.

The overall trend of increasing non-physician personnel continues to mush-room, jumping 68 percent since 2009. “The cost savings for non-acute services becomes clear when you look at the cost of hiring non-physicians as compared to physicians, in terms of compensation,” said Watts.

The greatest compensation percent-age changes for clinical positions in the last five years include increases for certi-fied surgery technicians (22.8 percent), bone density technicians (16.7 percent), clinical supervisors (15.5 percent), non-certified surgery technicians (13.4 per-cent), and certified nurse assistants (10.7 percent). Pharmacy technicians repre-sented the deepest drop (13.1 percent) in annual average income.

“As hospitals and practices consider hiring strategies for 2014, non-physician providers are likely to be an increasing part of the mix,” said Watts. “Having a clear understanding of salary benchmarks and associated costs for all healthcare providers gives hospitals and practices the edge they need to attract and keep top non-physician provider talent as a key part of their staffing mix to serve patients and contain costs.”

Staffing Trends on the MoveHORNE LLP’s 2013 staff salary study shows increased demand for NPs and other non-physician providers

Katherine Watts

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 MAY 2014 > 7

By CINDy SANDERS

Consider yourself warned.A white paper released earlier

this year by SANS, a global leader in cybersecurity research, training and certification, painted a bleak picture of where those in the healthcare indus-try currently stand in terms of keeping protected information safe and secure. The report was created using healthcare-specific data provided by Norse, a live threat intelligence and security solutions firm, from September 2012-October 2013. The eye-opening results underscored the vulnerability of providers, payers, business associates and patients.

Authored by Barbara Filkins, a senior SANS analyst and healthcare specialist, the report detailed the widespread problem. In analyzing the Norse data collected dur-ing the 13-month sample, the intelligence found:

• 49,917 unique malicious events,• 723 unique malicious source IP ad-

dresses, and• 375 US-based healthcare-related

organizations compromised … averaging

about one a day.Filkins wrote, “The data analyzed was

alarming. It not only confirmed how vul-nerable the industry had become, it also revealed how far behind industry-related cybersecurity strategies and controls have fallen.”

Furthermore, the analysis made it clear that the threats aren’t unique to any one type of healthcare company, but pro-

viders are seemingly the most vulnerable. In looking at the sectors compromised by malicious traffic, healthcare providers led the way with 72 percent. Business associ-ates accounted for 9.9 percent of the ma-

licious traffic, health plans 6.1 percent, healthcare clearinghouses 0.5 percent,

pharmaceuticals 2.9 percent, and other related entities 8.5 percent.

Most alarming, noted Filkins, was the level of activity found in what was just a sample set.

Speaking to Medical News from her California office, Filkins said ‘malicious events’ are defined as an outside threat or event that

might have penetrated the system and could range from hijacking con-

tacts to pushing sensitive information outward. She noted that many companies, practices and facilities have policies in place warning employees not to click on an un-known email or link. (And who hasn’t re-ceived a suspicious link under the guise of coming from a friend or colleague?) Yet, she said, “People need to be looking at not only what comes into their network, but what goes out of their network.”

To find and address malware typically requires a HIT professional. “A lot of times an attacker will use a very common proto-col so it might look like someone is brows-ing the web, but you might have to dig a little deeper under the covers,” she noted of finding and locating problems. “A lot of these events continued not just for days … but for months,” she added.

Locking the Front Door, Leaving the Back Wide Open

Oftentimes the point of entry for at-tackers was not the main information sys-tem. Instead, those with malicious intent entered through peripheral surfaces like network printers, call contact software, routers, medical devices, and … ironi-cally … security cameras. While the main system was securely locked and password protected, many times, Filkins said, the default password remains on these add-on surfaces. Finding the admin password, she continued, is as easy as doing a quick Inter-net search for the device in question.

“There are some very basic things that can be done to get started with pro-

SANS Cyberthreat White Paper Shows Dark Clouds on HIT HorizonWidespread security issues put systems, patients at risk

(CONTINUED ON PAGE 9)

8 > MAY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

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transplants statewide. Gov. Phil Bryant signed Senate Bill

2217 bill into law after the Mississippi Legislature unanimously approved tweak-ing the act initially passed in 2008. More than 1,300 Mississippians await a lifesav-ing organ transplant.

“We’ve seen far too many men,

women and young children die while on the waiting list,” said Kevin Stump, CEO for MORA, the state’s federally designated organization that oversees the procurement of organs and tissues for transplantation. “This legislation gives us all renewed hope that more lifesaving gifts will be donated and transplants occur.”

Passage of the Mississippi UAGA in 2008 was instrumental in establishing the state’s fi rst donor registry, now with nearly 650,000 registered Mississippians, more than 25 percent of the state’s 18-and-older population. By comparison, Louisi-ana, one of two southern states to exceed the nationally recommended 50 percent minimum Donor Designation Share, has 61 percent of its adult population on the donor registry list, which state lawmakers established in 1997. Only North Carolina has surpassed Mississippi in the speed of gathering organ donors. Since its program was established in 2007, the Tar Heel state has a 58 percent donor designation share, according to Donate Life America’s sixth annual National Donor Designation Report Card, released in mid-2013.

“When (UAGA) was first signed into law, an automatic repealer forced reassessment of the pro-gram,” explained An-derson. “Removing it will help us get more Mississippians to sign up for the registry. The true fi rst-person consent eliminates the decision-making stress for the next of kin in the event of an untimely death. The fact that we have nearly 650,000 donors is impressive and speaks very well of Mis-sissippians and the job MORA has done to bring awareness of the need. We want the numbers to be even higher to meet all the needs of organ donor patients on the waiting list in Mississippi.”

Building on a LegacyUMMC’s transplantation program

made international headlines on June 11, 1963, when James D. Hardy, MD, and his surgical team successfully completed the world’s fi rst lung transplant.

“Even today, (more than) 50 years after he did the fi rst lung trans-plant and a decade after he passed away, I can’t go to a national meeting without somebody asking me about Dr. Hardy,” said Marc Mitchell, MD, James D. Hardy Profes-sor and chairman of the Department of Surgery at UMMC.

Mitchell calls the landmark lung transplant one of the “seminal events” in surgery.

“The world’s fi rst lung transplant . . . was a major, major feat,” he said. “It’s actually more diffi cult to do a lung trans-plant than a heart transplant, so it’s inter-esting that he did the fi rst lung transplant before he did the fi rst heart transplant.”

David Pankratz, MD, dean of the School of Medicine in 1953 at the still-under-construction medical center, re-cruited Hardy, then director of surgical research at the University of Tennessee, to UMMC. Within a year, Hardy’s focus zeroed in on organ transplantation as the next great surgical frontier.

With each successful experiment, Hardy unraveled the intricacies of trans-plantation and became convinced that human-to-human organ transplants were not only possible, but entirely ethical.“Many of the fundamental documents that govern human subject research hadn’t been written,” said Ralph Didlake, MD, professor of surgery, director of the Center for Bioethics and Medical Hu-

manities, and a former resident of Hardy’s. “At the time, Dr. Hardy was asking the right ques-tions about the moral-ity of these transplants. These questions helped establish the boundaries of what could be done.”Within a year of his groundbreaking lung transplant, Hardy made even bigger news when he and his surgical team became the fi rst to success-fully transplant a donor heart – taken from a chimpanzee – into a human. The atten-tion paid to that fi rst heart transplant – a controversial decision in its day – quickly surpassed that of the fi rst lung transplant. “No matter what operation or sentinel event occurs, somebody has to be the fi rst to do it,” said Martin McMullan, MD, professor of surgery, special advi-sor to the vice chancellor, and a for-mer Hardy resident. “The value of Dr. Hardy’s fi rst transplant was to show the world that transplants were likely doable.”

2014 GoalsSince Jan. 1, the UMMC transplan-

tation team has completed 46 transplants, including 30 kidneys, 10 livers, and three each pancreas and hearts.

“We had a very busy fi rst quarter,” he said. “We hope that trend continues.”

Even though transplantation predic-tions are diffi cult to make, Anderson said UMMC will likely complete 110 to 115 kidney transplants in 2014, following 103 in 2012 and 104 in 2013. Liver transplants should reach 30 to 40, while pancreas transplants, which are much more diffi cult to predict, will probably reach nine or 10 by year’s end, said Anderson.

The transplantation team is keenly focused on growing the state’s living donor kidney program.

“We don’t do very well with living do-nations, and there are many reasons for it that we’re hoping to overcome and grow the ability of people who want to donate a kidney to a friend or loved one,” said Anderson. “We’ve done three of those this year, with several more scheduled. Our goal is 10 or more, compared to a total of four living kidney transplants last year.”

In late August, UMMC plans to host a transplantation symposium for continu-ing medical education (CME) credit for physicians, nurse practitioners and nurses.

“If we’re going to do more trans-plants, we need more support and inter-action from the medical community,” he said. “Hopefully over the next few years, there will be no reason for Mississippians to leave the state to get a liver or pancreas transplant.”

Lifesaving Gifts, continued from page 1

Supporting Waiting-List Transplant Patients

On March 3, the University Transplant Guild will host the fi fth annual Day at the Derby to raise funds for solid organ transplant and Heart Mate II left ventricular assist device (LVAD) patients and their families. The non-profi t organization also provides needs-based educational, physical and pharmacological support to transplantation patients.

The adult-only Derby event, slated for 4:30 pm to 9 pm, will be held at The South Warehouse on Silas Brown Street in downtown Jackson, and includes a silent auction and drawdown, and live music by The Faze4 Band.

Patrons are encouraged to wear colorful ties and hats.

On an ongoing basis, Back Yard Burgers near UMMC raises funds for the Guild to benefi t solid organ transplant and LVAD patients. On Mondays, UMMC staff and students presenting their ID badges receive a 10 percent discount and $1 donation to the guild.

Dr. James D. Hardy

Dr. Marc Mitchell

Dr. Christopher

Anderson

Dr. Ralph Didlake

Read Mississppi Medical News Online:

MISSISSIPPIMEDICALNEWS.COM

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 MAY 2014 > 9

ground to gain. That’s something we, along with other state agencies, private groups and hospitals throughout Mississippi, are working to improve.”

The ACEP report, issued in the Annals of Emergency Medicine, ranked Al-abama 44th, with a grade of D; Arkan-sas 50th,with a D minus; Florida 27th, with a C minus; Georgia 29th, with a D plus; Louisiana 42nd, with a D; and South Carolina 33rd, with a D plus. The District of Columbia ranked first and Massachusetts ranked second, each receiv-ing a B minus. No state received an A. “Our state’s relatively high score is due in part to (UMMC) assets, including MED-COM, AirCare and our residency program, which has been training new emergency medicine physicians for the state since 1986,” said Richard Summers, MD, chair emeritus of emergency medicine at UMMC.

Mississippi’s rank has im-proved from 34th to 26th over-all since 2009, the last time ACEP conducted its state-by-state report card. In the assessment, ACEP researchers ana-lyzed 136 objective measures in five cate-gories of access to emergency care, quality and patient-safety environment, medical liability environment, public health and in-jury protection, and disaster preparedness. The report’s authors highlighted the capac-ity of Mississippi’s hospitals, which added to the state’s access-to-care score. They praised the emergency communications capabilities and existing plans. And noted the liability environment was favorable, with average malpractice payments being the sixth low-est nationally, and that liability insurance premiums are below the national average. However, the state faces challenges in pub-lic health and injury prevention due in part to its high rate of fatal injuries, smoking and obesity, the authors found.

“Most critically,” the authors wrote, “traffic safety in Mississippi is a major concern. The state has the second-highest rate of motor vehicle occupant deaths, the highest rate of bicyclist deaths, and one of the highest rates of pedestrian deaths.” The School of Medicine’s four-year emergency medicine residency program, begun in 1986, is the state’s major source for new emergency medicine physicians. It recently received approval to expand from 36 to 40 positions, beginning in July. Nursing schools, both at UMMC and those around the state, contrib-ute to the supply of emergency-de-partment RNs, BSNs and MSNs. At UMMC, which houses the state’s only Level 1 trauma center, a newly renovated adult acute care area in the Adult Emer-gency Department opened Feb. 19, the second part of a three-phase overhaul. Jones said the renovations improve patient flow and brought state-of-the-art facilities and equipment that will improve care for patients. Pediatric emergency facilities at UMMC’s Batson Children’s Hospital recently re-ceived a much needed renovation and expansion. The Colonel Harland Sand-ers Children’s Emergency Department and the Selby and Richard McRae

Children’s Trauma Unit, a $5.8 mil-lion construction project begun in late 2009, opened in Dec. 2011. The work tripled the space available in the state’s only Level 1 pediatric trauma area to 16,000 square feet and increased capacity from 15,000 patients per year to 35,000. MED-COM coordinates day-to-day emer-gency communications across Mississippi, sending ambulances to the most appropri-ate hospitals, arranging air-medical flights and patient transfers. Founded at UMMC in the wake of Hurricane Katrina in 2005, MED-COM also serves as a statewide communications center during disasters to connect medical responders, state, local and federal agencies, and law enforcement. AirCare, UMMC’s helicopter trans-port program founded in 1996, flies two helicopters, one from UMMC, the second from Key Field in Merid-

ian to serve the entire state. A third heli-copter will soon be added in Grenada. “Both AirCare and MED-COM are signifi-cant resources for Mississippi’s population,” said Jonathan Wilson, UMMC director of emergency services. “Those assets improve emergency and trauma care for Mississippi-ans from the scene of accidents and injuries all the way to the emergency department doors of any of our state’s hospitals.” UMMC also regularly works with the Mis-sissippi Emergency Management Agency and the Mississippi State Department of Health on disaster planning and response, Wilson said. By collaborating both in sim-ulations and actual disasters, the Medical Center helps improve safety and emer-gency care for residents across the state.

Jones pointed to the TelEmergency network, which uses live, secure audio and visual connections to link emergency

medicine doctors in UMMC’s Adult Emer-gency Department with specially trained nurse practitioners at 19 rural hospitals. “We’re able to provide the care of board-certified emergency medicine physicians, by extension of nurse practitioners, to hospitals that may not otherwise have been able to attract or afford an emer-gency medicine physician,” Jones said. TelEmergency provides 600 to 700 consults a month and pro-vides round-the-clock coverage. “Bringing that level of expertise to hospi-tals helps decrease the number of patients who need to be transferred to larger hos-pitals and, when patients do need to be transferred, they arrive better stabilized and with a more complete work up,” Jones said. “This is definitely one of the many ways we’re improving emergency care in Mississippi.”

Best ER Care in Southeast, continued from page 1

tection,” Filkins noted. The most obvious … but clearly overlooked … is to change those default passwords. However, she con-tinued, changing to an easily deciphered password isn’t much help. Avoid using your children’s names, street address, pet names, combined physician names, name of the practice, or other easily discernable choices. The best passwords, Filkins said, include numbers and unique characters.

Mobile devices can also cause head-aches … in part because of unrealistic expectations and policies. “Everyone uses mobile devices,” Filkins stated. “Rather than trying to bury that and say, ‘oh, we never use mobile devices,’ maybe relax the punitive policies and instead say, ‘let’s get honest and figure out how to make them more secure.’”

Measures to Improve Security

“Know what’s on your network,” Filkins said. “Make sure your network is

configured properly and devices are config-ured properly.” She added it’s important to know who is using what and how it’s being used. Having a strong password policy is critical to proper configuration.

“Think like an attacker,” she contin-ued. “And if you can’t do it, get someone who can.” There are numerous resources and companies that can help with this task. It boils down to being aware, Filkins noted. “It’s basic awareness but in a digital world.”

She continued, “Know what your net-work pathways are for your organization.” Filkins said that often there’s an emphasis on protection for “bad things coming in” … but if something does penetrate the system, there isn’t much monitoring of outbound traffic. Egress filtering is as im-portant as ingress protection.

The Cost of FailureThe healthcare industry is particularly

attractive to cyber attackers because of the type of information housed on servers. With

medical identity theft, the victim is respon-sible for costs related to a compromised medical insurance record. A survey by the Ponemon Institute last year estimated that cost to be $12 billion in 2013.

Security breaches also represent major costs to the compromised entity. Steep fines, incidence handling, victim notifica-tion, credit monitoring for victims, and potential legal action represent direct out-of-pocket expenditures. In addition, a data breach could also significantly harm repu-tation and future business opportunities.

The greatest cost, however, is to a pa-tient who winds up with inaccuracies in his medical record that could result in a misdi-agnosis or wrongly prescribed medication.

The Takeaway“Today compliance does not equal

security,” Filkins wrote. “Organizations may think they’re compliant, but this data shows that they are not secure.”

SANS Cyberthreat White Paper, continued from page 7

10 > MAY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

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Baptist Health Systems Names Chris Anderson, FACHE, CPA as CEO

Chris Anderson, FACHE, CPA, has joined Baptist Health Systems as CEO. For the past 16 years, Anderson has served as the CEO of Singing River Health Sys-tem in Pascagoula, Miss.

The appointment fol-lows a comprehensive, national search by the Baptist Health Systems’ Board of Trustees, which began last fall. Board Chairman Kane Ditto called the move a very important and exciting one for the system as it continues its mission of providing high quality healthcare guided by its Chris-tian faith.

During his tenure at Singing River Health System, he was appointed by Governor Haley Barbour to serve on the Governor’s Commission on Recovery,

Rebuilding and Renewal following Hurricane Katrina from September to December 2005 and chaired its Health and Human Services Committee. In 2006, he co-chaired the Governor’s In-formation Technology Task Force, which led to the development of the Mississip-pi Coastal Health Information Exchange.

Anderson is a graduate of Mississip-pi State University and is a Certified Pub-lic Accountant. He achieved Fellow sta-tus in the American College of Health-care Executives. In 2007, The Journal of South Mississippi Business and the Sun Herald named Anderson one of the Top 10 Business Leaders on the Mississippi Gulf Coast.

Memorial Physician Clinics Welcomes Dr. Judith Smith

Memorial Physician Clinics is pleased to announce Dr. Judith W. Smith, Ortho-pedic Surgeon, is now seeing patients at Popp’s Ferry Road in Biloxi.

Dr. Smith is one of the few orthopedic surgeons in the state of Mississippi with fellowship training in foot and ankle recon-struction surgery. She graduated Cum Laude with her undergraduate degree from Princeton University in New Jersey. She earned her medical degree from Columbia University, College of Physi-cians and Surgeons in New York. She completed her residency in Orthope-dic Surgery at The Hospital for Special Surgery/The New York Hospital-Cornell Medical Center in New York, after two years of General Surgery residency at Yale-New Haven Hospital in Connecti-cut. She then pursued a fellowship in Foot and Ankle Surgery at the Medical College of Wisconsin in Milwaukee, after which she joined the orthopedic faculty at The Emory Clinic in Atlanta, Georgia, as chief of the division of Foot and Ankle Reconstruction.

Dr. Smith is Board Certified in ortho-pedic surgery.

Chris Anderson

Dr. Judith W. Smith

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 MAY 2014 > 11

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Hattiesburg Clinic Opens New Immediate Care Location

Hattiesburg Clinic is pleased to an-nounce the opening of Immediate Care - Petal, located inside Petal Family Prac-tice Clinic.

At Immediate Care - Petal, George E. “Tripp” Gillespie, III, DO; and Keith M. Simnicht, MD; provide treatment for mi-nor illnesses and injuries including cold, flu,allergies, sore throat, minor burns, sprains and broken bones. They also of-fer sports physicals, laboratory studies and X-ray services. All services offered by the Immediate Care-Petal providers are for non-work related injuries or illnesses.

The clinic is open Mondays through Fridays, 8 a.m. to 7:30 p.m., Saturdays 9 a.m. to 4:30 p.m. and Sundays 1 p.m. to 4:30 p.m. Immediate Care - Petal is lo-cated at 50 Parkway Lane in Petal.

Garden Park Medical Center selects Dr. Paul Mace as Chief Medical Officer

General surgeon Paul Mace, M.D., FACS, has been appointed as the Chief Medical Officer at Gar-den Park Medical Center. Mace’s functions will in-clude administrative liai-son to the medical staff and other members of the hospital leadership team. Priority will be given to Quality and Patient Safety, Medical Staff Services and Development, Clinical Ser-vice Line Strategy, Utilization Review, Medical Staff Satisfaction/Engagement, and Healthcare Information Technology.

Dr. Paul Mace was born and raised in Montgomery, Alabama. He received his medical degree from the University of South Alabama in 1991. Dr. Mace re-ceived his General Surgery training at the Tulane University School of Medi-cine in New Orleans, Louisiana from 1991 to 1997. While at Tulane, Dr. Mace also trained at the nationally renowned Charity Hospital. During his final year of training, Dr. Mace was named Chief Resident of the Tulane Surgery Depart-ment for 1996-1997. After completing his residency, Dr. Mace moved to Gulf-port in 1997 to establish his private prac-tice. He was able to utilize his extensive training and experience in Advanced Laparoscopic Surgery, Minimally Invasive Surgery, and Breast Surgery, to bring the best and most up-to-date treatment to his patients on the Gulf Coast. He re-ceived his Board Certification in General Surgery by the American Board of Sur-gery in 1998, is a Fellow of the American College of Surgeons, member of the American Breast Society, the Society of Laparoendoscopic surgeons, the Tulane Surgical Society, the Mississippi Medical Association, the Coast Counties Medical Society, and the American Medical As-sociation.

Fertility Associates of Memphis Announces New Tupelo Location

Fertility Associates of Memphis has announced the opening of a new satel-lite office in Tupelo, Miss., offering infer-tility consultations and new patient visits.

The office will be located at North Mississippi Medical Cen-ter’s Longtown Medical Park. Dr. Paul Brezina, who joined Drs. William H. Kutteh and Raymond W. Ke at Fertility Associ-ates of Memphis in 2012, completed his fellowship training at Johns Hopkins University. He will see patients on Mondays in Tupelo.

The group plans to coordinate much of the testing with the patients’ referring doctor and then have patients come to Memphis for more specialized care, such as intrauterine insemination and in vitro fertilization.

Fertility Associates of Memphis is the largest fertility center in the Mid-South. Doctors at Fertility Associates of Memphis are recognized nationally for their achievement and research, and they have been helping couples for more than 20 years. Last year, the prac-tice marked its 5,000th baby born from assisted reproductive technologies.

Dr. Rainna Bahadur Wins Most Compassionate Doctor Award

Patients rank Dr. Rainna Bahadur among the top physicians in the country, which earned the Missis-sippi Gulf Coast ophthal-mologist a Most Compas-sionate Doctor Award for 2013.

A Greenwood native, Bahadur is a partner at Eye Associates of the South, which has clinics in Biloxi, Ocean Springs and Gulfport.

This is the third consecutive year that Bahadur received the award. She also received Patient Choice Awards in 2011, 2012 and 2013.

The Most Compassionate Doctor Award is a national honor is based on pa-tients’ reviews of her work. It was given to only the top three percent of 870,000 active U.S. physicians for 2013.

Bahadur is a board certified and fel-lowship trained eye doctor who special-izes in refractive surgery and cornea and external disease. Her service specialties include cataract lens implants, dry eye syndrome, LASIK, comprehensive eye exams, diseases of the eye, cornea trans-plants, and other areas.

Bahadur received her fellowship training at the prestigious Dean McGee Eye Institute at the University of Okla-homa. She completed medical school and ophthalmology residency at the Uni-versity of Mississippi Medical Center in Jackson, where she was Chief Resident. She also is a magna cum laude graduate of Millsaps College.

Dr. Paul Mace

Dr. Paul Brezina

Dr. Rainna Bahadur

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