Louisiana Medical News May 2014

16
BY TED GRIGGS Another legislative session, another confrontation be- tween hospitals and Gov. Bobby Jindal’s administration over funding. The state Department of Health and Hospitals wants to reduce the number of people seeking treatment at emer- gency rooms for non-emergencies. To accomplish this, DHH has proposed paying hospitals a $50 “triage fee” to assess and refer those patients to a more appropriate pro- vider. However, Laura Richey, MD, president of the Loui- siana chapter of the American College of Emergency Physicians, said the plan does nothing to achieve its stated purpose, to “deter inappropriate use of hospital emergency departments.” Instead, the plan punishes hospitals for providing ac- cess to care that, in retrospect, is deemed “non-emergent,” Richey said. DHH says the triage fee will reduce Medicaid spend- ing by $4.5 million a year and encourage patients to build relationships with physicians, as envisioned in the medical home model. SOUTH LOUISIANA EDITION YOUR PRIMARY SOURCE FOR PROFESSIONAL HEALTHCARE NEWS On Rounds Read Louisiana Medical News online at www.louisianamedicalnews.com MAY 2014 / $5 Hospitals Oppose Triage Fee Dr. Bill Pinsky Speed Racer As a little kid, Bill Pinsky listened to the Indianapolis 500 on the radio. Now, he’s living the dream – racing alongside pro and celebrity drivers at the 2014 Toyota Grand Prix of Long Beach, Calif ... page 3 Hospital Rating Sites Proliferate Some may actually be useful The hospital industry’s challenges in the digital age, such as webochondria and just plain bad information, include coping with the proliferation of online ratings designed to help prospective patients ... page 5 Physician Spotlight PRINTED ON RECYCLED PAPER PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 (CONTINUED ON PAGE 6) To promote your business or practice in this high profile spot, contact Scott Cavitt at Louisiana Medical News. [email protected] • 337.235.5455 BY LYNNE JETER A conversation several years ago about the delayed but still looming ICD-10 conversion and other billing and coding challenges prompted Mike Sacopulos, JD, to create affordable compliance plans for small to midsize physician practices. “ICD-10 is a game changer,” said Sacopulos, founder and president of the Medical Risk Institute (MRI), based in Terre Haute, Ind. “As practices strug- gle to adapt to ICD-10 standards, we should anticipate mistakes and difficulties will arise. A coding and bill- ing compliance plan will assist the practice in this time of transi- tion. Compliance education and self-evaluation through software analysis will also reduce exposure to the practice.” Sacopulos became intrigued with putting together a coding and billing compliance package with a reasonable price tag after talking with a colleague, Karen Zupko of Karen- Zupko & Associates, a nationwide consulting firm that works with hundreds of practices on proper coding pro- cedures. “We noticed that many practices needed compliance plans, but there wasn’t a cost-effective solution on the market,” he said. “Larger practices and hospitals have the infrastructure to establish compliance plans and proper training. But those tasks are far more difficult for small to medium size practices. Also, the Office of Inspector Gen- eral’s stepping up enforcement efforts – a record number of claims were brought by the OIG for coding and billing fraud and failures to comply with applicable standards in 2013 – provided a good base. To me, the need and the timing seemed to merge to call Compliance Affordability a Sticking Point (CONTINUED ON PAGE 6) Mike Sacopulos, JD

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Louisiana Medical News May 2014

Transcript of Louisiana Medical News May 2014

Page 1: Louisiana Medical News May 2014

By TED GRIGGS

Another legislative session, another confrontation be-tween hospitals and Gov. Bobby Jindal’s administration over funding.

The state Department of Health and Hospitals wants to reduce the number of people seeking treatment at emer-gency rooms for non-emergencies. To accomplish this, DHH has proposed paying hospitals a $50 “triage fee” to assess and refer those patients to a more appropriate pro-vider.

However, Laura Richey, MD, president of the Loui-siana chapter of the American College of Emergency Physicians, said the plan does nothing to achieve its stated purpose, to “deter inappropriate use of hospital emergency departments.”

Instead, the plan punishes hospitals for providing ac-cess to care that, in retrospect, is deemed “non-emergent,” Richey said.

DHH says the triage fee will reduce Medicaid spend-ing by $4.5 million a year and encourage patients to build relationships with physicians, as envisioned in the medical home model.

SOUTH LOUISIANA EDITION

yOUR PRIMARy SOURCE FOR PROFESSIONAL HEALTHCARE NEWS

make blend:Type wordOUtlinecopy and pasteselect both sets of wordshold shift key and select gradientchoose reverse front to back

text:100 Helv. Ultra comp-20 AV(one on right)-100 (between words)stroke .25 pt.

On Rounds

Read Louisiana Medical News online at www.louisianamedicalnews.com

MAY 2014 / $5

Hospitals Oppose Triage Fee

Dr. Bill PinskySpeed Racer

As a little kid, Bill Pinsky listened to the Indianapolis 500 on the radio. Now, he’s living the dream – racing alongside pro and celebrity drivers at the 2014 Toyota Grand Prix of Long Beach, Calif ... page 3

Hospital Rating Sites ProliferateSome may actually be useful

The hospital industry’s challenges in the digital age, such as webochondria and just plain bad information, include coping with the proliferation of online ratings designed to help prospective patients ... page 5

Physician Spotlight

PRINTED ON RECYCLED PAPER

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

(CONTINUED ON PAGE 6)

To promote your business or practice in this high profi le spot, contact Scott Cavitt at Louisiana Medical News.

[email protected] • 337.235.5455

By LyNNE JETER

A conversation several years ago about the delayed but still looming ICD-10 conversion and other billing and coding challenges prompted Mike Sacopulos, JD, to create affordable compliance plans for small to midsize physician practices.

“ICD-10 is a game changer,” said Sacopulos, founder and president of the Medical Risk Institute (MRI), based in Terre Haute, Ind. “As practices strug-gle to adapt to ICD-10 standards, we should anticipate mistakes and diffi culties will arise. A coding and bill-ing compliance plan will assist the practice in this time of transi-tion. Compliance education and self-evaluation through software analysis will also reduce exposure to the practice.”

Sacopulos became intrigued with putting together a coding and

billing compliance package with a reasonable price tag after talking with a colleague, Karen Zupko of Karen-Zupko & Associates, a nationwide consulting fi rm that works with hundreds of practices on proper coding pro-cedures.

“We noticed that many practices needed compliance plans, but there wasn’t a cost-effective solution on the market,” he said. “Larger practices and hospitals have the infrastructure to establish compliance plans and proper training. But those tasks are far more diffi cult for small to medium size practices. Also, the Offi ce of Inspector Gen-eral’s stepping up enforcement efforts – a record number

of claims were brought by the OIG for coding and billing fraud and failures to comply with applicable standards in 2013 – provided a good base. To me, the need and the timing seemed to merge to call

Compliance Affordability a Sticking Point

(CONTINUED ON PAGE 6)

Mike Sacopulos, JD

Page 2: Louisiana Medical News May 2014

2 • MAY 2014 Louisiana Medical News

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Page 3: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 3

By LISA HANCHEy

As a little kid, Bill Pinsky listened to the Indianapolis 500 on the radio. Now, he’s liv-ing the dream – racing alongside pro and celeb-rity drivers at the 2014 Toyota Grand Prix of Long Beach, Calif.

This year, Toyota invited Pinsky, a pedi-atric cardiologist and founder of Racing for Kids, to compete in the Pro/Celebrity Race as one of the pro drivers. Over its 25-year history, Racing for Kids has raised over $6 million for children’s charities with the help of Indy car legends Al Unser, Jr. and Kyle Petty, pro athletes Jim Kelly and Carl Malone, Oscar-win-ning actor Adrian Brody, actresses Cam-eron Diaz and Ashley Judd, soap stars Eric Braeden and Vanessa Marcil and singer Brian McKnight. “Before a race weekend, we’ll go in and visit the local children’s hospitals, see the kids, pass out Racing for Kids hats and coasters and tell them about helmet and vehicle safety,” Pinsky explained. “The idea is to help these kids have a better day and hopefully attract media attention for the hospital.”

An Ohio native, Dr. Pinsky got in-volved in racing while teaching pediatric cardiology in Detroit, Mich. Around age 40, he went to the Skip Barber Racing School, completing the three-day, open-wheel, open-cockpit racing course. “After doing a few races, I knew right away that I needed to keep my day job,” he recalled with a laugh. “I enjoyed doing it, and knew I wanted to stay involved in racing.”

In 1989, he founded Racing for Kids, a 501(c)(3) foundation benefi tting children’s hospitals. During its 25-year history, numerous professional driv-ers and celebrities have brightened the lives of over 27,000 young patients in the U.S., Canada, Mexico, Brazil, Japan and Australia. “I’ve been told we are the longest-sustaining children’s charity in professional motor sports,” he said.

Reared in a family of professionals, Pinsky was inspired by his father, a social worker, and three uncles – a surgeon, a pharmacist and a dentist – to pursue medicine. Pinsky started in pre-med at Washington University in St. Louis, Mo. and fi nished at the University of Akron in his home state. Following graduation, he attended St. Louis University School of Medicine.

Early on, Pinsky was fascinated by

pediatric cardiology. “During my fi rst year of medical school, I was introduced to a pediatric cardiologist who was partly in private practice and partly at the uni-versity,” he explained. “He was an early mentor. I liked him, I liked what he did. And, when I had free time, I’d go to the pediatric cardiology clinic at the chil-dren’s hospital or I’d go to his offi ce and just observe him taking care of patients. I did that on and off throughout the fi rst year of medical school.”

During his fourth year of med school, Pinsky took an elective in pediatric car-diology, publishing a manuscript in the fi eld before graduating. For his pediatric residency, he attended Houston’s Texas Children’s Hospital, an affi liate of Baylor College of Medicine, remaining there for his pediatric cardiology fellowship. After fi nishing, he stayed in academic medi-cine at Baylor until 1980, when he joined the faculty of the University of Nebraska Medical Center in Omaha.

While in Nebraska, Pinsky was re-cruited by Tulane University School of Medicine in New Orleans to be chief of pediatric cardiology. Later, he moved to Detroit, where he served as chief of pedi-atric cardiology at Wayne State Univer-sity for Children’s Hospital of Michigan. In 1992, he became the associate dean at Wayne State’s medical school and an of-fi cer in the Detroit Medical Center. While serving as associate dean, he held a vari-ety of jobs, including chief medical offi cer and president of managed care for DMC, CEO of Sinai Hospital and chief quality offi cer for the Detroit health system.

After 14 years in Detroit, Pinksy fi -nally decided to head South. “After my son’s (Benjamin) senior year in high school, my wife Karen and I were ques-

tioning why we were still up here in the cold weather,” he explained. Daughter Rachel also moved South, settling in Poplarville, Miss.

In 1999, Pinsky was recruited to serve as Ex-ecutive vice president and chief academic of-fi cer at Ocshner Health System in New Orleans. “I oversee all of the aca-demic activity at Och-sner, which includes both education as well as the research,” he ex-plained. “The education side includes the super-vision for medical stu-dents. We teach quite a lot of the LSU and Tu-lane third- and fourth-year students, and we also have our own medi-

cal students. Our graduate medical edu-cation is 345 house staff with continuing medical education and research.”

Pinsky also teaches at the University of Queensland School of Medicine in Brisbane, Australia, which entered into a partnership with Oschner in 2009. Con-sisting of two years of clinical study by American students at UQ followed by two years at Ochsner, the UQ-OCS program graduated its second class of 29 gradu-ates in December 2013 who will begin their residencies in July 2014. As head of the UQ Ochsner Clinical School, Pinsky has witnessed the program grow from 9 graduates in its fi rst class to its current enrollment of 237 fi rst- and second-year, 67 third-year and 31 fourth-year students. “The whole goal was to create a type of global or transnational medical school of-fering students the opportunity to learn how medicine is practiced in two different countries, while at the same time increas-ing the number of graduates of medical school here in Louisiana so we could at-tract more doctors for our immediate area,” he explained.

At press time, Pinsky was gearing up for the Toyota Grand Prix. “My goal is to fi nish the race, and represent Racing for Kids well,” he said.

Physician Spotlight

Dr. Bill PinskySpeed Racer

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Page 4: Louisiana Medical News May 2014

4 • MAY 2014 Louisiana Medical News

Read Louisiana Medical News Online:

LOUISIANAMEDICALNEWS.COM

By BARBARA MCCONNELL

Your demise: not an easy subject to think or write about, yet advance direc-tives such as a ‘living will’ provide answers on the type of medical care you want when you can’t answer for yourself, and offers protection for the patient, doctor, family and healthcare facility.

On April 16, a healthcare organiza-tions non-profi t initiative, the National Healthcare Decisions Day (NHDD), en-couraged all Americans to think about, discuss and document personal advance healthcare decisions. The goal in Loui-siana was to provide clear, concise and consistent information on healthcare de-cision making for the public, healthcare providers and facilities, focusing on pro-viding information, tools and resources to Louisiana residents.

Attorney generated forms to make your future health wishes known are the living will (advance directive), healthcare power of attorney (proxy), ‘do not resus-citate’ (DNR), and organ donation. They must comply with state and federal laws, and are approved by various religious or-ganizations for their members.

There is also a fairly new form called the LaPOST, or Louisiana Physician Or-ders for Scope of Treatment, which was approved by the Louisiana legislature in

2010. It is different; it is not an attorney generated form, but rather a document between the physician and patient of any age, who has an advanced illness or a se-rious condition and has six months to a year to live. It is designed to improve the quality of end-of-life care with the per-sonal wishes of the patient, translated into specifi c physician orders. It is voluntary and binding, but can be changed at any time.

The bright gold colored sheet, easy to fi nd in a chart, is divided into sections. It initially states what the life-limiting condi-tion is, and continues to spell out patient decisions on CPR and resuscitation, intu-bation or mechanical ventilation, use of antibiotics, artifi cially administered fl uids and nutrition by tubes or IV, and other instructions.

And it’s portable-it goes with the patient anywhere they go in the health system, and should be honored by other physicians, EMS personnel, nurses, and healthcare workers along the way.

Susan Nelson, MD, is a geriatrician, board-certifi ed in internal medicine, ge-riatrics, hospice and palliative medicine. She is also Chair of the LaPOST Co-alition, which is a statewide network of healthcare professionals who promote and educate about the LaPOST process. They did the original end-of-life research

back in 2006 as directed by the Louisiana leg-islature as part of the Louisiana Health Care Redesign Collaborative after storms Katrina and Rita devastated New Or-leans and the Louisiana coast.

“What I have ex-perienced from my 30 years from the hospital standpoint, because that is my background, is it’s not unusual to witness when a patient is at the end of their life and there is nothing clearly documented regarding what the patient wanted and what were their wishes in the type of care they would receive.

“We want the patient to have an awareness of what they want instead of us having to guess, and families not feel-ing guilty and having fi ghts with their sib-lings. I see a lot of post traumatic stress disorder in families that are distraught over what a patient would or would not have wanted done, because they haven’t had the conversation.”

The home of the grant-funded La-POST, is the Louisiana Healthcare Quality Forum (LHQF) dedicated to im-proving healthcare for all of the state.

Cindy Munn, LHQF chief executive offi cer, said that coincidentally her group

and Nelson’s group both originated at the same time in 2006, though separately, but now they have come together. “Katrina and Rita cre-ated the opportunity for state leaders to discuss ways to improve how healthcare was delivered and how to improve outcomes.”

Munn noted that LHQF also has the means to measure patient participation in and satisfaction with LaPOST, and can provide education and outreach to both physicians and the public, and fi nds the community leaders who help.

“The one thing we want to continue to promote is the conversation and many people don’t have a comfort level with that, but the best gift you can give some-one is to have that conversation,” she added.

John Rainey, MD, oncologist, ex-plained, “Any advance directive as a piece of paper is not much use if there has not been a prior discussion among fam-ily members, caregivers and the patient themselves as to what the patient’s wishes are. It’s important to the process that ev-eryone is on the same page.”

He noted that family squabbles of long-standing need to be cleared up, and the legal aspects of dying-wills, bills and estate distributions, need to be settled.

Rainey added, “There have been other forms in the past for patients to sign, but what’s more important is that I have ongoing conversations with them throughout treatment and they have the family talk, before any forms are signed.”

In March, Nelson was named vice-chair of the National POLST Paradigm Task Force, which is the driving force nationally behind the adoption by the in-dividual states of the end-of-life physician orders, with Louisiana being the 14th state to adopt.

She is also Medical Director of Se-nior Services and PACE Baton Rouge at Franciscan Missionaries of Our Lady and St. Joseph Hospice, and is on the volun-teer board of LHQF.

National Healthcare Decisions Day – Having the ConversationThe Louisiana Health Care Quality forum promotes the day with LaPOST

Dr. Susan Nelson

Cindy Munn

MAY21-242014

EATING AND DRINKING FOR A GOOD CAUSE

201421-2420142014

Page 5: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 5

By TED GRIGGS

The hospital industry’s challenges in the digital age, such as webochondria and just plain bad information, include coping with the proliferation of online ratings de-signed to help prospective patients.

Some of the reports, like NerdWallet.com’s list of the Most Affordable Hospi-tals in Louisiana, may actually be useful to con-sumers, said Paul Salles, president and chief ex-ecutive officer of the Louisiana Hospital As-sociation.

“There’s lots of publicly reported infor-mation out there, and I think these kinds of websites really attempt to pull it together in a more user-friendly way, which is not a bad idea,” Salles said.

A lot of healthcare data is being re-ported on various websites, including gov-ernment portals. The reports in March alone included grades on emergency care and price transparency laws. Louisiana got an “F” in both cases.

Groups like NerdWallet take the publicly reported pricing data, aggregate it and try to tell a little bit of a story with it, Salles said. “I think you’ll see more of that.”

Napala Pratini, an analyst for Nerd-Wallet, said what con-sumers can really take away from the report, more than whether it might be best to go to LSU Medical Center for X, Y or Z operation is the idea that they can comparison shop on big procedures.

“In healthcare, a lot of people don’t realize that they do have the ability to shop around,” Pratini said. “And there-fore they just kind of jump on the closest hospital or the one their mom went to.”

The decision isn’t really made on a quantitative basis, she said.

While this isn’t necessarily bad some-times, there is some data available to help patients make better decisions. Price is one data point to consider, and so is patient satisfaction.

NerdWallet’s Best Hospital tool in-cludes both. The prices come from Medi-care charge data, which should be what the hospital bills average across the board for the 100 most common procedures.

Salles said from a consumer perspec-tive, these sorts of websites are more useful than a hospital chargemaster, which is sort of a data dump and not easy to navigate.

A list of inpatient and outpatient treatments provides the consumer with more of a “here’s-what-to-expect” look at the hospital experience, Salles said.

Salles said while more websites at-tempt to give consumers pricing informa-tion, in much the same way that retailers

do, it’s hard to predict when the public will pick up on it and what the fi nal form of that information might be.

It’s diffi cult to predict how quickly that will happen or if hospital pricing in-formation will ever be like Expedia, where you can buy airline tickets, Salles said.

“Healthcare services aren’t deliv-ered like that. Even a knee replacement for each individual could be different, whereas a trip on an airplane from New Orleans to Dallas is pretty much the same,” he said.

There are all kinds of variables that must be factored into a knee replace-ment surgery, such as the age of the pa-tient and comorbidities, that don’t affect the cost for a plane ticket.

“I don’t necessarily agree that all comparisons should be based on some of the dollar stuff,” Salles said. “I think that, like in this website, which has in-formation on patient satisfaction, there are other aspects that play a role in con-sumer decisions.”

And those factors are also important.Pratini said NerdWallet is not trying

to predict what the patient is going to pay.It’s well-known that high hospital

charges drive higher insurance rates.Pratini said the fi rst step in making

pricing more transparent is to make that information available to the public.

In California, hospitals are making their chargemaster data available, al-though that data is convoluted and can be

different at every hospital, Pratini said. No one would expect the average consumer to go online and access the chargemaster and understand it.

Most people probably wouldn’t even know where to go online to fi nd the chargemasters, she said. Still this sort of information is becoming more widely available, and although there are lots of moving parts and the process is complex, the healthcare industry is slowly moving toward pricing transparency.

Salles said he doesn’t know that hos-

pitals can use these sorts of affordability rankings because there are so many out there.

Hospitals are interested in where they stand in the community and their quality measures, and hospitals are attuned to those sorts of rankings, he said.

Pratini said NerdWallet has analyzed hospital affordability in 13 states.

Once the company has compiled in-formation from enough states, NerdWallet might approach some of the big hospital organizations, she said.

Hospital Rating Sites ProliferateSome may actually be useful

The 5 Most Affordable Hospitals in Louisiana

1 Baton Rouge General Medical Center. Most affordable for shingles and hernia treatments. Patient satisfaction rate is 77 percent.

2  American Legion Hospital, Crowley. Most affordable for emphysema and pneumonia treatments. Patient satisfaction rate, 52 percent.

3  LSU Health Shreveport. Most affordable for severe heartburn and spinal fusion treatments. Patient satisfaction rate, 72 percdnt.

4  Franklin Medical Center, Winnsboro. Most affordable for tuberculosis and asthma treatments. Patient satisfaction rate, 59 percent.

5  Our Lady of the Lake Regional Medical Center, Baton Rouge. Most affordable for heart pacemaker implantation and hip replacement. Patient satisfaction rating, 78 percent.

Paul Salles

Napala Pratini

Page 6: Louisiana Medical News May 2014

6 • MAY 2014 Louisiana Medical News

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Paul Salles, president and chief ex-ecutive officer of the Louisiana Hospital Association, said the estimate is a “gross understatement” and the triage fee ap-pears to be just a reduction in funding for hospitals.

The LHA and LA-ACEP are pushing for a collaborative effort that also includes DHH, the Louisiana State Medical Soci-ety, and other providers for Medicaid. For the LHA, this would include the five man-aged care companies in Bayou Health.

“We’re certainly happy to be part of the discussion. But we don’t want to be the only part of the discussion,” Salles said. “There are a lot of other people who have responsibilities in this arena way before the patient gets to the hospital that really need to be addressed as part of this.”

The “other people” start with the five private managed care organizations under Bayou Health, which oversee the care for around 900,000 Medicaid recipients in Louisiana.

Part of the Bayou Health companies’ compensation covers doing population health and medical management activi-ties, including patient outreach, Salles said. The Bayou Health firms get admin-istrative funds to do these kinds of things.

Hospitals do not.“We really don’t have the resources,”

Salles said. “We’re really not equipped to reach out to people before they get to the hospital and try to direct them, and inform them and try to get them into dif-

ferent care settings.”LA-ACEP believes increasing access to

primary care, mental health and addiction treatment, and case-management for Med-icaid enrollees with complex chronic medi-cal conditions, can reduce inappropriate visits to emergency rooms, improve health outcomes, and save the state money.

Washington proved that’s possible with its “ER is for Emergencies” cam-paign, Richey said.

Three of the Bayou Health compa-nies – Amerigroup, LaCare and Louisi-ana Healthcare Connections – receive a flat fee, similar to an insurance premium, for healthcare. The companies profit from any healthcare savings they generate.

The other two firms, UnitedHealth-care Community Plan of Louisiana and Community Health Solutions of Louisi-ana, are paid for the services they provide. These companies share in any savings that result from reducing healthcare costs. All five of the companies received top marks in an independent review that looked at close to 900 requirements that included provider relations, network adequacy, fi-nances and core benefits. The Centers for Medicare and Medicaid Services required the review for the program, which the Jindal administration launched in 2012.

However, Salles said the Bayou Health companies face no penalty if they do not perform the patient outreach and population management activities or fail to improve patient outcomes.

“And that’s really our problem with this. Quite honestly, cutting hospitals with-out engaging some of the other responsi-bilities around this process just benefits the managed care companies,” Salles said.

If Bayou Health patients continue to be hospitalized at the same rates as they were before the managed care companies were hired, Salles said, the attitude ap-pears to be, “Oh well.”

In the LHA’s opinion, there really needs to be a more comprehensive ap-proach to the budgeting process, he said.

The hospitals think the Bayou Health companies need to be a big part of the budget process, Salles said. Physicians should also be included in the discussion because a big part of the state’s healthcare cost issues involve access to care.

There are some areas of the state where people may not have adequate access to primary care physicians, Salles said. Hospitals can’t serve as the backstop for all of those issues and for cuts in fund-ing related to all of those issues.

The proposed budget cuts take place against a backdrop of $260 million in hos-

pital funding cuts over the last six years and declining ratings in Louisiana’s score on the American College of Emergency Physicians’ 2014 Report Card. Louisiana ranked No. 42 overall, down from No. 36 in 2009. The state’s overall grade dropped from a D+ to a D.

Louisiana ranked lower in four of the five categories: access to emergency care, quality/patient safety, medical liability and public health/injury prevention. The state ranked No. 3 in emergency pre-paredness in both report cards. However, Louisiana slipped from an A in the final category to a B+.

Richey said cuts to DHH, other pub-lic health agencies and hospitals all likely played a role in the state’s Report Card score.

Many of the items measured in the Report Card relate more to public health initiatives than to hospitals themselves, she added.

Salles said the Hospital Association is asking its supporters in the state Legisla-ture, and elsewhere, to oppose the triage fee proposal.

Hospitals Oppose Triage Fee, continued from page 1

for an affordable solution.”The process starts with a practice

completing a questionnaire geared toward determining its compliance needs. From this, a coding and billing compliance plan is tailored to meet the practice’s needs. Next, training is offered to staff on compliance is-sues. The package also makes use of a soft-ware tool that helps the practice see how its coding compares to other practice of the same specialty located in the same state. Additionally, the package includes ongo-ing support and education for a year, said Sacopulos.

“The idea is to provide a turnkey com-pliance service to practices,” he empha-sized.

Various companies, such as Medical Compliance Plus and Practice Support Re-sources Inc., offer compliance documents in template form.

“We differ from this approach in that we fit the compliance plan to the prac-tice,” he explained. “In my opinion, a 180-plus page book full of template docu-ments is the legal equivalent of playing Go Fish. Practices are busy; this is a complex topic. That’s why (we) tailor documents and supplies ongoing support via a telephone hotline. On the other end of the spectrum are specialty consulting or legal firms that can custom design documents and supply individualized auditing services. Some of these firms are top notch, such as Horne LLP, but they’re often beyond the finan-cial reach of smaller practices. We try to balance the need for individual attention with economic reality.”

Around the same time the Office of Civil Rights (OCR) announced it was resuming random HIPAA audits, it dis-patched 1,200 notices following a pilot program that revealed nearly 90 percent of surveyed practices, hospitals and other covered entities weren’t HIPAA-compliant.

“We should expect heavy fines to be levied,” said Sacopulos. “The OCR claims to collect $8 to $9 for every dollar they spend/invest on enforcement. That alone should make us want to hide under our beds.”

Prior to 2012, there were no random HIPAA audits. The system was complaint and notice driven. In 2012, with the help of an outside consulting firm, OCR launched a pilot program of random audits of medi-cal practices and other covered entities. Ap-proximately 130 entities were audited, noted Sacopulos.

“That’s a small numerator when com-pared to the enormous denominator of all the medical practices, hospitals … around the country,” he said. “We’re now seeing the expansion of the random audit program initially by a factor of about 10. We should expect these audits to become far more rou-tine in the future.”

Outside the random audit program, MRI is seeing a significant interest in the enforcement of HIPAA regulations at both the state and federal level.

“OCR has trained every state’s Attor-ney General’s Office on enforcement,” said Sacopulos. “Recently, we’ve seen the Fed-eral Trade Commission bring action against a medical provider for failure to safeguard patient information. If that wasn’t enough, plaintiff law firms are now filing private civil actions patterned from failures to meet HIPAA standards. Practices need to place the review their HIPAA compliance effort towards the top of the to-do list.”

Sacopulos described ICD-10 conver-sion preparation and increased activities of the Office of Inspector General (OIG) as “mixing to create a perfect storm.”

“In large part, this is why we believe it’s never been more important to have a current and comprehensive approach to compliance,” he said.

Compliance, continued from page 1

Page 7: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 7

lhcqf.org

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uality Forum

Initiative

The Louisiana Health Information Technology (LHIT) Resource Center, the state’s regional extension center (REC), offers a Medicaid Specialists Program that includes education, technical and support services.

You Qualify If:•You are a specialty or sub-specialty physician,

dentist, nurse practitioner or physician assistant.• At least 30 percent of your patient volume is

attributed to Medicaid.

• You are not currently receiving REC assistance.

We have worked with more than 1,700 providers across 37 different specialities to adopt and meaningfully use certified electronic health record (EHR) systems. We also help providers maximize financial incentives, minimize administrative downtime and prepare for future health care initiatives.

TO LEARN MORE about the

LHIT Resource Center, Medicaid

Specialists Program and eligibility requirements,

contact us at (225) 334-9299or [email protected].

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Are you a specialty care provider who would like assistance meeting

Meaningful Use objectives?

By LANZI MEyERS, JD

Healthcare professionals dedicate their careers to ensuring that the needs of others are being met. However, it is equally important that they take the steps necessary to plan for their own future needs and the needs of their loved ones. After all, an ounce of pre-vention is worth a pound of cure. This article will ad-dress the estate planning methods physicians, nurse practitioners, physician assistants, and other professionals in the health-care industry can utilize to protect themselves, their families, and their assets.

Estate planning is a topic that many people would prefer not to address, whether it be because they assume that they are too young, do not have a large enough estate, or don’t like thinking about death. However, one of the biggest mis-takes that can be made in this area is as-suming that you do not need a plan. Those in the healthcare industry, above all others, have a first-hand understanding that death can happen, and does happen, to any per-son, at any age. Further, the healthcare industry gives rise to estate planning issues that go above and beyond the issues faced by others.

Often times, physicians hold business interests in healthcare practices, whether it be through a group practice, joint ven-tures, or ownership in a hospital. What will happen to these business interests upon the death of the physician? It is important that there is a plan in place for the proper disposition of these business interests in a way that causes the least interruption to continued business operations, ensures the best continued care for patients, and saves the physician’s family from having to fight for proper settlement. Additionally, the naming of an executor in a will gives you the power to name a trusted individual to ensure that the affairs of your estate are properly wound up. Absent such plan-ning, the court has the power to name this executor. Moreover, healthcare providers are a constant target of legal action, includ-ing malpractice lawsuits and liability arising from business investments. Asset protec-tion planning, which includes the selection and organization of an appropriate busi-ness entity, will place hard-earned assets beyond the reach of future creditors and can lower the provider’s financial profile so as to discourage lawsuits.

Along with providing for the transfer of assets, an estate plan gives you the ability to

dictate the individual that will make health-care decisions on your behalf should you be unable to make these decisions on your own and document your wishes regarding life support. In Louisiana, when a person

is incapacitated such that he or she is unable to take care of

his or her person or property, an in-

terdiction pro-ceeding will take place.

Interdictions can be expen-sive, time consuming, embarrassing,

require annual accountings, and re-sult in a court-appointed curator

making decisions on your be-half instead of the person of

your choosing. Further, a living will relieves family members from the bur-den of having to make

difficult decisions regard-ing the continuance of life

support and can document wishes such as organ and tissue donation.

Healthcare can be a very lucrative in-dustry and, as such, it is even more impor-tant to put a plan in place to transfer assets to the proper parties, limit expenses associ-ated with estate administration, minimize the possibility of costly litigation between beneficiaries and/or business partners, and reduce estate and other transfer taxation. The majority of physicians either own or intend to purchase a substantial amount of life insurance to protect their families and businesses. While life insurance proceeds are paid income tax free to beneficiaries, they are subject to estate taxation. There-fore, it can be of great benefit to use an ir-revocable life insurance trust to safeguard your death benefit from estate taxation. Of equal importance is to update existing plans to account for the changes in estate taxation law, birth of children, modifica-tion of trust provisions as children are born and grow older, and modification of trust-ees and guardians as circumstances change.

Having an estate plan in place will spare your loved ones the expense, delay and frustration associated with managing your financial affairs when either tragedy or the natural course of life occurs. It also offers estate planning opportunities espe-cially important to healthcare providers, such as planning for the disposition of busi-ness interests, shielding your personal assets from professional liability, and reducing es-tate tax liability so as to pass the optimal amount of wealth to your heirs.

Estate Planning for Healthcare Professionals

Lanzi Meyers, JD, specializes in regulatory, compliance and transactional matters with Gachassin Law Firm in Lafayette.

Page 8: Louisiana Medical News May 2014

8 • MAY 2014 Louisiana Medical News

(CONTINUED ON PAGE 10)

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

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

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

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

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

Blue Cross and Blue Shield of Louisiana

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

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

That Rewards That Rewards Doctors and Patients Patients

for Better Health.for Better Health.

01MK5620 02/14 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company and is an independent licensee of the Blue Cross and Blue Shield Association.

By ANGELA MILLER, CHC, CMC

The OIG has had compliance pro-gram guidance since the early 1990’s for Physician Group Practices and other types of providers such as hospital, DME. With the Healthcare Reform Act and Patient Protection Affordable Care Act, a Compliance Program is required since 2013. The required compliance program should follow the OIG Compliance Guid-ance for your physician practices. An ef-fective compliance program will develop

a risk assessment and audit protocol to monitor the business’ activity to prevent fraud and abusive activities. The pro-gram will also ensure contracts and rela-tionships comply with federal Stark Law and Anti-kickback Statute.

Keep in mind a physician practice has to maintain compliance for several areas such as HIPAA Privacy (2003) and HITECH security (2009) which also in-cludes the Omnibus Rule (2013), OSHA standards, Human Resource Processes, licensing requirements and more. Each

program has very specific elements that must be implemented to be “effective and active,” including a program manager(s), support from the top down, standards of conduct, policies and procedures, train-ing, monitoring and more. As you can see there are many pitfalls that are possi-ble. Without compliance the business op-erations will suffer one way or the other.

HITECH Security is beyond your billing system. It looks to whether or not someone can hack open ports in your server, what employees are saving on

their PCs and mobile devices and are the devices encrypted, who has access to PHI and e-PHI, are staff emailing PHI and more. This is a very intensive process of examining the IT infrastructure and does require knowledge and understanding of HIPAA and HITECH rules. The Office for Civil Rights (OCR) as well as the Of-fice of Inspector General (OIG) will be auditing to ensure compliance with the HIPAA and HITECH provisions.

Security audits include wrongfully attesting to Meaningful Use or not main-taining meaningful use guidelines for the money a provider was paid for their Electronic Medical Records system and are prosecuted under the Federal False Claims Act which includes a treble dam-ages penalty.

HIPAA Audits are increasing mainly due to the number of breaches being re-ported and the penalties are steep consid-ering the cost of monitoring in a proactive manner. A breach can be anything where PHI ends up in the wrong hands such as but not limited to stolen or lost mobile de-vices containing PHI.

Omnibus Rules expands all the pri-vacy and security rules to Business As-sociates. A business associate is anyone who may have potential access or need to see protected health information such as consultant, attorney, billing companies, etc. Providers must have a business asso-ciate agreement updated in 2013 with the new rules. Providers must keep a log of all business associates, date, and purpose at a minimum.

OSHA rules for work place safety, signs as appropriate for your business must be maintained and training per-formed with staff.

Human Resource Compliance en-sures that you perform all verification prior to hiring, complete all the necessary forms, completed your new hire process and checklists, employee evaluations are performed, employees disciplined accord-ingly, consistency, and all must comply with federal and state laws.

All the programs require the need for monitoring the processes to ensure they start and stay compliant. This au-diting process will include reviewing bill-ing revenue reports, selecting a sample of claims to ensure the documentation is sufficient to warrant the evaluation and management code billed and services provided, patient records for privacy ac-knowledgement and appropriate consent or authorization, if applicable, IT net-work and devices audit at least annually, meaningful use compliance, inspection of the OSHA items that are appropriate for your office, employee records to verify they have been checked against the sanc-tion provider databases, and all employee training has been completed. Keep in mind, if the audit results in problem areas that need to be corrected, ensure those is-sues are corrected and documented edu-cation is provided.

Using compliance to improve your

Better Operations from Better Compliance

Page 9: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 9

A Look at Healthcare Bills Under Serious Consideration

Legislative AffairsBY CINDY BISHOP

At this writing the 2014 Regular Ses-sion of the Louisiana Legislature is almost at the midway point. Lawmakers have until June 2, 2014 to wrap up their busi-ness and adjourn sine die. The Louisiana Legislature has an outstanding website (www.legis.la.gov) where the public at large can listen to the committee hearings and sessions of the House and Senate via live streaming. The website also gives the public access to copies of all the legislation under consideration.

• House Bill 1074 by Rep. Lenar Whitney is a measure that provides a lim-ited exemption to state licensure require-ments for visiting physicians. HB 1074 addresses the issue of out-of-state physi-cians traveling to Louisiana to attend to the medical needs of official sports teams. HB1074 would allow physicians who are licensed to practice medicine in another state or country to attend to the acute care needs of the official traveling party of athletes and staff of an athletic team while the team is competing in Louisiana. How-ever, the exemption provided for in House Bill 1074 does not allow the performance of any elective procedure by a physician

while in the state of Louisiana. HB 1074 was filed at the behest by Dr. Michael Leddy, an orthopedic surgeon who prac-tices in Alexandria. Dr. Leddy serves on the Board of Directors of the Louisiana Orthopedic Association and is a state del-egate for the American Orthopedic Soci-ety for Sports Medicine. The measure has the backing of the Louisiana Orthopaedic Association. The American Orthopedic Society of Sports Medicine has recog-nized this to be a concern and has sup-ported legislation across the United States addressing this measure. Additionally, the Medical Practice Act governed by the Louisiana State Board of Medical Exam-iners has criteria for international doctors to practice in the state of Louisiana. Cur-rently, twenty (20) states have adopted this legislation. This measure being brought on behalf of the American Orthopedic Society of Sports Medicine and has the support of the Louisiana State Board of Medical Examiners and the Louisiana Or-thopaedic Association (www.legis.la.gov)

Another health care measure being considered during the 2014 Regular Ses-sion of the Louisiana Legislature is Sen-

ate Bill 497 by Senator David Heitmeier, chairman of the Senate Committee on Health and Welfare. SB 497 provides for the payment of healthcare services. The measure was considered on April 8, 2014. Senator Heitmeier explained that his bill is an attempt to address the prob-lems related to “balanced billing.” At the outset of the committee hearing, Senator Heitmeier amended his bill to put a cap of 300 percent of Medicare if a healthcare provider is not a contracted provider and is billing a patient for services rendered. For the past several years, legislation has been considered that would prohibit hospital based healthcare providers from billing patients “out-of-network” rates for services rendered. Under the provi-sions of Senate Bill 497, if a healthcare provider was not a contracted provider in a managed care network, then the most he or she could charge would have been 300 percent of Medicare. If the provider wanted to exceed the 300 percent thresh-old, the healthcare provider would have been required to get approval from a De-partment of Insurance “workgroup.” SB 497 did not muster the required votes to

get out of the committee but Senator Heit-meier is still looking for solutions to this issue. If you have any suggestions or rec-ommendations please email them to me at [email protected] and I will pass them along to Senator Heitmeier.

• House Bill 746 by State Repre-sentative Helena Moreno prohibits the use of tanning equipment by minors. Rep. Moreno explained that the bill was filed on behalf of a group of dermatologists who researched, studied and provided clear evidence that linked tanning beds to cancer. Under the provisions of House Bill 746, any younger than 18 would not be able to use a tanning bed. Proponents of the measure stated that six states and countries such as Brazil and Australia have passed similar legislation. Dr. Keith Sonnier, Chairman of the Louisiana State Medical Society’s Council on Legislation, testified on behalf of the measure, stating that they, LSMS, support the prohibition of tanning beds by minors because this measure will help prevent the incidence of melanomas in teenagers. Also speak-ing on behalf of the measure was Karen

(CONTINUED ON PAGE 12)

Page 10: Louisiana Medical News May 2014

10 • MAY 2014 Louisiana Medical News

By ANITA JOHNSON, MD

As a surgical oncologist focused on treating breast cancer, I see daily how devastating a breast cancer diagnosis can be. But I also see daily how new and often cutting-edge treatments give women the hope and courage they need to help man-age or overcome the physical, mental and emotional challenges of breast cancer, and in many cases, beat the disease altogether.

One in eight women will develop breast cancer in her lifetime. While the leading risk factors are well known – older age, family history, mutations in certain genes – the most important risk factor for breast cancer is simply being a woman.

The fact that any woman can de-velop breast cancer is one reason annual

mammograms and clinical breast exams are so important; regular screening helps detect cancer early. As with every type of cancer, when breast cancer is discovered early there are more treatment options available, survival rates are longer and the cure rate is higher.

In the U.S., trends in breast cancer are encouraging. Data from the National Cancer Institute show consistent declines in both new cases and deaths from breast cancer since 1990. Further, the U.S. Cen-ters for Disease Control and Prevention (CDC) reports that from 2000 to 2009 the incidence of breast cancer in the U.S. decreased by 0.9 percent per year, while mortality decreased 2.1 percent annually.

What’s most notable about these data is that breast cancer mortality is decreas-

ing at more than twice the rate of inci-dence – meaning that women with breast cancer are living longer. That trend also is borne out by CDC data: although less than 75 percent of women with breast cancer survived more than five years in the 1970s, in 2005 more than 90 percent did.

There may be several reasons be-hind the decline in breast cancer deaths. However, new technologies and improve-ments in existing treatments are very likely contributing to higher survival rates and improved quality of life for women with breast cancer. In addition to continued re-finements in breast-conserving and recon-structive oncoplastic surgery techniques, there is an array of advanced treatment technologies available today.

For example, genomic testing is an innovative new diagnostic tool that allows tumors to be examined on a genetic level. By identifying mutations that occur in a cancer cell’s genome, doctors can better understand what caused the tumor and tailor treatment based on these findings. Genomic testing might suggest a drug normally used for another type of cancer could be an appropriate treatment for breast cancer based on the genetic prop-erties of the tumor.

Another example is intraoperative ra-diation therapy (IORT), one of many new technologies that deliver radiation more precisely, helping minimize damage to healthy tissue and treatment times. With IORT, radiation is delivered directly to the tumor site after a surgeon has removed the tumor. A 30-minute dose of IORT can often replace weeks of traditional radia-tion.

In addition to radiation, there have been numerous advances in chemother-apy treatments for breast cancer. Targeted therapy blocks specific molecules involved in tumor growth by directing drugs or other specially-created compounds (e.g., man-made immune system proteins) to attack cancer cells. A targeted therapy, chemoembolization delivers medication through a catheter directly into a tumor using image guidance. The chemotherapy drugs are mixed with particles, called mi-crospheres, which block blood flow to the tumor.

With so many options available to treat breast cancer today, treatments can almost be tailored to the individual based on factors such as her genetic profile, loca-tion of the tumor, the type of tumor and whether the cancer has spread, among others. However, which treatment a woman ultimately chooses is a very per-sonal decision best made in collaboration with her family, personal physician and oncologist.

The specter of breast cancer can be frightening, but it is important to remem-ber that most women will not develop the disease. Women who are at an increased risk should talk to their doctors about how often they should receive mammograms and what other screenings, such as genetic testing, might be beneficial. Although breast cancer continues to claim too many lives – more than 35,000 each year – ad-vanced treatment options are having a significant impact on survivability and quality of life.

Anita Johnson, MD, FACS, is medical director of breast surgical oncology at Cancer Treatment Centers of America at Southeastern Regional Medical Center in Newnan, Ga. 

New Breast Cancer Treatment Options Boost Survival, Offer New Hope

business operations is essential and will improve efficiency, cash flow, and keep your business “between the ditches.” Ef-fective compliance programs will also en-sure the company is meeting all federal and state laws, the coverage criteria for the services you provide which will reduce risk for overpayments in audits, reduce the provider’s risk for criminal charges and help keep penalties to a minimum. You can use the compliance program as a marketing point to referral sources be-cause providers do not want to risk refer-ral business to a company that is unethical or not compliant which may cause the “Badges” to show up at their office as a secondary investigation or even for ques-tions.

As a former compliance officer, I developed a compliance program that

reflected the personality of the company and the executive team. This saved the company when we disclosed we had a rouge employee who violated federal law. I also focused on working closely with billing to ensure we all stayed current on education and changes with payers.

Have you started on your compli-ance programs? The programs are re-quired and upon audit or investigation, especially, the government is not giving lenience for not having put programs into place. Failing to have compliance pro-grams in place could result in the govern-ment pursuing criminal charges, which sounds as painful and expensive as it re-ally is unfortunately.

Here is the good news, if you pull the OIG Compliance Guidance and work plan for 2014, this will help you outline

a program if you need to do the program yourself. Office for Civil Rights has sam-ple Privacy Notices and other forms. A consultant or your healthcare attorney can review what you have done as part of the independent audits of these pro-grams to give you an assessment of your program. This will help your compliance or regulatory officer develop changes and improve the efficiency of the program. An efficiency and effective set of com-pliance programs will improve the com-pany’s operations and reduce risk. Don’t look at compliance programs as “cost centers but rather “reward programs” for your company!

Angela Miller, CMC, CHC, is president of Medical Auditing Solutions LLC. Contact her at www.MedicalAuditingSolutions.com

Better Operations from Better Compliance, continued from pag 8

Page 11: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 11

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By CINDy SANDERS

Consider yourself warned.A white paper released ear-

lier this year by SANS, a global leader in cybersecurity research, training and certification, painted a bleak picture of where those in the healthcare industry cur-rently stand in terms of keeping protected information safe and secure. The report was created using healthcare-specific data pro-vided by Norse, a live threat intel-ligence 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 se-nior SANS analyst and healthcare spe-cialist, the report detailed the widespread problem. In analyzing the Norse data col-lected during 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 vulnerable the industry had become, it also revealed how far behind industry-re-lated 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 as-sociates accounted for 9.9 percent of the malicious traffic, health plans 6.1 percent, healthcare clearinghouses 0.5 percent, pharmaceuticals 2.9 percent, and other related entities 8.5 percent. Most alarm-ing, 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 contacts to pushing sensitive information outward. She noted that many compa-nies, practices and facilities have policies in place warning employees not to click on an unknown email or link. (And who hasn’t received a suspicious link under the guise of coming from a friend or col-league?) Yet, she said, “People need to be looking at not only what comes into their network, but what goes out of their net-work.”

To find and address malware typi-cally requires a HIT professional. “A lot of

times an attacker will use a very common protocol so it might look like someone is browsing 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 Internet search for the device in question.

“There are some very basic things that can be done to get started with protec-tion,” Filkins noted. The most obvious …

but clearly overlooked … is to change those default passwords. However,

she continued, changing to an eas-ily deciphered password isn’t

much help. Avoid using your children’s names, street

address, pet names, com-bined 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 headaches … in part be-

cause of unrealistic expectations and policies. “Everyone uses mobile de-vices,” 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 con-figured properly.” She added it’s impor-tant 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 network pathways are for your organi-zation.” Filkins said that often there’s an emphasis on protection for “bad things coming in” … but if something does pen-etrate the system, there isn’t much moni-toring of outbound traffic. Egress filtering is as important as ingress protection.

The Cost of FailureThe healthcare industry is particu-

larly attractive to cyber attackers because of the type of information housed on serv-ers. With medical identity theft, the vic-tim is responsible 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 notification, credit monitoring for victims, and potential legal action represent direct out-of-pocket expenditures. In addition, a data breach could also significantly harm reputation and future business opportuni-ties.

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

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 Shows Dark Clouds on HIT HorizonWidespread security issues put systems, patients at risk

Page 12: Louisiana Medical News May 2014

12 • MAY 2014 Louisiana Medical News

Physicians’ health Foundation oF louisiana

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

888-743-5747 www.phfl.org

By LyNNE JETER

The 2013 HORNE Medi-cal Offi ce Staff Salary Survey, a fundamental annual industry tool to gauge and project salary and benefi t trends among medi-cal offi ce staff, refl ects a boost in demand for nurse practitioners (NPs), with a startling 68 percent jump in the addition of non-phy-sician providers to practices and hospitals from 2009 to 2013.

Based on the context of the Affordable Care Act (ACA) and shrinking reimbursements, in-dustry leaders anticipated the spike in demand of non-physi-cian roles, but perhaps not to the extent reported, said Katherine G. Watts, CPA, CHC, part-ner in charge of healthcare for HORNE LLP, publisher of the annual survey since 2009.

“In practices and hospitals across the nation, revenue isn’t growing as fast as your expenses, and surviving as an institu-tion is going to require a different mindset going forward,” said Watts. “However,

understanding 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 staff-ing priorities with an eye toward fi nding 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 ben-efi t of helping to fi ll 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, provide disease man-agement patient education, and help patients make the best life-style 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. Considered licensed independent contractors, NPs are trained to order and interpret diagnostic tests. Some states allow NPs to practice independently with-out 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 fi rst 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 re-quire an average of 5.3 support staff mem-bers.

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 percentage changes for clinical positions in the last fi ve years include increases for certifi ed surgery technicians (22.8 percent), bone density technicians (16.7 percent), clinical super-visors (15.5 percent), non-certifi ed surgery technicians (13.4 percent), and certifi ed nurse assistants (10.7 percent). Pharmacy technicians represented 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 provid-ers gives hospitals and practices the edge they need to attract and keep top non-phy-sician provider talent as a key part of their staffi ng mix to serve patients and contain costs.”

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

GRAPHIC COURTESY HORNE LLP

Morgan, who identifi ed herself as a forty year old mother of two. She stated that she has stage 4 melanoma and the recov-ery has been brutal. She cited that the World Health Organization has declared a 75 percent chance increase in relative risk to melanoma in people under the age of 35. Also the WHO report states that they are “Very confi dent that in the years to come we will look at tanning beds the same way we look at cigarettes.” Lastly, the owner of a Planet Beach franchise in Louisiana stated that he supports House Bill 746. He testifi ed that “Sunless tan-ning products exist and are exponentially safer.” House Bill 746 received favorable consideration on the House fl oor (97 yeas and 1 nay) and at this writing, heads to the Senate Committee on Health and

Welfare for further consideration.If you have any questions, concerns

or comments about legislation impacting healthcare, please feel free to contact me at [email protected] or at (225) 923-1599.

Credits: Earl Willis, an associate of Checkmate Strategies, contributed to this edition of Louisiana Medical News.

Legislative Affairs content is provided by Checkmate Strategies, publisher of Health Care Information Services. All content ©

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

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

checkmate-strategies.com

Legislative Affairs, continued from page 9

Page 13: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 13

In the News

GENERAL SURGEON

OCHSNER HEALTH SYSTEM is seeking a Board Certified/Board Eligible General Surgeon to join our growing team in Baton Rouge. Both newly trained and experienced physicians are encouraged to apply. Salary offered will be competitive and commensurate with experience and training.

Ochsner is perfectly positioned to provide value and efficiencies in the healthcare reform environment of accountable care, medical homes, budget cuts, declining reimbursement, and increased regulation.

The Greater Baton Rouge region has over 1,400 employees serving our patients in ten Ochsner Health Centers and Ochsner Medical Center Baton Rouge, a 151-bed facility. We employ more than 130 physicians and mid-level providers who provide an excellent referral base. Ochsner Health System is a physician-led, non-profit, academic, multi-specialty, healthcare delivery system employing over 900 physicians. The system includes 9 hospitals and more than 40 health centers. We offer a generous and comprehensive benefits package. We also enjoy the advantage of practicing in a favorable malpractice environment in Louisiana. Please visit us at www.ochsner.org.

Baton Rouge represents the best of Louisiana’s vibrant culture. It is a very family-oriented city with great schools, restaurants, shopping, and an abundance of sports and cultural opportunities. We are the state capital, with a metropolitan population of over 600,000 and home to Louisiana State University and Southern University. Please e-mail CV to: [email protected], Ref. # AGSBR02 or call for information: (800) 488-2240. EOE.

Sorry, no J1 visa opportunities available.

Peoples Health Appoints Dr. Anthony Grieco to Market Medical Director

METAIRIE – Peoples Health an-nounced the appointment of Dr. An-thony Grieco to market medical director of the New Orleans-Westbank region for Peoples Health. Grieco provides utilization management and market support for the region. He supports the company’s medical management department and regional physician net-work and develops special projects that are aligned with the mission and vision of Peoples Health. He performs regular census rounds at network facilities with the company’s inpatient care teams and facilitates resolution of external provid-er issues.

With an extensive background in medical management, Grieco has served as senior physician for other managed care organizations, includ-ing Ochsner Health System and several private practices throughout the United States. In his previous position as lead medical director at Blue Cross Blue Shield, he managed seven other medi-cal directors while overseeing utilization management, implementing a patient-centered medical home program and developing metrics for care coordi-nation quality measures. Grieco also served as a captain in the Navy Medical Corps, where he functioned as staff OB/Gyn physician and representative to the Navy Bureau of Medicine and Surgery’s medical inspector general.

Grieco earned a Bachelor of Arts in Speech-Broadcasting and holds a Doctorate of Medicine with a concen-tration in obstetric and gynecology from Marshall University in Huntington, W. Va. He completed his pre-medicine coursework at Tulane University and earned a Master of Business Adminis-tration in healthcare management from Southeastern Louisiana University. He is certifi ed by the American Board of Ob-stetrics and Gynecology. Additionally, he is a fellow of the American College of Obstetricians and Gynecologists and serves as a member of the American College of Physician Executives and the Louisiana State Medical Society. Dur-ing his military service, Grieco received several personal awards, including Navy Achievement and Commendation med-als, such as the Navy Meritorious Ser-vice Medal.

Peoples Health is a Medicare Ad-vantage company serving a 23-parish area that includes New Orleans and Ba-ton Rouge.

Louisiana Heart Hospital announces Executive Appointments

LACOMBE- Warren E. Beck, CEO of the Cardiovascular Care Group (CCG), announced a new management team to further propel Louisiana Heart Hospi-

tal’s integrated delivery system. Steve Blades will serve as the fi rst Chief Ex-ecutive Offi cer for the Louisiana Heart Medical Group (LHMG); Roy Wright will succeed Blades as the President and Chief Executive Offi -cer of the Louisiana Heart Hospital; and Anthony Morales, Jr., MD, FACC has been appointed to serve as the Chief Medi-cal Offi cer for the Louisi-ana Heart Hospital and the Louisiana Heart Med-ical Group.

The group was cho-sen to execute the next phases of the integration model championed by Blades over the past two years resulting in national rec-ognition and awards, and region-lead-ing patient satisfaction scores.

Blades served as the CEO of the hospital since August of 2012. In that time he has built one of the largest multi-specialty group practices on the Northshore. “Steve Blades brings ex-ceptional skills and talent with more than 30 years of experience in cardio-vascular medicine practice manage-ment and delivery design. His work in physician recruitment and initiat-ing integration at LHH over the past two years has produced remarkable results,” said Warren Beck. “We have always believed that the building block for a great healthcare delivery system is physicians working in an integrated practice model. We think the time is right to build our group practice to 100 physicians or more and have tapped Steve and his wealth of experience in physician group development to lead the effort on a full-time basis.”

“When we made the commitment to build the Louisiana Heart Medical Group, we knew we would need to fi nd an experienced CEO for the hospital,” said Beck. “We launched a nationwide search for Steve Blades’ successor and have found a seasoned Chief Executive in Roy Wright. Roy has shown outstand-ing leadership throughout his career and brings to LHH exceptional skills in hospital operations, strategic planning, marketing and the development of en-trepreneurial ventures in ambulatory and post-acute care.”

Wright comes with nearly 30 years experience in healthcare and hospital leadership. The last 12 years have been in top-level positions at Health First in Brevard County, Florida. He led the 386-bed network of community hospi-tals for Health First improving both the quality and effi ciency of care delivery. He holds a Bachelor’s in Pharmacy and an MBA with certifi cation in Health and Hospital Administration from the Uni-versity of Florida.

“CCG believes the best care is patient-centered and physician led. Our plan is to build delivery systems throughout the country that integrate

care across the full continuum of servic-es from prevention to acute care, from surgery to rehabilitation and from diag-nosis through disease management,” said Harry R. Jacobson, MD, Chairman of the CCG Board. “Steve Blades has been the moving force behind our re-cruiting an exceptional group of physi-cians on the Northshore that will soon grow to the largest multi-specialty group practice in the region. Roy brings the total package in hospital manage-ment and is a highly talented addition to our team.”

Of new Chief Medical Offi cer An-thony Morales, MD, Beck says, “We are thrilled to bring Dr. Morales onto the Executive team. He brings a broad sweep of experience in healthcare and an equally impressive understanding and compassion to the patients on the Northshore.”

Dr. Morales completed his medi-cal degree at Louisiana State University, New Orleans and a Residency in Internal Medicine at St. Barnabas Medical Cen-ter, Livingston New Jersey. He complet-ed a fellowship in cardiology at Tulane and is a Fellow in the American College of Cardiology. Dr. Morales joined the Louisiana Heart Medical group in 2012. He has been a member of the Medical Staff at LHH since November 23, 2005 and has practiced on the Northshore in St. Tammany Parish for 28 years.

Dr. Anthony Grieco

Steve Blades

Roy Wright

Beauregard Memorial Names Charron New CEO

DERIDDER- Robert “Bob” M. Charron has accepted the position of Chief Executive Offi cer at Beauregard Memorial Hospital in DeRidder ef-fective April 1, 2014. Mr. Charron brings over 30 years of healthcare ex-perience to Beauregard Memorial, and most recently was President, Chief Executive Offi cer and co-owner of BR Healthcare Services, which spe-cialized in developing strategies for hospitals to both increase revenues and profi tability through more effi cient operations and new revenue opportu-nities. Prior to forming BR Healthcare, Mr. Charron was the Chief Executive Of-fi cer of Memorial Hospital in Palestine, Texas. Charron received his education from Trinity University in San Antonio, Texas, where he obtained his Master’s of Science degree in Healthcare Ad-ministration. With a track record of in-novation, increased patient satisfaction, positive physician relations and recruit-ment, improved effi ciency, and market growth, Charron is well prepared to face the coming changes and challeng-es in healthcare.

Robert M. Charron

Page 14: Louisiana Medical News May 2014

14 • MAY 2014 Louisiana Medical News

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Karen Fontana Joins Kean Miller

NEW ORLEANS- Kean Miller LLP announced that Karen M. Fontana has joined the fi rm as Special Counsel in its New Or-leans offi ce. A partner in the Niles, Bourque fi rm for ten years, Ms. Fon-tana will practice with Kean Miller’s health law, medical malpractice de-fense, and commercial litigation teams. Her practice involves the sophisticated representation of physicians and health-care providers, including medical mal-practice defense, peer review proceed-ings, privilege disputes, products liabil-ity, and general and complex contract negotiations. Karen has successfully represented clients on appeal before the Louisiana Fourth and Fifth Circuits.

“We are excited to welcome a sea-soned attorney with Karen’s personal reputation and litigation experience to our New Orleans offi ce, the fastest growing offi ce in our fi rm. This strate-gic addition is demonstrative of our commitment to serve clients wherever needed,” said G. Blane Clark, Jr., Man-aging Partner of the 145 attorney law fi rm.

Karen is listed in Louisiana Super Lawyers, 2012-2014, and has consistent-ly been named by New Orleans Maga-

zine as a Top Lawyer in the Greater New Orleans region. She was selected for inclusion into the 2011-2013 editions of the Martindale-Hubbell Bar Register of Preeminent Women Lawyers and was recognized as a Charter Fellow of the Litigation Counsel of America. Karen re-ceived her B.A., magna cum laude, from Catholic University of America in 1990, fi nishing in three years while participat-ing in the University Honors Program. She earned her J.D., magna cum laude, from Tulane University Law School in 1995, graduating fi fth in her class. She was awarded Order of the Coif and served on the Tulane Law Review Senior Editorial Board. Following law school, Karen served as Law Clerk to the Honor-able Justice Walter F. Marcus, Jr. of the Louisiana Supreme Court.

Valentine Appointed to Louisiana State Board of Medical Examiners

NEW ORLEANS—Dr. Christy Valen-tine, president and founder of Valentine Medical Center, was ap-pointed to serve on the Department of Health and Hospitals’ Louisiana State Board of Medical Examiners (LSBME).

The LSBME consists of seven physicians ap-pointed by the gover-

nor from nominees submitted by the Louisiana State Medical Society and the Louisiana Medical Association. Dr. Valentine joins the board as one of two appointees from the Louisiana Medical Association.

The LSBME protects the health, welfare and safety of Louisiana citizens against the unprofessional, improper, and unauthorized practice of medicine by ensuring that those who practice medicine under its jurisdiction are quali-fi ed and competent to do so. In addi-tion, the LSBME serves in an advisory capacity to the public and the state with respect to the practice of medicine.

“I am truly honored by this desig-nation and dedicated to its mission,” said Dr. Valentine. “Ensuring qualifi ed professionals are practicing state-wide is integral to ensuring access to quality care and improving the level of health in Louisiana.”

The board examines all applicants for the practice of medicine, issues li-censes or permits to those possessing the necessary qualifi cations and takes appropriate administrative actions to regulate the practice of medicine in the state of Louisiana. Serving a four-year term, Dr. Valentine will attend regular LSBME meetings monthly and any spe-cial meetings as deemed necessary by the board president.

Karen M. Fontana

Dr. Christy Valentine

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Page 15: Louisiana Medical News May 2014

Louisiana Medical News MAY 2014 • 15

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Family Physicians Acuna, Hutchinson, Kane and Seep Join Memorial Medical Group

LAKE CHARLES- Memorial Medical Group welcomes Drs. Rodney Acuna, Carolyn Hutchinson, Per-cival Kane and Michael Seep to their staff. They will be seeing patients at Memorial Medical Group Family Medicine Clinic, located at 2750 Aster Street in Lake Charles.

Dr. Rodney Acuna received his medical de-gree and a masters de-gree in community health from the Davao Medical School Foundation in Ba-jada Davao City, Philip-pines. He then went on to complete his residency in family medicine from San Pedro Hospital, Inc. in Guerrero St. Davao City, Philippinesand the University of Texas Health Science Center in Hous-ton.

Dr. Carolyn Hutchin-son received her medical degree from Saba Uni-versityin the Netherlands Antilles. She then went on to complete her fam-ily medicine residency at Lake Charles Memorial through the Louisiana State University Health Science Center’s Family Medi-cine Residency program.

Dr. Percival Kane graduated from the Louisiana State University School of Medicine. He then completed a rotat-ing internship at CharityHospital in New Orleans, followed by his family medi-cine residency at W.O. Moss Regional Hospital, where he also served as Chief Resident.

Dr. Michael Seep graduated from the Louisiana State University School of Medicine, and then went on to com-plete his family medicine residency at W.O. Moss Regional Hospital.

Immediately prior to joining Memo-rial Medical Group, the doctors all saw patients at CHRISTUS St. Patrick’s Fam-ily Medicine Center.

Drs. Acuna, Hutchinson, Kane and Seep will provide comprehensive care for patients 12 years of age and older.

For more information or to make an appointment, please call Memorial Medical Group Family Medicine Spe-cialists at (337) 480-8900.

Dr. Rodney Acuna

Dr. Carolyn Hutchinson

Dr. Percival Kane

Dr. Michael Seep

Page 16: Louisiana Medical News May 2014