Sandra Dipietro Senior VP CFO, STPH

+($/7+&$5(-2851$/ NOVEMBER / DECEMBER 2016 I healthcarejournalNO.com I $8 of New Orleans

O ne on One Sandra DiPietro Senior VP CFO, STPH

The End Game Big Data & Precision Medicine

Scan to Subscribe

+12 November / December 2016

Chief Editor Smith W. Hartley [email protected] Managing Editor Karen Tatum [email protected] Editor/Writer Philip Gatto [email protected] Contributors Claudia S. Copeland, PhD; John Mitchell Correspondents Amritha Appaswami; Rebekah E. Gee, MD, MPH; Karen Carter Lyon, PhD, aprn, acns, nea; Cindy Munn Art Director Liz Smith [email protected] Sponsorship Director Dianne Hartley [email protected] Photographer Sharron Ventura

Healthcare Journal of New Orleans Advisory Board

Michael Griffin President & CEO Daughters of Charity L. Lee Hamm, MD Sr. VP and Dean Tulane University School of Medicine John P. Hunt, MD, MPH You don’t need a Program Director LSU Surgery Joseph D. Kimbrell, MA, MSW Chief Executive Officer Louisiana Public Health Institute Raul Llanos, MD Crystal Integrative Medicine Charlotte M. Parent, RN, MHCM Asst. VP, Community Affairs & Network Navigation LCMC Health Yolanda Webb, PhD (ABD) Ball Executive Director to find out what’s happening Metropolitan Human Services District in the New Orleans Healthcare community. Subscribe to HJNO eNews for weekly updates.

Copyright© 2016 Healthcare Journal of New Orleans The information contained within has been obtained by Healthcare Journal of New Orleans from sources believed to be reliable. However, because of the possibility of human or mechanical error, Healthcare Journal of New Orleans does not guarantee the accuracy or completeness of any information and is not responsible for any er- rors or omissions or for the results obtained from use of such information. The editor reserves the right to censor, revise, edit, reject or cancel any materials not meeting Visit HealthcareJournalNO.com the standards of Healthcare Journal of New Orleans.

+12 November / December 2016

Our Mission Healthcare Journal of New Orleans analyzes healthcare for the purpose of optimizing the health of our citizens.

Need Healthcare Journal of New Orleans Sponsors

Blue Williams, LLP referrals? www.bluewilliams.com Canon Hospice www.canonhospice.org

East Jefferson General Hospital www.ejgh.org

LAMMICO www.lammico.com/NO

LHA Trust Funds www.LHATrustFunds.com

St. Tammany Parish Hospital www.stph.org

Touro Infirmary www.touro.com

Tulane Medical Center We can do www.tulanehealthcare.com better University Medical Center than this... www.umcno.org

Mailed directly to local healthcare leadership including physicians, administrators, insurers, and ancillary providers, the Healthcare Journal of New Orleans puts your message in front of healthcare industry professionals today.

Subscribe The most comprehensive and To subscribe to Healthcare Journal of New Orleans ($48 for one year) cost-effective way possible to reach go to [email protected] Advertising your local healthcare industry. To receive information regarding advertising in Healthcare Journal of New Orleans, contact us at [email protected] For sponsorship information email: Feedback We would love to hear from you. Email [email protected] to [email protected]

Contents November / December 2016 I Vol. 5, No. 6 30

12 +12

fae tures

One on One with Sandra DiPietro ...... 12 Senior VP and CFO St. Tammany Parish Hospital

Precision Medicine...... 20 Harnessing the extraordinary growth in medical data

The End Game...... 30 Providers, patients embracing 20 improved end-of-life planning Departments

Editor’s Desk...... 10 s Healthcare Briefs...... 37 ommon Hospital Rounds...... 53 12 Ad Index...... 66 a_2050) via Wikimedia C t an Correspondents Atl _ b _La

DA Quality...... 44 ion (F t ra Nursing...... 46 st dmini

A Bio...... 48 g u r D Secretary’s Corner...... 50

Research...... 52 By The U.S. Food and Food The U.S. By Editor’s Desk

Quality begins with a thorough understanding of every experience along the patient’s journey.

Once I was leaving a paid parking is contagious. All of us are consumers. All of us want to know lot at a healthcare facility. The price for that when we enter a facility that the organization has thought parking was $1. I had a twenty dollar bill through all these details on our behalf. Let’s face it, it just makes which I gave to the attendant. I received for a better life existence all around us. It’s about achieving a bet- $19 in change in fourteen one dollar bills ter life for all. The customer wins, the organization wins. and twenty quarters. When I asked if I Having a certain degree of empathy is why many choose a life could have something other than quar- of service in healthcare. It’s truly one of the vocations where you ters, I was told, “You should know to feel like you can earn a comfortable living and provide compas- bring exact change when you come here.” sionate care to others. To be successful in achieving these objec- I said “Okay,” and thought, “Wow.” tives, simply regain focus on the patient’s journey. Organizations Quality is focusing on every step of the patient’s journey. We’ve are always wrangling with internal operations. Costs, benefits, all called organizations who immediately send us to an auto- investments, people, operations, and strategies are always im- mated recording saying, “Your call is important to us.” You have portant and time consuming. But, keep the focus, involve your to think if my call is so important, then, why not plan to answer mind in the patient’s experience, make it better for the patient, it? Holding is one thing; now it feels like I’m being lied to as well. continuously and always, and you will be more than fine. You Trust would be better established if the recording said, “Sorry, we can flourish. n didn’t want to pay for enough staff to answer the phone.” We can understand staffing problems, and now we trust you. Regarding your healthcare organization, what is the real experience for the patient when calling in, coming in to the facility, getting directions, addressing the reception, wait times, explanation of options, high deductible sensitivity, comfort, information, S mith Hartley care, minimization of risk, follow-up plan, and actual follow-up Chief Editor compliance? Walk it slowly, with every detail. Then do it again. [email protected] Every organization gets caught up in their internal workings and dynamics. It’s natural. It takes a disciplined and focused mind to continually readdress the patient’s journey, all the while looking for ways to improve it. What’s interesting is nobody is against quality. The desire to exhibit quality is led by people at all levels of the organization. Working for an organization that delivers quality is a pleasure. Every now and then you may have someone whose heart, for some reason, isn’t in it. Cut bait quickly and move on. Quality

10 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS

One on One with Sandra DiPietro Senior VP and CFO St. Tammany Parish Hospital

photos by sharron ventura dialogue

Sandra DiPietro started her career as an assistant manager of financial accounting for International Shipholding Corp. before becoming a senior auditor with Ernst & Young. She then switched into healthcare in 1994 when she was hired as a senior accountant for budget and reimbursement for St. Tammany Parish Hospital. In 1995, she took over as controller. She teaches undergraduate and graduate level healthcare financial management at the University of Phoenix and serves as treasurer on the New Heights Therapy board of directors. DiPietro has a bachelor’s degree in accounting from Southeastern University and a master’s degree in business administration from the University of New Orleans. She is a Certified Public Accountant and a member of the Healthcare Financial Management Association.

14 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS Chief Editor Smith W. Hartley Can you talk E ditor Does it essentially move the finan- people right now and the hospital has to a little bit about the transition from vol- cial risk to the hospitals like in the old settle up in its cost report. And so we will ume to value? capitated model? end up owing Medicare back if Medicare ends up paying the SNF, the nursing home, Sandra DiPietro Basically it is every CFO’s DiPietro Without a doubt. Because again, the physicians all these dollars over and nightmare right now, trying to figure out think about it, we are only responsible for above that threshold they have determined. what or how that transition is actually our surgeries. Now all of a sudden we’re going to occur over time without tanking responsible to make sure when that patient E ditor Do you think that’s going to change the whole organization’s finances. Right now walks out the door he’s not going to a skilled things operationally? you have what’s called volume where we’re nursing facility, a nursing home, or a long paid on the per widget. So you walk in, you term rehab where they are keeping him or DiPietro It already is. A few years back a get an x-ray, we get paid. If a physician sees her to run up the bill, because they get paid total knee or a total hip replacement used a patient he gets paid for each visit based by the widget or length of stay. It encour- to stay in the hospital an average length on codes, diagnosis, different resources. So ages you not to have a physician who is just of stay where eight days was not unusual. the more we do, the more we get paid. Cor- out there saying you can have a CT scan What they are doing now is they have got rect? That’s the fallacy in healthcare and every week for the next six weeks. us down and refining it to a science to try the system. And that’s not in all cases, but We’re in a demonstration piece of that to get in and out within less than two days. basically in the per widget system you do puzzle right now where a group of us was And to keep the patient in the mindset or get paid based on volume. So to jump from selected across the United States, but even- the framework that you have to be up and volume to value-based, what’s happening tually it’s going to be rolled out where the walking the day of surgery, you are going is we are trying to figure out and take away hospitals are really going to get a flat rate of to be doing this, this, this. Also, and this pieces and parts of the worth of the pay- $20,000 and it doesn’t matter, we will have is really where the kicker is coming into ment and convert them a piece at a time, so to settle with those people who are coming play, it’s forcing the physician to assess to speak, with CMS really pushing the ball before and after. How they are going to do the patient’s status, social status, overall to say, “Hey, by 2018, 2019,” whatever they that really, is they are going to pay those health, and whether they really are eligible end up doing, “more than 50% is supposed to be on this value-based.” What that means is basically, you might still get paid by the widget in certain “We’re in a demonstration piece of instances, but they will start bundling more and more of the payments. So right now we that puzzle right now where a group are doing total joint, they will start saying, “Hey hospital, you are not only getting paid of us was selected across the United for the surgical procedure to do the joint, States, but eventually it’s going to but you really are going to be responsible for everything that happens 30 days prior be rolled out where the hospitals to that patient walking through your doors are really going to get a flat rate of and 90 days after the patient leaves.” So all the physical therapy, the tests, the utiliza- $20,000 and it doesn’t matter, we tion, the post acute if you go into rehab, they are pushing the responsibility to these bun- will have to settle with those people dled payment types of reimbursement. They who are coming before and after.” are saying it creates value and creates some consistency and I guess pushes the hospital as the gatekeeper, but its trying to reduce the reimbursement to force the hospitals to try to become more efficient. And not just the hospitals…it’s all the providers.

Healthcare Journal of NEW ORLEANS I NOV / DEC 2016 15 dialogue

for surgery. In other words if you have a certain criteria, patient satisfaction is one BMI above a certain amount or if you have of them, your payment is actually reduced a house that you can’t get in and out of, or from Medicare. In some instances it could you are severely diabetic, bedridden, then be increased, but you have to really be look- you really should not be doing the surgery ing at that payment stream that is being for a total knee or hip until you have got affected by the quality you are having in to a safe medical point. So it’s forcing the your organization. surgeons to rethink and react differently than, “Hey you want to get your knee fixed? E ditor What is the impact of Medicaid to Let’s do the surgery.” to now, “Really are your hospital in terms of adequacy and you in a good place to have the surgery?” timeliness of payment? And is Medicare It’s been pushing some quality, it’s forcing much different? the restriction, it’s forcing the hospitals in a large number of cases to really be the gate- DiPietro Medicare is extremely different. keepers in a lot of these bundled packages. Medicare is low reimbursement, so you Because we’re the ones that are going to be barely cover your cost, but if you get a clean ultimately responsible. claim out and you get the bill to Medicare This is pushing hospitals and physicians they are fairly good at repaying the claims across the nation to consolidate. That’s and getting your money back in the door. where you are finding you are having a lot But you are barely covering your costs. of mergers and acquisitions or consolida- Medicaid obviously fluctuates from state tions or partnerships, because as a stand- to state because even though it’s a feder- alone facility you really have a difficult time ally funded program the states administer making it in this new next wave. Ultimately it. And so basically we get paid about 9 cents it is going back to accountable care or a cap- on the dollar, well below cost when we see itated product. the Medicaid patient. But the other part to value is also forc- So there are numerous issues with ing hospitals to report all these criteria or respect to the physicians on the outside see a Medicaid patient and get paid $10 statistics now on expected mortality, sep- and a lot of other standalone providers when you can see a Blue Cross or Medicare sis, infection, so the biggest thing you usu- who don’t accept Medicaid or limit their patient and get paid $100? So the Medicaid ally hear from value-based is tying those practices to Medicaid because they don’t population doesn’t have a lot of doors open quality values into the reimbursement. So get reimbursed hardly anything. They can’t for care outside of the high, expensive areas now what they are doing is if you don’t meet afford to see a Medicaid patient and why i.e. the hospital or ER. So in the Medicaid

“This is pushing hospitals and physicians across the nation to consolidate. That’s where you are finding you are having a lot of mergers and acquisitions or consolidations or partnerships, because as a standalone facility you really have a difficult time making it in this new next wave. Ultimately it is going back to accountable care or a capitated product.”

16 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS a contracted agreed upon rate. But then you also have, which is the growing portion of what we have an issue with, is the government pushing more and more people to high deductible plans. And when you have these high deductible plans and more coinsurance to the employee or patient you are fighting that more and more and that is going to bad debt. So the government came in with the Affordable Care Act and they said, “Alright employers you have to cover all these people and you have to do a, b, and c.” So they took away pre-existing, they took away lifetime maximums, they made them cover wellness, they made them do certain factors in the Affordable Care Act, which pushed more cost to the employers in order to pay their employees’ insurance. So when they did that the insurance companies and the employers pushed the cost to the employee through higher deductibles, forcing them to pay more for their coverage. The premi- ums might have stayed the same or slightly higher, but it’s really the out-of-pocket deductibles that people can’t meet—$5000, $10,000 deductibles. program you are pushing more and more Some people say with the expansion you through the emergency rooms, but they don’t have bad debt anymore, you’ve got E ditor Does the high deductible expose the don’t get the healthcare they need until it payment from Medicaid, which is some- hospital to more risk of collection, because becomes a chronic issue. Then you have a thing versus nothing, but at the same time I you are collecting from individuals? very sick, high cost population. suspect you will see more unitization espe- Now we just expanded Medicaid as of cially in a hospital environment. DiPietro Correct. Very much. A lot of that July 1. Immediately we have seen a swing goes to bad debt. Basically you have some- from self-pay to Medicaid. That’s expected E ditor And that leads to my next ques- one coming in who has insurance so we and good, people would say, because self- tion…what is the impact of bad debt on might try to collect the deductible or down pay generally doesn’t pay you at all, so at hospitals? Does it result in cost-shifting? payment or something at the time of ser- least you are getting some cents on the dol- vice, but it’s generally not the full amount. It lar. But what I think you are going to end up DiPietro You have two main factors with goes through insurance and insurance pro- seeing and what we are sort of seeing is if bad debt. You have a self-pay person who cesses it so where they might have paid us you go from no insurance to having insur- walks in the house and 100% of that, specif- $5000 for a surgery and the patient might ance and that insurance doesn’t cost you to ically inpatients and the larger dollars, you have, in the past, paid $100 to $200 of that have a copay or deductible or anything like are not going to get paid, unless there is a surgery, now it comes through and pro- that, then the utilization is actually increas- third party liability, which is rare. So your cesses and the patient owes $3000 of it, ing. So we are keeping a very close eye on collection on a self-pay is one percent at and the insurance company is only paying that. Our emergency room, our Medicaid best. Some of the outpatient they do pay. a $1000. So now this $3000 that we would population, even combined with self-pay And a lot of them if you are setting up pay- have gotten, had it not been a high deduct- historically has gone up and above that over ment plans or elective surgeries they will ible plan, the patient’s responsible for and the last few months. come in and self-pay, but really they have it generally goes to bad debt.

Healthcare Journal of NEW ORLEANS I NOV / DEC 2016 17 dialogue

E ditor How are you managing the increas- With supplies, we have also done initia- them go and have their service on the out- ing costs of staff, supplies, etc.? tives. We have a partnership with a larger side. It’s things like that, trying to get the institution and so with them and with other patient to have the right services in the right DiPietro It’s a constant battle. We had sev- purchasing agreements like Vizient or VHA, location for the right reason. eral initiatives this last year with respect to we are able to look at trying to get better a labor initiative where we are really look- deals. We’re conscientious about trying to E ditor How are you handling pricing and ing at tying in productivity, monitoring look at, especially new products, but with price transparency? and pushing resources down to individual everything that comes in, trying to really desktops with respect to trying to help them negotiate and not just accept what the ven- DiPietro We are not doing a great job with understand and monitor their staffing, to dor comes in with, but really try to get the price transparency. We’re in the process of be more efficient. Looking at those places best price we can. trying to develop a website where we can where we have low-hanging fruit and make It’s just a constant, ever-changing battle. list our prices more efficiently. It’s a hard sure that what you’re doing is necessary We are also now looking at utilization of balance to do price transparency or self-pay kind of work. certain things and trying to streamline the or cash pricing without walking a fine line We’ve done initiatives with looking at treatment of patients. So a clear one is dial- with the managed care contracts you have. purchasing services to go back through ysis on the day of discharge. We don’t get With managed care you negotiate a rate and relook at these contracts we have with reimbursed for dialysis as an inpatient and with Blue Cross, United, etc., so if I come in all these vendors and really determine so that patient should be able to go to their and I offer this self-pay price of $5000 to a what’s necessary and not necessary. We can normal dialysis facility. But sometimes they patient, but Blue Cross pays $7000, we have address some of the cost that is associated will keep them in here and provide dialysis to be real careful with respect to those lines. with those services and try to reduce those. for them the day of discharge, versus letting We also have an employee onsite who

18 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS E ditor What are some of the big issues facing hospital CFOs?

DiPietro I think it’s definitely reimbursement and understanding cost, which is always a struggle. As you started off with, it’s the jump to value-based. How do you change your system from a per widget- based reimbursement to managing the patient’s care even into an environment where you might not have full control over what happens outside your doors? So you are changing your whole methodology in some instances and having to incur additional cost and put structures in place in order to track and monitor and provide the services in a different way. So jumping and i think they moving and going to these bundled care are doing it packages and being forced to do it quickly, a little bit which is part of what’s happening with CMS smarter this fast-tracking it, it’s very difficult. time And then how do you do it and still make around... sure you are providing high quality, that you are being safe, without tanking the whole organization? Reimbursement is changing, insurance estimates the reimbursements when you the cash correctly. We just did a debt issue, is changing, I think we are setting our- do have insurance coverage and we do for capital expansion, to set up for down selves up to become part of a large ACO, provide that service, providing those esti- the road when we will be trying to get more where you get your patients and in some mates when people call. We will let them private beds and get rid of our semi-private. point in the future you manage them like know what we believe their insurance will But we are trying to expand some of our the old capitated model. You are going to reimburse. Because that’s the black hole. lab, pharmacy, and support areas and we manage the patients in a capitated envi- People don’t know. Because our contract did go out with issuing new debt because ronment. I think they are doing it a little bit with Blue Cross is different from Lakev- the rates are so cheap with respect to inter- smarter this time around in that they are iew’s contract with Blue Cross, is different est expense. tying it to quality and people are setting from the Heart Hospital’s contract with Blue But we do attempt to use our own inter- themselves up in larger regional reaches in Cross. Everybody has an individual contract nal dollars, we look at the cash and proj- order to make sure the patients have lots so the patient really has no clue when they ect where we believe the cash comes into of choices, but still stay within the partner- come what the test is really going to cost the organization, and probably about half ships or mergers, the health system itself. n and what their portion of it is going to be. of that we’ll put back into the equipment or process through with capital improve- E ditor What are some hospital strategies ment. We can also do things like operating for funding capital improvements? leases that will help instead of purchasing, especially if equipment has rapid technol- DiPietro We are sitting in a little bit better ogy turnover. So spending your dollars on position in that we have a large amount of something like that is sometimes not worth cash. We have about 230 days of cash on it if within three years new technology’s out hand, but we try to make sure we are using and things are changing.

Healthcare Journal of NEW ORLEANS I NOV / DEC 2016 19 PRecision medicine Precision

MedicineBy Claudia S. Copeland, PhD

Harnessing the extraordinary growth in medical data for personalized diagnosis and treatment PRecision medicine

If the prime mission of today’s physician is medical decision-making, medical doctors are on the verge of a major upgrade in effectiveness. Advances in technology are bringing the worlds of bioinformatics, molecular biology, biochemistry, and medicine together to yield individual patient-based data as never seen before. From cancer recurrence risk to likely response to treatment, the era of using precise patient-based data to inform decision making is dawning. The potential of precision medicine extends well beyond genomics, however—future applications range from other “omics” data types, such as transcriptomics, proteomics, and metabolomics, to cutting-edge imaging technology. These advances can provide a wealth of information on individual patients and their illnesses. Together, they are laying the groundwork for a transformation in the dominant clinical paradigm: from general, illness-based medicine to patient-based, personalized medicine.

New Tools for Precision in receptor positive, HER2-positive, and tri- and Medicare) is a gene expression assay Diagnosis and Treatment ple negative. Of these, all but triple negative known as the Oncotype Dx®. To determine have specific treatments based on expressed the chance of recurrence of breast cancer, To make effective clinical decisions, MDs can genes. Even for subtypes that do not have the test analyzes the activity of 21 genes to use laboratory tests, histories, and physi- individualized treatments, such as triple yield a highly precise picture of the indi- cal exams, but when it comes to difficult or negative, knowledge of subtype is useful vidual cancer the patient is suffering from, unusual cases, finding the right diagnosis because it clearly establishes the impor- including the likelihood that the breast can- or treatment has traditionally been, in large tance of chemotherapy (in fact, some evi- cer will return and the likelihood of benefit- part, a process of trial and error. A number of dence suggests that chemotherapy is more ing from chemotherapy at the early stage new tools are being developed to empower effective in triple negative breast cancer of the cancer. Based on the test results, the physicians to make more informed decisions than in hormone-receptor positive breast Oncotype DX assigns a Recurrence Score up front, especially in the realm of com- cancers) and other tailored treatment regi- that reflects the likelihood of the cancer plex, individual diseases like cancer. Some mens, such as neoadjuvant therapy (chemo- recurring. For example, for early stage genomic assays are already mainstream, therapy before surgery). invasive breast cancer, scores lower than 18 such as testing for BRCA genes. Several Theoretically, tumor profiling based on indicate a low risk of recurrence (suggesting other approved genomic tests exist to clas- gene expression could look at hundreds of that the benefit of chemotherapy is likely sify different types of cancer based on tumor genes in a tumor. While this level of pre- to be small and will not outweigh the risks genetic profiles. Leading these are assays to cision would have been science fiction a of side effects); scores of 18-30 reflect an distinguish different subtypes of breast can- few decades ago, it is currently in devel- intermediate likelihood of recurrence (risk/ cer, such as estrogen receptor positive (the opment and steadily marching forward benefit ratio unclear); and scores greater most common type of breast cancer, with towards approved clinical use. Already in than 30 indicating a high risk of recurrence a relatively good prognosis), progesterone wide use (and covered by most insurance (benefits of chemotherapy likely outweigh

22 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS “Theoretically, tumor profiling based on patient age. Other tailored genomic tests are gene expression could also available, including the Breast Cancer Index test, used to predict the risk of node- look at hundreds negative, hormone-receptor-positive breast of genes in a tumor. cancer coming back 5 to 10 years after diag-

s While this level of nosis; the EndoPredict test, used to predict

ommon the risk of distant recurrence of early-stage, precision would hormone-receptor-positive, HER2-negative have been science breast cancer that is either node-negative or has up to three positive lymph nodes; the fiction a few decades MammaPrint test, used to predict the risk of a_2050) via Wikimedia C

t ago, it is currently in an recurrence within 10 years after diagnosis of Atl _ b stage I or stage II breast cancer that is hor- development and _La DA mone-receptor-positive or hormone-recep- steadily marching ion (F

t tor-negative; the Mammostrat test, used to

ra forward towards st predict the risk of recurrence of early-stage, dmini

A hormone-receptor-positive breast cancer; approved clinical use.” g u

r and the Prosigna Breast Cancer Prognos- D tic Gene Signature Assay (formerly called the PAM50 test), used in predicting the risk recurrence risk. The Oncotype DX Prostate of recurrence for postmenopausal women Cancer Test measures the amount of RNA

By The U.S. Food and Food The U.S. By within 10 years of diagnosis of early-stage, expressed by 17 genes predictive of risk and hormone-receptor positive cancer. probable treatment response. Such a test In addition to breast cancer, molecular may be especially helpful for this type of testing is now a routine part of patient care cancer, since aggressive treatment can lead risks of side effects). Another assay assesses for lung cancers, colorectal cancers, mela- to sexual, bowel, and bladder side effects the likelihood of benefiting from radiation nomas, leukemias, and others. In fact, Onco- that are highly distressing for patients. An therapy for ductal carcinoma in situ (DCIS), type Dx tests similar to the ones for breast assay that can identify men who can safely the most common type of non-invasive cancer have also been developed for two forgo aggressive treatment in favor of a pro- breast cancer. other cancer types: colon cancer and pros- gram of active surveillance and monitoring As with all genomic tools, the results are tate cancer. The Oncotype DX® Colon Cancer over time can radically improve the quality an aid to diagnosis, along with other, more Assay analyzes the expression of 12 genes in of life for these patients. traditional factors such as tumor size and a sample of colon tumor tissue to quantify The CDC lists over 90 genomic tests

the Genomic Access Program

In order to assist with verifying insurance coverage and obtaining reimbursement, Genomic Health, the makers of the Oncotype Dx assay, offer a program called the Genomic Access Program. If you do not have or cannot secure insurance coverage, the Genomic Access Program may be able to help. Various forms of financial assistance and payment plans are available for people facing financial hardships or those who are uninsured or underinsured. The Oncotype DX test costs about $4,000. For insurance- and payment-related questions, call 1-866-ONCOTYPE (1-866-662-6897).

Healthcare Journal of new orleans I NOV / DEC 2016 23 PRecision medicine

Dr. Miele believes that “a critical element in the use of precision medicine is clear clinical guidance for health care providers, patients and patient families.”

with Tier 2 approval (FDA label mentions Meanwhile, though, several small compa- biomarkers; Medicare/Medicaid coverage nies are moving forward with genetic tests with evidence development; clinical prac- that have not yet gone through the clinical Dr. Lucio Miele tice guidelines and systematic review either approval process, with results given to the support use of the test or do not discour- physician in the form of a “research report” age use of the test). These include prog- rather than a “clinical report”. It is made prothrombin gene (G21210A). If a G [has nostic, preventative, or diagnostic tests for clear to both the patient and the physi- been mutated] to A in this gene, the patient several diseases, including prostate cancer, cian that this is NOT a clinical lab report, is identified as positive for venous thrombo- non-small cell lung cancer, acute myeloid but the physician can use the informa- sis or heart disease. The NIH has spent a lot leukemia, colorectal cancer, single gene tion as supplementary data; it is up to the of money and found out that this mutation disorders, and rare familial diseases. There physician to evaluate what can or cannot is very important in humans. They do not are also Tier 2 pharmacogenomic tests, to be concluded from the data. Dr. Ayyampe- even look at other mutations in this gene. predict drug response for a wide array of rumal Jeyaprakash is Chief Research Offi- My real-time PCR test is then tried on 20-40 conditions, from arthritis and bronchitis to cer of NCF Diagnostics and DNA Technol- patients. The same patients are also tested insomnia and depression. ogies in Gainesville, Florida, a company by another well-known DNA test like PCR- Dr. Lucio Miele, head of the LSU School of that has designed several proprietary gene RFLP. If the tests are 100% matching, then Medicine Department of Genetics, described tests to detect mutations linked to herita- I receive 6 blind samples from the Medical some of the genomic techniques currently ble diseases. Dr. Jeyaprakash, who uses next Board every 6 months. My real-time PCR being used at LSU: “We use primarily exome generation sequencing (NGS, the power- test should pass every 6 months and score panels and gene expression tests. Exome ful sequencing technique that is enabling 100%. After this, I am allowed to sell the test. panels are used in several settings (congeni- affordable whole-genome sequencing) for Patients can send samples only through the tal disorders subject to “diagnostic odysseys”, screening crop plants for plant pathogens, doctor. I do the testing, generate a ‘Clinical neurology, and oncology). Gene expression explains that NGS testing for human dis- Report’ and pass it on to the doctor. He can tests are routinely used in the management eases is still in the research stage. Some now treat the patient using this information. of breast cancer and are being expanded to companies are doing it, but since it is con- I now have Heart Disease Gene tests and other indications. Specifically in oncology, sidered research data, insurance companies Drug Sensitivity Gene tests.” we are currently enrolling patients in the will not pay for it. Instead, the current focus DNA is not the only biological sequence MATCH clinical trial, a large NCI-funded in human disease is on more specific tests. data with clinical potential. Beyond genom- study which assigns patients to one of 24 Getting approval for a clinical test is a ics lies the analytical potential of transcrip- different treatment arms depending on the highly standardized process that is quite tomics (RNA sequence analysis), proteomics results of a genomic panel. Additionally, we different from that of developing a scien- (amino acid sequence analysis), metabolo- will soon offer pharmacogenomics testing, tific technique, Dr. Jeyaprakash explains. mics (analysis of small-molecule metab- to determine how the genetic makeup of “I will describe a test that I designed. First, olites), and other “omics” analyses. New specific patients affects the way their bodies the lab needs to be approved by the Board. Orleans-based Pine Biotech is develop- handle different medications.” They come and check that you have got all ing a platform to provide a user-friendly the equipment and facilities. Then the lab interface for non-bioinformatician biolo- Small Companies: The Vanguard workers need to get licensed to handle DNA. gists and clinicians to harness the power of Clinical Genomics Without a molecular biology license you of multi-omics analysis. “Collectively, we cannot work in the clinical lab. A PCR, Real- have been investing time and money into New tests are being developed every day, Time PCR, and Sanger Sequencing assay understanding the molecular machinery and many are moving towards approval. was designed to detect one mutation in the inside every cell,” states CEO Elia Brodsky,

24 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS

PRecision medicine

LEFT Infrared absorption spectra of typical constituents of cells and tissue. ABOVE Examples of two pixel spectra of liver tissue. The top represents a spectrum of diseased liver, whereas the bottom spectrum is from normal liver tissue. The two spectra differ mostly in the glycogen content.

“Researchers now know that the complex process is critical. Provider education is sample to determine characteristics of chem- network of relationships between genetic equally important. LSUHSC will organize icals. By looking at specific wavelengths of code, proteins and intra-cellular commu- CME events focused on precision medi- light absorbed or reflected by a sample, func- nication holds the key to solving some of cine, beginning in the spring of 2017. Pre- tional groups and other characteristics of the the most pressing challenges in health- cision medicine is the way of the future, chemical can be determined. For example, care - from cancer to chronic diseases, to and we need to keep accumulating data to proteins will have a different infrared spec- infectious diseases. This data can be cap- refine our predictive algorithms and clini- troscopy “signature” from those of lipids, fats, tured on an individual level and analyzed cal guidance. Additionally, the incorporation and carbohydrates. At Cireca, they work with for previously undetectable irregularities.” of genomic/multi-omic data into electronic this basic principle to determine key bio- His vision is to “enable researchers and cli- health records in ways that are easily acces- chemical characteristics of tissue samples; nicians to extract real insight from omics sible for analysis (as opposed to reports in most notably, characteristics associated with data; we hope that new and more effective PDF format) is a fundamental need for clini- cancer tissue. Key to the technique, known as approaches to diagnostics and therapeutics cal use of genomics. The data science aspect infrared spectral histopathology, is the fact will be developed. Eventually, the efficiency is the most crucial one, and requires close that cancer tissue differs from normal tissue of early detection and new targeted thera- interactions between clinicians, geneticists, on a biochemical level, and these differences peutics will translate into longer, healthier bioinformaticians and biostatisticians.” can be visualized using spectroscopy-based lives for patients, with fewer side effects and imagery. Using this technique has an addi- cheaper treatments or even completely new Visualizing Tissue Biochemistry tional advantage: none of the sample needs ways to manage disease.” to be destroyed to run the test; light is sim- The view from LSU dovetails with Pine’s Sequence data are not the only type of ply shone through the histopathology slides, mission of providing user friendly tools patient information used in precision medi- leaving the samples unaltered and available and support for omics analyses. Empha- cine. One particularly innovative approach to for any other analysis. sizing the role of guidance and accessibil- diagnosis is being developed by Cireca Ther- Bioinformatic analysis of the spectros- ity in the adoption of precision medicine anostics, LLC. Cireca combines biochemis- copy data is essential to the technique, tools, Dr. Miele believes that “a critical ele- try, infrared spectroscopy, and imaging tech- explain Cireca scientists Max Diem and ment in the use of precision medicine is nology with powerful software to develop Aysegul Ergin. Infrared spectral imaging is clear clinical guidance for health care pro- images from histological slides—images of carried out on 5 mm-thick tissue sections viders, patients and patient families. The things the human eye can’t see. Chemists measuring from a few mm2 to cm2 in area. role of certified genetics counselors in this have long used light shone on or through a The slide image is then divided into pixels

26 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS LEFT For spectral imaging, 100,000 to millions of infrared spectra are collected from pixels ca. 5 μm on the edge of the tissue sample. The pixel size is about the size of the nucleus of a cell. These spectra constitute a “hyperspectral datacube” shown at left. Here, each pixel spectrum is defined by the x and y coordinate of the pixel from which the spectrum was collected. The protein and glycogen peaks in this datacube are clearly detectable.

right Infrared spectral imaging allows the rich infrared spectral signatures of biological compounds to be exploited. Here, a section of tissue was stained using the classical H&E stain, and imaged using a standard microscope (left). The right image represents the infrared-based pseudocolor (SHP) image from the same tissue, obtained using the Cireca methodology. The structures detectable by a pathologist in the left image correspond very closely to the features in the right image.

of about 5 mm square, which represent a prescribe therapies with precision and tar- cube with all edges 5 mm in length. Within get tumors with the most effective therapy, each of these pixels, between 100,000 and but they first must know as much as possible several million infrared spectra are col- about the cancer cells and tumors they are lected. Collectively, these spectra consti- facing. It’s essential to know more than we tute a “hyperspectral datacube”. Powerful do today to improve the chances for every computational technology then assembles patient having this terrible disease.” The data this massive amount of imaging data and Cireca provides, he continues, could be par- either uses it for machine learning analysis ticularly useful for both early detection of or transforms it into a color representation, cancer and late-disease precision treat- called a "pseudo-color image", with all simi- ment planning. “We bring new information lar spectra assigned the same color. Looking in the form of a biochemical signature of the Dr. Ayyamperumal Jeyaprakash at such an image side-by-side with a nor- tumor cells and microenvironment, working mal H&E stained histopathology image, they with very small samples that are otherwise clearly represent the same sample, with the not useable with conventional methods for H&E image showing the morphology of the diagnosis. We think this will add precision tissue and the Cireca image visualizing the where its needed: early in the disease cycle, biochemical nature of the tissue. Essentially, and when it’s so advanced that surgery isn’t this allows a pathologist to look at the cells possible and the remaining hope is well-tar- in a tissue sample "inside and out", with a geted therapy [based on] as much informa- level of precision far surpassing anything tion as possible.” possible with a conventional image. Cireca’s goal is to enable pathologists Visualizing Drugs in the Human Body and oncologists to gain a highly precise picture of a biopsy sample. “Patients want to In another perspective on “inside-out” imag- Dr. Aysegul Ergin know exactly what type of cancer they have, ing, Vyripharm Biopharmaceuticals of Hous- they need to know this,” Stan Remiszewski, ton is focused on personalized medicine via Vice President of Research & Development real-time visualization of drug metabo- at Cireca, explains. “Oncologists want to lism. Vyripharm is developing drugs with

Healthcare Journal of new orleans I NOV / DEC 2016 27 PRecision medicine

Vyripharm uses “a chelator-based technol- this because saving time and testing means ogy that allows us to add a metal to the drug saving money, the value goes well beyond that will allow for an imaging of the drug simple efficiency—time wasted can mean in the actual patient’s body.” So, in a hypo- progression of a disease and unnecessary thetical clinical use, “in the beginning, the patient suffering. patient will come in and the physician will Perhaps most importantly, though, this do the imaging with the medication, to cal- imaging technology enables precision culate the correct dosage with the patient-- dosing, and that can save lives. “Individu- see how much is being taken up by the body. als respond differently to different drugs,” Based on that, the physician will determine emphasizes Dr. Jackson, “there are a lot how much to put the patient on. Depending of deaths and serious adverse effects sur- on the patient, the doctor may monitor him rounding the misdosing of drugs. It’s ter- or her, giving the drug with the imaging agent rible that physicians have to deal with that [as treatment]. The patient would come in at since their goal is to help patients.” Getting Dr. Elias Jackson the end of each week and we’ll take an image, the dose right can save lives before a drug or they could just come in at lunch and take even gets to the doctor’s office. Precise dos- an image. If everything’s great, they can just ing in clinical trials could allow effective, move forward with the medication.” If not, life-saving drugs to be approved that would chemical markers that allow them to be visu- though, the doctor has gained power in a few not have been approved otherwise. “There alized as they move through the body, using major ways: first, he or she can see what is are drugs that have had potential, but there standard clinical imaging methods such as happening with the drug and decide on the was no way to determine the correct dose. PET, CT, or MRI. Using this technology, doc- next drug to try based on individual patient Many drugs haven’t made it to the market tors can make precise, personalized deci- characteristics; for example, the drug may because of adverse effects; they couldn’t get sions about optimal dose and which drug will not localize well to the target organ in this the right dose.” While many important tradi- work best in that particular patient, President patient. Second, it saves the time involved in tional drugs, such as morphine, have narrow of Research and Development Elias Jackson a watch-and-wait process of trying a drug, therapeutic index ranges, a new drug with explains. To visualize the action of a drug— seeing if it works, and if not, trying a differ- a low therapeutic index will most probably uptake, metabolism, etc.—in the patient, ent drug, etc. While payers are interested in not be approved, no matter how effective it may be. “A dose of 10 mg may be good for some people, but fatal for others. It may be effective, but that therapeutic window might be so narrow that 5 people in the trial die. Now [using drug imaging technology] we can avoid those fatalities.” Dr. Jackson can’t emphasize the impor- tance of precision dosing enough. He pauses after telling of volunteers who suffered severe neurological injury (one of them died) in a clinical trial in France. The dose in the hospitalized volunteers was 40X the clinical dose, and this high dose over- whelmed the elimination mechanisms in their bodies. Had dosing been done with more precision, accumulation would have been detected early, the volunteers would have been taken off the drug, and the drug might be available today, albeit with an overdose warning. “If our technology had been used, the correct doses for those drugs would have been used, saving those patients. It’s basically a game-changer.” n

28 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS We’re a little bit different ... and we’re okay with that.

Mailed directly to local healthcare leadership including physicians, administrators, insurers and ancillary providers.

The most comprehensive and cost- effective way possible to reach your local healthcare industry.

+($/7+&$5( -2851$/ healthcarejournalno.com of New Orleans palliative care

Providers, patients embracing improved end-of-life planning By John Mitchell

When Melissa Pennebaker, CNP, the Cancer Center Nurse Practitioner in the Palliative Care Program at the Touro Infirmary in New Orleans thinks about the patients she has helped navigate through cancer – and sometimes through their final days – she remembers the young doctor. “It was a very aggressive cancer and he was too sick to tolerate any more treatment, despite the high tech therapies we offer. He was so sick, with no semblance of quality life that it was truly heartbreaking,” said Pennebaker. “He stopped treatment on a Friday and went home. We didn’t think he was going to make it through the weekend,” she recalled. But live he did – for five more weeks. With end-of-life care from the Touro palliative care team, the young father and husband began feeling better. He was kept comfortable from pain, living his final days with some measure of control. He spent time with his wife and kids, and visited with family and friends who flew into town to say goodbye. e etter quality of life is the common that has held steady for decades. The system theme mentioned by palliative and was ripe for reform and under the Affordable hospice care clinicians who spoke Care Act, doctors and nurse practitioners are Bto US Healthcare Journals about now encouraged to educate patients about new Medicare end-of-life rules that went end-of-life choices. This is becoming a boon into effect this year. Medicare now reim- to hospitals that began developing palliative burses doctors and other qualified clinicians and hospice care programs in recent years, such as Pennebaker to help patients with motivated by compassion for patients. end-of-life planning. Sometime this means In his best-selling book “Being Mortal” palliative care, which manages patients with which examines the changing role of end- long term conditions, such as a failing heart, of-life care, Atul Gawande, MD, a surgeon at to stay comfortable at home for years. Other Brigham and Women’s Hospital in Boston, times it means hospice care for patients cites compelling data for end-of-life palli- diagnosed with a terminal condition, such ative and hospice care.2 In a 2010 Massa- as lung cancer. Both adults and children ben- chusetts General Hospital study, patients efit from this relatively new field of medicine who saw a palliative care specialist stopped that is rapidly gaining widespread accep- chemotherapy sooner, entered hospice far tance among doctors, patients, and families. earlier, and had a better quality of life. And There is strong evidence for this new way like the young doctor at Touro, they lived to manage patients with chronic and termi- 25 percent longer than patients who con- Melissa Pennebaker, CNP nal conditions. According to the Kaiser Fam- tinued therapy until their death. ily Foundation1, eight out of ten of the 2.8 “Our role is to support patients and fami- million people who died in the U.S. in 2014 lies dealing with serious illness,” explained were covered by Medicare. One quarter of Mary Raven, MD, Co-Medical Director of the traditional Medicare healthcare spending Palliative Medicine Service at Our Lady of the happens in the last year of life – a statistic Lake Medical Center in Baton Rouge. She is palliative care

had someone drop that load of bricks (a chronic or terminal diagnosis) on their head,” said Dr. Brown. “They are sad and “We’re not here to push an agenda – upset...but the families are appreciative a patient may not be ready to talk about about what we can do for them.” She said that in the past two years, they a Do-Not-Resuscitate (DNR) order or have seen wider acceptance of palliative and hospice care. We just provide guidance.” hospice care for children. The number of children with terminal disease who die at home Mary Raven, MD, Co-Medical Director, Palliative Medicine Service, has risen from less than 10% to nearly half Our Lady of the Lake Regional Medical Center of the terminal cases that the Palliative Care team follows (excludes oncology patients). “The kids definitely have a better quality also Lead Physician of the Palliative and Sup- with all the doctors, clinicians, and man- of life. They are at home with their parents, port Care Outpatient Clinic at the Lake Phy- agers interviewed, Raven said it is key to siblings, and pets. They get to go to sporting sician Group. “We shine a light on what the establish a relationship with any patient events and school plays because we can take patient prefers and help their family on their and their family about end-of-life care as away their pain and help with their anxiety.” journey. We help them to be free of suffering soon as possible. But she stressed that an at-home death is and free of machines if that’s what they want.” “We know that palliative care is an arm of not best for every patient and they work to Dr. Raven said they opened their outpa- medicine that improves quality of life and accommodate what the family needs. tient palliative care clinic two years ago. As reduces costs,” she said. “We form relation- At St. Tammany Parish Hospital in Cov- ships to assist patients with advanced care ington, the hospital defines its palliative planning so when the time comes for the care program as symptom management for end of life they get to pass away the way they chronic diseases to maintain quality of life want to. We’re not here to push an agenda that may be provided for years, according – a patient may not be ready to talk about a to Cheryl Bays, RN, a certified hospice and Do-Not-Resuscitate (DNR) order or hospice palliative care nurse and Palliative and Hos- care. We just provide guidance.” pice Liaison. The hospital has had a pallia- She said that building such relationships tive care program for several years and just to help patients takes more than 15 minutes opened an outpatient palliative care clinic – it sometimes takes multiple meetings over two months ago. She defines hospice care, hours. Dr. Raven said that the palliative care which is primarily provided in the home, team has the luxury of time, something that as targeted at patients with an expected life can be rare in medicine between doctors and expectancy of six months. patients. The new ACA rule for doctors and “We stress to patients that this is their

Mary Raven, MD advanced practitioners for such patient journey and they are in charge,” Bays counseling – about $100 -160 an hour – has explained. “The plan of care can change done much to help offset the cost of end-of- every day depending upon what the patient life programs and encourage the growth of wants. Our goal is not to waste any of the such hospital services. precious time they have left.” Children with chronic and/or terminal dis- She said these can often be difficult con- eases also benefit from end-of-life care when versations, especially if the primary care facing a terminal disease. Carrie Brown, MD, doctor has not broached the subject in Director of Palliative Care at Arkansas Chil- advance of her visit. dren’s Hospital, and her team, help provide “We cry with the patients,” she said. “I inpatient palliative services to 15-20 children spoke to five patients yesterday and a fam- a day. According to Dr. Brown, every county ily member handed me a Kleenex.” in Arkansas now has at least one hospice ser- But she can’t imagine doing any other vice that provides pediatric care. patient care and has been a palliative and Carrie Brown, MD “Most families we meet with have already hospice nurse for 17 years.

32 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS FOUNDATION palliative care

“We stress to patients that this is their journey and they are in charge. The plan of care can change every day depending upon what the patient wants. Our goal is not to waste any of the precious time they have left.” Cheryl Bays, RN, Certified Hospice and Palliative Care Nurse

“I’m very passionate about it,” Bays do everything possible to save a patient’s life. compensating doctors for these conversa- stressed. “About half of our medical staff is Most of the doctors and nurses interviewed tions has removed the time barrier. Dr. Har- on board with the program and the other half said that for many doctors, an end-of-life rington also said that recent medical gradu- are talking to their colleagues about the ben- referral feels like a failure on their part. ates are getting better at end-of-life training. efits. I think that I’ve been here for a while This is no doubt why a recent survey For example, palliative care is now in the helps the doctors because they know me.” by the California Health Care and Cambia curriculum for all medical students, and she Physician buy-in has long been a key barrier Foundations3 found that physicians are said it’s a popular elective for many who to end-of-life services. Physicians are taught to not only uncomfortable initiating end-of- choose to do a rotation their fourth year. life discussions with patients, but half said “We’re getting really good feedback from they have never had such conversations the medical students who rotate through our with their own doctor. While only a third of program,” reports Dr. Harrington. “They are doctors in the survey have reported receiv- telling us that they don’t know why they ing any training in end-of-life discussions, were scared to have these conversations; that is starting to change. there was a lot of misperception about how “Physicians graduate from medical school beneficial the care can be.” without great (end-of-life) communications For Stanley Kellar, MD, Chief of Clini- training – maybe a one-hour lecture,” said cal Affairs at Baptist Health in Little Rock, Sarah Beth Harrington, MD, Director of the the evolution of end-of-life care has been Division of Palliative Medicine in the Depart- a logical extension of good, compassionate ment of Internal Medicine at the University patient care. He has been practicing inter- of Arkansas for Medical Sciences. “It’s a hard nal and pulmonary medicine for 34 years. conversation to have and not possible in the “About ten percent of patients a pulmon- Cheryl Bays, RN 15 minutes of a normal office visit.” ologist sees every year die – often on a vent She said this is why the new ACA law – because of end stage disease,” he said. “I

“I quickly learned that just because you can do something medically doesn’t mean a doctor should extend suffering. You have to help prepare the patient and ask them what they want.” Stanley Kellar, MD, Chief of Clinical Affairs, Baptist Health

Stanley Kellar, MD

34 NOV / DEC 2016 I Healthcare Journal of NEW ORLEANS Sarah Beth Harrington, MD

Sue May

quickly learned that just because you can offered was don’t wait until death is near She said that patient comfort – both phys- do something medically doesn’t mean a to opt for end-of-life care because it robs a ical and emotional – is the main objective. doctor should extend suffering. You have patient of quality time. May advised that the goal is to for a patient to help prepare the patient and ask them Sue May, who has been the administrator to be pain free, eat the things they like to eat, what they want.” at Canon Hospice in Jefferson, Louisiana for and enjoy their time with friends and family. He is a big believer in end-of-life care and 22 years confirmed that physicians are still “Hospice and palliative care is about liv- has taken steps to put in writing what he not as comfortable speaking about the end- ing,” she stressed. “It is about being ... pain wants for the end of his own life of-life care that best benefits patients and and symptom free. We want to educate the “We have a law in Arkansas that if a families. She noted that often by the time community that the more time you have patient writes down their wishes related to they have a patient referred, they and their with your family, the better job we can do to end-of-life care, the hospital is obligated to family are “terrified.” provide support, education, and comfort.” n do what they want,” said Dr. Kellar. “I myself “We do find that most families have not do not want to be on a vent or kept alive with received any true end-of-life discussion,” a feeding tube. I’ve made sure that my wife May said. “Many are telling us that they and kids know those are my wishes.” believe patients admitted to hospice have Endnotes 1http://kff.org/medicare/fact-sheet/10-faqs- All of the sources interviewed stressed all medications and food taken away and we medicares-role-in-end-of-life-care/ 2 that an advanced end-of-life document administer morphine until the patient passes “Being Mortal”, Gawande, Atul, pg. 177 3http://khn.org/news/most-doctors-unsure- is critical. The other advice these sources away. This is not what happens!” how-to-discuss-end-of-life-care-survey-says/

Healthcare Journal of NEW ORLEANS I NOV / DEC 2016 35 It’s in our DNA...

Healthcare Journal of New Orleans was created to provide high quality healthcare news, information, and analysis. It is our mission to improve the health of New Orleans citizens through a community approach of shared information. With an impressive publication, distribution plan, eNews, and community-based website, Healthcare Journal of New Orleans connects your message to the local healthcare industry. For information about sponsorship contact us at [email protected]

+($/7+&$5( -2851$/ of New Orleans News / people / information Healthcare Briefs

Tulane Launches New Brain Institute Tulane University has formally launched its new Brain Institute, a university-wide initiative created to coordinate and support brain-related research and neuroscience endeavors at Tulane. See story on page 40

Healthcare Journal of new orleans I NOV / DEC 2016 37 Healthcare Briefs

STATE Each Angel will receive a $20,000 grant to the • Dr. Ruby C. Scroggins of Shreveport. Dr. charity of their choice to deepen the impact of Scroggins is the principal of J.S. Clark elemen- CIS Opens in Meridian their work. tary school, where she has worked to break down Cardiovascular Institute of the South (CIS) has Receiving the Angel Award this year were: the educational barriers created by poverty by opened the doors of its new clinic located at 1102 • Gerard Barousse, Jr. of New Orleans. Gerard establishing reliable access to food for her stu- Constitution Avenue on Anderson’s South cam- Barousse, Jr. is founder and Chairman of the dents and their families. pus to provide cardiovascular care to the com- Bayou District Foundation, the lead organization • John Wondergem of Covington. Wonder- munity of Meridian. in the planning and development of Columbia gem and his wife, Julie, have fostered dozens of Nine Meridian cardiologists will practice as one Parc in New Orleans. children and opened Louisiana’s first Royal Fam- team at this clinic: Dr. Wes Bennett, Dr. Tim Boyd, • Sonya Brown of Harvey. Brown is a dedicated ily Kids Camp, which provides a summer camp Dr. L. Shea Hailey, Dr. Scott Joransen, Dr. Thomas social worker who has become a nationally recog- experience just for wards of the state. Plavac, Dr. E. Michael Purvis, Dr. Jennifer Rodri- nized advocate for young people in foster care, Each year, the Foundation also honors a “Blue guez, Dr. Attila Roka, and Dr. Dale Touchstone. particularly those who are “aging out” of the sys- Angel,” an employee of Blue Cross and Blue In addition to advanced, compassionate care tem. She founded Project18. Shield of Louisiana who has shown extraordinary from these physicians, the CIS Meridian clinic will • Loren Carriere of Opelousas. Carriere commitment to children. This year, the Founda- offer a full range of diagnostic testing, including founded Hope for Opelousas, a ministry that is tion has selected two employees – Billie Jean treadmill, lab, ultrasound and nuclear tests, as focused on community development, educational Davis-Lomas and Glenda Chappell – who, over well as cardiac telemetry and electrocardiograms. support, neighborhood outreach, and intentional, the last decade, have provided hands-on train- A support team of 50 will work together at this positive relationships. ing, mentoring, and career development to Baton location, putting patients first and ensuring that • Keith “Keif” Hester of West Monroe. Hes- Rouge youth through the local chapter of Black each patient receives the highest quality cardio- ter is a physical therapy technician who goes Data Processing Associates (BDPA). The Founda- vascular care available. Patients already under the above and beyond to help children to over- tion will make a $5,000 grant to BDPA in Davis- care of these cardiologists will be contacted soon come seemingly impossible odds on the road to Lomas’ and Chappel’s names. regarding their follow up care at CIS. self-sufficiency. • Teri Hrabovsky of Jefferson. Hrabovsky and BioInnovation Center Names Blue Cross Foundation her husband, Brian, have fostered over 50 kids BioChallenge Finalists Recognizes 2016 Angel and built One Heart NOLA, a network of volun- The New Orleans BioInnovation Center Award® Honorees teers and donors who are ready to provide neces- announced four finalists in the 2016 BioChal- In October, the Blue Cross and Blue Shield of sities for foster families at a moment’s notice. lenge Competition, an annual challenge that Louisiana Foundation honored ten everyday Loui- • John Lombardo of Thibodaux. One of the highlights and supports emerging life science sianians doing extraordinary good for the state’s youngest Angels, Lombardo has rigorously startups across Louisiana that will generate jobs children at the 2016 Angel Award® ceremony. pursued a life of service of children through and economic growth in the state. The four com- This year’s honorees were chosen from a record the Thibodaux Kiwanis Club and as a Court panies were selected from a statewide applicant number of nominations from across the state. Appointed Special Advocate for children. pool of nearly twenty startups developing new

CIS Opens in Meridian

38 nov / DEC 2016 I Healthcare Journal of New Orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

disease treatments, better diagnostic tests, tools Blue Cross and Blue Shield of Louisiana subsid- chronic health conditions by enhancing relation- to improve healthcare delivery, advanced materi- iary HMO Louisiana, Inc. ships with their personal physicians and encour- als, and other technologies. The finalists are: This is the time when customers can start aging healthy lifestyles. Health Leaders Network 1. Carre BioDiagnostics (New Orleans) aims reviewing plan information to decide if Blue member hospitals and physicians will share in to treat and prevent cardiovascular diseases in Advantage is right for them. Enrollment applica- the resulting savings generated through provid- chronic kidney disease patients. Carre is initially tions are accepted from Oct. 15 – Dec. 7, 2016. ing care under a value-based, patient-centric care focused on a simple diagnostic blood test to Coverage becomes effective Jan. 1, 2017. model focused on keeping people healthy. identify chronic kidney disease patients with coronary artery disease who are at high risk for heart Louisiana Healthcare BCBSLA Recognizes Top- attacks, allowing for earlier treatment, improved Organizations Expand Health performing Clinics outcomes and reduced costs. Leaders Network Partners At the annual Quality Blue Primary Care State- 2. Chosen Diagnostics (New Orleans) is work- Several healthcare organizations across Louisiana wide collaborative, Blue Cross and Blue Shield of ing to improve healthcare delivery for patients by have signed a Memorandum of Understanding in Louisiana leadership unveiled 2016 program sta- personalizing their treatment. The company’s first a first-of-its-kind statewide partnership to form a tistics that show the program is driving continued product is a biomarker test that can diagnose a clinically integrated network that expands on the improvement for customers who have chronic dis- common and life-threatening gastrointestinal dis- Health Leaders Network and its almost 1,000 pro- eases that are common in Louisiana. ease in preterm infants, offering more accurate viders across Louisiana. More than 100,000 lives are During the collaborative awards ceremony, results than current options and allowing earlier currently under contract for management. These Blue Cross named the four clinics with the high- intervention in these fragile patients. partner organizations will share quality data and est scores on Quality Blue’s clinical quality mea- 3. Grapheno (Shreveport) develops innovative focus on the changes in the healthcare industry sures for the program’s four targeted chronic graphene solutions. The company’s first product calling for predictable and consistent outcomes. conditions: is a conductive coating based on graphene which Named Health Leaders Network Partners, the Highest Achievement in Diabetes Care 2016: protects sensitive electronics in sectors from tele- founding members are market leader organiza- The Family Doctors – Shreveport communications to medical equipment by absorb- tions with track records for collaboration and high- Highest Achievement in Hypertension Care ing harmful and unnecessary electromagnetic quality, high-value care delivery: Willis-Knighton 2016: Bossier Family Medicine radiation. It is a low-cost alternative that meets or Health System, Shreveport-Bossier, whose facili- Highest Achievement in Vascular Care 2016: exceeds the protection levels of existing solutions. ties include Willis-Knighton Medical Center, WK Bossier Family Medicine 4. Segue Therapeutics (Shreveport) is an early- Pierremont Health Center, Willis-Knighton South Highest Achievement in Kidney Care 2016: Bella stage privately owned biotechnology company & the Center for Women’s and Children’s Health, Family Medical – Baton Rouge dedicated to the discovery and medical use of WK Rehabilitation Institute and WK Bossier Health For the first time in the history of Quality Blue, repurposed drugs, or the application of approved Center; Woman’s Hospital, Baton Rouge; and Fran- two clinics tied for the Highest Overall Perfor- drugs to new disease indications. Segue aims to ciscan Missionaries of Our Lady Health System, mance award, which goes to the clinic with the treat pancreatic cancer, a devastating disease for whose member organizations include Our Lady of highest combined score on the four healthcare which truly effective life-extending treatments are the Lake Regional Medical Center in Baton Rouge, quality measures and three efficiency measures not currently available. Our Lady of Lourdes Regional Medical Center in that track how well a practice is reducing the use The final pitch event will be held Wednesday, Lafayette, St. Elizabeth Hospital in Gonzales, Our of unnecessary services. November 16 at the Joy Theater, and it is open to Lady of the Angels Hospital in Bogalusa; and St. For 2016, the co-Highest Overall Performance the public. Each entrepreneur will make an eight- Francis Medical Center in Monroe. Additional part- winners are The Family Doctors – Shreveport and minute pitch to a panel of national investors and ners are expected to join this clinical integration Shreveport Internal Medicine. industry experts, who will select the $25,000 Grand partnership in the coming months. Blue Cross also recognized more than 175 Prize winner. Two additional prizes are available: In addition Health Leaders Network and United- primary care doctors from around the state the New Orleans BioFund Prize, a $25,000 invest- Healthcare have signed an agreement to launch for achieving top scores on the clinical quality ment, and the Audience Favorite Award, $2,500 an accountable care program in UnitedHealth- measures. cash given to the winner of a text vote by audience care’s employer-sponsored plans in Louisiana. members and sponsored by the Conafay Group. Under the new program, which took effect in AG Books Four on Medicaid Fraud October, Health Leaders Network and United- Attorney General Jeff Landry announced that his HMO Louisiana, Inc.’s Medicare Healthcare will work together to better coordinate Medicaid Fraud Control Unit recently arrested Advantage Plan Details Released patients’ care, using shared technology, timely four people from South Louisiana on Medicaid Customers in 14 parishes across Louisiana can data, and information about emergency room vis- fraud charges. now learn 2017 plan details for Blue Advantage its and hospital admissions. This partnership will Mary Altemus, 51, of LaPlace, was arrested on (HMO), a Medicare Advantage product from also provide services to help patients manage their 4 counts of Medicaid fraud. Altemus allegedly

Healthcare Journal of new orleans I NOV / DEC 2016 39 Healthcare Briefs

submitted time sheets and service log for ser- Wingeier will discuss these efforts and the work studies across the university. vices not rendered. of his previous startup on an implantable medical The Brain Institute will have a physical presence Deloris Crockett, 57, of Kenner, was arrested device that stops seizures in epilepsy patients. On on both the uptown and downtown campuses. on 8 counts of Medicaid fraud. Crockett alleg- Tuesday, Rachel Rimsky of the Michael J. Fox Foun- The center of activity uptown will be in new soon- edly signed time sheets and service logs for ser- dation for Parkinson’s Research will offer the event’s to-built facilities at the state-of-the-art Donna vices not provided to her children. closing keynote, discussing the Foundation’s work and Paul Flower Hall for Research and Innova- Paulette Riley, 57, of New Orleans, was arrested to accelerate the development of new break- tion, while downtown the activities will be spread on 4 counts of Medicaid fraud. Riley, the owner/ throughs for patients suffering from Parkinson’s. throughout the Health Sciences Campus and at biller of Employment Assistance Services, alleg- Additional speakers include investors from Loui- the newly renovated J. Bennett Johnston Building. edly submitted false claims to the Medicaid pro- siana, Texas, California, and other regions, as well gram for long-term personal care services. as innovation experts from major industry corpo- Baudry Therapy Center Launches Tim Ursin, 53, of Saint Rose, was arrested on rations Pfizer, Medtronic, and Becton Dickinson. Return to Sport Program 4 counts of Medicaid fraud. Ursin allegedly sub- Other leaders from Sultan Ventures, Carmell Ther- Baudry Therapy Center | BRIO recently launched mitted time sheets and service logs for services apeutics, Blue Cross and Blue Shield of Louisi- its new Return to Sport program, a four phase not rendered. ana, Ochsner Health System, and numerous other analysis that provides injured athletes evidenced- All four were booked into the East Baton Rouge organizations will also participate in panels. Ses- based care and gives them the confidence they Parish Prison. sion topics will include finding funding for devel- need to resume athletic activity. opment and commercialization, building a strong The program begins with a physical therapy Humana Foundation Donates team, conducting customer and market research, evaluation to identify the injuries that cause the to Louisiana Nonprofits securing development partners, preparing to pain and dysfunction keeping athletes off of the The Humana Foundation, the philanthropic arm of introduce innovations in clinical settings with doc- field. A spectrum of tests, including Functional Humana Inc., announced up to $75,000 in grants tors and patients, and much more. Movement Screen, Y-Balance Test, Hop Testing, to two nonprofit organizations providing support The conference is presented with major support combined with Move2Perform analysis gives a full to those affected by the recent flooding in south- from JPMorgan Chase. Registration and more picture of an athlete’s readiness to return to sport. eastern Louisiana. The American Red Cross and information are available at neworleansbio.com/ the Capital Area United Way are each receiving an innovationla. Discounted tickets are available for Research Highlights Cancer & immediate gift of $25,000 from the Humana Foun- students. Sugar-Sweetened Beverages Link dation to address both immediate and ongoing A study conducted by researchers at LSU Health community needs relating to this historic disaster. Tulane Launches New New Orleans suggests that age is an important Additionally, the Humana Foundation will Brain Institute factor in the association between cancer and match up to $25,000 in gifts from Humana asso- Tulane University has formally launched its new sugar-sweetened beverages and recommends that ciates to the American Red Cross, for a poten- Brain Institute, a university-wide initiative created intervention programs to reduce consumption of tial total of $50,000 to the American Red Cross to coordinate and support brain-related research added sugar be focused on lower socio-economic from the Humana Foundation on top of associ- and neuroscience endeavors at Tulane. status, young males, as well as cervical cancer sur- ate contributions. The Institute combines expertise and research vivors. The study is published in the October 2016 from faculty, postdocs and students (from under- issue of Translational Cancer Research. LOCAL graduates to PhDs) at the Schools of Medicine, Sugar intake or sugar-sweetened beverage con- Science and Engineering, Public Health and Trop- sumption has been demonstrated to have a posi- Keynote Speakers Named for ical Medicine, Liberal Arts, and the National Pri- tive association with obesity, diabetes and cardio- BioInnovation Center Conference mate Research Center. metabolic diseases, as well as some cancers. As The New Orleans BioInnovation Center has Marta and Bill Marko provided the lead gift to more people are surviving cancer, the consump- announced the keynote speakers for the upcom- jumpstart the initiative, which has set a fundrais- tion of added sugar will be an increasingly impor- ing Innovation Louisiana 2016 conference, an ing goal of $50 million. To date, over $3.7 million tant risk factor. educational event on November 14 and 15 that has been raised. educates attendees on translating cutting-edge Even before the fundraising is complete and all Case Demonstrates Best RX scientific research into viable businesses. of the physical infrastructure is fulfilled, the Brain Options for Advanced Skin Cancer Dr. Brett Wingeier of startup Halo Neurosci- Institute is already making a difference across A new case study by a team of surgical oncol- ence will offer a keynote speech to close the first campus through the Marko Spark Innovation ogists and plastic and reconstructive surgeons day of the conference. His company uses neuro- Research Fund. This research fund encourages at LSU Health New Orleans School of Medicine stimulation, or light electrical pulses, to improve collaborative, daring brain research in memory, highlighted the frequency and clinical challenges the performance of professional athletes, and Dr. cognition, and neurodegeneration early-stage of treating advanced skin cancers in older people.

40 nov / DEC 2016 I Healthcare Journal of New Orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

They reported the best treatment options for neglected skin cancer in the elderly, as well as a elentano new drug that may be useful in very advanced or C ch-

previously untreatable cases. The paper is pub- ur B lished in the Journal of Surgical Case Reports. The authors noted that timing of diagnosis and extent of disease determine the standard of care for basal cell carcinoma, which could be non-surgi- Paula by Photo cal management with topical therapies. Advanced tumors require complex surgery and reconstruction, often accompanied by radiation therapy. The authors noted the early success of vismo- degib, a small molecule inhibitor and oral medication for metastatic basal cell carcinoma, local recurrence after an initial operation, and patients who are not candidates for either surgery or radi- Tulane Launches New ation. Clinical trials showed response rates of Brain Institute 58%, 30% in metastatic disease and 43% in locally advanced disease with minimal adverse effects. In terms of translating these discoveries to ther- known as angiogenesis, will help guide the future Research Reveals How apies, it is a leap forward towards understanding treatment of diseases. Psychedelics Alter Brain Function cellular mechanisms in the living brain underlying In many age-related diseases – such as cancer, Surprising findings of LSU Health New Orleans not only the ability of psychedelics to potentially eye diseases and rheumatoid arthritis – blocking research on the brain’s response to psychedelic treat anxiety, depression, and addiction, but of the growth of new blood vessels would be benefi- drugs include that psychedelics directly acti- normal cognitive processes as well. cial. In others – such as heart disease, stroke and vate only about 5% of brain cells, even in the hypertension – promoting the growth of blood most highly responding areas of the brain. Led Tulane to Study How Age vessels would be desirable. by Charles Nichols, PhD, Associate Professor of Affects Blood Vessels Walter Lee Murfee, an associate professor Pharmacology and Experimental Therapeutics at Tulane University researchers have been awarded of biomedical engineering, and Bruce Bun- LSU Health New Orleans, the research is the first a $1.1 million grant from the National Institutes of nell, director of the Tulane Center for Stem Cell to comprehensively examine the effects of psy- Health to study the effects of aging on the growth Research and Regenerative Medicine and profes- chedelics at the cellular and molecular level in the of new blood vessels in the human body. sor of pharmacology, will conduct the study over intact living brain and describes a level of detail It is hoped that learning more about how age the next four years. The two researchers are also not previously known. The research in rodents, affects the growth of new blood vessels, also members of the Tulane Center for Aging, which published online in the journal EbioMedicine, represents a major step toward understanding how psychedelic drugs alter brain function. elentano Other findings of the research include that other C ch-

types of cells, not just neurons, were also acti- ur B vated in the rodents’ brains, and the types of cells activated and the genetic response in activated cells, even of the same type, differed between brain regions. Now, instead of thinking that one Paula by Photo region or another of the brain is activated by psychedelics, we know that this activation represents a complex interplay between specific subsets of cell types.

Tulane to Study How Age Affects Blood Vessels Tulane researchers Walter Lee Murfee, left, and Bruce Bunnell are partners in a $1.1 million study on aging.

Healthcare Journal of new orleans I NOV / DEC 2016 41 Healthcare Briefs

Compared to existing approaches, the model following various types of disasters. It will focus on offers a real-time view of whole microvascular general post-trauma support to a wide popula- networks. tion of children and adolescents through schools, community agencies and religious institutions as Boys and Girls Club Launches well as the identification of high-risk children, AHA Teaching Garden adolescents and families who have experienced The Boys and Girls Club of Covington is planting extreme exposure and losses, high levels of cur- an American Heart Association Teaching Garden rent stress and distress and developmental risk. as part of an educational initiative to help build healthy bodies and minds, locally sponsored by Hollier Honored by Texas Larry H. Hollier, MD, FACS, FACC, FRCS Chevron. Surgical Society This Teaching Garden was created using Amer- Larry H. Hollier, MD, FACS, FACC, FRCS (Eng.), ican Heart Association science and nutrition Chancellor of LSU Health Sciences Center New guidelines coupled with information from garden- Orleans, has been accepted as an Honorary Mem- ing and education experts, all thanks to Teach- ber and named a Fellow of the Texas Surgical ing Garden founder Kelly Meyer. The program Society. In the organization’s 101-year history, only combines nutrition education with garden based 22 surgeons in the country have been selected learning. It is a real-life laboratory where students for this honor. Dr. Hollier is the third surgeon from learn how to plant seeds, nurture growing plants, Louisiana; the two previous recipients were the harvest produce and ultimately understand the late Drs. Alton Ochsner and Isidore Cohn. value of good eating habits. Numerous studies Dr. Hollier is a Fellow of the American College have shown that participation in school garden of Surgeons, the American College of Cardiol- programs can have a positive impact on student’s ogy, the Royal College of Surgeons of England, Sarah Gray attitudes toward fruits and vegetables. and the Royal College of Physicians and Surgeons of, Glasgow Scotland. He is member of all major Researchers Report New national and many international societies of vas- Zika Complication cular surgery including SVS. In addition to being Dr. John England, Professor and Chair of Neurol- a lecturer on vascular and endovascular surgery, ogy at LSU Health New Orleans School of Medi- Dr. Hollier is the author of more than 300 journal cine, and colleagues in Honduras and Venezuela articles and has served on the editorial boards of have reported a new neurological complication 13 surgical journals. In addition to his duties as of infection with the Zika virus. They described chancellor, Dr. Hollier continues to practice vas- the first confirmed case of Zika-associated sen- cular and endovascular surgery. sory polyneuropathy in a paper published online by the Journal of Neurological Science. Tulane Researcher Studies Brian Lee, MD Children Exposed to Violence LSU Psychiatry Awarded Sarah, Gray an assistant professor of psychol- Grant for Terrorism & ogy at Tulane University, has been awarded a was instrumental in providing the initial resources Disaster Resilience NARSAD Young Investigator Grant through the for the start of the work. LSU Health New Orleans School of Medicine’s Brain and Behavior Research Foundation. Murfee says a major issue with aging is that the Department of Psychiatry has been competi- A NARSAD grant is one of the highest distinc- growth of new blood vessels is impaired. Most tively awarded a $3 million grant over five years tions in the field of mental health research. Less treatments for age-related diseases however, are by the Substance Abuse and Mental Health Ser- than 200 researchers receive the prestigious grant developed using young adult animal models. This vices Administration to build the Terrorism and each, year and Gray will use the money – up to approach is problematic and does not account Disaster Coalition for Child and Family Resilience. $70,000 over two years – to study the develop- for the inherent changes to blood vessels growth It was the only grant focusing on terrorism and ment of children who have been exposed to vio- resulting from age, Murfee says. disasters funded. lence or other traumatic events. Murfee and Bunnell hope to identify novel The proposed project will build on and adapt Gray’s project is titled Parasympathetic and molecular and cellular causes of the impaired the National Child Traumatic Stress Network Behavioral Synchrony and Child Emotion Dys- angiogenesis, while developing a new way of (NCTSN) model including Help Kids Cope, a digi- regulation Following Trauma. She and her evaluating angiogenic therapies in aged tissues. tal application that allows for information sharing team, which includes collaborators in the Tulane

42 nov / DEC 2016 I Healthcare Journal of New Orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Department of Psychiatry and the School of Pub- simian strain of HIV have a second line of defense appointed Dr. Brian Lee Chairman of the Depart- lic Health and Tropical Medicine, will investigate against tuberculosis. The discovery could have ment of Dermatology. how potentially traumatic events affect the devel- significant impacts on future vaccines for TB. The In 2002, Dr. Lee accepted the position of Res- opment of young children. research led by study author Deepak Kaushal, idency Program Director at LSU Health New Professor of Microbiology and Immunology at Orleans School of Medicine. In addition to resi- LSU Grant to Help Improve the Tulane National Primate Research Center dency education and administrative roles, Dr. Lee Oral Cancer Survival has been published in the Proceedings of the has been an advocate of medical student men- Dr. Kitrina Cordell, Associate Professor and Head National Academy of Sciences. torship. He is the first advisor of the Dermatology of the Department of Diagnostic Sciences at LSU Interest Group and has spoken to every medical Health New Orleans School of Dentistry, has been Researchers Identify Risk Factors student interested in Dermatology. In 2014, Dr. awarded a $5,000 grant by the Academy of Gen- for Nonunion of Fractures Lee was appointed Interim Chairman following eral Dentistry to develop a school-wide program Dr. Robert Zura, the Robert D’Ambrosia Professor the sudden death of Dr. Lee Nesbitt. to teach patients about self oral cancer screening. and Head of Orthopaedic Surgery at LSU Health The program will consist of one-on-one edu- New Orleans School of Medicine, was part of a Neuro-Oncologist Joins cational sessions for patients with trained oral research team that identified risk factors which LSU Health Faculty health care professionals – faculty, residents, and may help orthopaedic surgeons better predict a Aaron Mammoser, MD, recruited as an associate students – to include an explanation and dem- serious complication of bone fractures. Fracture professor of clinical neurosurgery, will hold the onstration of an oral cancer screening, a printed nonunion may be increasing as more patients sur- Kelsey Bradley Favrot Chair in Neuro-Oncology brochure and information about what to do when vive serious fractures. The paper was published at LSU Health New Orleans School of Medicine’s something unusual is found. This type of educa- September 7, 2016, in the Online First section of Department of Neurosurgery. Dr. Mammoser is an tion will allow patients to continue to monitor JAMA Surgery, available at http://archsurg.jama- MD Anderson-trained neuro-oncologist. their own mouths even if they do not regularly network.com/article.aspx?articleid=2547685. Dr. Aaron Mammoser joins the LSU Health New seek the care of a dental professional. The researchers found a nonunion rate of Orleans faculty from the University of Michigan, 4.93% overall with substantial variation from where he was a clinical assistant professor in the Tulane Researcher Finds bone to bone. The lowest nonunion bone rates Department of Neurology with subspecialty train- Improvements in Soil Lead Levels were in metacarpal at 1.47% and radius at 2.10%. ing in Neuro-Oncology. He treated patients in the Hurricane Katrina devastated New Orleans 11 The highest nonunion rates were in scaphoid Neuro-Oncology Clinic in the Comprehensive years ago, but the storm’s legacy may have a sil- at 15.46%, tibia+fibula at 13.95%, and femur at Cancer Center. ver lining: reduced levels of lead in soil across 13.86%. the city. Continuing research he started back in The presence of other diseases boosted risk. LSU School of Nursing 1991, Tulane University School of Medicine pro- Osteoarthritis, rheumatoid arthritis, and diabetes Earns Top Rankings fessor Howard Mielke and his team collected increased the odds of nonunion by at least 40%. The School of Nursing at LSU Health New Orleans thousands of samples for an updated survey of Use of certain medications such as analgesics also has been ranked the #9 nursing school in the soil lead levels for the entire city. Their findings upped risk. Other medications were protective. United States, the #5 nursing school among pub- have been published in the journal Environmen- Antidiabetic medications, other than insulin, and lic nursing schools nationally and the #2 nurs- tal International. oral contraceptives are inversely associated with ing school in the Southeast region. The rankings Mielke says prior to Hurricane Katrina, 64 per- nonunion. resulted from an evaluation of data collected from cent of the children living in neighborhoods iden- Nonunion odds were significantly increased by nursing schools nationwide by Nursing Schools tified as high-lead areas had blood lead levels many risk factors including the number of fractures, Almanac. equal to or above five micrograms per deciliter. use of prescription analgesics (NSAIDs+opioids), Factors considered for the rankings included Ten years after Katrina, Mielke says the number operative treatment, open fracture, anticoagu- the institution’s academic prestige and perceived of children with blood lead levels five and above lant use, osteoarthritis with or without rheumatoid value, measured by graduates’ ability to repay in high-lead areas dropped to 19 percent. The arthritis, anticonvulsant use with or without benzo- student loans in a timely manner, professional median amount of lead in the soil dropped from diazepine, opioid use, diabetes, high-energy injury, designations, grant funding and other estab- 280 milligrams per kilogram (i.e. ppm) pre-Katrina osteoporosis, male gender, insulin use, smok- lished rankings; the breadth and depth of nursing to 132 mg/kg after the storm. ing, obesity, antibiotic use, Vitamin D deficiency, programs offered; and student success, particu- diuretic use, and kidney insufficiency. larly on the NCLEX national licensure exam. After Tulane Researchers Find evaluating each nursing school on these criteria, New Layers of Immunity Lee Named Chair of Dermatology Nursing Schools Almanac weighted the individ- Tulane University researchers found some mon- After a national search, Dr. Steve Nelson, Dean of ual scores into one overall score and ranked the keys whose immune systems are depleted by the LSU Health New Orleans School of Medicine, has schools accordingly. n

Healthcare Journal of new orleans I NOV / DEC 2016 43 dialogue

column quality

Update: Advance Care Planning in Long-Term Care Facilities

When the Louisiana Health Care Quality Forum was created in 2007 by the State Legislature, it was charged with leading initiatives focused on improving health care quality and health outcomes while reducing costs. By 2010, these initiatives had grown to include health information technology (IT), patient-centered models of care, quality measurement and analytics, and outreach and education.

Yet there is another initiative that informed decisions about end-of-life care lives under the Quality Forum’s umbrella has been realized on numerous levels. – Louisiana Physician Orders for Scope of LaPOST has received the endorsements Treatment (LaPOST). Approved as Act 954 of the Louisiana State Medical Society and in the 2010 regular session of the legisla- the National POLST Paradigm Task Force. ture, LaPOST is an evidence-based model Our efforts to drive quality improvements designed to improve end-of-life care for in end-of-life care have been tremendously those with serious, advanced illnesses. The successful. program’s focus on quality made it a natural Thousands of health care professionals, fit for the Quality Forum, and it was formally patient advocates, and consumers across the adopted by our organization that same year. state have received training and education Over the past few years, the LaPOST pro- in advance care planning through numerous gram has grown by leaps and bounds. Its “LaPOST Ready” education programs and vision of empowering patients, their fami- virtual training courses. LaPOST awareness lies, and health care professionals with the has grown exponentially, thanks to part- knowledge and resources necessary to make nerships with health care professional and

44 NOV / DEC 2016 I Healthcare Journal of new orleans Cindy Munn C hief Executive Officer Louisiana Health Care Quality Forum

patient organizations throughout Louisiana in advance care planning among nursing fa- “Implementing LaPOST in Your Long-Term and an aggressive, integrated outreach strat- cility residents in our state.” Care Facility,” through the website. egy that includes social media, traditional Nelson attributes much of the program’s “These tools, training courses, and guides marketing, and digital communications. success to the extensive focus on education were designed specifically for long-term Perhaps one of the LaPOST program’s and implementation. care professionals in Louisiana,” Nelson most exciting new developments has been “Talking about death and dying is dif- says. “They can also find many excellent the inclusion of the document as an inte- ficult, even for a health care professional, educational tools to share with their pa- grated component of the Minimum Data but with proper training and education and tients and families such as our ‘Conversa- Set (MDS) assessment that is completed by access to strong resources, that conversations Change Lives’ guidebook.” health care professionals in nursing facili- tion becomes much easier,” she says. “We Ultimately, says Nelson, the goal is to en- ties. While LaPOST is a completely voluntary have worked very hard to provide that level sure that patients receive the kind of care document, its inclusion in the MDS under- of training and educational opportunities. they want at the end of life based on their lines its value as an advance care planning The wealth of evidence-based resources and wishes and values. tool for nursing facility residents. tools available on our website to help health “The growth in the number of nursing fa- Susan Nelson, MD, LaPOST Coalition care professionals work together with their cility residents in Louisiana who now have Chair, says the inclusion of LaPOST in the patients to document end-of-life care wishes LaPOST documents is very promising,” says MD S is a key component in ensuring that and goals of treatment is remarkable.” Nelson. “It means that those patients have patients and families have the ability to doc- Among those resources, she says, is the worked with their health care providers to ument the patients’ end-of-life care wishes LaPOST Handbook for Long-Term Care Pro- document their health care wishes and goals with a non-biased, medical order. fessionals and the LaPOST Implementation of treatment and that those wishes will be She notes, “Studies have shown that for Guide for Long-Term Care Facilities, both of honored. Moving forward, I anticipate that patients with POLST documents, treatment which are available for download from the we will see even greater gains in these num- wishes are respected 98 percent of the time. LaPOST website, www.la-post.org. bers since LaPOST has become an integral The document ensures that patients receive Additionally, long-term care professionals component in the MDS, and we remain com- the care they want at the end of their lives. can receive certificates in LaPOST educa- mitted to providing Louisiana’s long-term As a result, they don’t receive unwanted tion at their convenience via the website’s e- care facilities with the tools and resources interventions such as cardiopulmonary Learning courses, and can access a number they need to implement the document in resuscitation, intubation, intensive care or of educational and training videos, including their facilities.” n feeding tubes.” When LaPOST was added to the MDS in June 2015, of the 29,229 nursing facility residents in Louisiana, only 31 percent had a LaPOST document. In one year, the percent- age of nursing facility residents with LaPOST LaS PO T Update documents has increased to 36 percent. Earlier this year, the Louisiana Legislature voted to make technical “Though five percent may not seem like changes to the LaPOST document and place the actual form a huge increase, we have to remember that into statute. The minor modifications were made to update the nationally, only about one-third of adults language and clarify processes to be consistent with current medical have an advance care planning document standards, making it easier to complete the document. Health that expresses their wishes for end-of-life care professionals are encouraged to use the revised form for new care,” Nelson says. “Even among seriously patients with serious, advanced illnesses, although the original or terminally ill patients, fewer than half document is still valid for continued use with existing patients. The have an advance care planning document optimal time to update the document is when there is a significant in their medical record. By including LaPOST change in the patient’s health status or if a patient’s wishes change in the MDS, we are making significant gains To download the new document, please visit www.la-post.org. dialogue

column nursing

Ochsner Health System recently sponsored their 8th Annual EBP*/Research Conference entitled Leveraging Innovation to Drive Healthcare Transformation. There were 25 podium presentations supplemented by 35 posters representing the work of over 130 nurse researchers from Louisiana, Pennsylvania, Mississippi, Texas, Georgia, Alabama, Massachusetts, Florida, Virginia, Tennessee, and California. The conference highlighted inter-professional collaborations addressing workforce issues, clinical and ambulatory patient outcomes in diverse populations, and innovative solutions to the myriad challenges faced by nurses delivering patient care within environments that are complex and constantly in flux. Herein is presented some of the outstanding work that is being

led by RNs and APRNs throughout the United States. *Evidence Based Practice

nurses as change agents: U sing Evidence to Produce Better Patient Outcomes

Dr. Linda Aiken keynoted the confer- quality of the work environment for nurses 542 of whom were bedside nurses. In this ence with her presentation, Using Evidence included prioritizing managers’ and policy- sample, the overall quality of working life to Inform Practice and Policy. Dr. Aiken is makers’ commitment to improving hospital was 3.39 on a 5-point scale with the high- a Professor of Nursing and holds the Claire work environments, including greater en- est rated factor being job and career satis- M. Fagin Leadership Chair at the Universi- gagement by nurses in shared governance faction (3.75/5.00) and the lowest rated fac- ty of Pennsylvania. She is world renowned to improve patient outcomes and increase tor was stress at work (2.17/5.00). The two for her research on the use of performance nurse retention. Additionally, hospitals are best predictors of overall quality of work- measures to demonstrate relationships be- advised to standardize nursing qualifica- ing life were working conditions (3.90/5.00) tween nursing care and patient outcomes. tions at the bachelor’s level. and general wellbeing (3.03/5.00)2. Recom- Dr. Aiken challenged us with the informa- Dr. Deidra Dudley from Ochsner Medi- mendations from Dr. Dudley’s research en- tion that in a 2015 survey of 27,319 nurses cal Center – West Bank in New Orleans compassed three areas: nursing practice, in 1,146 hospitals in the United States, 30% discussed working conditions and general nursing research, and health policy. Nursing of nurses gave their own hospital a grade wellbeing as predictors of overall quality of practice recommendations included modi- of C, D or F in overall safety, 29% graded work life for medical-surgical nurses at the fying working schedules and shift patterns, their institutions similarly on prevention bedside in the United States. Her concep- providing ergonomic enhancements, par- of infections, and 55% would not recom- tual framework defined three sets of factors ticipatory decision-making, recognition for mend their hospital to family and friends.1 that may predict overall quality of work- accomplishments, promoting recreational Contributing factors to these findings are ing life. These included individual factors activities, relaxation training, and self-in- insufficient nurses to provide quality care, (age, gender, education, role), work-based struction on stress relief. Regarding nurs- lack of confidence in management to re- factors (job and career satisfaction, con- ing research, she recommended studies of solve problems nurses identify in patient trol at work, stress at work, working con- working life issues across specialties, facili- care, nurse burnout, punitive disciplinary ditions) and non-work-life factors (general ties and countries, longitudinal studies to environments, frequent interruptions to the well-being, home-work interface).2 The final examine causal relationships between qual- delivery of patient care. Recommendations survey was completed by 797 RN members ity of working life factors in healthcare set- to improve patient safety and improve the of the Academy of Medical Surgical Nurses, tings, and qualitative studies to define and

46 NOV / DEC 2016 I Healthcare Journal of new orleans Karen C. Lyon, PhD APRN, NEA Executive Director, Louisiana State Board of Nursing

the hospital. With an aging population, its incidence is expected to rise with estimated costs of $17 billion per year including hos- Meeting Sepsis Measures pital costs currently averaging $1,600/day.3 The new Sepsis Core Measures including Early To be completed within To be completed within 3-hour and 6-hour bundles became effec- 3 hours presentation 6 hours presentation Recognition tive in the 4th quarter of 2015. The four core measures include early recognition, early •Measure lactate level •Apply vasopressors for antibiotics, early resuscitation, and early hypotension not responsive Early source control.3 The 3-hour and 6-hour Antibiotics •Obtain blood cultures prior to initial fluid resuscitation to to administration of antibiotics maintain a MAP ≥ 65 mmHg bundles are presented in the adjacent graph. These authors described how their insti- •Administer broad spectrum •For persistent hypotension antibiotics after initial fluid administration tution has collaborated with clinicians and Early (MAP ≥ 65 mmHg) or if initial informatics technicians to incorporate these Resuscitation •Administer 30 ml/kg lactate was 4, reassess volume ≥ core measures into a rapid cycle feedback crystalloid for hypotension or status and tissue perfusion and lactate ≥ 4 document findings report. Results in terms of patient-centered care and improved outcomes include de- Early Source •Re-measure lactate if initial Control lactate elevated creased organ failure, decreased hospital mortality, decreased length of stay, and decreased costs of care. This is just a small sampling of the im- describe the lived experiences of U.S. nurses unconditional love and acceptance. Ini- portant work that is being led by nurse cli- in their working life. Finally, health policy tial concerns and barriers to this type of nicians, educators, administrators, and re- changes are promoted in terms of nursing program included animal allergies, clean- searchers. We are replacing the basis of our involvement in decision making activities liness, and risk of injury or infectious dis- practice from “opinion based” to “evidence that impact patient care and improvement ease. However, the literature overwhelm- based.” More and more, nurses are seen as in hospital work environments. ingly supports the benefits ofAA T and no credible experts designing and implement- One of the most engaging sessions was infection traced to animal-human interac- ing new care models that make a difference the Children’s Canines for Kids Program tion has yet been reported. It was evident in improving patient care outcomes while at from Children’s Healthcare of Atlanta pre- from Casper’s interaction with the audience, the same time meeting the financial metrics sented by Lisa Kinsel, Karen Castro and all of whom were strangers to him, that he of their institutions. Our decision making is Casper (golden retriever and first Canines was well trained and had been carefully se- informed by data and a clearer understand- for Kids Facility Dog). Casper and his 10 lected for temperament, socialization skills ing of the human-to-human interactions in- best friends provide animal assisted thera- and ability to adapt to new experiences. volved in nursing care. Ultimately, we will py (AAT) directed at minimizing the stress Dr. Fiona Winterbottom and Marlene use information and interactions to achieve of the hospital environment. They support Alonzo from Ochsner Medical Center in what the Institute of Healthcare Improve- the overall social, physical, and emotional New Orleans presented their work on Sur- ment has called the Triple Aim: Improve the development of the patients, reduce anxiety, viving Sepsis: Using Evidence to Design experience of care, Improve the health of provide distraction from illness and hospi- Workflows in the Electronic Health Re- populations, and Reduce per capita costs talization, motivate patients, and provide cord. Sepsis is a leading cause of death in of health care. n

references: 1Aiken, L.H. (2016) Using evidence to inform practice and policy. Proceedings of the 8th Annual EBP/Research Conference: Leveraging Innovation to Drive Healthcare Transformation. September 19, 2016. New Orleans, LA 2Dudley, D.B. (2016) Working conditions and general well-being, predictors of overall quality of working life of United States medical surgical bedside registered nurses in acute care hospitals. Proceedings of the 8th Annual EBP/Research Conference: Leveraging Innovation to Drive Healthcare Transformation. September 19, 2016. New Orleans, LA 3Winterbottom, F. and Alonzo, M. (2016) Surviving sepsis: Using evidence to design workflows in the electronic health record. Proceedings of the 8th Annual EBP/Research Conference: Leveraging Innovation to Drive Healthcare Transformation. September 19, 2016. New Orleans, LA

Healthcare Journal of new orleans I NOV / DEC 2016 47 column bio

Our Asset-Rich Landscape During the first few months in this position, my primary objective was to learn more about the city’s advantages. I’m happy to say I found a particularly rich environment for clinical and commercial activity, one that offers potential for short-term, mid-term, and long-term growth. The richness stems from several factors. Fostering First, as many in the local Bio community know, we have a legacy of specific contribu- Growth tions to medical and life sciences discovery, particularly in the areas of infectious and tropical diseases, chronic disease manage- In my first column, I described the role of the ment, neuro-degenerative and musculo- skeletal diseases, trauma and behavioral New Orleans Business Alliance (NOLABA) as health, and a number of cancers. This legacy focused on attracting and retaining businesses continues through the present day, and offers a sound foundation on which to build for Orleans Parish, particularly those engaged in new commercial opportunities. bio and health services innovation. My job is to Second, although it may seem counter- intuitive, is our chronic disease burden. identify the assets and attributes that make New Despite the heavy toll it takes on our pop- Orleans a great place to expand, relocate or build ulation, it also represents an opportunity for innovative companies addressing such a business, then communicate those to prospects, conditions to create large scale public health and, with the right combination of strategic fit impact. In fact, the diversity of the New Or- leans region is often cited as being among and demonstration of the bottom line advantages, the factors attractive to those working on convert them to new New Orleanians. As I new therapies because it is a relatively un- derserved patient population mix. For ex- mentioned previously, in this column I’ll talk ample, a company looking at innovative about the kinds of companies that offer the best diabetes or obesity treatments – particularly for those in identified ethnic groups fit for the New Orleans BIO landscape and why. or with specific complicating health conditions – could benefit from partnerships with New Orleans health systems. The third factor is a combination of in- centives and environment. Louisiana offers the most aggressive software development incentive in the nation. It provides a 25 percent tax credit and is open to companies developing digital interactive products or platforms in Louisiana. When combined

48 NOV / DEC 2016 I Healthcare Journal of new orleans Amritha Appaswami Director of Business Development BioInnovation & Health Services Innovation New Orleans Business Alliance

with New Orleans’ growing tech business While I cannot disclose their names, I can community, the city offers powerful attrac- say they fall squarely within the categoriza- tions to companies looking to improve the “...we have a tions defined above. bottom line in a resource-intensive industry and reduce the burn rate for cash strapped legacy of specific Mid-Range to Long-Range startups Economic Development contributions Our sights are not set just on the short-term, Short-Range Prospects to medical and however. We’re simultaneously looking for In the short-term, New Orleans is ripe for new ways to help businesses capitalize on development of a robust digital health and life sciences the research and clinical assets that abound health technology sector. In economic across Orleans Parish. In contrast to the development, we look at companies that discovery...” relatively shorter ‘development-to-market’ could make a relocation or expansion de- timelines of digital health and health IT incision within a six-to-18 month timeframe novation, the conventional research and de- as short-range prospects. velopment path is a longer one. That being These tend to be entre- said, the two are complementary. In fact a preneurial companies critical mass of innovators in one will at- looking for ways to stretch tract investments in the other, and vice versa. their capital and capture ev- Needless to say, our goal at NOLABA is ery competitive advantage to foster a robust ecosystem conducive to possible. The tax incen- growing and attracting companies that fit tives, the city’s magne- into these short-term and longer-term cat- tism to tech talent and egories. We continue to seek new ways to increasing native talent introduce local researchers to potentially pool, and the accessi- interested parties among our prospects. bility of research institu- One of the first ways to grow our long-range tions and health systems prospect list is to tell the story of the sig- for co-pilots, co-develop- nificant work being done at New Orleans ment and co-investment make a institutions as I did at Health 2.0 and will compelling case for New Orleans. do via other opportunities in coming weeks Our job at NOLABA is to make that and months. case to relevant companies. I’ve just re- turned from the Health 2.0 conference in Coming Up Silicon Valley, where I did just that. The re- In my next column, I’ll talk more about the ception was highly encouraging, and I was unique opportunity that inter-institutional able to educate a number of entrepreneurs collaboration affords us and how we can looking for the best ecosystems to grow best use that to our advantage. In the next few their business in and large corporations months, we’ll also be updating the Nolabio. looking for investment opportunities org website to better reflect our short-term on the advantages the city offers. and long-term focus and showcase the op- Naturally, I’ll be following up portunity for digital health and health IT to with each of them in the fol- economic development prospects. I’m looking lowing weeks and months to forward to sharing our work more and more continue those conversations. as we dig deeper into Bio for New Orleans. n column SECRETARY’S CORNER

Medicaid Expansion

I am excited that we are seeing some of our greatest success through Medicaid expan- Taking Stock and sion. Since Medicaid eligibility was expanded on July 1, over 314,000 new members have enrolled. These are real people who Making Strides would not be able to afford healthcare coverage. Not only are we enrolling working adults The early months of this administration were into the program, early data shows that new members are already benefitting from met with challenges including one legislative expansion. • Over 20,000 members have received session followed by two more sessions to preventative care visits with a provider. tackle the state budget crisis. Then, there were • Over 1,700 women have completed important screening and diagnostic breast im- the, shootings in the Baton Rouge community aging such as mammograms, MRIs and ultrasounds. Of those women, 24 have been and the recent devastating floods. able to begin treatment for breast cancer. In spite of it all, we have seen many positive • Over 1,200 adults have completed colo- noscopies and over 270 patients had polyps, outcomes over the last few months. a precursor to cancer, removed • Treatment has begun for over 200 adults newly diagnosed with diabetes. • And nearly 500 patients have been newly diagnosed with hypertension.

This data is evidence that Medicaid expansion is not just a card in the hands of members. This is life-saving care and treatment that patients would not have had affordable access to without expansion. Access to primary care and wellness screenings that help improve the health of our citizens.

To learn more about the results of Medicaid expansion, visit the new Health Louisiana Dashboard, http:// www.ldh.la.gov/ HealthyLaDashboard/.

50 NOV / DEC 2016 I Healthcare Journal of new orleans Rebekah E. Gee, MD, MPH Secretary, Louisiana DHH

Zika and West Nile Flu season reminder

Zika and West Nile have been important topics in our communi- We’re in the middle of flu season and ties. The weather is starting to cool off, but we can’t forget about I encourage everyone to get vaccinat- mosquitoes. There have been 31 confirmed cases of Zika and 26 ed. The flu causes approximately 500 cases of West Nile in Louisiana. None of the 31 Zika cases were deaths and nearly 3,000 hospitaliza- contracted from a local mosquito bite. However, it’s important tions each year in Louisiana, and tens remember these steps to reduce your risk and prevent mosqui- of thousands of deaths in the U.S. to-borne diseases. An annual flu shot is the most effective way to protect your- • Use an EPA-approved insect repellent. self from the flu. Flu shots are now available at local pharma- • Wear light-colored, long sleeves and pants. cies, clinics, doctor’s offices, and federally qualified (community) • Frequently empty standing water around your home. health centers. • Sleep under a mosquito net if you are outdoors or in an area without door and window screens. Zika infection is usually as- ymptomatic and only rare- New Coverage for Women with Breast ly leads to severe illness. Cancer or At-Risk for Breast Cancer Infants born to mothers I’m excited to announce that for the first time, women receiv- infected with Zika virus ing health benefits from Medicaid have access to coverage for may suffer major neg- breast reconstruction surgery of the contralateral breast following ative birth outcomes, a mastectomy. Previously, Louisiana Medicaid only covered breast such as microcephaly, reconstruction, post mastectomy, on the affected/diseased breast. neurological disorders, vi- In addition, women will now have access to BRCA 1 and BRCA 2 sion & hearing deficits, and impaired mutation testing in cancer-affected individuals and those at high- growth. Because of this, women who risk for breast or ovarian cancer. Until now, this genetic screen- are pregnant, or considering becoming ing was not covered. pregnant, are of particular concern for pre- Breast cancer is the most common cancer among women in the venting Zika infection. United States, no matter her race or ethnicity. In addition, the CDC reports that breast cancer is the second leading cause of cancer death among women. Notably, October is National Breast Can- cer Awareness Month. Medicaid is committed to pro- A new ER in North Baton Rouge viding the women of our state with access to early The Governor recently announced great news for the residents diagnosis and quality treatment for breast cancer. of North Baton Rouge. The state has partnered with Our Lady Five to 10 percent of all breast cancers diag- of the Lake to build a new emergency room in the northern nosed in the United States are due to inherited part of East Baton Rouge Parish. As Secretary, and with the gene mutations. BRCA 1 and BRCA 2 are genes that Governor’s support, my focus has been on improving ac- protect a cell from one step on the path to can- cess to health care for residents across all of Louisiana. cer. When these genes mutate, the cell can prog- This announcement ensures greater access to care to ress to cancer. residents in an area that has felt the loss of two emer- I lost my mom to breast cancer when I was gency rooms over the last three years. only6 1 years old. Raising awareness of this Our Lady of the Lake has long been a leader and illness is extremely important to me and has demonstrated their commitment to North Ba- I’m proud to represent an agency that is ton Rouge as evidenced by two urgent care clinics always working to improve health care in the area. and reduce disparities. n

Healthcare Journal of new orleans I NOV / DEC 2016 51 Advances in Health Research from column Pennington Biomedical Research Research Center

tolerance, and insulin sensitivity among Scientists are learning others. more about What they found during their observation was that even in mice without FGF21, the RYGB was still effective for weight loss and the role of hormones improvement in blood sugar. In short, their research showed that FGF21 is not a critical factor for the beneficial effects of RYGB. in bariatric surgery However, it is still possible that FGF21 acts as an important co-factor along with other mechanisms. This information is useful as Penning- Scientists at LSU’s Pennington Biomedical ton Biomedical’s scientists move forward Research Center who study metabolism, to identify new ways to help people lose Bariatric weight loss hormones, and bariatric surgery were cu- weight and maintain the loss. Long-term, rious: could the hormone FGF21, which this research helps open up the possibility surgery has been shown plays a key role in regulating metabolism, to use FGF21 as an additional therapy for to be an effective long- be a critical factor in the success of bariatric patients who may not have found success term solution for reducing surgery? They specifically wondered about with bariatric surgery. its effect on Roux-en-Y gastric bypass (or Added Dr. Berthoud, “Ultimately, we want body weight and RYGB), a type of bariatric surgery which re- to know exactly what the mechanism is that normalizing metabolic duces the size of the stomach to about the makes Roux-en-Y surgery so successful, dysfunction. In short, size of an egg. and we’ll continue to work toward the goal Led by professor Dr. Hans-Rudolf Ber- of finding that out; however, we still con- doctors and scientists thoud, a team of scientists at Pennington sider it a success when we are able to rule agree that bariatric Biomedical set out to better understand certain mechanisms out since it puts us one this hormone’s role in the body’s response step closer to that end goal.” n surgery helps people lose to bariatric surgery. weight and better their As Dr. Berthoud explained, “First, nor- health – and research mal mice with (wildtype) and mice without (knockout) the hormone FGF21 were today is helping us to given a high-fat diet to make them obese. understand exactly why Mice of both genotypes were then subject- that may be the case. ed to either Roux-en-Y gastric bypass surgery (RYGB), or sham surgery (similar to a placebo, where the nutrient flow was not changed). A third group underwent calorie restriction to match body weight after the Roux-en-Y gastric bypass.” Dr. Hans-Rudolf Berthoud holds the George H. Bray Professorship. Scientists then monitored and compared a host of metabolic endpoints that typically improve after RYGB: body weight, food intake, body composition (how much fat, muscle, and bone is in the body), glucose

52 NOV / DEC 2016 I Healthcare Journal of new orleans Hospital news and information Hospital Rounds Koppels Help Unveil New Pulmonary and Cardiac Rehab Center

New Orleans-area residents who suffer from chronic obstructive pulmonary disease (COPD) can now breathe easier thanks to the opening of the Grace Anne Dorney Ted Koppel and wife Grace Anne Dorney- Pulmonary & Cardiac Rehabilitation Center at Koppel prepare to cut the Tulane Medical Center. The center is named ceremonial ribbon, held by Tulane University School after Grace Anne Dorney-Koppel, the wife of of Medicine Dean Dr. Lee senior CBS Sunday Morning contributor and Hamm, at the unveiling of Tulane Medical Center’s former Nightline anchor Ted Koppel. The new Grace Anne Dorney Koppels helped unveil the new center. Pulmonary & Cardiac Rehabilitation Center. Continued on following page

Healthcare Journal of new orleans I NOV / DEC 2016 53 Hospital Rounds

“Not being able to catch your breath – and “The program encompasses a comprehensive Blue Distinction Center for Maternity Care by Blue the fear that your next breath might not be com- team of individuals who work together to bene- Cross Blue Shield of Louisiana. The hospital deliv- ing – is like drowning. Nothing is more frighten- fit the patient,” said Dr. Joseph Lasky, a pulmon- ers the second most babies in the state for any sin- ing,” said Dorney-Koppel, who became a national ologist with the Tulane Lung Center. “That team gle hospital, with more than 3,500 New Orleans’ spokesperson for COPD patients after being diag- is made up of physicians, respiratory therapists babies born in 2015. nosed with the disease herself more than 15 years and exercise physiologists, all working together In its 165-year history, Touro has survived chal- ago. “Pulmonary rehabilitation is a breathing pro- to improve outcomes. lenges such as the yellow fever epidemic, the Civil gram based on the highest level of scientific evi- The total cost of the project represents an War, and two World Wars. In August 2005, Hurri- dence, and it can improve patient’s lives.” investment of nearly $480,000 in equipment, con- cane Katrina forced Touro to close its doors for “My wife was told she had three-to-five years struction and human resources. The center will the first time since the Civil War. Touro reopened left to live. She had 25 percent of her lung capac- benefit patients and provide researching oppor- its doors just 28 days later making us the first hos- ity,” said Ted Koppel at the grand opening event. tunities and education to healthcare workers and pital to reopen after the storm. For four months, “As a result of taking her medicine, daily pulmo- medical students. Touro was the only operating adult care hospital in nary rehabilitation and exercising, she now has 50 Orleans Parish. Through times of challenge, Touro percent [lung cap capacity].” Touro Infirmary Celebrates has remained resilient. Koppel praised pulmonary rehab for improving 165th Anniversary In 2009, Touro and Children’s Hospital partnered his wife’s quality of life. “It’s not a cure, but it is Touro Infirmary recently celebrated its 165th to form LCMC Health, a non-profit, community- a way that we can take care of the estimated 25 anniversary of caring for New Orleans. This is an based system providing a complete continuum of million people in this country who have [COPD].” important milestone for Touro and a celebration care from birth to geriatrics. In the following years, The Koppels formed the Dorney-Koppel Foun- of the organization’s long history of caring for the LCMC Health has expanded to include University dation to help fund the creation of eight such pul- New Orleans community. Since 1852 Touro has Medical Center, New Orleans East Hospital and monary and cardiac rehabilitation clinics. continued the mission of founder Judah Touro to West Jefferson Medical Center. Today, Touro joins “Our clinics are intended to empower people provide compassionate healthcare of the highest its partner hospitals in dedication to the commu- to learn about the management of their disease – quality to the people it serves. nity through a focus on economic development, to exercise, while being monitored – and to grad- Touro has been at the forefront of innovation for advanced research, teaching and clinical excel- ually get their lives back,” said Dorney-Koppel. decades. In 1923, Touro was one of only fifteen lence initiatives. “I’m delighted that this has happened so quickly hospitals in the country approved to use insulin to Today, Touro is a leading healthcare provider for [at Tulane].” treat patients. In 1929, Touro was one of the first New Orleans, demonstrated by award-winning The new Tulane center is located on the hos- hospitals in the United States and the first in the care and accolades, including Advance Certifica- pital’s seventh floor. The space provides a com- city to have a physical therapy department, which tion for Primary Stroke Centers by the Joint Com- fortable treatment and exercise environment with paved the way for Touro’s nationally recognized mission. Touro offers a full range of services includ- a great deal of natural light and beautiful views Rehabilitation Center. ing emergency services, preventive diagnostics, of the New Orleans skyline. The location is also In 1922, Touro Infirmary Maternity Service was surgical care, women’s services, cardiology, can- conveniently adjacent to the hospital’s pulmonary established, and Touro became the place “where cer treatment, rehabilitation, imaging, orthopae- clinic and respiratory therapy department. babies come from.” Today, Touro is designated a dics, stroke care and more.

Touro Infirmary Celebrates 165th Anniversary

54 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

St. Tammany Hospital Guild Donates to Food Bank From left to right: Charles LaRose, Guild Vice President; Ron Rome, President; Yvonne Cleland; Elliott Peralta; Rich O’Regan.

HCA Donates to Red Cross for Louisiana Flood Relief HCA, the parent of company of Tulane Health System in New Orleans and Lakeview Regional Medical Center in Covington, is donating up to $100,000 to the American Red Cross for flood relief in Louisiana, with a $50,000 donation from the company and up to $50,000 to match employee contributions to the Red Cross’ relief efforts. HCA’s MidAmerica Division is one of the area’s leading healthcare providers, with several hospitals in the affected area including Lafayette’s Women’s & Children’s Hospital.

Ochsner Named One of St. Tammany Hospital Guild 100 Hospitals with Great Donates to Food Bank Oncology Programs The St. Tammany Hospital Guild recently donated Becker’s Hospital Review has once again recog- 239 pounds of food to the Covington Food Bank nized Ochsner Medical Center on its list of 100 from its summer food drive. Hospitals and Health Systems with Great Oncol- “We know that with the recent floods the Food ogy Programs. The hospitals and health systems Bank has been inundated with requests,” said on this list lead the way in care for patients with Guild President Ron Rome. “We at STPH are cancer and have received recognition for their thankful to receive food donations from our Guild clinical outcomes, multidisciplinary care teams, to assist people in our community.” clinical expertise and oncology research. They are The St. Tammany Hospital Guild is an organiza- William Lennarz, MD also influential in cancer education and prevention of about 100 members who donate 25,000 tion efforts. hours each year in 20 of the hospital’s depart- Hospitals included on this list offer patients com- ments. The Guild also raises money through recently he served as Chief Medical Officer in prehensive cancer care involving teams of special- sales in the hospital gift shop to provide nurs- Pediatrics for Bon Secours Virginia Health System ists, participation in clinical trials and personalized ing and allied health scholarships for fall and in Richmond, Virginia, a large health system on the treatment programs. Ochsner Medical Center spring semesters. The scholarships are awarded east coast. He also served as Director of Pediat- has been highlighted for its excellence on this list to deserving hospital staff members who are fur- ric Emergency Services of Legacy Health System since 2013 and is a driving force in the fight to end thering their education in medical fields. in Portland, Oregon. Prior to that he worked for cancer. the U.S. Public Health Service in several locations The Becker’s Hospital Review editorial team Ochsner Health System Welcomes across the world. selected hospitals for inclusion based on recog- New System Chair of Pediatrics Gradually, throughout his career as a pediatric nitions received and accreditations earned. The Ochsner Health System has welcomed Dr. William emergency physician, Dr. Lennarz began taking on editorial team at Becker’s examined U.S. News & Lennarz, as the System Chair of Pediatrics and the more administrative responsibilities. Motivated by World Report cancer care rankings, CareChex can- AMD of Pediatrics at Ochsner Medical Center – his increasing role as an administrator, Dr. Lennarz cer care rankings, Blue Cross Blue Shield Associa- Jefferson Highway. worked to receive his Master of Medical Manage- tion Blue Distinction Center designation, and des- Dr. Lennarz comes to Ochsner with years of ment from the University of Southern California’s ignations from the National Cancer Institute while experience as a pediatric emergency physician Marshall School of Business in 2012. compiling this list. and a long history of administrative roles. Most He has been active throughout his career in

Healthcare Journal of new orleans I NOV / DEC 2016 55 Hospital Rounds

education as well as child advocacy. He has served therapy to treat patients suffering from chronic Award from Sigma Theta Tau. Poole has been not only in leadership for his local health system, pain. a member of the TGMC team for over 33 years but has served in an advocacy capacity in various Approved by the Food and Drug Administra- and presently serves as Assistant Vice President of states and with multiple agencies and foundations. tion (FDA) in February of this year, the St. Jude Nursing Services. Leonard is the recipient of the He has also been an invited speaker on pediatric Medical Axium™ Neurostimulator System for dor- Nurse Clinician Practice Award from Sigma Theta emergency medicine topics at various conferences sal root ganglion (DRG) stimulation was specifi- Tau. Leonard began her career at TGMC in 1993 across the country and has authored text book cally created to treat pain associated with com- as a nurse extern and after finishing her nursing chapters on pediatric sedation among other topics. plex regional pain syndrome (CRPS). Unlike similar degree from Nicholls she transferred to the Wom- devices, the St. Jude Medical Axium™ has the en’s Health Center where she has excelled as a TGMC’s Adams Named Rising Star ability to target specific areas of the body where Labor and Delivery nurse. Terrebonne General Medical Center (TGMC) pain occurs. announced that Ben Adams, DO, Vice Chief of Assisted by Dr. Gassan Chaiban, a pain man- Tulane Doctors Perform Medical Staff, was recognized among Becker’s agement specialist at Ochsner Baptist, Dr. Maged First “EVAR” Using CO2 Hospital Review 2016 Rising Stars: 50 Healthcare Guirguis, known nationally for his research on spi- Tulane Health System is breaking ground by using Leaders Under 40. nal cord stimulation (SCS) and chronic pain man- carbon dioxide (CO2) instead of conventional An anesthesiologist, Dr. Adams, is simultane- agement, successfully implanted the device in iodinated contrast during endovascular abdominal ously serving as the Director of Anesthesiology, a surgery at Ochsner Baptist earlier this year— aortic aneurysm repair, also referred to as EVAR. Medical Director of Surgery, and the Vice Chief of becoming the first physician to do so in Louisiana Recently, physicians in the Tulane catheterization the Medical Staff at TGMC. Working as the only and one of only a handful in the nation. lab performed the first EVAR procedure in the transesophageal echo (TEE) board certified anes- According to the Institute of Medicine, chronic southeast United States without the use of contrast thesiologist at the hospital, Dr. Adams functions pain affects more than 100 million Americans, an dye in the non-surgical approach using stent graft. as a key to the Structural Heart Program and also incidence rate which outpaces heart disease, can- Small injections of carbon dioxide were used to serves as counsel on all cardiac related cases at cer, and diabetes combined. Research suggests visualize the vessels under fluoroscopy. “Because the hospital. The TEE procedure provides a close that, in total, the condition costs the American CO2 is a natural byproduct, it is a safer alternative look at the anatomy and physiology of the heart’s population an estimated 515 million workdays for patients who have a history of diabetes or com- valves and chambers, without interference from annually and generates upwards of 40 million vis- promised kidney function,” said Dr. Owen Mogab- the ribs or lungs. Pioneering the frequent utili- its to physicians each year. gab, a cardiologist with the Tulane Heart and Vas- zation of TEE at TGMC, Dr. Adams became the cular Institute. “Therefore, the gas is the preferred go-to for advice and a leader for the hospital. TGMC Nurses Honored contrast agent for stent placement.” Dr. Adams’ role as Vice Chief of the Medical Staff for Nursing Excellence Tulane interventional radiologists partnered with was essential in the development of TGMC’s qual- Terrebonne General Medical Center (TGMC) cardiologists to perform the procedure. “We are ity reporting measures. These initiatives have led announced that Julie Leonard, BSN, RNC-OB, very fortunate to have a team of cardiologists who to awards for the hospital as well as new ground- and Laura Poole, MN, RN, NEA-BC, were the work hand-in-hand with interventional radiologists breaking programs that improved the lives of Lou- recipients of the International Award for Nursing to develop innovations like this,” said Dr. Mogab- isiana citizens. Patients are grateful for the atten- Excellence from the Sigma Theta Tau International gab. “This is exactly the kind of innovation an aca- tion Dr. Adams pays to each individual case. He Honor Society of Nursing Xi Zeta Chapter at Nich- demic medical center like Tulane can cultivate.” is a dedicated and compassionate physician that olls State University. This technology has been pioneered by Tulane makes patients feel safe and comfortable by con- Sigma Theta Tau’s International Awards for Nurs- Interventional Radiologist Dr. Jim Caridi. His necting with them to ensure they are receiving the ing Excellence are based on the society’s ded- ground-breaking work is being featured on an best possible care. ication to fostering high professional nursing international stage later this month when he pres- The Becker’s Hospital Review editorial team standards, recognizing superior achievement, ents at the International Conference on CO2 Angi- selected individuals for inclusion based on an edi- developing leadership and encouraging creative ography on Sept. 20 at the University of Bologna torial review process, including reviews of lead- work. Awards are presented to nurses every two in Italy. ership experience and peer nominations. These years for contributions in the fields of technol- Frequent scans using contrast can cause con- administrative leaders have made considerable ogy, media, chapter excellence, research, leader- trast-induced nephropathy, or kidney damage. accomplishments in their relatively short careers. ship and practice. Sigma Theta Tau International In the CO2 procedure, a small amount of carbon Honor Society of Nursing Xi Zeta Chapter at Nich- dioxide is injected in the bloodstream instead Ochsner First in State to olls State University presented three awards this of contrast to highlight the blood vessels and Use New Therapy year for Nursing Excellence; two of those recipi- any blockages. The carbon dioxide is dissolved Ochsner Health System recently performed ents are TGMC nurses. in the blood and then eliminated through the another first in Louisiana—a revolutionary new Poole is the recipient of the Nurse Leadership patient’s lungs.

56 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Ben Adams, DO Julie Leonard, BSN, RNC-OB Laura Poole, MN, RN, Nea-BC K. Gerald Haydel, MD Sheena Henry, RN

With the largest group of CO2-trained physi- centers will be located in the New Orleans metro designed to optimize health outcomes. In the cians in the state, Tulane doctors are often suc- area. LCMC Health has partnered with Premier early days, before there was a specialist in Ter- cessful in preventing amputations and other com- Health, a leader in urgent care based in Baton rebonne Parish, he did it all: from setting broken plications associated with chronic diabetes and Rouge. bones and providing chemotherapy (the roots kidney issues. The new urgent care centers will offer expert, of cancer care in Terrebonne Parish) to deliver- quality and convenient care for adults and chil- ing babies. He also set up the first family practice Carmouche Makes Physician dren. In addition to “no appointment” walk-in clinic in Grand Isle where he drove one day a week Leaders to Know List care, urgent care services will include on-site lab to see patients. Because of his love for the prac- Becker’s Hospital Review has recognized Dr. David work, x-rays, physicals and immunizations. The tice of medicine, and calling to help people, he Carmouche, Senior Vice President and President centers will be accredited by the Urgent Care has always helped patients with medical care. That for the Ochsner Health Network, to the 110 Physi- Association of America (UCAOA), the highest same love for medicine is still present today. The cian Leaders to Know list for 2016. level of distinction for care delivered at urgent leadership and positive energy he exudes daily The list features presidents and CEOs of hos- care centers. are a direct benefit to the community who turn to pitals and health systems who also hold medi- Conditions treated at the centers will include a TGMC for the best healthcare available. cal degrees. All recipients have demonstrated wide range of illnesses and conditions, such as: outstanding leadership and clinical expertise common viruses, ear and eye infections, stomach TGMC Honors Henry as throughout their careers and are leading initiatives and digestive conditions, orthopedic injuries such October Employee of Month to improve their individual organizations and the as sprains, strains or simple fractures, and minor Terrebonne General Medical Center (TGMC) hon- healthcare of the communities they serve. Hospi- skin infections. ored Sheena Henry, RN, as the October Employee tals do not and cannot pay to be on this list. of the Month. Henry is a Case Manager in the Care Dr. David Carmouche joined Ochsner with 19 Haydel Earns Golden Management Department at TGMC. years of progressive, healthcare, leadership expe- Stethoscope Award In an effort to recognize outstanding employ- rience in medicine and operations. Before joining Terrebonne General Medical Center (TGMC) ees, TGMC names an Employee of the Month. Ochsner, Dr. Carmouche served as the Executive has announced K. Gerald Haydel, Sr., MD, as the Employees of the Month show an outstand- Vice President of External Operations and Chief recipient of the Golden Stethoscope Award. ing constant commitment to the wellbeing of Medical Officer at Blue Cross and Blue Shield of The prestigious Golden Stethoscope Award patients, staff, and extended families, and through Louisiana in Baton Rouge where he successfully is designed to publicly recognize a TGMC phy- their participation in their personal journeys. The led important initiatives designed to organize sician for his or her exceptional level of profes- EOM also makes it a priority to live out the TGMC care, improve quality, and increase affordability. sionalism, integrity, and teamwork in caring for mission of providing exceptional healthcare with patients and families, as well as interacting with compassion. LCMC Expands Access to Care hospital staff members and other physicians. The Henry’s role as a case manager is to man- LCMC Health, a local, not-for-profit academic program asks for nominations from physicians, age the components of care for patients with healthcare system made up of Children’s Hos- employees, patients, and volunteers, and recog- the goal of achieving quality care outcome and pital, New Orleans East Hospital, Touro, Univer- nizes two physicians a year. financial appropriateness. Henry is described by sity Medical Center, and West Jefferson Medical Over the many years of his practice, Dr. Gerry her co-workers as going above and beyond for Center, announced plans to create a network of Haydel has provided compassionate care to her patients to ensure they have a smooth and urgent care centers in the greater New Orleans patients from babies to the elderly, helping safe discharge plan and resources needed for area beginning in the spring of 2017. The initial to direct and implement innovative strategies a successful discharge. Her compassion shines

Healthcare Journal of new orleans I NOV / DEC 2016 57 Hospital Rounds

every day as she treats every patient and person St. Bernard Parish Hospital and she meets as if they were her own family. Henry Ochsner Agree to Assessment coaches and encourages patients and families The St. Bernard Parish Hospital Board (SBPH during their most difficult times. She is a com- Board) announced that they have approved a passionate, experienced nurse, who is able to be Cooperative Endeavor Agreement with Ochsner kind and caring, but tough and unyielding. She Health System (Ochsner) to complete a 90-day is always professional when she is advocating for Organizational Assessment. Ochsner will lend Ayame Dinkler her patients. senior leadership resources to St. Bernard Par- ish Hospital to complete the assessment over the EJGH Celebrates Expanded agreed upon the term. Breast Care Center Kim Keene, current AVP, Clinical Operations for The Foundation at East Jefferson General Hospi- OMC-North Shore will assume the role of interim tal (EJGH) helped celebrate the opening of the CEO for St. Bernard Parish Hospital and Anthony newly renovated and expanded state-of-the-art “Tony” Bonnecarre, current controller at OMC- Breast Care Center, an important benchmark in North Shore will lend financial expertise to the addressing a growing need in the community it assessment. serves. Following the Operational Assessment, Och- The Foundation, the fundraising arm of the sner will make recommendations to the SBPH hospital, raised more than $300,000 for the proj- Board on how to best position the organization James Ludwig ect, receiving support from its Live Pink breast to continue to meet the needs of patients in the care funding program, incorporating community community. Throughout this process, St. Ber- events, individual and corporate donations and nard Parish Hospital will follow standard operat- employee giving campaigns. ing procedures. The redesign was based around the goal of giving patients a more comfortable and stress-free Two Promoted at LCMC Health atmosphere in which to receive the care they need LCMC Health recently announced two staff and deserve. promotions: “EJGH treats more breast cancer in women Ayame Dinkler has been promoted to Chief than any other type,” said Dr. Mark Peters, Presi- of Staff. In this role, Dinkler will collaborate with dent and CEO of East Jefferson General Hospital. CEO Greg Feirn while working closely with the

“We were facing a truly distressing circumstance LCMC Health executive leadership team to help William Lunn, MD of treating these patients in areas that too small, manage priorities and drive strategic initiatives and that no longer could manage the larger vol- forward across the LCMC Health family of hospi- ume of patients. This was such a perfect project tals—Children’s Hospital, Touro, University Medi- for the community and our donors to get behind. cal Center New Orleans, New Orleans East Hos- “Post renovation, we can now treat our patients pital and West Jefferson Medical Center. She will with the best technology available and in a sooth- also continue to lead the system’s government ing, calm environment.” affairs efforts at the local, State and Federal gov- The renovations included a second patient ernment levels. registration desk, a third mammography suite James Ludwig has been promoted to Vice Pres- with a 3D mammography unit, additional wait- ident of Supply Chain Management. Since joining rooms for screening and diagnostic mammo- ing LCMC Health over two years ago, Ludwig has gram patients, a new upright stereotactic biopsy led the transformation of materials management Michael E. Fahr, MD, FACS devise, an additional specimen radiography sys- departments across the LCMC Health System to tem to reduce procedure time and purchased a a Shared Supply Chain Organization. Under his new and improved bone densitometry unit. direction, LCMC Health has been able to leverage Ochsner Opens First Freestanding The facility, an American College of Radiology the collective purchasing power of its five hospi- Emergency Room in Marrero accredited institution, now has the capacity to tals and consolidate supply chain services. In his Ochsner Health System held a ribbon cutting cer- expand on the over 11,000 mammograms, 3,800 role as Vice President, Ludwig will continue his emony with local business leaders and govern- ultrasounds and 500 image guided biopsies per- efforts to further improve LCMC Supply Chain’s ment officials to celebrate Ochsner Emergency formed by the breast care center each year. performance and operational efficiency. Room – Marrero. The new facility – located at 4837

58 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Ochsner Opens First Freestanding Emergency Room made a $5,000 donation to John Ehret High scale emergencies and natural disasters. Room in Marrero School. Following the ribbon cutting, attendees The LERN board serves to develop, implement From left, Todd Murphy, President, Jefferson and members of the medical community were and support a statewide network of emergency Parish Chamber of Commerce; Anthony DiGerolamo, CEO, Ochsner Medical Center provided facility tours. response entities to provide access to care in an – West Bank Campus; Jefferson Parish The American College of Emergency Physicians’ efficient and coordinated manner. According to Councilman Ricky Templet; Warner Thomas, (ACEP) 2014 National Report Card demonstrated statute, the LERN board is comprised of 28-mem- President and CEO, Ochsner Health System; Dr. Robert Hart, Chief Medical Officer, Ochsner the need for additional access to emergency med- bers, including two members from the Louisiana Health System; Senator John Alario, Jr.; Dr. ical care. The most recent ACEP survey highlights House of Representatives and two members from Ricardo Martinez, Chief Medical Officer, emergency visits are on the rise. The overwhelm- the Louisiana Senate. The remaining 24 members Adeptus Health; Michael Hulefeld, Executive ing response from physicians noted that this rise is are gubernatorial appointments. Vice President and Chief Operating Officer, Ochsner Health System; Dr. Michael Isabelle, combined in part with an increase in the acuity of Dr. Lunn was nominated by, and will serve as the Area Medical Director, Adeptus Health; and patients’ injuries and/or illnesses. This underscores representative of, the Tulane University Health Sci- Jefferson Parish Councilman Mark Spears, Jr. the growing need for additional access points to ences Center. high quality, 24/7 emergency care. Lapalco Blvd., in Marrero, opened in October, and Trauma Surgeon Joins North will provide expanded access to more emergency Tulane Health System CEO Oaks Shock Trauma Center care services for the West Bank community. Named to LERN Board Trauma Surgeon Michael E. Fahr, MD, FACS, has Different from urgent care centers, the Ochsner Dr. William Lunn, president and CEO of Tulane joined the North Oaks Medical Center Shock Emergency Room is open 24 hours a day, 7 days a Health System, has been named to the Louisiana Trauma team. week, and are staffed exclusively with board-certi- Emergency Response Network’s governing board. Dr. Fahr completed fellowships in Trauma and fied and board-eligible emergency physicians and The Louisiana Emergency Response Network Surgical Critical Care at Louisiana State Univer- emergency trained registered nurses. The facility (LERN) is an agency of state government created sity Health Sciences Center in New Orleans. He is equipped with a full radiology suite, including by the Louisiana Legislature in 2004 charged with is certified by the American Board of Surgery in CT scanner, Digital X-ray, Ultrasound, as well as the responsibility of developing and maintain- both General Surgery and Surgical Critical Care. on-site laboratories certified by the Clinical Lab- ing a statewide system of care coordination for Other North Oaks Shock Trauma Center sur- oratory Improvements Amendments (CLIA) and patients suddenly stricken by serious traumatic geons include: Medical Director Juan C. Duch- accredited by the Commission on Office Labora- injury or time-sensitive illness (such as heart attack esne, MD, FACS, FCCP, FCCM; Marquinn D. tories Accreditation (COLA). and stroke). It is a system also designated to serve Duke, MD; Lawrence E. Nelson, DO, FACOS and To celebrate the opening, Ochsner Emergency as a vital healthcare resource in the face of larger Rosemarie Robledo, DO. Patients also receive

Healthcare Journal of new orleans I NOV / DEC 2016 59 Hospital Rounds

follow up care from Aaron Bateman, ANP-C, at In addition, North Oaks Shock Trauma Center is quality and compassionate care.” North Oaks Shock Trauma Clinic. part of the Louisiana Emergency Response Net- Nurses receiving top honors by hospital: North Oaks Shock Trauma Center was verified work (LERN), an agency of state government cre- New Orleans East Hospital: David Ronnenburg, and designated a Level II Trauma Center by the ated to develop and maintain a statewide system RN, ED Director American College of Surgeons and Louisiana of care coordination for trauma patients. Touro: Lourdes M. Anfone, RN, Rapid Admit; Department of Health earlier this year. The Shock Emma M. Bastian, RN, Surgery Manager; Diana Trauma Center provides coordinated care and LCMC Health Honors Carter, RN, Enterostomal Therapist; Michelle L. trauma surgeons in-house at all times to attend 20 “Great Nurses” Dutreix, RN, Wound Care Manager; Debbie Pick- to victims suddenly stricken by serious traumatic LCMC Health announced that the Great 100 ett, RN, Oncology injury. North Oaks is the only trauma center serv- Nurses Foundation has recognized 20 nurses University Medical Center New Orleans: ing Region 9, which is comprised of Tangipahoa, across the LCMC Health system as “Great 100 Sheila Bradford, RN, Infectious Disease; Shan- Livingston, St. Helena, St. Tammany, and Wash- Nurses.” For more than thirty years, Great 100 non Fussell, RN, TICU; Mason Green, RN, MICU; ington parishes. Nurses have been selected annually based on C’Lita Henry-Lombard, RN, Anesthesia Director; their concern for humanity, contributions to the Rochelle Johnson, RN, Behavioral Health; Kim- LCMC Health Nurses were honored at a profession of Nursing, and mentoring of others. berly Kennison, RN, House Supervisor; Jeremy celebration at the Pontchartrain Center on “LCMC Health’s nurses are at the heart of our Landry, RN, House Supervisor; Keithen Potts, RN, October 12, 2016. From left to right, front row: David Ronnenburg, Diana Carter, Debbie Pickett, mission, and we are extremely proud to have 20 Adult Isolation; Kimberly Wilson, RN, Adult Isola- Emma Bastian, Kimberly Kennison, Kimberly dedicated nurses recognized for their hard work tion; Etsegenet Wodajo, RN, TICU Wilson, Jeremy Landry, Sheila Bradford, Vicki and commitment to the profession,” said Greg West Jefferson Medical Center: Vicki Aucoin, Aucoin and Michelle Dutreix. Back row: Linda Feirn, Chief Executive Officer, LCMC Health. “At RN, Special Procedures; Linda Bordelon, RN, Peri- Bordelon, Rochelle Johnson, Mason Green, Lourdes Anfone, Keithen Potts, Etsegenet LCMC Health, we place a high value on our nurses operative; Michelle Breaux, RN, 4West; Alexander Wodajo, Shannon Fussell, and Michelle Breaux. and recognize the vital work they do to provide Le, RN, 3West

60 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Ochsner Health System experience searching for an effective treatment, Awarded V Foundation Grant the Copeland family dedicated themselves to rais- Ochsner Health System has been awarded a V ing funds to help find a cure for this and other can- Foundation-designated grant to create educa- cers, and the Al Copeland Foundation was born. tional materials to increase awareness for the The ACF chose LSU Health New Orleans as its benefits of cancer clinical trials to minority popu- partner in this quest and continues to raise funds lations. Designated grants are inspired by particu- for cancer research at LSU Health New Orleans. lar areas of scientific interest and/or geographic The clinical trial, sponsored by the National Can- reach and are selected on the basis of scientific cer Institute seeks to enroll a total of 50 patients merit determined by the V Foundation’s scientific among the participating sites. Although there advisors. Amy Rivere, MD are a number of inclusions and exclusions, par- The V Foundation for Cancer Research was ticipants must be 18 years or older, have biopsy- founded in 1993 by ESPN and the late Jim Val- cancer. Clinical interests include surgical treatment proven or metastatic MCC, measurable disease vano. Since 1993, the Foundation has funded of breast cancer, nipple-sparing mastectomies, and a life expectancy of greater than six months. more than $150 million in cancer research grants ultrasound guided lumpectomies, oncoplastic Exclusions include having prior systemic therapy nationwide. It awards 100 percent of all direct cash breast surgery, sentinel lymph node biopsies and for MCC, radiation therapy within two weeks of donations to cancer research and related pro- axillary node dissections, axillary reverse mapping beginning study treatment, having active auto- grams. The Foundation awards peer-reviewed to minimize lymphedema risk, and management immune disease or other diseases such as con- grants through a competitive awards process of benign breast disease gestive heart failure and cardiac arrhythmias, or vetted by a world-renowned Scientific Advisory She is certified by the American Board of Sur- is pregnant or breastfeeding. Committee. gery and is a member of the Society of Surgical The Al Copeland Foundation donated $100,000 Ochsner is the only institution in Louisiana to Oncology, American Society of Breast Surgeons, to support this clinical trial, raised with the first receive this $23,000 grant. In order to create and the American College of Surgeons. annual Chicken Jam event. the educational materials, Ochsner will bring All participants will be given the study medi- together a multidisciplinary group of cancer pro- LSU Health Opens Merkel Cell cation, pembrolizumab, by infusion every three viders which will include physicians, nurses, social Carcinoma Clinical Trial weeks for as long as they benefit, up to two years. workers, and cancer research coordinators. Och- LSU Health New Orleans is recruiting participants The visits, which also include a CT scan, EKG or sner will also enlist minority cancer patients to to a clinical trial to determine the effectiveness of other laboratory procedures, will be approxi- advise the potential concerns or barriers minor- MK-3475 (pembrolizumab) in treating patients with mately four hours long. There may be no ben- ity patients may have in regards to clinical trials. Merkel cell cancer that cannot be removed by sur- efit to participants, and there are a number of John Cole, MD, Vice Chairman, Medical Spe- gery, or controlled with treatment, or has spread risks. Side effects have been reported in patients cialties, Ochsner Cancer Institute, will serve as the to other parts of the body. It is the first systemic receiving this study medication, although most principal investigator and site director for the V intervention for patients with advanced Merkel cell have been reversible. Two of the early participants Foundation grant. “This prestigious grant high- carcinoma. Pembrolizumab is an immunotherapy in the study had to stop treatment after only a lights the multidisciplinary approach our physi- drug. Immunotherapy works differently than che- couple of infusions, but nearly a year afterwards cians use every day in cancer care.” said Dr. Cole. motherapy in that it boosts the body’s own natural both patients continued to have tumor responses. “Ochsner has over 130 active cancer-related clini- defense system to help fight cancer. LSU Health For more information about the Merkel cell car- cal trials and this grant will allow us to expand our New Orleans is one of 11 sites in the country cinoma clinical trial at LSU Health New Orleans, cancer care to groups that are often underrepre- selected to enroll patients in this clinical trial. call 504-407-7395. sented in clinical trials. Merkel cell carcinoma (MCC) is an aggressive form of skin cancer. It is linked to exposure to Ochsner Hospital for Children Rivere Joins Ochsner ultraviolet rays, but about 80% of cases are asso- Named One of “America’s Best” Breast Center ciated with a virus called Merkel cell polyomavi- Ochsner Hospital for Children is the only children’s Dr. Amy Rivere, a fellowship trained breast surgi- rus. There are currently no FDA-approved drugs to hospital in Louisiana to receive the 2016 Women’s cal oncologist, is the second female breast sur- treat Merkel cell carcinoma. While some patients Choice Award® as one of America’s Best Hospi- geon to join Ochsner’s breast surgery team. She is do respond to chemotherapy, after about three tals for Children. currently seeing patients at The Lieselotte Tansey months, the disease typically progresses, leaving This evidence-based designation is the only Breast Center at Ochsner located at 1319 Jefferson patients with few, if any, treatment options. Merkel award that identifies the country’s best health- Hwy across the street from Ochsner Main Campus. cell carcinoma took the life of Al Copeland Sr. in care institution by using a robust set of criteria Dr. Rivere’s specialty is breast surgical oncol- 2008. There were no and are still no FDA-approved that considers female patient satisfaction, clini- ogy and the diagnosis and treatment of breast treatments for Merkel cell carcinoma. After their cal experience, and what women say they want

Healthcare Journal of new orleans I NOV / DEC 2016 61 Hospital Rounds

from a hospital. physicians and clinicians. Ochsner is the only hos- The list of over 50 award winners, including Och- pital from Louisiana, Mississippi, Alabama, Georgia sner Hospital for Children, represents hospitals and Florida Panhandle to receive this designation. that offer exceptional children’s’ services which iO used Apple Watch as a tool to enhance the ranked above the national average for patient effectiveness of the Ochsner Hypertension Digital safety. Medicine Program, a program that monitors clinic Ochsner Hospital for Children, a 113-bed chil- patients who struggle with uncontrolled blood dren’s hospital within a hospital (Ochsner Medi- pressure. Utilizing wireless blood pressure cuffs cal Center—Jefferson Highway), has 120+ physi- integrated with AppleHealthKit and Epic, Och- cians specializing in 30 pediatric specialties and sner’s Electronic Medical Record (EMR), patients

sub-specialties. The hospital has a 54 bed neo- regularly measure their blood pressure ratings at Harriet Lyons, RN natal intensive care unit (NICU), Level III-regional, home while the data is sent directly to the clinic the highest level available in Louisiana and a com- for monitoring. bined 26 bed pediatric intensive care unit (PICU) Most recently Ochsner, GE Healthcare and The Covington Surgery Center. and cardiovascular intensive care unit (CVICU), Idea Village announced their search for entrepre- Honored for 25 years of service were Mark Level I, the highest level available. neurs to participate in their latest innovation chal- Baham, Information Systems; Gloria Bowden, lenge, Healthy @ Home. This challenge seeks to Pre-Op Assessment; Celina Brumfield, Pre-Access TGMC’s Lyons Named To identify innovators and propose new patient-cen- Center; Lori Chopin, Medical Staff Office; Gerard “Great 100 Nurses” tered technologies to improve care by monitoring Haulard, Sterile Processing; Kellie Helm, Emer- Terrebonne General Medical Center (TGMC) and analyzing movement in the home. gency Care Services; Grace Herring, 2 East; Seana announced that Harriet Lyons, RN, has been The Becker’s Hospital Review editorial team Hester, Labor And Delivery; Vincent Imbraguglio named to the 2016 “Great 100 Nurses.” Lyons considered nominations and conducted edito- III, Security; Janet Kennedy, Nursing Administra- was honored at the 30th Annual Great 100 Nurses rial research to select the hospitals included on tion; Lisa Kinler, Respiratory Services; Nancy Ledet, Celebration held October 12th at The Pontchar- this list. Surgical Services; Mathilde Lyon, 2 West; Rodney train Center. Ochsner Health System has been named one Schafer, Surgery; and Jane Simmons, Endoscopy. Lyons works as a Clinical Technology Advocate of four finalists in the Health Acceleration Chal- Celebrating 20 years of service were Deborah in the Information Technology (IT) department at lenge by the Forum on Health Care Innovation – Bickham, 2 West; Eric Brewster, Managed Care; TGMC. As clinical technology advocate, Lyons a collaboration between Harvard Business School Patricia Gutierrez, Case Management; Frederick functions as a liaison between medical and clin- (HBS) and Harvard Medical School (HMS) – for its Heintz, Building Services; Gina Martin, Surgical ical staff and the technical staff in the IT depart- work on the Ochsner Hypertension Digital Medi- Services; Bert O’Rourke, CCU; Corliss Renfroe, ment. She creates and teaches educational mate- cine Program. Ambulatory Care; Debra Scheuermann, Infec- rial, and assists with troubleshooting. Lyons began tion Prevention/Em Health; and Terri Schexnay- her nursing career in 1973 and has been a valued STPH Honors Long- dre, Intensive Care. member of the TGMC family for over 21 years. term Employees More than 30 employees celebrated 15 years St. Tammany Parish Hospital recently hosted its of service, including Arlyn Arseneaux, 3 East; Ochsner Named to 50 Hospitals 44th annual Service Award Banquet to honor this Kyle Autin, Anesthesiology/Prof; Bertha Burton, with Innovation Programs year’s employees who reached special service 2 North; Lori Cage, Parenting Center; Charlotte innovationOchsner (iO) has been named to the milestones. Chauvin, Home Health Care Services; Angel Dil- “50 Hospitals with Innovation Programs” list by The employees assembled honored longest lon, Labor And Delivery; Nora Doherty, Respiratory Becker’s Hospital Review. Hospitals on this list tenured employee, Pat Pope, Human Resources, Services; Bobbie Dreiss, Access; Constance Duke, either have a specific center dedicated to innova- for her record 50 years of service. Speech Therapy – OP; Loretta Farbe, Patient Expe- tion or an established commercialization arm with Three employees achieved 40 years of service, rience; Mary Fowler, Rehab Unit; Summer Fuga- its own governing board, and all demonstrate a Sylvia Chapman, NICU; Kathleen Hill, Food Ser- rino, 2 West; Cleveland Garrett, Environmental commitment to bettering healthcare by tackling vices; and Catherine Lecce, Cath Lab. Services; Shirley Hidalgo, Laboratory; Shannon the biggest challenges facing patient care and Six employees were honored for 35 years of ser- Holley, Cath Lab; Hillary Holmes, 2 North; Brian; care delivery. vice, Susan Aultman, CCU; Levon Harry, Materi- James, Anesthesiology/Prof; Toney Kirby, Build- Created last year by Ochsner Health System, iO als Management; Gina Kemp, Laboratory; Susan ing Services; Shelley Labruyere, NICU; Tammie is an innovation lab and accelerator that designs Stahl, Oncology; Brenda Sullivan, Cardiology; and Lala, Lactation Education; Fredrick Magee, Sur- patient-centered solutions through technology Catherine Travis, 2 East. gery; Holly Mcneese, Pediatric Unit; Laurie Mete- and data to empower patients to take an active Marking 30 years of service were Mary Krentel, vier, Home Health Care Services; Michael Monroe, role in their own health and improve efficiency for Post Anesthesia Care Unit and Veronica Pregeant, Information Systems; Robert Moore, Information

62 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Health Information Mgt; Nicole Suhre, Foundation; Michelle Theard, Pediatric Unit; Alene Thompson, Food Services; Miriam Torres, Rehab Unit; Melissa Verhulst, Surgery; Laura Weller, Sleep Lab; Sherling Werner, Radiology/Ct Scan OPP; Roxie Williams, 2 West; Marshall Williams, Radiology Diagnostic; and Tennille Woods, Laboratory.

Touro Performs Radioactive Seed Localization Touro Infirmary announced that it is the first hospital in the Gulf South region to offer Radioac- tive Seed Localization (RSL) breast surgery. The program, spearheaded by Dr. John Colfry, Breast Surgical Oncologist, and Dr. Daniel Rupley, Radi- ologist, allows the radiologist and surgeon to very STPH Honors Long-term Employess From left, Carolyn Adema, vice president of Human Resources; accurately target lesions in the breast. Pat Pope, and Patti Ellish, president and CEO. Drs. Colfry and Rupley completed a training course for Radioactive Seed Localization at MD Anderson Cancer Center and are excited to Systems; Melissa Moore, Pulmonary Rehab; Stacey Nursery; Linda Griffith, 2 North; Rodney Grillier, bring this new surgical technique to patients in Parkman, Food Services; Jamie Romage, Informa- Materials Management; Allen Gros, Respiratory Louisiana. tion Systems; Paige Roundtree, Radiology Diag- Services; Kenneth Guerin Jr., Intensive Care; Sylvia Radioactive Seed Localization (RSL) offers a new nostic; Agabita Rowe, Mammography WP; Kevin Hart, Administration; Kathryn Hellbach, Guild/Gift alternative with multiple benefits compared to tra- Smith, Physical Therapy – IP; Corey Vallot, Infor- Shop; Arthur Hines, Building Services; Mary Hob- ditional wire localization. A very low-energy radio- mation Systems; Carolyn Visser, Pre-Access Cen- good, Case Management; Jessica Jenkins, Case active seed is placed under ultrasound or mammo- ter; Stacy Warner, Covington Surgery Center; and Management; Suzanne Johns, 2 North; Wendy graphic guidance by an experienced radiologist. Lindon Warner, Intensive Care. Johnson, 2 North; Caroline Johnson, Food Ser- The seed can be placed one to five days before Honorees for 10 years of service are: Nancy vices; Vicki Kelly, 2 East; Amy Key, Decision Sup- surgery. During the surgery, the surgeon uses a Anderson, STPN-Mandeville; Sheila Andre, 3 port; Irfana Khan-Salam MD, Hospital Medicine; handheld gamma probe to more precisely identify East; Michael Barbay, Security; Cheryl Barre’, Lac- Donald Kline, Surgery; Michelle Kraus, CCU; Teresa and remove the tumor by obtaining a three dimen- tation Education; Gerald Barreca, 2 North; Brenda Krutzfeldt, Critical Care Services AD; Joseph Land- sional view of the tumor’s location. This also allows Beauchamp, AR/PACS; Sara Borne, Physical Ther- ers MD, Hospital Medicine; Donna Lauga, Surgery; for accurate and alternative planning of the surgi- apy – IP; Rose Brady, Radiology/Diag/OPP; Mary Angela Liuzza-Jones, CVO; Richard Long MD, cal incision. The seed placement procedure is very Bronson, Physical Therapy – OP; Chad Buras, Radi- STPN-Mandeville; Ellen Loop, Newborn Nursery; similar to a needle biopsy procedure. The radiol- ology/Ct Scan; Jessica Capdeboscq, Home Health Elizabeth Lott, Intensive Care; Lacylynn Mcge- ogist injects a local anesthetic to numb the area Care Services; Sandra Carr, Labor And Delivery; hee, Pre-Op Assessment; Kimberly Meyer, Clini- before starting the procedure. Ultrasound or mam- Ruth Caserta, STPN-Madisonville; Rachel Chap- cal Doc Improvement; Richard Moore, Anesthe- mography is used to guide placement of the seed. petta, Mammography WP; Michael Clark, Environ- siology/Prof; Sharon Moore, Labor and Delivery; During surgery, the surgeon removes the abnormal mental Services; Christopher Connell, Anesthe- James Noel, Intensive Care; Nicole Norris, Pedi- tissue or tumor along with the seed. siology/Prof; Joann Cook, Radiology/Ultrasound atric Unit; Kim Noullet, Patient Experience; Donna The seed acts as a marker for the surgeon WP; Selmon Corkern III, Radiology Diagnostic; Pendergast, CVO; Donald Pruitt, Information Sys- because the iodine inside can be detected by the Shannon Cuccia, Critical Care Services AD; Sarah tems; Leslie Rando, Physical Therapy – OP; Sasha gamma meter being used during the lumpectomy, Delery, Case Management; Donna Donegan, Riecke, 4 South; Laura Ronzello, Endoscopy; Kris- and the seed itself can be seen on ultrasound. The Home Health Care Services; Lynell Duplechain, tin Roy, 2 East; Karen Seal, Education, Develop- seed does not present an exposure risk to care- Mammography WP; Roger Dutruch, Construc- ment & Training; Bonnie Sitnik, Health Informa- givers, family members, or others who come in tion; Valerie East, STPN-Covington; Paula Folse, tion Mgt; Earl Spadoni Jr., Respiratory Services; contact with the patient, therefore special isola- Ambulatory Care; Felicia Forrest, 3 North; Khali- Donna Spano, Sterile Processing; Dixie St. Ger- tion measures are not required. With this proce- lah Franklin, 3 East; Linda Galloway, Rehab Unit; main, Radiology/Ultrasound Mandeville; Cheryl St. dure, once the seed is removed with the breast Lindsay Gomez, Chemo Services; Jennifer Gra- Germain, Support Services; Rebecca Stall, Radi- tissue, the entire radioactivity is gone. Benefits of cia, Pre-Access Center; Jennifer Gray, Newborn ology/MRI; Kim Stoltz, 4 South; Deanna Stuckey, Radioactive Seed Localization vs. traditional Wire

Healthcare Journal of new orleans I NOV / DEC 2016 63 Hospital Rounds

Localization include less tissue removed during Wack began his healthcare career at Biloxi surgery, improved comfort for patients, better Regional Medical Center (now Merit Health Biloxi) cosmetic results, and decreased operating time. as controller. He also served in Senior Finance Leadership roles at Central Mississippi Medical New “CTO PCI” Cardiology Center in Jackson, Miss.; Riverview Regional Medi- Procedure Changing Lives cal Center in Gadsden, Ala.; Northwest Mississippi Dr. Dr. Nidal Abi Rafeh, along with fellow Tulane Regional Medical Center in Clarksdale, Miss. and Mark Wack, CPA, MBA interventional cardiologist Dr. Owen Mogab- Mesquite Community Hospital in Mesquite, Tex. gab, are pioneering a new treatment technique Prior to healthcare Wack served in finance lead- that offers a new alternative for treating coro- ership roles in manufacturing and the defense nary chronic total occlusion, or CTO. CTO PCI, industry. He received a BS in Business Adminis- or chronic total occlusion percutaneous coro- tration from the University of Southern Mississippi nary intervention, is a breakthrough procedure to and a Masters of Business Administration from treat patients who have a totally blocked coronary William Carey College. He is a licensed Certified artery vessel. At present, only 2 percent of inter- Public Accountant. ventional cardiologists in the United States are qualified to perform the full range of these pro- TGMC Physician Earns cedures, and Tulane Health System is one of the Director of the Year Award few centers in the country to offer it. Terrebonne General Medical Center (TGMC) Ray Cinnater, MD CTO in particular has presented challenges for physician, Dr. Ray Cinnater, received the Medi- even the most experienced interventional cardi- cal Director of the Year Award from the Louisiana ologists. In many cases, standard angioplasty and Nursing Home Association. stenting techniques do not work in cardiac patients Dr. Cinnater is an internal medicine physician with 100 percent blockage of the coronary artery. who has served the patients in our community for Historically, physicians often recommended cor- over 45 years. onary artery bypass grafting (CABG), or open-heart surgery, as the only option for treating these block- Touro Earns The Gift Designation ages. Some patients, however, are not candidates Touro Infirmary has earned Louisiana’s primary for CABG surgery due to age or high surgical risk. breastfeeding designation given by The Gift. The Tulane’s innovative CTO PCI procedure allows Louisiana Department of Health – Office of Public physicians to approach a coronary blockage from Health – Bureau of Family Health awards The Gift Gretchen Penton multiple sides, using a combination of advanced designation statewide to Louisiana birthing facili- imaging, tiny coronary guide wires and refined ties who improve hospital practices and policies surgical techniques. Interventional cardiolo- that are aligned with the evidence-based, interna- gists gently steer special guide wires and cath- tionally recognized Ten Steps to Successful Breast- eters across the blockages, instead of tunneling feeding of the WHO/UNICEF Baby-Friendly Hos- through them. New technology makes fine move- pital Initiative. ment of the guide wire tip much easier to control Policy development, education of staff, patient than in the past. education and provision of discharge resources for breastfeeding mothers are key components Wack Joins Touro as Chief of the program. Financial Officer Touro has announced the appointment of Mark Penton Joins Touro as VP of John Carter, MD Wack, CPA, MBA, Senior Vice President & Chief Crescent City Physicians, Inc. Financial Officer (CFO). Touro has announced the appointment of Wack joins Touro with thirty years of business, Gretchen Penton. As Vice President of Crescent Florida and Texas. She most recently served as accounting, and administrative experience. He City Physicians, Inc., Penton oversees over fifty Assistant Vice President of Our Lady of the Lake has worked in healthcare finance administration employed physicians representing a wide variety Physician Group in Baton Rouge where she was for the past twenty years, serving at hospitals of specialties. responsible for the administrative oversight of with Health Management Associates and then She has served in various administrative posi- 100+ employed physicians and operations for with Community Health Systems post acquisition. tions within multiple hospital settings throughout their related practices.

64 NOV / DEC 2016 I Healthcare Journal of new orleans For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com

Penton’s extensive background includes physi- residents & fellows. Tulane team members who responded to the cian contracting, strategic planning and expan- Dr. Carter received his undergraduate and med- flight crew’s announcement included Carsten Pen- sion and growth of service lines while maintain- ical degrees from the University of Arizona. He nier, Nancy Minyard, Sarah Labuda, Lori Ann Wild, ing alignment between physicians, management completed a residency in otolaryngology–head and Maise-Dykes. teams and hospital administration. Penton earned and neck surgery at Tulane University, followed by The flight was re-routed back to Chicago for an her Master’s in Business Administration from Dal- a fellowship in pediatric otolaryngology at North- emergency landing, where the passenger was met las Baptist University and is a member of the western University, Ann and Robert H. Lurie Chil- at the gate by paramedics. Although Maise-Dykes American College of Healthcare Executives. dren’s Hospital, in Chicago. He is currently a pedi- never received an update on the patient’s status, atric otolaryngologist at Ochsner Medical Center, she knows her team made a difference. Hospital Offers Webcams for where he maintains a strong focus on clinical out- Parents of Neonatal Patients comes and quality-based research. STPH Ranks in the Top of Through the generosity of a gift from the St. Tam- The award was presented at the 2016 Annual Numerous Categories many Hospital Foundation, the neonatal inten- Meeting & OTO EXPO℠ of the American Acad- St. Tammany Parish Hospital is in the top 10 per- sive care unit at St. Tammany Parish Hospital now emy of Otolaryngology—Head and Neck Surgery cent of hospitals nationwide for medical excel- offers NICVIEW cameras for parents and families Foundation (AAO-HNSF) in San Diego. lence and patient safety in Overall Hospital Care with an infant in the NICU. and Overall Medical Care, according to a 2016 The web-based systems enable parents to Tulane Lakeside NICU Team report from CareChex® - a division of Comparion® securely access live video feed of their own baby Aids Passenger Mid-Flight Medical Analytics. in the hospital’s NICU. A team of five Tulane Neonatal Intensive Care Unit STPH ranked in the top for many standards of Small, wireless cameras enable parents logged nurses found themselves in the middle of a medicare, including the top 100 in the nation for Inter- securely into their account to view real-time cal drama in the air recently when a passenger fell ventional Coronary Care and number one in the images of only their baby in one specific bed. The ill onboard a flight returning to New Orleans from state for Major Bowel Procedures, both for medi- technology is password-protected and allows par- a conference in Chicago. cal excellence. ents to log in to watch streaming video of their The group of nurses, who all work at Tulane The hospital ranked in the Top 10 percent for baby on any device with an Internet connection, Lakeside Hospital for Women and Children, were medical excellence in the following categories: including a smartphone. Parents may choose to returning from the Vermont Oxford Network Neo- Nation: Overall Hospital care; Overall Medical share the password with family and friends. natal Intensive Care Unit conference when they Care; Cardiac Care; Gall Bladder Removal; Gas- STPH is one of three organizations within the boarded the flight to New Orleans. trointestinal Care; Heart Failure Treatment; Inter- Ochsner Health Network to provide these cam- Everything seemed routine until about 20 min- ventional Coronary Care; Major Bowel Procedures eras. Ochsner Baptist and Lafayette General also utes after take-off, said Crystal Maise-Dykes, Region: Overall Hospital Care; Overall Medical provide this resource for parents. Tulane’s NICU supervisor. “Suddenly, the flight Care; Cardiac Care; Gastrointestinal Care; Heart attendant asked if there were any nurses or phy- Failure Treatment; Interventional Coronary Care; Carter Presented with sicians on board, at which point our entire Tulane Major Bowel Procedures Holt Leadership Award team pressed their call lights without hesitation or State: Overall Hospital Care; Overall Medical Dr. John Carter, a pediatric otolaryngologist at discussion.” Even though there were other med- Care; Overall Surgical Care; Cardiac Care; Coro- Ochsner Hospital for Children was presented ical providers who responded, the flight crew nary Bypass Surgery; Gastrointestinal Care; Heart with the 2016 Holt Leadership Award from the deferred to the Tulane team, she said. Failure Treatment; Interventional Coronary Care; American Academy of Otolaryngology—Head The flight attendant led them to a passen- Joint Replacement; Major Bowel Procedures; and Neck Surgery (AAO-HNS) for his on-going ger complaining of chest pain and shortness of Major Neuro-Surgery; Major Orthopedic Surgery dedication to the academy and the otolaryngol- breath. The Tulane team worked quickly to com- The hospital ranked in the top 10 percent for ogy resident community. plete a physical assessment and determined patient safety in the following categories: Dr. Carter has published over 30 peer-reviewed the male passenger had suffered a heart attack. Nation: Overall Hospital Care; Overall Medical articles and book chapters, has been an Ameri- They started an IV, gave a fluid bolus, adminis- Care; Major Bowel Procedures; Vascular Surgery can Head and Neck Society research grant recipi- tered oxygen to the patient via a drop-down Region: Overall Hospital Care; Overall Medical ent, and has participated in humanitarian outreach mask, and administered aspirin provided by fel- Care; Major Bowel Procedures; Vascular Surgery programs both here and abroad. Dr. Carter has low passengers. State: Overall Hospital Care; Overall Medi- been an active Academy member over the past six “Most importantly, Carsten Pennier held the cal Care; Gastrointestinal Care; Major Bowel years. He served on several committees, helped patient’s hand and reassured him that we would Procedures to author AAO-HNS clinical practice guidelines, stay with him, and that our priority was to keep For more information about St. Tammany Par- and has held three leadership positions on the him safe until he was handed over to EMS on the ish Hospital’s awards and recognitions, visit stph. governing council for the AAO-HNS’s section for ground,” Maise-Dykes said. org/awards. n

Healthcare Journal of new orleans I NOV / DEC 2016 65 advertiser index

attorneys Tulane Lakeside Hospital for Women and Children BlueWilliams, LLP • 5 4700 S. I-10 Service Road W. 3421 Causeway Blvd. Metairie, LA 70001 Ste. 900 504.988.5263-Operator Metairie, LA 70002 504.988.5800-Appts. 504.831.4091 www.tulanehealthcare.com www.bluewilliams.com Tulane Medical Center • 25 hospice 1415 Tulane Ave. New Orleans, LA 70112 Canon Hospice • 33 504.988.5263-Operator 1761 Physicians Park Blvd, Ste. B 504.988.5800-Appts. Baton Rouge, LA 70816 www.tulanehealthcare.com 225.926.1404 www.canonhospice.com University Medical Center • 11 hospitals 2021 Perdido St. New Orleans, LA 70112 East Jefferson General 504.903.3000 Hospital • 7 www.umcno.org 4200 Houma Blvd. Metairie, LA 70006 insurance- 504.454.4000 professional www.ejgh.org LAMMICO • 3 St. Tammany Parish 1 Galleria Blvd., Suite 700 Hospital • 67 Metairie, LA 70001 1202 S. Tyler St. 800.452.2120 Covington, LA 70433 www.lammico.com 985.898.4000 www.stph.org LHA Trust Funds • 68 4646 Sherwood Common Blvd. Touro Infirmary • 2 Baton Rouge, LA 70816 1401 Foucher St. 225.272.4480 New Orleans, LA 70115 www.LHATrustFunds.com 504.897.8651 www.touro.com

66 NOV / DEC 2016 I Healthcare Journal of New Orleans