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Archive for August, 2014

“Road to Recovery” Information and Training Session

Tuesday, August 26th, 2014

August 26, 2014, Lawrenceville, Ga. For more information, visit Georgia CORE

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The Affordable Care Act

Monday, August 25th, 2014

By Helen K. Kelley

From ATLANTA Medicine, 2014, Vol. 85, No. 3 

Lisa Perry-Gilkes, M.D.

Lisa Perry-Gilkes, M.D.

The Affordable Care Act (ACA), the national health reform law passed in 2010, was enacted with the purpose of providing new funding for public health and prevention, bolstering the healthcare and public health workforce and infrastructure, and fostering innovation and quality in healthcare. Reasons for the law included a high-uninsured rate, unsustainable healthcare spending, lack of emphasis on prevention of disease, poor health outcomes and health disparities across demographic lines.

In January this year, some provisions of the ACA went into effect that will bring about major changes for physicians. In an article published on Dec. 13, 2013, U.S. News and World Report stated that doctors should prepare themselves for three major changes in how they as a profession do business: a shift from private practice to medical networks, a full integration of electronic health records and changes in the healthcare payment model.

Atlanta Medicine recently spoke to two local physicians – Dr. Lisa Perry-Gilkes, chair of the Board of Directors of the Medical Association of Atlanta and in practice with Polaris Medical Group, and Dr. Thomas E. Bat, CEO of North Atlanta Primary Care – who shared their opinions and thoughts about these changes and how the Affordable Care Act has affected the way they do business.

How has ACA affected patients’ care?

Dr. Perry-Gilkes: As of now, it hasn’t had any effect on my practice at all. The changes that go with the ACA don’t impinge on what I do currently and haven’t affected my ability to care for patients. However, I don’t know what it will be like next year.

Dr. Bat: The ACA has caused many patients to experience increased stress due to concerns about costs of premiums, access to care and ability to continue seeing their doctors, as well as general confusion about whether or not the medications they are taking are covered. These patients need to sit down with a caring physician to discuss all these issues and to “re-establish” care, even though this is time-consuming for both physician and patient. Many patients with chronic debilitating diseases are struggling with this the most.

Simply finding out which physicians and health systems accept the new exchange patients is a challenge. Some patients who previously had commercial insurance and have been “switched” to exchange plans are now finding they have to choose a primary care physician and make a visit just to get a referral to continue specialty care. This gatekeeper model has not always worked well in the past, but encouraging patients to have their own personal physician is a good thing.

Thomas E. Bat, M.D.

Thomas E. Bat, M.D.

Has the State of Georgia’s political position toward ACA made a positive or negative impact?

Dr. Perry-Gilkes: Honestly, I believe we missed out on an opportunity to have more people covered. About 60 percent of Georgia residents would have liked the Governor to go with the Affordable Care Act, but he didn’t.

The lack of providers is a real issue – in Georgia, we still have sick people who are not covered. You have to take into consideration the disparity between metro Atlanta and the rest of Georgia – there’s a big difference in the accessibility of care for people who live in or near a big city and people who live in rural areas. What the federation of medicine needs to do is try and find the happy medium between metropolitan and suburban and rural healthcare. There isn’t one shoe to fit all the problems, so it’s going to take some compromise.

It’s important that we, as physicians, let our patients and legislators know what we can do to make things better.

Dr. Bat:Our state leaders have looked at participation in the exchanges, accepting the Federal Exchange instead of building a state-based exchange. Considering all of the unclear issues and problems in the exchanges, this appears to have been a good decision. The exchanges have not functioned well, as the technology and the goals are not well defined by ACA.

The political decision to not expand Medicaid is a two-edged sword. Leaving federal money on the table that is especially needed in our rural health systems can be devastating. However, growing a payment system that does not work makes no sense. Our practice elected to start taking Medicaid again, as the government promised Medicare payment rates or parity two years ago. But the state has failed to process claims for Medicaid at the promised rates.

Medicaid patients are always a challenge due to their income, but many times they have accompanying educational and personal issues that create additional challenges. To not compensate providers for these challenges is a failed policy. Building and enlarging a failed policy will lead to a system that does not work for a greater percentage of our population. There are better ways to deal with the uninsured and poor; certainly block grants and healthcare vouchers are worth exploring.

What suggestions would you make to improve ACA?

Dr. Perry-Gilkes: I think we can find ways to improve access to healthcare. We’re going to have to come to a meeting of the minds to get all citizens of Georgia covered.

It’s not an insurmountable problem, but it’s going to take physician leaders and legislators working together to solve it. Healthcare is a “cornucopia” of challenges. If everyone would give a little, we can make a change.

Dr. Bat: I don’t think any one person can comprehend the challenges in this broad piece of legislation. A one-size-fits-all federal mentality does not work in a country as large and diverse as ours.

One of the impending parts of the ACA, referred to as the Independent Payment Advisory Board (IPAB), will be a disaster if implemented. The amount of analytics required to comply with the government’s guidelines for a Physician Quality Reporting System (PQRS) and Meaningful Use (MU) are making it virtually impossible to focus on patient care while documenting what the government requires.

Mandatory enrollment for individuals and employers has caused a great deal of grief in the political world, yet we all need insurance. Encouraging our population to participate is a much better route than mandating coverage.

How has ACA affected your business?

Dr. Perry-Gilkes: Currently, it hasn’t affected my practice except for making changes to implement the electronic health record for patients. That’s had a significant impact.

And I wish the Medicaid plans we have in Georgia now were not so difficult to work with.

Dr. Bat: I think it’s too early to tell. As we move to “at-risk” population payment models, the more we do for our chronically ill patients, the worse our physician profiles will appear in government rankings. Of course, this will affect our pay and “bonuses.” We are exploring population-focused care models that are based on both capitation and fee-for-service, with bonus pools that include insurance companies, health systems and private IPAs.

Since we are currently a PCMH [patient-centered medical home] model, we believe population health is important, but the team serves one patient at a time to maximize outcomes. The newer compensation models will challenge us, because they see the “population” outcomes as more important than the “individual” outcomes. And, of course, all of this will be based on quality criteria that is truly reflective of economic data.

What do your physician colleagues think of ACA?

Dr. Perry-Gilkes:The majority of physicians I know are so busy taking care of patients that the ACA is still in the back of their minds. Nothing has really hit us yet – we’re still taking care of patients just as we have been for the past several years.

Other than the implementation of electronic medical records for patients, I haven’t seen anyone making major changes. No one’s losing any patients, and no one’s turning any patients down, either.

I don’t think the sky is falling, but it may be dipping a little bit. Doctors will always be here, and they will always care for patients. It just may not be done exactly the same way as in the past.

As healthcare providers, we have a lot of work to do – and one of our tasks is to help align the patient’s expectations and responsibilities when it comes to care.

Dr. Bat: Most of my physician friends are overwhelmed, just taking care of their patients. A busy physician is pulled in too many directions to become very involved in the political system. Physicians are hurt by constantly being referred to as the problem that needs to be fixed. America has the greatest healthcare in the world, and the use of statistics to suggest otherwise is disingenuous.

Unfortunately, this has allowed the government and large health systems to take over and profit from the confusion. Look at the recently released Medicare payment data: physicians received 7 percent of the nearly $1 trillion Medicare budget. That 7 percent includes all the medications, chemotherapy, vaccinations and tests that they perform in their offices. Diagnostic centers, labs and hospitals collect the remaining 93 percent of healthcare dollars. Yet physicians are portrayed as the bad guys.

It’s hard to be a doctor today, but fortunately for Americans we love what we do, and we will continue to work for the betterment of our patients.

 

 

 

 

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Rheumatoid Arthritis

Monday, August 25th, 2014

By W. Hayes Wilson, M.D.

From ATLANTA Medicine, 2014, Vol. 85, No. 3 

Rheumatoid ArthritisRheumatoid Arthritis (RA) is the prototypical autoimmune arthritis. It’s a rheumatologic illness with the most immune targeted therapies.

In the late 1990s, TNF inhibitors were introduced and marked the advent of targeted biologic therapy for RA. The evolution of therapy for rheumatoid arthritis has been from symptomatic treatment to relatively unfocused disease modifying anti-rheumatic (DMARD) therapy, and presently to biologic and small molecule therapies that target particular proteins important in the inflammatory process.

As understanding of the immune process has improved, so have the tools for treatment, diagnosis and monitoring. The 1987 American College of Rheumatology (ACR) criteria uses the Rheumatoid Factor (RF) and Erythrocyte Sedimentation Rate (ESR) lab tests to help diagnose RA. The 2010 EULAR/ACR Criteria added tests for C-reactive protein (CRP) and anticitrullinated peptide /protein antibodies.

Anticitrullinated peptides/protein antibodies can be present years before the onset of arthritis, and they have been demonstrated to have a high diagnostic specificity and a high positive predictive value for RA.(1) Understanding of citrulline immunity could ultimately lead to new therapies and possibly prevention of RA.(2)

Differences in immune response to stress may help in understanding rheumatologic conditions. For instance, patients with RA have been shown to have higher stress-induced levels of IL-1b and IL-2 compared to patients with psoriasis and healthy controls.(3) It has been shown that cell immunity associated with cytomegalovirus (CMV) exposure influences the clinical response to DMARD therapy in RA. The suggestion is that changes in T-cell immunity mediated by viral persistence may affect treatment response and possibly outcomes in RA.(4)

The advent of anti-TNF therapy brought on the renaissance of rheumatology; however, anti-TNF therapy can unexpectedly trigger the onset or exacerbate multiple sclerosis (MS). This is thought to be related to the balance of regulatory T-cells (Tregs) and effector T-cells (Teffs). A better understanding these differential effects of TNF on Teffs and Tregs may lead to safer and more effective anti-TNF therapies.(5)

RA is considered to be a complex genetic disease characterized by genetic factors with environmental triggers. New insights from DNA sequence-based analysis of gut microbial communities suggest a possible role for the microbiota in the pathogenesis of RA.(6) It has been proposed that the step beyond therapy is to induce immune tolerance in the treatment of rheumatoid arthritis.(7)

More confident diagnoses and better understanding of the immune process have led to more effective therapies and allowed the opportunity to tailor therapy in such a way as to achieve low disease activity, commonly referred to as Treat to Target. Years ago we referred to our therapies as remittive; however, they were more properly Disease Modifying. Clearly, our goal is to attain 100 percent improvement; however, until we can reach that goal, we will strive for the greatest improvement.

It is clear that immune modulation can in some cases place patients in a clinical remission; however, combined therapy with biologic response modifiers has resulted in unacceptable side effects. At this juncture a combination of a conventional DMARD therapy with a Biologic Response Modifier seems to give the best opportunity to preserve joint architecture in this chronic inflammatory erosive arthritis. It is exciting to be on the cusp of real understanding and meaningful therapies for one of the most disabling medical conditions.

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Craig McCoy Joins Emory Saint Joseph’s Hospital as New CEO in September

Wednesday, August 20th, 2014

Craig McCoyCraig McCoy has been named new chief executive officer of Emory Saint Joseph’s Hospital, effective September 1. McCoy joined Emory Healthcare in May 2011 as CEO of Emory John’s Creek Hospital.

Since May 2014, McCoy has served as interim CEO of Emory Saint Joseph’s while also managing his responsibilities at Emory John’s Creek.

Under McCoy’s leadership at Emory Johns Creek, the hospital has made several improvements:

  • The construction of a new Breast Imaging Center focused on women’s imaging and composed of mammography, tomosynthesis (3-D mammography), bone density scanning, stereotactic biopsy and ultrasound.
  • The development of a new 19-chair infusion center in conjunction with the Winship Cancer Institute and Emory University Hospital Midtown.
  • Achievement of multiple quality accolades, including: Healthgrades National Patient Safety Excellence Award (2013, 2014); GHA Chairman’s Honor Roll (2011, 2012, 2013); Accredited Cancer Program with Commendation by the Commission on Cancer; Accredited Chest Pain Center with PCI through the SCPC; Accredited Vascular Ultrasound by ACR; Breast Imaging Center of Excellence by ACR; Primary Stroke Center Accreditation by The Joint Commission; ICAEL Accreditation (Echocardiography).
  • Improvements in operations and overall financial performance.

McCoy has a background working in community hospital settings. Prior to joining Emory Healthcare, he served as CEO of a hospital in Phoenix, Arizona that was part of the Vanguard Health System. Additionally, McCoy worked with Vanguard in a variety of other capacities, as well as serving as vice president of professional services at Oconee Medical Center in South Carolina.

Originally from South Carolina, McCoy holds a bachelor’s degree from Furman University and a master’s of health administration from Medical University of South Carolina/Clemson University.

 

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Georgia-Based Consortiums Awarded Millions in Grants by the National Cancer Institute

Monday, August 18th, 2014

Earlier this month, the National Cancer Institute announced that two Georgia-based consortiums have won millions of dollars in grants. The winners are formed collaborations of several institutions throughout the state that will lead NCI’s Community Oncology Research Program (NCORP) in their respective communities.

The award winners are a consortium led by Georgia Regents University Cancer Center in Augusta and a statewide partnership, named “Georgia NCORP,” made up of Atlanta’s Northside Hospital Cancer Institute, Savannah’s St. Joseph’s/Candler’s Nancy N. and J.C. Lewis Cancer and Research Pavilion, and Georgia CORE – the Center for Oncology, Research and Education. Georgia CORE’s affiliates in this endeavor are Harbin Clinic in Rome, John B. Amos Cancer Center in Columbus, Medical Center of Central Georgia in Macon and Northeast Georgia Medical Center in Gainesville. The Georgia NCORP award alone is $5.85 million over five years, providing Georgians with 110 oncology clinical providers in 41 different locations throughout the state.

GRU is working in partnership with the Morehouse School of Medicine in Atlanta, University Cancer and Blood Center in Athens, the Jiann-Ping Hsu College of Public Health at Georgia Southern University in Statesboro and DeKalb Medical in Decatur. Additionally, Memorial University Medical Center in Savannah has been awarded NCI funding through a partnership with cancer centers in South Carolina.

While the awards bring valuable resources to those organizations, the funding and recognition are a big win for the state as a whole, according to C. Michael Cassidy, President and CEO of the Georgia Research Alliance. “Our strategic investments in statewide cancer initiatives led to Georgia’s emergence as a national leader in research with an unparalleled network of leading-edge cancer centers,” said Cassidy. “GRA Distinguished Cancer Scientists were actively involved in the creation of each of these programs.”

According to NCI, the five-year grants go to institutions and organizations that will ensure the latest scientific discoveries are translated into the most effective strategies to prevent, diagnose and treat cancer. Georgia fared exceedingly well with its two designations and awards to academic and community-based cancer centers, the collective reach of which nearly covers the state.

“These national awards are a result of the state’s remarkable progress in bringing the highest quality of cancer care and clinical trials to patients in their own communities,” said Georgia CORE President and CEO Nancy M. Paris. “In fact, the number of trials available in Georgia has doubled in just the last five years, thanks to the extraordinary level of collaboration among community and academic oncologists committed to a unified, comprehensive approach to meeting the highest international standards of care and research.”

The Georgia NCORP consortium has been designated as an NCORP Community Site, one of only 34 sites awarded nationwide this year. The GRU-led consortium has been designated as a NCORP Minority/Underserved Community Site – the only one for Georgia, and one of just 12 selected nationally. Recently, Winship Cancer Institute of Emory University was named as a Lead Academic Participating Site for NCI’s new National Clinical Trials Network (NCTN), one of only thirty cancer centers to receive this designation. The NCTN will concentrate on late-phase treatment and advanced imaging trials through its relationship with NCORP.

NCORP is NCI’s national network of cancer care investigators, providers, academia, and other organizations that conduct multi-site cancer clinical trials and cancer care delivery research studies in diverse populations across the U.S. More information can be found at ncorp.cancer.gov.

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Doctor Jonathan H. Kim Joins Emory Healthcare

Wednesday, August 13th, 2014
Doctor Jonathan H. Kim

Jonathan H. Kim, M.D.

Emory Saint Joseph’s Hospital welcomes sports cardiologist Jonathan H. Kim, MD. The recently recognized sub-specialty of sports cardiology is rapidly growing worldwide.  Kim is the first sports cardiologist in the Emory Healthcare system and the only specialist in Atlanta to launch this practice, which focuses on evaluating and treating cardiovascular conditions specific to athletes of all ages and levels. According to Kim, patients include both high school and college students, professional and recreational athletes, as well as older and master athletes competing in various sports and athletic activities.

“This practice is dedicated to managing cardiovascular disease in athletes while also improving their preventative cardiac care,” says Kim about the individualized care he provides.  “To that extent, we offer a range of services and suggest the most appropriate treatment options to help athletes stay active in sports if at all possible,” The newly established program includes these services for athletes:

  • Pre-participation cardiac evaluation and screening for competitive athletes at all levels from high school and beyond;
  • Clearance for athletic participation after cardiac procedures/surgery or other previous limitations;
  • Evaluation and treatment for cardiac related symptoms (examples include chest pain, shortness of breath, dizziness, palpitations, fainting) and issues in athletic patients while training or competing in various sporting disciplines;
  • Evaluation of impairment in athletic performance due to cardiovascular causes or medications;
  • Establishing preventative cardiac care and providing comprehensive cardiovascular screening;
  • Focused treatment for patients with cardiovascular disease who continue to exercise and engage in athletic activities; and
  • Focused cardiovascular assessments for older patients interested in participating in ultra-endurance events such as marathons or triathlons

“We recognize that athletes are simply different compared to the general population from a cardiac perspective.  Symptoms, such as chest pain, may mean something very different compared to chest pain in a non-athlete.  Intense exercise also causes normal changes in the heart and because of this, strategies for treating heart conditions in athletes may be different or altered,” Kim says.  “Certain cardiac treatments or medications may be standard for the general population, but may have side effects that limit athletic performance or even preclude athletics if utilized,” he added.

Kim says that one critically important task of the sports cardiologist is to identify athletes at risk for sudden cardiac arrest.  “In a minority of athletes, exercise actually increases the risk of precipitating a cardiac arrest. This is because there are some cardiac conditions that can be present, but without symptoms.  Although rare, in some cases, exercise can actually increase the chance of a cardiac arrest.  Our job is to help identify these athletes before they are allowed to compete.  Additionally, we want to limit unnecessary testing and stress on athletes who are incorrectly identified as potentially having cardiac disease.”

Kim’s role as a sports cardiologist includes a significant research focus within exercise physiology and sports cardiology.  His sports cardiology research background is diverse and he has published work ranging from the effects of exercise on the heart’s structure and function to a current project that is evaluating blood pressure changes in football players.  He has also published work evaluating sudden cardiac arrests in long distance running races, which was published in the New England Journal of Medicine in 2012.

Clinically, Kim also works with the Atlanta Falcons, as well as college athletes from the Georgia Institute of Technology and Emory.  He is the Team Cardiologist for Georgia Tech Sports Medicine and also conducts a majority of his research with the Sports Medicine staff at Georgia Tech.  Kim is also one of the assistant medical directors for the annual Peachtree Road Race™ in Atlanta.

Kim is an Assistant Professor in the Division of Cardiology at Emory University.  He received his Bachelor of Science in Biology at Emory University.  A Fulbright Scholar, Kim earned his medical degree from the Vanderbilt University School of Medicine.  He completed his internship and residency in internal medicine and pediatrics at the Massachusetts General Hospital/Harvard University, followed by a fellowship in general cardiology at Emory University.  In addition to his clinic and research interests, Kim serves as an adjunct assistant professor in the Division of Applied Physiology at the Georgia Institute of Technology.

 

 

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DeKalb Medical Welcomes Doctor Nathan A. Jové

Wednesday, August 13th, 2014

DeKalb Medical recently welcomed Nathan A. Jove, M.D., a third generation orthopedic surgeon, to its surgical team. Dr. Jove has followed in the footsteps of his grandfather, Dr. Julio Jove, and his father, Dr. Maurice Jove.

Dr. Jove earned his undergraduate degree in chemistry from Emory University. He received his medical degree from Temple University School of Medicine in Philadelphia, Pennsylvania. Dr. Jove then trained at the Detroit Medical Center where he worked for a significant portion of his training at Detroit Receiving Hospital – the largest trauma center in Detroit. Dr. Jove trained with physicians who took care of the Detroit Tigers, Detroit Pistons and Detroit Red Wings.

Dr. Jove has presented his research all over the country, including a prestigious opportunity for an oral presentation at the American Academy of Orthopaedic Surgeons Annual Conference in March 2013. He was given the honor of Chief Resident for his program throughout his final year of residency.

 

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Medical Association of Atlanta Board Retreat

Friday, August 8th, 2014

August 8-10, 2014

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