THE BULLETIN

A PUBLICATION OF THE MUSCOGEE COUNTY MEDICAL SOCIETY

ERUDIRE ET DELECTARE

V O L U M E 5 8 • N U M B E R 9

SEPTEMBER 2013

2300 Manchester Expressway, Woodruff Pavilion, Suite 101A | Columbus, Georgia

706-322-6646 | www.sfhorthopaedics.com

Expertise inTreatments ofthe Hand

Welcome Dr. Sean A. Blake

Orthopaedic Institute

Sean A. Blake, DO

Dr. Blake is now available to see patients at this location:

The St. Francis Orthopaedic Institute is pleased to welcome Sean A. Blake, DO, DPT, to our community. Dr. Blake, a board-eligibleorthopaedic surgeon, brings additional training and expertise specializingin the treatment of the hand. He earned his medical degree from theOhio University College of Osteopathic Medicine in Athens, Ohio andhis Doctor of Physical Therapy degree at Slippery Rock University,Slippery Rock, Pennsylvania. Additionally, Dr. Blake completed his residency at the Ohio University College of Osteopathic Medicine inWarren, Ohio and a hand surgery fellowship at the University at BuffaloOrthopaedics in Buffalo, New York. With the addition of Dr. Blake, St. Francis Orthopaedic Institute continues to ensure the highest quality of care possible in orthopaedic surgery, joint replacement andsports medicine.

PAID ADVERTISEMENT

3

THE BULLETINSociety Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904

706-322-1254 • FAX 706-327-7480 • www.muscogeemedical.org

C o n t e n t sPresident’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Hospital News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 13

Editor: David H. Levine, M.D. • Associate Editor: Casey Geringer, D.O.Managing Editor: Lisa Venable

Officers 2013:

President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James D. Majors, M.D.

Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ashish K. Jain, M.D.

Secretary-Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William Frank Willett, III, M.D.

Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fred Flandry, M.D.

Alternate Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W. Frank Willett, III, M.D.

Executive Committee: Glenn E. Fussell, Ashish K. Jain, David H. Levine, Raj Alappan, FrederickFlandry, Larry E. Brightwell, Edmund M. Molnar, Jr., William Frank Willett, III, James D. Majors, RyanGeringer, Kurt Jacobson

Delegates: Michael Borkat, MD, Frederick Flandry, MD, Glenn E. Fussell, MD, Ryan Geringer, DO,James Hagler, MD, James D. Majors, MD, Vincent Naman, MD, Folarin Olubowale, MD, TimothyVillegas, MD, W. Frank Willett, MD, Joseph Zanga, MD

Alternate Delegates: Larry Brightwell, MD, Casey Geringer, DO, A. J. Jain, MD, Norman Luton, MD,Henry Ngo, MD, Mac Molnar, Jr., MD

Ad position is at the sole discretion of the Editorial Board.

Members are urged to submit articles for publication in The Bulletin. Deadline for copy is the 11th of the month preceding date of issue.The Bulletin of the Muscogee County Medical Society is the official monthly publication of the Muscogee County Medical Society, 2300Manchester Expressway, Suite F-7, Columbus, GA 31904. All material for publication should be sent to the Managing Editor not laterthan the 11th of the month. Advertising requirements and rates upon request. Opinions expressed in The Bulletin, including editorials,are those of the individual authors and do not necessarily reflect policies of the Society unless stated. Advertisements in this magazinedo not necessarily represent endorsement or support by the Muscogee County Medical Society.

In November 2011, new rules and guidelines were proposedand subsequently enacted regarding the treatment of chronicpain for a period of greater than ninety days. This was inresponse to the proliferation of narcotic prescriptions havingtripled in the State of Georgia after two events had occurred.The more onerous event was the crackdown on the “PainClinics” along the Interstate highways in the state of Florida.The more subtle event was the withdrawal of Darvocet fromthe marketplace by the FDA.

Included in Rule 360-3 were several provisions that radically changed the treatmentof chronic pain. “Pain Clinics” were more clearly defined and had new regulations tofollow. Other practitioners had new rules to enact that included visits every 90 days,pain contracts or agreements, monitoring via periodic hair or urine drug screens.We now have to maintain records on the drug screens for a period of ten years.These changes to care were onerous and radical. But the intent was to provide toolsso the practioner could better manage chronic pain, by reducing abuse anddiversion. Diversion had become a major problem in our state.

On July 31, the Georgia Composite Medical Board notified us that the GeorgiaPrescription Drug Marketing Program (PDMP) was available for registration andqueries. We have been waiting for nearly a decade for such a tool. The followingtwo paragraphs are from their notice.

Georgia prescribers will be able to use the GA PDMP to determine where (whichpharmacies) their patients are having their controlled substance prescriptionsfilled, and if their patients have been obtaining controlled substance prescriptionsfrom other physicians and where those prescriptions have been filled. Two otherPDMP function will allow prescribers to see a listing of how many controlledsubstance prescriptions have been filled as having been written in the name of thatprescriber. A similar function will allow a prescriber to see how many controlledsubstance prescriptions have been filling using their DEA permit number.

Even though prescribers have just gained access to the PDMP, communitypharmacies have been reporting prescription data to the PDMP since mid-May.Even then they were required to report their controlled substance prescriptiondata starting with prescriptions filled on September 1, 2012. The number havesteadily climbed after the bugs were worked out to close to 15 millionprescriptions from January 2013 through June. In June alone, 3 millioncontrolled substance prescriptions were reported as being filled.

I registered and within two days I was able to query the Georgia Prescription DrugMarketing Program (PDMP). The first patient I queried was a middle class female

P R E S I D E N T ’ S M E S S A G EGlenn E. Fussell, M.D.

4

Mike SeeFully Licensed GA/AL Realtor

706-315-5289 (CELL) • mikesee@coldwellbanker.com.5670 Whitesville Road • Columbus, GA 31904

www.kpdk.com

PAID ADVERTISEMENT

5

with a truly sad story of having chronic pain from a neurological condition. Sheseemed to be honest with me, signed a pain agreement, passed her drug screeningand kept regular follow-up visits as requested. What I discovered was astonishing.She was being seen by 3 pain doctors. She was also being seen by six primary carephysicians. I’m pretty sure she had signed a medication agreement in each ofthose nine provider’s office. Each prescribing physician was assigned to a uniqueindependent pharmacy. Year to date, she had received 3323 Hydrocodone 10 mgtablets, averaging 17 tablets per day. She obviously wasn’t taking that many as herlevel of function was good enough to do this complex task without making errors.This is highly suspicious for diversion.

Having made that astonishing discovery, I proceeded to check out a few more whoI suspected may have not been totally honest with me. One case is a lady who liveshere and splits time between Ohio and Florida. I discovered that she had beenhonest with me. I was able to verify where she had filled prescriptions in Georgia,Ohio, and Florida. But the quantities and timing were appropriate. In this case, itprovided objective data that the patient was being responsible and honest withher prescriptions.

I looked up another patient that I had dismissed for abuse or diversion. He haddoctors in Columbus, Albany, and Fitzgerald Georgia. He had major pathology thatjustified the use of chronic narcotics, but not at the quantities he was being prescribed.

Chronic Pain is a two edged sword. On one hand we should attempt to adequatelycontrol pain and improve function. On the other hand, we are vulnerable todishonesty from a few operators who abuse or divert narcotics. We now have atool that we have been waiting on for several years.

So I encourage you to take the time to access the Georgia Prescription DrugMarketing Program (PDMP). Don’t wait any longer. This tool will help in themanagement of pain. Access the GA PDMP website at: www.hidinc.com/gapdmp.

6

A R T I C L E O F I N T E R E S T

Asthma - A Potential New Therapy for Moderate to Severe Patients

Asthma is currently treated as a “one size fits all” disease. Therapy starts with analbuterol inhaler, then a long acting B-agonist, leukotrienes and/or inhaledsteroids are added as needed. Methylxanthines, antihistamines, Cromolyn andallergy testing /immunotherapy are added usually with only moderate success.Finally, for severe asthma oral steroids are administered. Those with severedisease (5-10% of all asthmatics) account for most of the treatment spending.This is due to the costs of medications, tests, office visits, hospitalization (whichis 15 times more likely), lost work (which is 20 times more likely) and is due toincreased infections, medication side effects and the limited activity whichaccompany exacerbations.

The pathogenesis of asthma has been shown to be a “chronic inflammatorydisorder of the airways in which many cells and cellular elements play a role; inparticular, mast cells, eosinophils, T lymphocytes, neutrophils, and epithelialcells. In susceptible individuals, this inflammation causes recurrent episodes ofwheezing, breathlessness, chest tightness, and cough, particularly at night and inthe early morning. These episodes are usually associated with widespread butvariable airflow obstruction that is often reversible either spontaneously or withtreatment. The inflammation also causes an associated increase in the existingbronchial hyperresponsiveness to a variety of stimuli (NHLBI 1997).”

When T helper type 2 (Th2) inflammation is initiated it produces interleukins(IL) 4 and 13 causing the inflammatory cascade to produce bronchospasm,bronchial lumen mucus, hyperplasia and hypertrophy of the bronchial smoothmuscle and goblet cell hyperplasia. For individualized care, biomarkers haveproven very helpful in many therapeutic modalities. Asthma is no different.Exhaled nitric oxide has shown promise as a marker of inflammation, but also theprotein periostin in venous blood has shown great correlation with the degree ofinflammation as well as being predictive of a greater likelihood of response to anew therapeutic approach.

A new therapeutic approach to disease treatment is to design monoclonalantibodies to specific targets altering the disease pathway. This has been donefor asthma. Blocking IL 13 has been successful in treating asthma in animalmodels and early clinical trials. Periostin has been predictive of who wouldrespond to the monoclonal antibody that has been developed (Lebrikizumab).We currently are enrolling moderate to severe asthmatics (those with an ACQ-5score > 1.5 and any night time awakenings or use of rescue medications more

David C Subich, MD, CPI, Medical Director - Columbus Regional ResearchInstitute (formerly Southeast Regional Research Group)

7

than twice a week or any symptoms two times a week or interference with dailyactivities) in a study where a new monoclonal antibody has shown great promisein decreasing symptoms in those with elevated periostin as a part of theirinflammatory response. The monoclonal antibody (Lebrikizumab) isadministered subcutaneously in the abdomen every four week over a 52 weekperiod. The effects on exhaled nitric oxide and periostin will be followed.Response rates will then be explored with asthmatics with high, intermediate andlow periostin levels at the start of therapy. If the initial study findings areconfirmed, a simple blood test may help predict which patients with asthma willrespond to this treatment, potentially reducing their morbidity and potentialmortality. We would welcome any questions related to this or any of the othertrials we are currently conducting, as well as the opportunity to assist you inpresenting these opportunities to your patients.

8PAID ADVERTISEMENT

RestaurantBy Chef Jamie Keat ing, CEC

Private Dining Available for Small Events1201 Front Avenue, Suite E • Columbus, Georgia

706-507-9909 • www.epicuisine.com

PAID ADVERTISEMENT

St. Francis OB/GYN Physician Partners Welcomes Dr. George Jeryl Everidge St. Francis OB/GYN Physician Partners will welcome George Jeryl Everidge, MD,in September. Originally from Macon, Dr. Everidge brings 35 years of OB/GYNexperience, having practiced obstetrics and gynecology in Columbus since 1978.He was previously chief of obstetrics and gynecology at Doctors Hospital. Aftergraduating from the University of Georgia, Dr. Everidge earned his medicaldegree from the Medical College of Georgia in Augusta, Ga. Then, he completedan internship and residency in obstetrics and gynecology at the Naval RegionalMedical Center in Portsmouth, Va. He is board-certified by the American Collegeof OB/GYN and is a member of the Muscogee County Medical Society, SouthernMedical Society, Georgia Obstetrical Society and the American College ofOB/GYN. Dr. Everidge’s office will be located in St. Francis’ new Butler Pavilion,Suite A002, at 2300 Manchester Expressway on the hospital’s main campus. Formore information or to refer a patient, call 706-324-1069.

Center for Breast Health First in Georgia to Offer Automated Breast UltrasoundThe St. Francis Center for Breast Health is the first facility in Georgia to offerAutomated Breast Ultrasound (ABUS). ABUS offers more detailed imaging fordetecting breast cancer in women with dense breast tissue. Forty percent ofwomen have dense breasts, and cancer is four to six times more likely to occurin these women. Cancer in women with dense breast tissue can be difficult todetect with mammography alone. The Center for Breast Health is accredited bythe American College of Radiology. It is staffed by an experienced team of board-certified physicians, registered mammographers, sonographers and a certifiedbreast patient navigator. For more information or to refer a patient,call 706-257-7700.

St. Francis Offering Free Web-based SeeMyRadiology Software for Image SharingSt. Francis Hospital recently installed Web-based software called SeeMyRadiology,an online community for sharing medical images (radiology, cardiology, scannedreports, JPG, etc.) among hospitals, imaging centers, physicians and patients andis offering this service free to physicians. St. Francis SeeMyRadiology is a secure,HIPAA-compliant cloud computing solution with sophisticated encryption andcompression that allows image sharing, routing, viewing and archiving. Medicalimages can be uploaded with the ease of a photo sharing site, eliminating theneed for CDs or DVDs. Users at subscribing facilities or any off-site location canupload exams/images from a PACS or portable digital media from the St. FrancisSeeMyRadiology Web site. Authorized physicians can then logon to view anexam/image in seconds using a Web browser or a free app from Apple iTunes foriPads or iPhones. The system provides real-time tools for collaboration amonghealth care providers. Its benefits are:

9

S T. F R A N C I S H O S P I T A L N E W S

• Immediate, on-the-fly image transmission of admissions to St. Francis and transfers to the Emergency Department

• Ability to share, store and access images quickly and easily from anywhere• Web-based viewing tools accessible from PCs and mobile devices• Elimination of duplicate exams and unnecessary radiation exposure

For more information or to activate your free SeeMyRadiology account, contactJeanie Adams, RIS/PACS administrator, at 706-320-2769 or viaadamsje@sfhga.com. Be sure to include your first and last name, email addressand NPI number. Once SeeMyRadiology has verified your information, you willreceive an email to activate your account, log-in and begin viewing images.

Dr. Kemisha Key to Join St. Francis Hospitalist Team September 3 Kemisha Key, MD, will join St. Francis’ hospitalist team September 3. Dr. Keyearned master’s degree in public health policy and management from EmoryUniversity in Atlanta, Ga., and her medical degree from Wayne State UniversitySchool of Medicine in Detroit, Mich. She completed an internal medicineresidency at the University of Illinois at Chicago/Advocate Christ Medical Centerin Oak Lawn, Ill. Dr. Key has conducted research in “Rest Cerebral Oxygenationas a Biomarker in Heart Failure Patients.” She has presented on the “Safety andPrognostic Value of Cerebral Oximetry Monitoring in Heart Failure PatientsDuring Cardiopulmonary Exercise” and on “Severe Diabetic Ketoacidosis andPancreatitis Associated with Aripiprazole.” Dr. Key is a member of the AmericanMedical Association and an associate of the American College of Physicians.

Four Physicians Join St. Francis Emergency DepartmentFour new physicians joined St. Francis’ Emergency Department in August andSeptember. They are Keith Anthony Blanks, DO; Eric Ragan, MD; Frank Saucier,MD; James B. Thomas, MD.

Dr. Blanks earned his doctor of osteopathic medicine degree from WesternUniversity of Health Sciences in Pomona, Calif. He completed a residency infamily practice at The Medical Center in Columbus, Ga. Dr. Blanks is board-certified by the American Board of Family Medicine and is a member ofColumbus/Fort Benning Medical Association. Previously, he was a staff physicianin The Medical Center’s Emergency Department and was the medical director ofDoctor’s Hospital’s Emergency Department.

Dr. Ragan earned his medical degree from the Morehouse School of Medicine inAtlanta, Ga. He completed a residency in family practice at the Floyd MedicalCenter in Rome, Ga. He served as deputy chief at Camp Casey U.S. Army Clinic inthe Republic of Korea and as a senior medical officer during Operation IraqiFreedom. Previously, he previously worked in the Emergency Department andTrauma Center at the Columbus Regional Medical Center. He is board-certified infamily medicine by the American Board of Family Medicine.

Dr. Saucier earned his medical degree from the Medical College of Georgia inAugusta, Ga. He completed a family medicine residency at The Medical Center in

10

11

Columbus, Ga. He was previously a staff physician in the Emergency Departmentat Columbus Regional Hospital. Dr. Saucier is board-certified by the AmericanBoard of Family Practice and National Board of Examiners

Dr. Thomas received his medical degree from the Kirksville College of OsteopathicMedicine in Kirksville, Mo. He completed internships at the University of AlabamaBirmingham, in Birmingham, Ala. and at The Medical Center in Columbus, Ga. Healso completed a residency in family practice at The Medical Center. Dr. Thomasis board-certified in emergency medicine by the American Board of Family Practiceand the American Association of Physician Specialists. Previously, he previouslyworked as an emergency physician at The Medical Center. He is a member ofAmerican Association of Physician Specialists Medical, Association State ofAlabama and Montgomery County Medical Association.

St. Francis Orthopaedic Institute Welcomes New Shoulder FellowsThe St. Francis Orthopaedic Institute welcomes Dr. Parthiv Patel and Dr. DomenicScalamogna. The two began their fellowship training in shoulder and elbowsurgery and rehabilitation under George McCluskey III, MD on August 1. Thetraining will focus on arthroscopy, joint replacement, complex reconstruction andtrauma surgery. Dr. Patel earned his doctor of osteopathic medicine from theMidwestern University in Downers Grove, IL. He completed an internship andresidency at Midwestern University in Chicago Heights, IL. Dr. Patel is a memberof the American Osteopathic Academy of Orthopedics, the American Academy ofOrthopaedic Surgeons, among others. Dr. Scalamogna earned his medical degreeat the University of Pittsburgh in Pittsburgh, PA. He completed an internship andresidency in orthopaedic surgery at National Naval Medical Center in Bethesda,MD. He received the Navy and Marine Corps Commendation Medal andAchievement Medal. Dr. Scalamogna is a member of the American Academy ofOrthopaedic Surgeons and the Association Medicale Internationale De Notre-Dame De Lourdes.

September Educational OpportunitiesSt. Francis will offer these educational opportunities in September:Cancer Conference: Wednesday, September 18, 12:30-1:30 p.m., St. FrancisHospital Concourse East Classroom. Lunch will be provided. A reservation is notrequired. For more information, contact Ruby Gladney at 706-660-6096 orgladneyr@sfhga.com.Chest Conference: Tuesday, September 19, 6 p.m., Boardroom. Dinner will beprovided. call Deana Berger at 706-320-2701 two weeks in advance with thenames of cases that you would like to present. Breast Cancer Conference: Friday, September 20, 7-8 a.m., St. Francis HospitalConcourse East Classroom. Breakfast will be provided. A reservation is notrequired. For more information, contact Ruby Gladney at 706-660-6096 orgladneyr@sfhga.com.

St. Francis Hospital is accredited by the Medical Association of Georgia to providecontinuing medical education for physicians. St. Francis Hospital designates this live activityfor a maximum number of 1 AMA PRA Category 1 Credit™. Physicians should claim only thecredit commensurate with the extent of their participation in the activity.

12

PAID ADVERTISEMENT

PAID ADVERTISEMENT

2821 Harley Court, Suite 300Columbus, GA 31909

(706) 576-4900

13

Senior Leadership Changes Announced The following changes in our senior leadership team at Columbus RegionalHealthcare System were recently announced. Tamara (Tami) Jackson, MSN,FACHE, Chief Executive Officer (CEO) for Doctors Hospital, became CEO ofHughston Hospital in addition to her current role as CEO of Doctors Hospital,effective July 15. Since joining Columbus Regional Healthcare System in April,Mrs. Jackson has led Doctors Hospital forward by establishing trust-basedworking relationships with the employees and members of the Medical Staff. Shewill bring the same dedication and commitment to her new role atHughston Hospital.

At the same time, a shining star was brought back to Hughston Hospital asMichelle Breitfelder, RN, MSN, FACHE, CIC, returns as Vice President and ChiefNursing Officer (CNO). In addition to Mrs. Breitfelder’s role as CNO forHughston Hospital, she will continue to lead the Crimson project and clinicaltransformation initiatives across the entire Healthcare System as she has for thepast eight months. Given Mrs. Breitfelder’s well-established workingrelationships with the physicians and staff at Hughston Hospital, and her strongcommitment to teamwork, she will help Mrs. Jackson lead new programdevelopments and existing program enhancements at Hughston Hospital.

Regina Blount, BSN, MS, a long-time trusted adviser to physicians working atDoctors Hospital and the current Director of Surgical Services at DoctorsHospital, is being promoted to the position of Vice President and Chief NursingOfficer (CNO) for Doctors Hospital. Ms. Blount, like Mrs. Breitfelder, will assistMrs. Jackson in leading new program developments and existing programenhancements at Doctors Hospital. The consolidation of two CEO positions (i.e.Doctors Hospital and Hughston Hospital) into one position in addition to theelimination of the corporate office position most recently held by Mrs. Breitfelderwill reduce operating expenses without affecting either patient care or ourcommitment to the physicians and staff who work at both Doctors Hospital andHughston Hospital.

Welcome to Our New Board MembersThe Columbus Regional Medical Foundation board of directors recentlywelcomed the following new members: John T. Hargrove, Principal, H & HConsulting Group; Dr. Charles Stamey, retired physician; Stacy Faison, SeniorBusiness Banking Relationship Manager, Certus Bank; Travis F. Wade, VicePresident, Synovus Securities; Wanda Amos, owner, Columbus Cottonmouths;Kim Wright, community leader; and Beth Parsons, Columbus Regional Auxiliary.No new appointments were made to the Columbus Regional Healthcare Systemboard of directors. The business and community leaders who serve on our boardsin a voluntary capacity devote countless hours to help Columbus Regional fulfillits mission of service to the region. Their dedicated service is greatly appreciated.

C O L U M B U S R E G I O N A L H E A L T H C A R E N E W S

14

PAID ADVERTISEMENT

15

Columbus Regional Healthcare System Joins Statewide Healthcare AllianceColumbus Regional Healthcare System has joined other hospital and health systemCEOs from central and South Georgia to participate in a newly formed alliancewhich creates what is believed to be one of the nation’s largest collaborations ofhospitals, health care systems and physicians aligned to develop a clinically-integrated network. The alliance, called Stratus Healthcare, consists of 23 hospitalsand approximately 1,500 physicians. Stratus, a non-equity partnership at theoutset, expects to form a non-profit limited liability corporation, pooling bothhuman capital and financial resources to meet its mission and vision. Theinstitutional members of Stratus Healthcare will work together in a formalizedpartnership to exchange best practices, coordinate resources, develop connectedinformation systems, and manage the health of populations. As a foundingmember of the Alliance, Columbus Regional Healthcare System’s three hospitals –Doctors Hospital, Hughston Hospital and The Medical Center – will take advantageof the envisioned benefits to be derived from collaboration but will remainindependent as a locally governed and locally operated health care system.

‘Stratus’ was chosen as the name because of the upward inference of the word andthe alliance’s goal to strive for excellence. “The collaborative wants to elevatehealth care to a higher level,” said William T. Richardson, CEO for Tift HealthSystem. “We wanted an organizational title that reflects our mission to enhance thehealth and wellness of our patients by delivering exceptional care through aconnected community of physicians, hospitals and shared services. Each Stratuspartner wants to add value for patients and create scale, yet realizes it could beaccomplished much easier through a coordinated effort with other health careorganizations. Columbus Regional Healthcare System is an important health careleader within the region, and having them as a Stratus partner is significant.”

Joining the Stratus Healthcare alliance makes sense for us at Columbus Regional aswe continue our journey of becoming more clinically integrated. By sharing bestpractices and securing high-speed clinical record sharing across the alliance, wehope to lower the cost of health care and improve efficiencies. Furthermore, thework that will be done by the alliance in developing education programs andcoordinating care should also benefit our health care system since we are aregional referral center and many of these hospitals are natural partners for us tooffer our specialized services and skills with, whether by telemedicine or throughon-site program development. Stratus Healthcare will consist of the followingmember hospitals:

Bleckley Memorial Hospital (Cochran) Central Georgia Health System

- Medical Center of Central Georgia (Macon)- Central Georgia Rehabilitation Hospital (Macon)- Medical Center of Peach County (Byron)

Coffee Regional Medical Center (Douglas)Columbus Regional Healthcare System

- The Medical Center (Columbus)- Doctors Hospital (Columbus)- Hughston Hospital (Columbus)

16

Crisp Regional Hospital (Cordele) Dodge County Hospital (Eastman) Houston Healthcare

- Houston Medical Center (Warner Robins)- Perry Hospital (Perry)

Jasper Memorial Hospital (Monticello) Oconee Regional Medical Center (Milledgeville) Putnam General Hospital (Eatonton) South Georgia Medical Center Health System

- South Georgia Medical Center (Valdosta)- Smith Northview Hospital (Valdosta)- Louis Smith Memorial Hospital (Lakeland)- Clinch Memorial Hospital (Homerville)- SGMC-Berrien Campus (Nashville)

Taylor Regional Hospital (Hawkinsville) Tift Regional Health System

- Tift Regional Medical Center (Tifton) - Cook Medical Center (Adel)

THE MEDICAL CENTERNew O-Arm Purchased at The Medical CenterThe Medical Center has purchased a state-of-the-art O-Arm with both spine andcranial applications for use in its neurosurgery program. This sophisticatedtechnology is considered the gold standard for neurosurgery. It allowsneurosurgeons to obtain visualization of spinal anatomy allowing for increasinglyaccurate placement of spinal implants. The O-arm Imaging System providescomplete multi-dimensional surgical imaging. It is the only approved platform thatprovides surgeons with real-time, 3-D images, as well as multi-plane, 2-D andfluoroscopic imaging. Initially intended for use primarily in complex orthopedicsurgical procedures, the new navigation system incorporated into the O-armImaging System is designed to expand to additional surgical applications such asimage-guided cranial surgery. We are committed to continued programmaticenhancement in our services and are pleased to add this new dimension to thecomprehensive neurologic care provided at The Medical Center through theNeuroscience Center at The Medical Center. A diverse and expert team includes24-hour neurosurgery coverage and an in-house neurologist.

Ethics Conference to Address “Our Legacy in Health Care”Paul J. Voss, Ph.D., president and founder of Ethikos and Georgia State Universityprofessor, will be the Ethics Conference speaker on Thursday, Sept. 26, at theColumbus Regional Conference Center at The Medical Center. Physicians are invitedto the 12:30-1:30 p.m. luncheon presentation entitled “That Michelangelo Moment:Our Legacy in Health Care.” This presentation will combine classical wisdom withmodern-day business realities to help physicians better appreciate trends and howto place them within an historical context. A presentation open to all staff entitled“The Culture of Excellence and the Excellence of Culture” will be held from 11 a.m.to 12 noon and repeated from 2 to 3 p.m. This presentation will provide concreteand specific tools for helping individuals enhance their understanding of career

17

development and collaboration. The conference is sponsored by ColumbusRegional Healthcare System Ethics Committee. For reservations, please callRev. Dr. Michael Stewart, director of Pastoral Services, at 706-571-1795.

Physicians Graduate from Residency ProgramSeventeen physicians were recognized during the 38th Graduation Exercises ofthe Family Medicine Residency Program at The Medical Center on June 28.Several awards were presented to the 12 Family Medicine residents who spentthree years training on our campuses. Five physicians received internshipcompletion certificates through the Transitional Year Program. Dr. HowardVigrass, founding Director of the Family Medicine Residency Program, presentedDr. Audrea Vaughan with the Howard Vigrass M.D. Resident of the Year Award.

Parent Advisory Council for NICU Recognized NationallyThe Parent Advisory Council at The Medical Center has received an ExtraordinaryProgram Award from the Association for Healthcare Volunteer ResourceProfessionals of the American Hospital Association. The Parent Advisory Council,which seeks to support Neonatal Intensive Care Unit families and staff at TheMedical Center, received an award earlier this year from the Georgia HospitalAssociation’s Society of Directors of Volunteer Services.

CME Opportunities Offered for PhysiciansEach of the following Continuing Medical Education (CME) opportunities forphysicians has been approved for one hour of CME credit:Pediatric Grand Rounds: Every Thursday, 8:15 a.m., Columbus RegionalConference Center at The Medical Center. Open to any physician or other healthprofessional providing care for children. For more information, call MargaretCaldwell at 706-571-1220. Cancer Conference: Every Monday, 12:30 p.m., Conference Room at the John B.Amos Cancer Center, except for first Monday which is held at Columbus RegionalConference Center at The Medical Center. (Approved as a series.) For moreinformation, call David Fletcher at 706-571-1102.

The Medical Center is accredited by the Medical Association of Georgia to providecontinuing medical education for physicians. The Medical Center designates thislive activity for a maximum of 1 AMA PRA Category 1 Credit TM. Physicians shouldclaim only the credit commensurate with the extent of their participation inthe activity.

M C M S N E W S

18

Muscogee County Medical SocietyUpcoming Events

SEPTEMBER 2013MCMS Beer Tasting

Sponsored by

SunTrust Bank Private Wealth Management

Thursday, September 19th

6:30-8:30 p.m.

Chattahoochee River Club

Space is limited!

Please respond to: lisavenable@muscogeemedical.org

Practice Change Address:

Sylvester McRae, M.D.

2300 Manchester Expressway, Butler Pavilion, Suite A002

Columbus, GA 31904 (Phone: 706-576-4648 same)

Practice Change Address:

G. Jeryl Everidge, M.D. will move on September 6th

2300 Manchester Expressway, Butler Pavilion, Suite A002

Columbus, GA 31904 (Phone: 706-323-9047 same)

Practice Change Phone:

St. Francis Cardiovascular Surgery

Belk Brooks, M.D. and Kerry Paape, M.D.

706-596-4170

W E L C O M E N E W M E M B E R S

We welcome our new members to the Muscogee County Medical Society:

David C. Subich, M.D., graduated from the Medical collegeof Ohio. He completed his residency in InternalMedicine at Cleveland Clinic Foundation, Cleveland, OH.He is a Certified Physician Investigator with 25 years ofresearch experience. Dr. Subich serves as Medical Directorfor Columbus Regional Research Institute. His office phoneis 706-321-0489 Welcome Dr. Subich to the MuscogeeCounty Medical Society!

NEW RESIDENT MEMBERS

Monica Bui, D.O., is currently a PGY-I Family MedicineResident at The Medical Center in the Family MedicineResidency Program. Dr. Bui is a graduate of PhiladelphiaCollege of Osteopathic Medicine, Georgia Campus. She isslated to complete residency training June 30, 2016. Herpost-residency plans are undetermined at this time.

Dean P. Cardi, D.O., is currently a Martin Army FamilyMedicine Resident at Martin Army Community HospitalProgram. He is a graduate of Lake Erie College ofOsteopathic Medicine, Erie, PA. He is scheduled to completeresidency training in June 2014. Afterwards, he plans to be aFlight Surgeon at Ft. Irwin, CA, while fulfilling his obligationto the U.S. Army.

Mariha N. Feliciano, M.D., is currently a PGY-I FamilyMedicine Resident at The Medical Center in the FamilyMedicine Residency Program. Dr. Feliciano is a graduate ofRoss University School of Medicine, West Indies. She isslated to complete residency training June 30, 2016. Herpost-residency plans are undetermined at this time, but shewould like to stay in Georgia.

19

Michelle C. Forrester, M.D., is currently a PGY-I FamilyMedicine Resident at The Medical Center in the FamilyMedicine Residency Program. Dr. Forrester is a graduate ofMedical College of Georgia. She is slated to completeresidency training June 30, 2016. Her post-residency plans areundetermined at this time.

Jason S. Frederick, M.D., is currently a Transitional YearResident at The Medical Center in the Transitional YearResidency Program. He is a graduate of the Ross University,West Indies. He is scheduled to complete training on June 30,2014 and then plans to complete residency in PhysicalMedicine and Rehabilitation.

FNU Geetanjali, M.D., is currently a PGY-I Family MedicineResident at The Medical Center in the Family MedicineResidency Program. She is a graduate of Jawaharlal NehruMedical College, Ajmer, India. She is scheduled to completeresidency training on June 30, 2016 and her post–residencyplans are not determined at this time.

Thaddeus M. Pajak, D.O., is currently Chief Resident at TheMartin Army Community Hospital Family Residency Program.He is a graduate of Edward Via Virginia College of OsteopathicMedicine. He is slated to complete residency training in June2014 and his post-residency plans are to practice full spectrumfamily medicine.

Sufiyan M. Patwa, M.D., a graduate of University ofSt. Eustatius School of Medicine, St. Maarten is currently aPGY-I Family Medicine Resident at The Medical Center inColumbus, Georgia. He is slated to complete residency trainingon June 30, 2016 and his post-residency plans areundetermined at this time.

20

Uyen T. Phan, M.D., a graduate of Ross University School ofMedicine, West Indies is currently a PGY-I Family MedicineResident at The Medical Center in Columbus, Georgia. She isslated to complete residency training on June 30, 2016 andshe has not finalized her post-residency plans.

Shahid A. Shigri, M.D., is currently a PGY-I Family MedicineResident at The Medical Center in the Family MedicineResidency Program. He is a recent graduate of University ofMedicine and Health Sciences, St. Kitts. He will completeresidency training on June 30, 2016 and his plans areundetermined at this time.

Katie Lynn Westerfield, D.O., is currently a third yearresident at The Martin Army Community Hospital FamilyMedicine Residency Program. She is a graduate of KirksvilleCollege of Osteopathic Medicine. She is slated to completeresidency training on June 31, 2014 and her post-residencyplans are to attend a family medicine OB fellowship.

Devin R. Willis, M.D., is currently a PGY-I Family MedicineResident at The Medical Center in the Family MedicineResidency Program. He is a graduate of Ross University Schoolof Medicine, West Indies. He is slated to complete residencytraining on June 30, 2016 and his post-residency plans aren’tdefinitive at this time.

21PAID ADVERTISEMENT

Lynda Worthington, CRS, GRI, ABRAssociate Broker in Ga. and Ala., Military Specialist706-256-1000 BUSINESS • 888-474-9847 FAX

706-888-0629 CELLULAR

w w w. l y n d aw o r t h i n g t o n . c o m

lwforhomes aol.com5670 Whitesville Rd.Columbus, Ga. 31904

Transitional Year Residents - July 2013

First Year Residents in the Family Residency ProgramColumbus Regional - July 2013

22

Ugochi Azuike, D.O.

Nazia Azmat, M.D.

Devin R. Willis, M.D.

Sunni Beeck, D.O. ZahidulChowdhury, M.D.

AldeneMcClymont, M.D.

FNU Geetanjali,M.D.

Sufiyan M.Patwa, M.D.

Uyen T. Phan, M.D.

Shahid A. Shigri,M.D.

Monica Bui, D.O. Mariha N.Feliciano, M.D.

Michelle C.Forrester, M.D.

Jason S.Frederick, M.D.

Mohammed AbbasMomin, M.D.

Matthew West, M.D.MohammadPathan, M.D.

Congressman Dr. Phil Gingrey Speaks to MCMS

To honor Dr. Mac Molnar, Sr.,Dr. Fussell made a presentationof a framed copy of the HODResolution Muscogee Countymade in memory of MacMolnar, Sr. to Mac Molnar, Jr.and his sister, Suzanne. Thosein attendance expressed theirgreat respect and admirationfor Dr. Mac Molnar, Sr. for hismany years of service to thecommunity.

Over 100 members and theirguests attended the MCMSmeeting at the RiverMillEvent Centre on Monday,July 15th with CongressmanPhil Gingrey, M.D. as ourspeaker. Reverend DonMcKelvey, Director ofChaplain Services, St. FrancisHospital’s invocation and Dr.Fussell began the meetingwith a brief business meetingto elect officers for 2014 andapprove delegates to MAGfor 2013. The slate of new officers received an unanimous approval vote. Newofficers are James D. Majors, M.D., President for 2014, W. Frank Willett, III, M.D.,President-Elect, and Glenn Fussell, M.D., Secretary Treasurer. We also confirmedthe MCMS Delegates to MAG’s 159th House of Delegates which will be October19-20, 2013 at Lake Lanier Islands Resort in Buford. Our delegate are GlennFussell, M. D., Frank Willett, M.D., Jim Majors, M.D., Fred Flandry, M.D., RyanGeringer, D.O., Joe Zanga, M.D., Jim Hagler, M.D., Folarin Olubowale, M.D., TimVillegas, M.D., Vince Naman, M.D., Michael Borkat, M.D. and alternate delegatesare Norman Luton, M.D., Henry Ngo, M.D., Larry Brightwell, M.D., A.J. Jain, M.D.,Mac Molnar, Jr., M.D. and Casey Geringer, M. D. Dr. Fussell reported that themembership has grown to over 250 regular and resident members with about 50retired and lifetime members. The goal he set for the membership committee

M C M S N E W SKen Smith, M.D., MCMS Program Committee Member

23

was to reach over 250 members. The hard work of Dr. Fussell and themembership committee including Chair, Ryan Geringer, D.O., Kendall Handy,M.D. and John Adams, M.D. should be commended. We need to thank them fortheir hard work and service on behalf of the society. Other important milestonesreached by Dr. Fussell and the Executive Committee members have been wellplanned and attended meetings, a revamped website, and a physician trainingrelationship with both Mercer University School of Medicine and PhiladelphiaSchool of Osteopathic Medicine, Georgia Campus.

Dr. Fussell also welcomed guests Georgia State Senator Josh McKoon, GeorgiaRepresentative Richard Smith and his wife, Clara, MAG Third Party Payer AdvocacyDirector Susan Moore, MAG, Membership Coordinator, Lesley Nevins. MCMSalso welcomed new members Scott Bell, M.D., Dean Cardi, D.O. and ThaddeusPajak, D.O. and Katie Westerfield, D.O. has also joined since attending themeeting. We welcome you to the society!

Congressman Gingrey appealed to physicians to get more involved in politics,and said that if elected to the Senate, he would work on a repeal of “ObamaCare”. Dr. Gingrey did medical training at Doctor’s Hospital in Columbus andknew many of the physicians in this area during his training period. As a trainedOB/GYN he stated that he respects the sanctity of life and as such will be workingto control the liberalization of abortion rules. He noted the growing deficit anddiscussed the Republican plan to control spending. He noted the unprecedentedmove of the President to postpone the business mandate component of thePPACA and the Congressional plan to correct this. He also stressed theimportance of physician input and support in Congress and the paucity of MDsin either house of the government. Congressman Gingrey asked for our supportas physicians to help him get elected to the Senate which, will otherwise lose twophysician members to retirement in the next election cycle.

24

PAID ADVERTISEMENT

Building built in 2012, next door to anindependent pharmacy and BeauregardHigh School. Great for an Urgent Care

or general practice. For details andleasing information, please contact

Tucker or Tiffany Simmons 334-364-9993.

3000sqft medical office space available forlease in the Auburn/Opelika, Alabama area.

25

A R T I C L E O F I N T E R E S TBy Richard Amerling, M.D.

Unaccountable Care Organizations

The release of preliminary performance data of 32 Accountable Care OrganizationPioneers has largely been spun by the media into a great success story. But forthose of us who actually deliver care, and who lived through the HealthMaintenance Organization fad some years back, this report is a big red flag.

For those too young to remember, the HMO was going to save health care inAmerica. The managed care model consists of a “gatekeeper” physician workingfor an insurance company to control patients’ access to higher-level care, tests,and hospitalizations. The gatekeeper is paid a set amount each month per patientenrolled to “coordinate” care. This arrangement, called “capitation,” creates astrong incentive for the physician to see the patient rarely, if at all. In addition, thegatekeeper is eligible for a bonus payment if total spending on his panel ofpatients was under a certain threshold.

This, obviously, creates more incentives to spend as little as possible. This systemworks just fine, as long as the patients are healthy! And managed care companieswent out of their way to recruit healthy patients. They pushed managed care ontoseniors by giving sales pitches on cruises, thus eliminating the bed andwheelchair-bound.

But “cherry picking” has limits. Eventually, managed care had to deal with sickerpatients, and the model started to collapse. Late referrals and late diagnoses leadto worse patient outcomes, and greater expense. The bureaucracy devoted tocare denial is itself quite expensive. Premiums at HMOs began to skyrocket, asconsumer complaints proliferated.

Many companies abandoned the strict gatekeeper/capitation model in favor of thePreferred Provider Organization. Beneficiaries had a choice of “preferredproviders,” with whom “discount” pricing had been “negotiated.” Prior approvalfor expensive procedures or medications still had to be obtained.

Instead of saving American medicine, managed care accelerated its demise bypitting doctors and insurance companies against patients. Any money not spenton actual care went to the burgeoning administrative sector, and to HMO profits,which supported exorbitant CEO paychecks and perks. Not one red cent wasdevoted to clinical research.

How is the ACO different from the HMO? The difference is merely cosmetic. TheACO is composed of physicians, other “providers,” and administrators. Itcontracts with the Center for Medicare and Medicaid Services (CMS) to providecare for selected beneficiaries. It receives a lump sum per patient per month from

26

which all care is to be provided. Money not spent on care (“profit”) is split evenlybetween the ACO and CMS.

Money spent in excess of the “bundled” payment is a loss to the ACO. The ACOcan also receive incentive payments for achieving (and reporting) certain“benchmarks” such as lowering blood pressure or cholesterol level. These“quality” indicators, which are based on large population studies, will almostcertainly lead to over-treatment of individuals, particularly the elderly.

Like HMOs, ACOs will face very strong incentives to cherry pick the healthy andto limit access to specialty care, procedures, expensive drugs, and hospitals.These incentives are devastating to the truly ill. And the ACO is accountable toCMS, not to the patient!

So how did the pioneer ACOs do? Melinda Beck reports in the Wall StreetJournal.

All of the 32 health systems in the so-called Pioneer Accountable CareOrganization program improved patient care on quality measures such as cancerscreenings and controlling blood pressure… But only 18 of the 32 managed tolower costs for the Medicare patients they treated—a major goal of the effort. Twohospitals lost money on the program in the first year. Seven have notified CMSthat they intend to move to another program where they will face less financialrisk. Two others have indicated they intend to leave the program.

Few details are reported on the CMS website. We don’t know the baseline healthstatus of the patients or the start-up and administrative costs for the ACOs.

Some insurance companies and hospitals will cash in on this boondoggle for afew years, before opting out or folding. The ACO, like the HMO, is not a viablelong-term model. Only a true free market, with transparent pricing and consumerchoice through direct payment, can bring high quality at a reasonable price.

Dr. Amerling is a practicing nephrologist and Associate Clinical Professor at AlbertEinstein College of Medicine. He has written and lectured extensively onhealthcare issues and is a Director of the Association of American Physicians andSurgeons.

(Reprinted with permission from AAPS online.)

PAID ADVERTISEMENT

Mus

coge

e C

ount

y M

edic

al S

ocie

ty23

00 M

anch

este

r E

xpre

ssw

ay

Suit

e F-

7 C

olum

bus,

Geo

rgia

319

04

Ret

urn

Serv

ice

Req

uest

ed

PR

SR

T S

TD

US

PO

STA

GE

PA

IDC

OLU

MB

US

GA

PE

RM

IT

NO

. 15

8

PAID

AD

VER

TIS

EMEN

T