Dylan Stephenson, Author at Southern Medical Association

All posts by Dylan Stephenson

A pregnancy can be one of the most joyous times for a family; the excitement of choosing a name, picking out colors for the nursery, selecting furniture. However, for many families this joy is short lived. According to the CDC, about 700 women die each year from complications of pregnancy with 60% of pregnancy related deaths preventable.

A pregnancy-related death can happen during pregnancy, at delivery, and even up to a year afterward (postpartum).

For 2011-2015:

  • About 1/3 of deaths (31%) happened during pregnancy;
  • About 1/3 (36%) happened at delivery or in the week after; and
  • About 1/3 (33%) happened 1 week to 1 year postpartum

Heart disease and stroke caused more than 1 in 3 deaths (34%). Other leading causes of death included infections and severe bleeding.

Every death reflects a web of missed opportunities. Factors playing a part include:

  • Access to care
  • Missed or delayed diagnoses
  • Not recognizing warning signs

Most deaths are preventable, no matter when they occur.

Join Drs. Nancy Phillip and Donald DiPette as they discuss Hypertension in Pregnancy and Diabetes in Pregnancy at the Focus on Women’s Health Conference.

Read more here.

On May 8, 2019, the Department of Health and Human Services (“HHS”) announced a final rule that will require direct-to-consumer television advertisements to include the list price for prescription pharmaceuticals that are covered by Medicare or Medicaid. The rule, which was promulgated through the Center for Medicare & Medicaid Services (“CMS”), requires the “the Wholesale Acquisition Cost” (i.e., the list price) of the drug to be included in the advertisement if the price is $35 or more for a one-month supply, or for the usual course of therapy.

“Patients have the right to know the prices of healthcare services, and CMS is serious about empowering patients with this information across-the-board,” said CMS Administrator Seema Verma.

This new CMS rule requires that advertisements for certain prescription drugs or biological products on television (including broadcast, cable, streaming and satellite) contain a “textual statement” indicating the Wholesale Acquisition Cost (referred to as “WAC” or the “list price”) for a “typical 30-day regimen or for a typical course of treatment, whichever is most appropriate, as determined on the first day of the quarter during which the advertisement is being aired or otherwise broadcast.” The statement is as follows: “The list price for a [30-day supply of] [typical course of treatment with] [name of prescription drug or biological product] is [insert list price]. If you have health insurance that covers drugs, your cost may be different.” It is important to note that the rule only applies to television advertisements, but not advertisements through other platforms, such as YouTube or Facebook.

Click here for a fact sheet about the final rule.

The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management.

Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness.

The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

Get the publication from The National Academies of Science, Engineering and Medicine .

U.S. Surgeon General releases new video "The Doctor Is In"

U.S. Surgeon General Jerome M. Adams, M.D., M.P.H., released a new video, “The Doctor Is In,” on the topic of vaccinations. As the Nation’s doctor, VADM Adams wants to share the message that vaccines are safe and effective ways to protect your children, your family, your neighbors, and yourself.

This is particularly timely, given that CDC announced yesterday that from January 1 to May 3, 2019, 764 individual cases of measles have been confirmed in 23 states. This is an increase of 60 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.

In the video, Dr. Adams responds to frequently asked questions about vaccination.

Watch the video.

FOCUS ON WOMEN'S HEALTH CONFERENCE

SMA's Focus on Women's Health Conference is the go-to meeting for any healthcare professional seeking a quality CME opportunity. This four-day conference with an abbreviated daily schedule is perfect for primary care physicians, nurses, as well as those in specialty practice.

Join us in beautiful Kiawah Island, South Carolina to gain updated knowledge on topics such as: Issues in Pregnancy, Eating Disorders, Substance Use Disorders in Women, Alternate Therapy for Obesity, Diabetes, and Thyroid Disease, Contraception Controversies, Behavioral Change for the Office-based Physician, Physician Burnout, and more!

COURSES

SOUTHERN MEDICAL JOURNAL

Women's & Children's Health

PODCASTS

These podcasts address all aspects of care of the female patient across her lifespan, including obstetrics and gynecology, mental health, and internal medicine. It also explores the special and unique care of children and adolescents, including the maternal-fetal period of life, ethical issues in pediatric medical and surgical care, and growth and development in children.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 05 • May 2019

Mental Health
Sickle Cell Disease, More Than Just Pain: The Mediating Role of Psychological Symptoms
Mona A. Robbins, PhD, Lakeya S. McGill, MA, Breanna M. Holloway, BA, and Shawn M. Bediako, PhD

Bioethics & Medical Education
A National Evaluation of Scholarly Activity Requirement in Osteopathic EM Residency Programs: Survey of EM Program Directors
Alexander Kirkpatrick, DO, Tom Doran, DO, David Mullins, DO, David Gnugnoli, DO, and John Ashurst, DO, MSc

Saying Goodbye
Robert Goldszer, MD

On “Team-Based Learning Activities for First-Year Medical Students: Perception of the Learners”
Hanieh Enayati and Jai Mathur

Emergency Medicine & Disaster Preparedness
CME Article: Patients on Involuntary Hold Status in the Emergency Department
Archana Roy, MD, Christian Lachner, MD, Adrian Dumitrascu, MD, Nancy L. Dawson, MD, Tyler F. Vadeboncoeur, MD, Michael J. Maniaci, MD, Ian C. Lamoureux, MD, Patricia C. Lewis, ARNP, Teresa A. Rummans, MD, and M. Caroline Burton, MD

Women’s & Children’s Health
OPEN: Incidence of Pediatric Cervical Spine Injuries in Iraq and Afghanistan
Xandria Gutierrez, BA, Michael April, MD, DPhil, Joseph Maddry, MD, Guyon Hill, MD, Tyson Becker, MD, and Steven Schauer, DO, MS

Commentary on “Incidence of Pediatric Cervical Spine Injuries in Iraq and Afghanistan”
LTC Wendy J. Wilcoxson, DO, USAF, MC

Propofol Versus Dexmedetomidine for Procedural Sedation in a Pediatric Population
Nicole M. Schacherer, MD, Tamara Armstrong, MD, Amy M. Perkins, MS, Michael P. Poirier, MD, and James M. Schmidt, MD 

Medicine & Medical Specialties
Otolaryngology: Breadth, Depth, Challenge, and Choice
Robert T. Sataloff, MD, DMA, Mary J. Hawkshaw, BSN, RN, and Brian J. McKinnon, MD, MPH

Commentary on “Otolaryngology: Breadth, Depth, Challenge, and Choice”
Mark Boston, MD

Fetal Hemoglobin Modulators May Be Associated With Symptomology of Football Players with Sickle Cell Trait
Carroll Flansburg, MA, MPH, Christina M. Balentine, BS, Ryan W. Grieger, MS, Justin Lund, MA, Michelle Ciambella, BS, Deandre White, BS, Eric Coris, MD, Eduardo Gonzalez, MD, Anne C. Stone, PhD, and Lorena Madrigal, PhD

Use of Cardiac Troponin Testing in the Outpatient Setting
Steven J. Ross, MD, Nikhil H. Shah, MD, Steve A. Noutong Njapo, MD, Daniel J. Cordiner, MD, and David E. Winchester, MD, MS

SMA Services, Inc.

Sponsored by SMA Services, Inc.

These podcasts address all aspects of care of the female patient across her lifespan, including obstetrics and gynecology, mental health, and internal medicine. It also explores the special and unique care of children and adolescents, including the maternal-fetal period of life, ethical issues in pediatric medical and surgical care, and growth and development in children.

HHS To Deliver Value-Based Transformation in Primary Care
The CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Today, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma are announcing the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system. Building on the lessons learned from and experiences of the previous models, the CMS Primary Cares Initiative will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall health care costs. The models were developed by the Innovation Center under the leadership of Adam Boehler and are part of Secretary Azar’s value-based transformation initiative.

“For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions. Primary care clinicians serve on the front lines of the healthcare delivery system, furnishing services across a wide range of specialties, from family medicine to behavioral health to gerontology. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system. CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high value care, the quality and cost effectiveness of patient care improves.

“As we seek to unleash innovation in our health care system, we recognize that the road to value must have as many lanes as possible,” said CMS Administrator Seema Verma. “Our Primary Cares Initiative is designed to give clinicians different options that advance our goal to deliver better care at a lower cost while allowing clinicians to focus on what they do best: treating patients.”

Administered through the CMS Innovation Center, the CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths:

Primary Care First and Direct Contracting.

The five payment model options are:

  1. Primary Care First (PCF)
  2. Primary Care First – High Need Populations
  3. Direct Contracting – Global
  4. Direct Contracting – Professional
  5. Direct Contracting – Geographic

The Primary Care First (PCF) payment model options will test whether financial risk and performance based payments that reward primary care practitioners and other clinicians for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes. PCF will provide payment to practices through a simplified total monthly payment that allows clinicians to focus on caring for patients rather than their revenue cycle. PCF also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).

Both models under PCF incentivize providers to reduce hospital utilization and total cost of care by potentially significantly rewarding them through performance-based payment adjustments based on their performance.  These models seek to improve quality of care, specifically patients’ experiences of care and key outcome-based clinical quality measures, which may include controlling high blood pressure, managing diabetes mellitus, and screening for colorectal cancer. PCF will be tested for five years and is scheduled to begin in January 2020. A second application round is also planned for participants starting in January 2021.

Like the PCF payment model options, the Direct Contracting (DC) payment model options are also focused on transforming primary care, allowing health care providers to take greater control of managing the costs of care for an aligned population of Medicare fee-for-service (FFS) beneficiaries. While the PCF models are focused on individual primary care practice sites, the DC payment model options aim to engage a wider variety of organizations that have experience taking on financial risk and serving larger patient populations, such as Accountable Care Organizations (ACOs), Medicare Advantage (MA) plans, and Medicaid managed care organizations (MCOs).  The DC payment model options are designed to create a competitive delivery system environment where organizations offering greater efficiencies and better quality of care will be financially rewarded. The payment model options include a focus on care for patients with complex, chronic needs and SIPs, as well as a voluntary alignment option that allows beneficiaries to align with the health care provider of their choosing.

Depending on the DC payment model option in which an organization is participating, the model participant will receive a fixed monthly payment that can range from a portion of anticipated primary care costs to the total cost of care. Participants in the global payment model option will ultimately bear full financial risk, while those in the professional payment model option will share risk with CMS. This will provide prospective model participants a range of financial risk arrangements from which to choose while providing a more predictable revenue stream and reducing health care provider burden commensurate with level of financial risk.

In addition, CMS is seeking public comment on one DC payment model option with an expected performance period launch in January 2021. The Geographic Population-Based option is designed to offer innovative organizations the opportunity to assume responsibility for the total cost of care and health needs of a population in a defined target region. Driving accountability to a local level empowers communities to devise strategies best designed to meet their health care needs. Given the novelty of this option, we are seeking public comment through a new Request for Information.

Together, CMS anticipates these five payment model options administered under the Primary Cares Initiative could:

  • Provide better alignment for over 25 percent of all Medicare FFS beneficiaries – nearly 11 million Medicare beneficiaries would potentially be included (a collective 5 million beneficiaries in the DC payment model options and a collective 6.4 million in PCF payment model options);
  • Offer new participation and payment options and opportunities for an estimated one in four (25 percent) primary care practitioners as well as other health care providers; and
  • Create new coordinated care opportunities for a large portion of the 11-12 million beneficiaries dually eligible for Medicare and Medicaid, specifically those in Medicaid managed care and Medicare FFS.

All five payment model options focus on supporting care for patients who have chronic conditions and serious illnesses. Through the PCF payment model options, high need patients with serious illness who do not have a primary care practitioner or care coordination and indicate an interest in receiving care from a practice participating in the model will be assigned to a model participant. Participating practices that choose to care for SIP patients will be required to provide care to clinically stabilize the patient. All payment model options include enhancements to encourage participation of providers who are focused on care for these populations.

CMS based the design of these payment model options on considerable stakeholder input. The models draw from Physician-Focused Payment Model Technical Advisory Committee (PTAC) review of proposals, including, but not limited, to The Advanced Primary Care Model from the American Academy of Family Physicians, An Innovative Model for Primary Care Office Payment from Jean Antonucci, MD, The Patient and Caregiver Support for Serious Illness Model from the American Academy of Hospice and Palliative Medicine, and The Advanced Care Model from the Coalition to Transform Advanced Care. All payment model options are responsive to stakeholder feedback that we received from advanced primary care practices expressing interest in accepting increased financial risk in exchange for greater flexibility and fewer requirements.

For a fact sheet on the CMS Primary Care First payment model options, please visit https://www.cms.gov/newsroom/fact-sheets/primary-care-first-foster-independence-reward-outcomes. More information on CMS Primary Care payment model options is at: https://innovation.cms.gov/initiatives/primary-care-first-model-options/.

For a fact sheet on the Direct Contracting payment model options, please visit https://www.cms.gov/newsroom/fact-sheets/direct-contracting. More information on the Direct Contracting model options is at: https://innovation.cms.gov/initiatives/direct-contracting-model-options/.

To view a fact sheet on the CMS Primary Cares Initiative, please visit: https://innovation.cms.gov/Files/x/primary-cares-initiative-onepager.pdf.

To review the Direct Contracting—Geographic Request for Information, please visit: https://innovation.cms.gov/Files/x/dc-geographicpbp-rfi.pdf.

CMS is also releasing the first annual evaluation report for the Comprehensive Primary Care Plus (CPC+) Model, which details the implementation experience and impact on beneficiary outcomes over the first year for practices that started participating in the CPC+ model in January 2017. To view the findings-at-a-glance, please visit: https://innovation.cms.gov/Files/reports/cpcplus-fg-firstannrpt.pdf. To see the report, please visit: https://downloads.cms.gov/files/cmmi/cpcplus-first-ann-rpt.pdf.

Physicians are viewed as leaders in their profession as well as in their practices, may that be in a private practice or in a hospital setting. And as leaders, they are expected to adapt in order to meet the strenuous demands of the constantly evolving healthcare landscape. However, change -- whether self guided or driven by an external factors such as policy mandates, job transitions, or improving quality standards -- is often seen as difficult and ineffective. In fact, statistics have shown that only approximately one-third of change efforts were considered successful by their leaders.

In this podcast, Stanley (Stan) Harris, PhD, Luck Professor and Associate Dean for Graduate and International Programs in Auburn University’s Raymond J. Harbert College of Business, discusses various types of change, provides insight into why some physicians might be resistant to change, and offers tips to help empower those facing transitions.

Navigating Insulin-Based Therapy for Type 2 Diabetes

Downloadable Slide Set Now Available

In this online webinar and slide set, Dr. Veronica Piziak discusses the application of new studies on NPH, regular insulin, switching, and other approaches to avoid hypoglycemia, control hyperglycemia, and reduce CV risk.

Join Dr. Piziak at the upcoming Focus on Women's Health Conference, July 15-18 in Kiawah Island, South Carolina where she will be discussing similar topics.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 04 • April 2019

Mental Health
Evaluating the Burnout-Thriving Index in a Multidisciplinary Cohort at a Large Academic Medical Center
Rebecca Gates, BS, David Musick, PhD, Mark Greenawald, MD, Kimberly Carter, PhD, RN, Richard Bogue, PhD, and Lauren Penwell-Waines, PhD

Medicine & Medical Specialties
Outcomes in an Interdisciplinary Diabetes Clinic in Rural Primary Care
Dana E. King, MD, MS, Ashley B. Petrone, PhD, Frederick M. Alcantara, MD, Megan M. Elavsky, PharmD, Michelle O. Prestoza, MD, Judy Siebart, MS, RD, and Greg Castelli, PharmD

Is Endurance Exercise Safe? The Myth of Pheidippides
Christine Rutlen, BA, and David L. Rutlen, MD

Commentary on “Is Endurance Exercise Safe? The Myth of Pheidippides”
G. Richard Holt, MD, MSE, MPH, MABE, DBioethics

Mycobacterium fortuitum Meningitis: Approach to Lumboperitoneal Shunt Infection
Jack Zakrzewski, BS, Kimberly Hu, BS, Brandon L. Neisewander, BA, Darian R. Esfahani, MD, MPH, Abhiraj D. Bhimani, BS, Harsh P. Shah, MD, Dafer W. Haddadin, MD, and Ankit I. Mehta, MD

OPEN: Inconsistencies in Colonic Tattooing Practice: Differences in Reported and Actual Practices at a Tertiary Medical Center
Joshua P. Spaete, MD, Jiayin Zheng, PhD, Shein-Chung Chow, PhD, Rebecca A. Burbridge, MD, and Katherine S. Garman, MD

A Brief Review of the Pharmacology of Hyperkalemia: Causes and Treatment
James M. Wooten, PharmD, Fernanda E. Kupferman, MD, and Juan C. Kupferman, MD, MPH

Quality Care & Patient Safety
Objectively Measured Physical Activity and All-Cause Mortality Among Cancer Survivors: National Prospective Cohort Study
Paul D. Loprinzi, PhD, and Allison Nooe, BS

Native Joint Septic Arthritis: Comparison of Outcomes with Medical and Surgical Management
Kaoru Harada, MD, Ian McConnell, MD, Eric C. DeRycke, MPH, Jürgen L. Holleck, MD, and Shaili Gupta, MD

CME Article: Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2)
Eric Dietrich, PharmD, BCPS, Kyle Davis, PharmD, BCPS, Lisa Chacko, MD, MPH, Kiarash P. Rahmanian, MPH, Lauren Bielick, BSN, RN, David Quillen, MD, David Feller, MD, Maribeth Porter, MD, MS, John Malaty, MD, and Peter J. Carek, MD, MS

Public Health & Environmental Medicine
Know the New HIV Testing Guidelines?
Pradeepthi Badugu, MD, and Steven Lippmann, MD

Bioethics & Medical Education
On “Importance of Interdisciplinary Medical Education: A Frontline Perspective”
Regwaan Choudhury, Third Year MBBS Student, and Jai Mathur, Fifth Year MBBS Student

SMA Services, Inc.

Sponsored by SMA Services, Inc.

Donna L. Breen, MD

I am an Otolaryngologist practicing general ENT and allergy for the past 30 years in Marksville, Louisiana after finishing my residency at Tulane Medical Center in 1988. I graduated from University of Alabama Medical School cum laude in 1983. Also, I completed a fellowship in Otolaryngic Allergy in 1992. I am proud to serve the needs of a semirural small town community and take care of adults and children with ear, nose, and throat problems who would have to travel many miles for their care.

Practicing in a small community was very new to me when I first came here. I grew up in New Orleans, Louisiana and was educated in the public and parochial schools there. Living in a smaller community remained a challenge for me in adjustment, but I have come to realize that this environment is perfect for me. I get to know my patients and their families, and their extended families, and relatives, which engages me in their lives, both as a medical doctor, friend and mentor. It is truly the best of both worlds and I have come to treasure my practice as a small town doctor in this community.

I joined the SMA in 1984, while I was a resident and I have been a member ever since. I enjoyed the collegiality as well as the learning experience. It is a big organization with a small town atmosphere in that we are emboldened to learn from the experts in a spirit of congeniality and relaxed learning experience. It is an organization where everyone has equal time, every question has equal value, and everyone has the right to understand the concepts that are being presented. No question or thirst for knowledge is too little and everyone is included in the quest for medical knowledge and skills in the healing arts.

Donna L. Breen, M.D.

Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

Join us for Health Technology Insights, Telehealth: What, Why, and How Can It Work For You? Drs. Andy Mohan and Reza Sadeghian will discuss the various aspects of telemedicine and how to use this information to the benefit of your patients and practice.

The Centers for Medicare & Medicaid Services has issued a new report that offers a look at how physicians fared the first year of its Quality Payment Program (QPP).

According to CMS, the goal of releasing the data in the report is to highlight successes and pain points that can inform QPP participation in the future.

The QPP includes two possible tracks for doctors, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model. In 2017, more than 1 million doctors enrolled in MIPS, about 95% of those eligible, while more than 99,000 qualified for APM, which is a higher risk-bearing, according to the report.

The participation numbers outperform CMS’ projections and goals for the program’s first year. According to the report, the agency was aiming for 90% participation in MIPS and for about 70,000 physicians to enter the more advanced models.

According to the findings, clinicians in rural practices participated in MIPS at a rate of 94%, which was effectively equal to the overall average and a remarkable accomplishment.

“We look forward to continuing to listen and identify ways to improve the Quality Payment Program to help drive value, reduce burden, and improve outcomes for our beneficiaries,” CMS wrote.

Not only has technology changed experiences for patients and their families, but it has also had a significant impact on medical processes and the practices of healthcare professionals.

Join us for Health Technology Insights, Tech Frustration and Burnout: Making Technology Work for You. Drs. Andy Mohan and Reza Sadeghian will provide you with simple, common-sense ideas on how to make technology and new innovations in health care work for you.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 03 • March 2019

Bioethics & Medical Education
A 5-Step Framework for the Assessment and Remediation of a Struggling Medical Learner in the Clinical Environment
Sarah B. Merriam, MD, MS, Melissa A. McNeil, MD, MPH, and Carla L. Spagnoletti, MD, MS

Development of a Vertically Integrated Trainee Program: Linking Future and Young Physicians
Jaron L. Pettis, BS, Daelan T. Johnson, Joshua T. Bosak, BS, Ian M. Brastauskas, MD, Erika A. Jansen, BS, Ryan McNutt, Rahul S. Raghavan, Sammy L. Huynh, BS, Alvin Lee Day, MD, Nancy Walborn, MEd, and Donald J. DiPette, MD

On “Improving Underrepresented Minority in Medicine Representation in Medical School”
Lagasthija Vijayaratnam and Jai Mathur

Medicine & Medical Specialties
CME Article: Characteristics of Syncope Admissions Among Hospitals of Varying Teaching Intensity
Michael I. Ellenbogen, MD, Daniel J. Brotman, MD, Jungwha Lee, PhD, MPH, Kimberly Koloms, MS, and Kevin J. O’Leary, MD, MS

Awareness of Birth Cohort Hepatitis C Testing Recommendation Among Baby Boomers: An Exploratory Survey Study
Vabhave Pal, MD, Yasir Ahmed, MD, Shikha Singh, MD, Kalpana Bhairavarasu, MD, and Lavi Oud, MD

Flexible Sigmoidoscopy Rather than Colonoscopy Is Adequate for the Diagnosis of Ipilimumab-Associated Colitis
J. Daniel Herlihy, MD, Stephen Beasley, MD, Andrew Simmelink, MD, Vinaya Maddukuri, MD, Asim Amin, MD, Michal Kamionek, MD, Carl Jacobs, MD, Krista Bossi, MS, and Martin Scobey, MD

Emergency Medicine & Disaster Preparedness
Trauma Providers’ Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs
Thomas H. Shoultz, MD, Megan Moore, PhD, MSW, May J. Reed, MD, Stephen J. Kaplan, MD, MPH, Itay Bentov, MD, PhD, Catherine Hough, MD, Lisa A. Taitsman, MD, MPH, Steven H. Mitchell, MD, Grace E. So, BA, Saman Arbabi, MD, MPH, Herb Phelan, MD, and Tam Pham, MD

Women's & Children's Health
Impact of Holidays on Pediatric Trauma Admissions to a Community Hospital in South Florida
Stephanie Eyerly-Webb, PhD, Rachele Solomon, MPH, LeAnne Young, MSN, RN, Keren Bard, Carrie Laituri, MD, Andrew Rosenthal, MD, and Julie Long, MD

Antibiotic Prophylaxis for Cesarean Delivery Among Alabama Providers
Dana Watson, MS, Alan Tita, MD, PhD, Lisa Dimperio, BS, Tera Howard, MD, and Lorie Harper, MD

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease
Melissa E. Day, BS, Sarah-Jo Stimpson, MD, Mark Rodeghier, PhD, Djamila Ghafuri, MBBS, Michael Callaghan, MD, Ahmar Urooj Zaidi, MD, Bryan Hannan, MS, Adetola Kassim, MD, MS, Andra H. James, MD, MPH, Michael R. DeBaun, MD, MPH, and Deva Sharma, MD, MS

Advanced Prescription of Emergency Contraceptive Pills Among Adolescents and Young Adults
Somsook Santibenchakul, MD, MPH, Mary Tschann, PhD, MPH, Alyssa Dee P. Carlson, MPH, Eric L. Hurwitz, PhD, DC, and Jennifer Salcedo, MD, MPH, MPP

Improving Documentation of Obstetric Anal Sphincter Injuries (OASIS) Using a Standardized Electronic Template at Two University-Affiliated Institutions
Padraic Chisholm, MD, Allison Sellner, Charles C. Kilpatrick, MD, MEd, Laurie S. Swaim, MD, and Francisco J. Orejuela, MD, MS

Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program
Wally R. Smith, MD, India Y. Sisler, MD, Shirley Johnson, BA, Thokozeni J. Lipato, MD, Jennifer S. Newlin, PA, Zakiya S. Owens, PA, Alma M. Morgan, MEd, Marsha J. Treadwell, PhD, and Kathryn Polak, MS

Commentary on “Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program”
Sara Mixter, MD, MPH, and Rosalyn W. Stewart, MD, MS, MBA

SMA Services, Inc.

Sponsored by SMA Services, Inc.

Diabetes in the South: Focus on Prevention

Richard E. Pratley, MD

Individualizing Diabetes Management in Early T2DM

Guillermo E. Umpierrez, MD, CDE

Navigating Insulin-based Therapy

Veronica K. Piziak, MD, PhD, FACP

“Southern Medical Association is very excited to work with CCO to advance the care of patients with or at risk for T2DM. Designed as an interdisciplinary initiative, this program targets the specific needs and challenges of clinicians practicing in the US diabetes belt,” says Randy Glick, Executive Director. “This collaboration also supports SMA’s mission to improve quality of care for patients in the southeastern region of the United States. The prevalence of T2DM and cardiovascular disease, coupled with fewer care providers in our regions of focus, makes this type of project much more meaningful. We are very grateful to be a part of this effort.”

“We are honored to be partnering with SMA and look forward to engaging with clinicians throughout the South to help them navigate the challenges of managing patients with T2DM and associated cardiovascular risk factors,” adds Alyce Kuklinski, NP, RN, General Manager, Internal Medicine, CCO.

About Clinical Care Options 
Clinical Care Options, LLC, is a global leader in the development of innovative educational programs and technology platforms. CCO’s team has been a pioneer in the creation of continuing education and decision support resources for healthcare professionals both in the United States and around the world for more than 2 decades. For more information, visit http://www.clinicaloptions.com

Randall E. Glick, BSB/PM MCP

Randall E. Glick, BSB/PM MCP
Executive Director

Greetings from the Southern Medical Association. I wanted to take a few moments to share with you our new vision, “The Business of Medicine Simplified”. We hear over and over again how the business side of medicine wreaks havoc on your career, jeopardizing the quality of care you provide your patients. We hear you … you’re angry, frustrated, and in some cases totally burned out. We believe the business of medicine should be easy and we plan to help you make it that way.

We are developing podcasts on the Business of Medicine which will cover relevant business topics, including:

  • Tech Frustration and Burnout: Making Technology Work for You
  • Choice Apps That Will Help Make Your Practice Run More Smoothly
  • Office Design, Practice Workflow Improvements

We plan to launch the first podcast on March 13; be sure to download it and listen!

I would also like to invite you to our Southern Regional Assembly taking place June 27-29 at the Hyatt Regency Birmingham - The Wynfrey Hotel in Birmingham, AL. The meeting’s theme is Business of Medicine Simplified and will provide practical, real-world information and tips you can use on a daily basis. For additional information and to register, visit sma.org/assembly.

We do want to hear what you need as it relates to the Business of Medicine. What topics should we cover? What do you want to hear in a podcast or as a webcast? Let us know. Send your wish list to education@sma.org.

Growth in national health spending over the next decade remains similar from last year’s projected average annual growth of 5.5 percent

National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).

Growth in national health spending is projected to be faster than projected growth in Gross Domestic Product (GDP) by 0.8 percentage points over the same period.  As a result, the report projects the health share of GDP to rise from 17.9 percent in 2017 to 19.4 percent by 2027. Read More.

The outlook for national health spending and enrollment over the next decade is expected to be driven primarily by:

  • Key economic factors, such as growth in income and employment, and demographic factors, such as the baby-boom generation continuing to age from private insurance into Medicare; and
  • Increases in prices for medical goods and services (projected to grow 2.5 percent over 2018-2027 compared to 1.1 percent during the period of 2014-2017).

Similar to the findings in last year’s report, the report found that by 2027, federal, state and local governments are projected to finance 47 percent of national health spending, an increase of 2 percentage points from 45 percent in 2017.  As a result of comparatively higher projected enrollment growth in Medicare, average annual spending growth in Medicare (7.4 percent) is expected to exceed that of Medicaid (5.5 percent) and private health insurance (4.8 percent).

Selected highlights in projected health insurance enrollment and national health expenditures by sector and payer include:

Health Insurance Enrollment: Net enrollment gains across all sources are generally expected to keep pace with population growth with the insured share of the population going from 90.9 percent in 2017 to 89.7 percent in 2027.

Medicare: Medicare spending growth is projected to average 7.4 percent over 2018-2027, the fastest rate among the major payers.  Underlying the strong average annual Medicare spending growth are projected sustained strong enrollment growth as the baby-boomers continue to age into the program and growth in the use and intensity of covered services that is consistent with the rates observed during Medicare’s long-term history.

Medicaid: Average annual growth of 5.5 percent is projected for Medicaid spending for 2018-2027.  Medicaid expansions during 2019 in Idaho, Maine, Nebraska, Utah, and Virginia are expected to result in the first acceleration in growth in spending for the program since 2014 (from 2.2 percent in 2018 to 4.8 percent in 2019).  Medicaid spending growth is then projected to average 6.0 percent for 2020 through 2027 as the program’s spending patterns reflect an enrollment mix more heavily influenced by comparatively more expensive aged and disabled enrollees.

Private Health Insurance and Out-of-Pocket: For 2018-2027, private health insurance spending growth is projected to average 4.8 percent, slowest among the major payers, which is partly due to slow enrollment growth related to the baby-boomers transitioning from private coverage into Medicare.  Out-of-pocket expenditures are also projected to grow at an average rate of 4.8 percent over 2018-2027 and to represent 9.8 percent of total spending by 2027 (down from 10.5 percent in 2017).

Prescription Drugs:  Spending growth for prescription drugs is projected to generally accelerate over 2018-2027 (and average 5.6 percent) mostly as a result of faster utilization growth.  Underlying faster growth in the utilization of prescription drugs, particularly over 2020-2027, are a number of factors including efforts on the part of employers and insurers to encourage better medication adherence among those with chronic conditions, changing pharmacotherapy guidelines, faster projected private health insurance spending growth in lagged response to higher income growth, and an expected influx of new and expensive innovative drugs into the market towards the latter stage of the period.

Hospital:  Hospital spending growth is projected to average 5.6 percent for 2018-2027. This includes a projected acceleration in 2019, to 5.1 percent from 4.4 percent in 2018, reflecting the net result of faster expected growth in both Medicare (higher payment updates) and Medicaid (as a result of expansion in five states), but slower projected growth in private health insurance as enrollment declines slightly due to the repeal of the individual mandate.

Physician and Clinical Services: Physician and clinical services spending is projected to grow an average of 5.4 percent per year over 2018-2027.  This includes faster growth in prices over 2020-2027 for physician and clinical services due to anticipated rising wage growth related to increased demand from the aging population.

The Office of the Actuary’s report will appear at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

An article about the study is also being published by Health Affairs and is available here: https://protect2.fireeye.com/url?k=529199bd-0ec4906d-5291a882-0cc47a6a52de-97641bdac742d461&u=http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05499

In this podcast, Dr. Donald DiPette, co-chair of SMA’s Focus on Women’s Health Conference and the immediate past president of SMA, discusses the need to investigate and develop new modalities to lower blood pressure to achieve increased hypertension control. He also offers insight into how busy clinicians can incorporate these newer modalities into their patient care, practice setting, and health system.

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