maryland physician magazine july/august 2011

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Physician Physician ORTHOPEDICS: Beyond the Hype MARYLAND PHYSICIANS: Are You Ready for ICD-10? HIT & Painkillers for EHR JULY/AUGUST 2011 VOLUME 1: ISSUE 2 www.mdphysicianmag.com YOUR PRACTICE. YOUR LIFE. Maryland

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Maryland Physician Magazine – Your practice. Your life. is a full-color bimonthly magazine for Maryland physicians and healthcare industry leaders, locally produced and published. Maryland Physician focus on the clinical and business issues impacting patient care and practice management in Maryland, using an integrated strategy that includes print, online and event outreach. Maryland Physician is are dedicated to building a Maryland-based physician and healthcare stakeholder network, with a commitment to achieving the highest standards of quality patient care. In addition to cover and key feature articles, every issue of Maryland Physician Magazine includes the following sections: Solutions, Policy, Compliance, Health IT, Good Deeds, Cases, Heritage and Legacy.

TRANSCRIPT

Page 1: Maryland Physician Magazine July/August 2011

Physician Physician

ORTHOPEDICS: Beyond the Hype

MARYLAND PHYSICIANS:Are You Ready for ICD-10?

HIT & Painkillers for EHR

JULY/AUGUST 2011 VOLUME 1: ISSUE 2

www.mdphysicianmag.com

YOUR PRACTICE. YOUR LIFE.

Maryland

Page 2: Maryland Physician Magazine July/August 2011

LOVE THE SERVICE. APPRECIATE THE CONVENIENCE. TRUST THE NAME.

call 1-888-972-9700 or visit our website at www.advancedradiology.com

Find us on

Page 3: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 3

16 Orthopedics: Beyond the HypeProper Procedure Selection is Key to Outcomes

F E A T U R E S

D E P A R T M E N T S

ContentsJuly/August 2011 Volume1: Issue 2

1612 25

Cases | 7 | Spinal Cord Stimulation: Managing Challenging Chronic Pain in Young Patients

Solutions | 8 | Protecting Your Practice in a RAC Audit Environment

Medical Beat | 10 | News and Notes in the Medical Field

Healthcare IT | 12 | EHR Painkillers – Practical Advice for a Conversion or Upgrade

Legacy | 20 | The Estate Planner’s Storybook of Everyday Tales and Unexpected Endings

Compliance | 23 | Maryland Physicians,Will You Be Ready?

Good Deeds | 25 | Raymond Wittstadt, M.D. – Making Music Pain Free

Heritage | 26 | National Name, Local Roots

On the Cover: Dr. Ronald Delanois, M.D., orthopedic surgeon at the Center for Joint Replacement and Preservation at Sinai Hospital, at LifeBridge Health & Fitness

Page 4: Maryland Physician Magazine July/August 2011

4 | WWW.MDPHYSICIANMAG.COM

IN THE MAY/JUNE INAUGURALIssue 2011 of Maryland Physician, Iwrote that my passion and goal is tokeep you - Maryland physicians andhealthcare stakeholders – informed, intrigued and inspired with cutting-edge treatment information and practi-cal advice for managing a clinicalpractice. Apparently, I’m on my way!

Less than 24 hours after that first issue was delivered to the USPS, I receivedmy first email from a Maryland physician. He applauded the content and design of the publication, both in print and online (www.mdphysicianmag.com). He suggested that we include pain management, a topic that has frustrated him as aprimary care provider. I listened, thanked him and will be including this topic lateron in our editorial year. I heard from another male physician who applauded thecover story of that inaugural issue, “Cracks in Maryland Medicine’s Glass Ceiling.”He plans to share the issue with his granddaughters, who are following his pathinto medicine, and felt that they would be inspired by the four outstanding femalephysicians we profiled. I’ve since received many more emails and comments –thanks to all of you and keep them coming!

Every issue includes a clinical feature. This month, Maryland Physician EditorLinda Harder spoke with three Maryland orthopedists about the latest advances inthis field, to guide your treatment and referrals. Not surprisingly, there was somedifference of opinion – we’ve shared it with you beginning on page 16. We plan topresent controversy where it exists, to bring you honest and meaningful contentthat facilitates your practice of medicine.

Confused about RAC audits, ICD-10, EHR, EMR and Meaningful Use timelines and requirements? The goal of Maryland Physician’s regular department,Healthcare IT, is to keep you informed. According to our online poll, EHR tech-nology is your practice’s biggest headache, no matter what the size of your practice.This issue’s HIT feature outlines tips to ease your EHR implementation pain,whether EHR is new to your practice or you’re upgrading an existing system.

Maryland Physician is dynamic and organic. Tweaks to our website and onlineconversations with you and with our subject matter experts are occurring nearlydaily. You may have noticed that we’ve changed our URL. You'll still be directed to us via the original URL too. Go online and reach out to all of us at MarylandPhysician and to our subject matter experts – we’re waiting to hear from you.

Wishing you all some relaxing and safe time this summer enjoying the splendorof our Chesapeake Bay or wherever your summer travels take you!

To life!

Jacquie RothPublisher/Executive [email protected]

JACQUIE ROTH, PUBLISHER/EXECUTIVE [email protected]

LINDA HARDER, MANAGING [email protected]

CONTRIBUTING WRITERS

Allison Eatough

[email protected]

Tracy Fitzgerald

[email protected]

CONTRIBUTING PHOTOGRAPHERS

Tracey Brown, Papercamera Photography

www.papercamera.com

Mark Molesky, Molesky Photography

www.moleskyphotography.com

DIGITAL

Andrei Palmer, Digital General Manager

Aertight Systems

[email protected]

ADMINISTRATION

Ginger Jenkins

Maryland Physician Magazine™ is published bimonthly by Mojo Media, LLC. a certified Minority Business Enterprise (MBE).

Mojo Media, LLCPO Box 1663Millersville, MD 21108410.987.6667www.mojomedia.biz

Subscription information: Maryland Physician Magazineis mailed free to Maryland licensed and practicing physicians and a select audience of Maryland healthcare executives andstakeholders. Subscriptions are available for the annual cost of $42.00. To be added to the circulation list, please email [email protected] or call 410.987.6667

Reprints: To order reprints of articles or back issues, please call 410.987.6667 or email [email protected]

Maryland Physician Magazine Advisory Board: An advisory board comprised of medical practitioners and businessleaders in diverse practice, business and geographic scopesprovides editorial counsel to Maryland Physician. Advisoryboard members include:

JOHN BARRY, M.D.Chesapeake Orthopaedic & Sports Medicine Center

KAREN COUSINS-BROWN, D.O.Maryland General Hospital

HOLLY DAHLMAN, M.D.Greenspring Valley Internal Medicine, LLC

PAUL W. DAVIES, M.D., FACSAdvanced Pain Management

MICHAEL EPSTEIN, M.D.Digestive Disorders Associates

STACY D. FISHER, M.D.University of Maryland Medical Center

REGINA HAMPTON, M.D. FACSSignature Breast Care

DANILO ESPINOLA, M.D.Advanced Radiology

GENE RANSOM, J.D., CEOMedChi

Although every precaution is taken to ensure accuracy of published materials, Maryland Physician and Mojo Media, LLCcannot be held responsible for opinions expressed or facts supplied by authors and resources.

Green logo here

Page 5: Maryland Physician Magazine July/August 2011

8.625” x 11.25”

T 8.5” x 11”S 7.5” x 10”O 1

CHALLENGE: When Dr. Navalgund came out of medical school, he had all the right medical training. But when he decided to open his own practice, he needed something new — an education in the business side of medicine.

SOLUTION: Dr. Navalgund had the Cash Flow Conversation with his PNC Healthcare Business Banker, who put his industry knowledge to work. Together, they tailored a set of solutions to strengthen his cash flow: loans for real estate and equipment along with a line of credit to grow his practice, plus remote deposit to help speed up receivables.

ACHIEVEMENT: DNA Advanced Pain Treatment Center now has four private practices and a growing list of patients. And Dr. Navalgund has a place toturn for all his banking needs, allowing him to focus on what he does best.

WATCH DR. NAVALGUND’S FULL STORY at pnc.com/cfoand see how The PNC Advantage for Healthcare Professionals can help solve your practice’s challenges, too. Or call PNC Healthcare Business BankerLes Pasternack at 1-866-356-6916 to start your own Cash Flow Conversation today.

DR. YESH NAVALGUND / OWNERDNA ADVANCED PAIN TREATMENT CENTER

CHRONIC PAIN MANAGEMENTPITTSBURGH, PA

SINCE 2006 21 EMPLOYEES

LEARNINGTHE BUSINESS OF MEDICINE

ACCELERATE RECEIVABLES

IMPROVE PAYMENT PRACTICES

INVEST EXCESS CASH

LEVERAGE ONLINE TECHNOLOGY

ENSURE ACCESS TO CREDIT

S

SPRING/SUMMER 2011 | 5

Page 6: Maryland Physician Magazine July/August 2011

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Page 7: Maryland Physician Magazine July/August 2011

DISCUSSIONManaging pain can bechallenging. Standard pain managementtreatments, including medication, injec-tions and blocks, acupuncture, therapyand rhizotomies are often attempted, but when they fail to relieve pain, otheroptions must be considered.

Spinal Cord Stimulation (SCS) treatschronic neuropathic pain of the back,

trunk and/or limbs, through the transmis-sion of electrical impulses that trigger selective nerve fibers along the spinalcord. The stimulation is provided byleads, inserted into the dorsal epiduralspace and connected to a generator. Thepatient experiences paresthesia in areaswhere they typically feel pain and theirlevel of discomfort is reduced.

The SCS procedure is performed byorthopedic physicians, neurosurgeons and trained pain specialists. The processbegins with a thorough review of the patient’s medical history, including reviewof past treatment approaches, and a physical examination. An X-ray and MRIof the lumbar, thoracic and / or cervicalspine are performed, as well as psycholog-ical testing to confirm if the patient canundergo the procedure.

SCS is performed in two stages: thetrial and the permanent implantation. Inthe first phase, using local anesthesia andmild sedation, one or two leads are placedinto the epidural space. The final lead position is determined by testing thestimulation while the patient providesfeedback. The lead(s) is then connectedto an external trial stimulator, worn on a belt throughout the trial. A remote control allows the patient to control theintensity of stimulation over the course of several days, leading ultimately to a determination of how much pain reliefcan be achieved using this technology.

Following a successful trial, thelead(s) and an implantable pulse genera-tor (IPG) are placed, either percutaneouslyor surgically. Percutaneous lead place-ments are generally less invasive but tendto have a higher migration rate than thoseplaced surgically. Surgical implants utilizepaddle-type leads which are placedthrough a laminectomy. Both procedures

require tunneling the leads from theepidural entry site to the “pocket” wherethe IPG is implanted. The sites mostoften used for the IPG implant are posterior, above or below the belt line.

SCS has positively impacted the threepatients described in this case. The firstpatient reports that her feet no longerhurt in a constant manner. “It’s a savinggrace when I need to be on my feet for an extended period of time,” the patientsaid. “I am a cycling instructor and I exer-cise regularly; I never would have beenable to do this without the stimulator.”

The second patient reported similarsuccess. “Before, I could not walk without a cane, pick up my grandchild,walk my dog or leave the house. I was onthe verge of total disability and despair.”Since receiving the stimulator implant,she has decreased her pain medications,lives an active lifestyle and has returnedto work full-time.

The third patient reported, “SCS reduces the amount of pain medication I need to take and allows me to sleep better – very important for the work I doin the elementary school system.”

For these patients and others, SCS isutilized as a practical treatment methodfor chronic, intractable pain when othertherapeutic measures have been exhausted. With proper patient selection, as well as correct device selection and positioning, SCS can be a highly success-ful, long-term solution for those withchronic neuropathic pain. Paul W. Davies M.D., completed his fellowshiptraining at Johns Hopkins University and isboard certified in Pain Management. He is thefounder and Medical Director of AdvancedPain Management, where he institutes amulti-disciplinary approach to care. He can bereached at [email protected].

JULY/AUGUST 2011 | 7

Cases

Spinal Cord Stimulation:Managing Challenging Chronic Pain in Mid-Life Patients

CASE: Three patientshave chronic pain issues.The first is a 47-year-oldflight attendant withplantar fasciitis and tarsaltunnel syndrome in bothfeet, despite multiple surgeries. The second is a45-year-old administratorwho suffered bilateralpatella dislocations as achild as well as chronicknee pain, leading toseven knee surgeries, including a total knee replacement in 2006. A48-year-old school teacherwith neuropathy, burningand numbness in thelower lateral area of herleft foot, causing balanceloss, is the third patient.Is there a common solutionfor all of these scenarios?

Paul W. Davies, M.D., FACS

Page 8: Maryland Physician Magazine July/August 2011

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ORRIED ABOUT AN upcoming audit? Fortunately, there are anumber of steps you can take to preparefor an audit, and protect your practice againstfindings that could end up costing you.

RAC Auditors Are IncentivizedRecovery Audit Contractors (RACs) haveexisted since 2005 and were originally established in Florida, New York and California, with South Carolina, Arizonaand Massachusetts following sooner after,to help deflect fraud and abuse inMedicare claims. As of 2009, the recoveryrate for claims has been a staggering $992 million, with inpatient hospitals representing the largest segment of fundsrecovered, including $19.9 million fromphysicians. Only 4.6 percent of RAC determinations have been fully or par-tially overturned on an appeal.

RAC auditors are incentivized by the errors they discover. For this reason,systems have been put in place by theCenters for Medicare and Medicaid Services (CMS) to validate their findings,including appointment of AdvancedMedas the validation contractor for RAC claims.They perform accuracy audits and confirmvalid reasoning or “good cause” for CMSto review a claim or a series of claims.

A Compliance Plan Is ImperativeThrough educating providers about thepresence of RACs and other entities, thegoal of CMS is to help providers establishefficient coding and documentation guidelines, which will ultimately avoid future overpayments. Development of acompliance plan within the practice is alsoimportant, to address all of the laws and rules that apply to the healthcare

environment: the Stark Law, Anti-kickbacklaw, HIPAA, CMS and local laws. A compliance plan also guides the provider in making the correct tactical decisions eachday. The Federal Register provides an outline of what a compliance plan shouldaddress, as well as guidance for your em-ployees to address violations they observe.

Document and Code ProperlyThe best way for a provider to prepare forthe arrival of a RAC auditor is to documentand code properly. There are many consultants and private auditors who arecapable of assisting you in this process. You may ask them to perform a pre-pay-ment audit and document their findings.This will provide valuable insights interms of how you can improve. Considerthe cost associated with this service as aninvestment. The resulting possible savingsfor your practice could be very significant.Can you endure a take-back of $90K ormore? Very few practices can; therefore,many consider paying a consultant or auditor an excellent use of resources.

When you contract with a company toperform the audit, consider choosing theclaims randomly. Perhaps you will focus onnew patient codes or level 4 services. You may request an audit on the use ofModifier 25 or Modifier 59, as these arewhat the RACs are most often reviewing.Also, ask your consultant to review yourprocedure documentation to assure you arecompliant according to American MedicalAssociation (AMA) and CMS rules.

Local Coverage Determinations(LCDs) offer another way to defend yourpractice and assure proper documentationor coding. The LCD will confirm thedocumentation requirement for a

procedure. They can provide insights onthe level of history or exam that would be expected in the encounter prior to the procedure and will tell you how often a procedure can be performed in a designated period of time, as well as whatdiagnosis are payable.

A Good DefenseAnother defense from the RACs is to hire an auditor or coding specialist underattorney/client privilege. This is recom-mended if you are receiving a significantnumber of coding requests for medicalrecords from Medicare. In many cases,this is a sign that auditors are “fishing”and it is possible that you are being reviewed for an audit. If time will allow,hire an attorney/client privilege auditor to review all of the encounters you aresending to the payer. This will confirm if your coding procedures are accurate orrequire change in order to achieve idealresults, in the event that a RAC auditor isassigned to your practice.

The current environment in healthcareis volatile for facilities and providers alike.Be proactive. Don’t wait to take the stepsnecessary to protect yourself and yourpractice, and assure that the results of anaudit from an outside payer will be positive.Kathleen J. Young, CPC CMA is the CEO ofResolutions Billing & Consulting, Inc. She canbe reached at [email protected]

Solutions

Protecting Your Practice in a RAC Audit Environment

By Kathleen J. Young

W

Page 9: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 9

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Page 10: Maryland Physician Magazine July/August 2011

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After almost 40 years at Anne Arundel Medical Center, CEO Martin L. “Chip” Doordan has retired.

Anne Arundel Health System’s Board of Trustees announced Doordan’s retirement in June. Victoria W. Bayless, the health system’sformer president, took over as CEO on July 1.

Doordan joined the Anne Arundel Medical Center (AAMC) in 1972as an administrative resident. In 1988, he became AAMC’s president andin 1994, the Board of Trustees named him president of Anne ArundelHealth System. AAMC has more than doubled in size under Doordan’sleadership. The health system has also built satellite locations in Bowie,Kent Island and Waugh Chapel.

“I never had a day where I didn’t want to come to work,” said Doordan. “It’s astonishing to think that nearly 40 years have flown bysince I first joined Anne Arundel General Hospital. Today we’re a gleam-ing, modern expansive health system, touching hundreds of thousands of lives each year. It’s been a real privilege to spend my career here.”

Doordan Retires from AAMC

The Maryland chapter of the AmericanCollege of Emergency Physicians recentlynamed Neel Vibhakar, M.D., an emer-gency medicine physician at BaltimoreWashington Medical Center, as its Emergency Physician of the Year.

Vibhakar, chairman of the Depart-ment of Emergency Medicine at BWMC,was honored during the college’s annualmeeting in Baltimore along with his co-worker Lynn Brown, R.N., who wasnamed Emergency Nurse of the Year.

Medical Beat

BWMC Doctor NamedEmergency Physician of the Year

Jacquie Roth x Publisher/Executive Editor410.987.6667 x [email protected]

www.mdphysicianmag.com

Newly named AAMC CEO Victoria W. Bayless with newly retired AAMC CEO Martin L. "Chip" Doordan

Clinical FeatureMaryland Physician focuses on the latest cancer developments. We talk with top Maryland specialists to get their take on the effectiveness of the latest treatments for prostate, breast and blood cancers.

Healthcare ITIn every issue, Maryland Physician explores a different facet of the race to implement EHRs to meet Meaningful Use and other e-health government incentives. Don’t be left behind – read what Maryland physicians and healthcare IT experts have to say that eases the pain of transition to an electronic world.

Imaging UpdateMaryland Physician delivers the latest advances in diagnostic imaging from Maryland radiologists – including when 3T MRI is proving most valuable and when it is not meeting early expectations - to get more from your imaging referrals.

In Every Issue and OnlineCases x Solutions x Compliance x Medical Beat x Heritage x Legacy x Policy

Space Reservation Deadline August 5, 2011 x Ad Materials Deadline: August 10, 2011

September/October 2011 Issue

Page 11: Maryland Physician Magazine July/August 2011

The University of Maryland Marlene and StewartGreenebaum Cancer Center is leading a multicenter clinical trial to evaluate a new approach in treating triple-negative breast cancer – an often aggressive typeof cancer that is more common in African-Americans and young women.

The trial, led by Saranya Chumsri, M.D., an oncologist at the Greenebaum Cancer Center, will helpresearchers see if the experimental drug entinostat canreprogram tumor cells to express a protein that wouldmake them sensitive to hormone therapy. It is based onlab studies by Angela H. Brodie, PhD., a University ofMaryland breast cancer researcher, and her colleagues.

Doctors will treat newly diagnosed postmenopausal patients with entinostat and an aromatase inhibitor called anastrozole (Arimidex) before they have surgery to remove theircancer. Researchers will then analyze tissue from the tumor and blood samples to evaluatewhether the treatment is effective. After surgery, patients will receive standard treatment, suchas chemotherapy and radiation. Researchers hope to enroll 41 patients at 20 sites, includingthe Greenebaum Cancer Center.

Freischlag Named Vice Presidentof National Vascular SocietyThe Society for Vascular Surgery®

recently elected Julie Freischlag, M.D.,chair of the Department of Surgery atJohns Hopkins, as its vice president.

In her new role, Dr. Freischlag willhelp lead the professional vascular medical society, which seeks to advanceexcellence and innovation in vascularhealth through education, advocacy, research and public awareness.

Dr. Freischlag, a vascular surgeon and one of only six female surgical chiefsin U.S. history, was featured in theMay/June 2011 issue of Maryland Physician magazine as a female physicianleader cracking medicine’s glass ceiling.

Along with her position at Johns Hopkins, Dr. Freischlag is the editor of the Archives of Surgery and the associate editor of the American Journalof Surgery. She serves on the editorialboards of the Annals of Vascular Surgery,the Journal of the American College of Surgeons and the Journal of the American Medical Association.

She is also involved with the American College of Surgeons, AmericanMedical Women’s Association, Associationfor Academic Surgery, Association ofWomen Surgeons, Chesapeake VascularSociety and Society of Surgical Chairs.

JULY/AUGUST 2011 | 11

Howard County General's Spine Center Earns DistinctionCareFirst BlueCross BlueShield has designatedHoward County General Hospital’s (HCGH) Spine Academy as a Blue Distinction Center for Spine Surgery®.

CareFirst BlueCross BlueShield, an independent licensee of the Blue Cross andBlue Shield Association, awards the designationto hospitals that meet evidence-based thresh-olds for clinical quality, including patient resultsand treatment expertise, and safety developedwith input from expert clinicians and leadingprofessional organizations.

HCGH is a member of Johns Hopkins Medicine.

Upper Chesapeake Named Cardiac Interventional CenterThe Maryland Institute for Emergency MedicalServices has designated Upper ChesapeakeMedical Center as one of 23 cardiac interven-tional centers in the region.

The designation signifies the medical centermeets state standards to receive patients trans-ported by ambulance who are experiencing anST-elevation myocardial infarction (STEMI) – themost common type of heart attack. Emergencymedical providers who identify patients with this kind of heart attack must take them to thenearest designated cardiac interventional center,bypassing non-designated hospitals.

University of Maryland Doctor Leads Trial on Breast Cancer

From left, John B. Chessare, M.D., presidentand CEO of GBMC HealthCare, and HmuMinn, M.D.

GBMC Doctor ReceivesCaregiver Award

Send news and announcements for publication consideration with high res photo

(300 dpi) to [email protected]

Greater Baltimore Medical Center recentlyawarded Hmu Minn, M.D., with its fourth annual Nancy J. Petrarca Compassionate Caregiver Award.

Dr. Minn, an internal medicine physicianand associate program director of GBMC’s internal medicine residency program, received $1,000 as part of the honor, created in 2008 to honor caregivers whodisplay extraordinary compassion in caringfor patients and their families. He hasworked at GBMC for five years.

Page 12: Maryland Physician Magazine July/August 2011

BY LINDA HARDER

12 | WWW.MDPHYSICIANMAG.COM

Practical Advice for a Conversion or Upgrade

Healthcare IT

Painkillers

EHR

Page 13: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 13

1PlanningIdentify your goals and theentire scope of work that theEHR system must address –is there more than one prac-tice location, will you wantpatients to access forms in akiosk or online, will you addor lose physicians? As muchas possible, anticipate growthin the practice over the nextfive to 10 years. Even withMeaningful Use deadlineslooming, the upfront invest-ment is worthwhile.

2 EvaluationEvaluate the most likely certified vendor packagesavailable and select two finalists. Make sure that youtry out the software onlineand that you talk to severalreferences from practicesthat are similar in size andscope to yours. “Ideally, visitthese practices and also haveyour IT people talk to thereference’s IT people becausethey’ll speak the technicallanguage,” says Triplett.

“When discussing thefunctionality and usage ofthe EHR system with thepotential vendors, be forth-right and comprehensive inyour explanation of currentand future needs,” addsPalmer. “The more under-standing the EHR vendorhas of your practice, the better the system can be setup to meet your needs. Also,it’s much better to learn thelimitations of the EHR system early on beforeyou’re expecting the systemto do something that it cannot be configured to do.”

Greenberg concurs thatthe evaluation stage is critical. He suggests that,

in addition to checking withother healthcare providersyou trust, you should checkyour vendor’s ranking onKLAS (www.klasresearch.com), an independent service that rates companiesbased on customer surveys.“Make sure a product supports your specialty, butbeware of highly specializedEHR vendors because theymay not be around in fiveyears,” he notes. “Also selectreferences where more thanhalf of the providers areusing the EHR.”

He counsels physicians toconsider the following factorswhen evaluating a company:

(continued on page 15)

The 5 implementation stages, and advice for each phase of the journey, are:

Whether your practice is small or large, andwhether you’re implementing a new EHR or upgrading anexisting one, it’s ahuge undertaking.We spoke with a number of IT professionals, practice managersand EHR vendorsfor tips to ease yourconversion pain.

WWhy Start NowAs we went to press, CMS indicated it may modify some Meaningful Usedeadlines in response to provider concerns. However, delaying EHRimplementation will still squeeze yourtimeframes in future years. PamelaMcNutt, Senior VP and CIO atMethodist Health System in Dallas,wrote in “Roadblocks on the Path to Meaningful Use,” a June 6, 2011 article in Modern Healthcare, “…. Starting in 2012 or later com-presses your time frames to movefrom Stage 2 to Stage 3. Everyonemust be at Stage 3 in 2015, regardlessof their start date. Some 70% of your Medicare incentive funds come during the first two payment years,and those two years will be in Stage 1 only if you start in 2011 or 2012.”

Rick Greenberg, regional salesmanager, Greenway Medical, says,“The return on investment for existedlong before the government providedfederal stimulus dollars. EHRs allowyou to better capture your proceduresand code more accurately, and theysave you all of the costs associatedwith paper charts.”

PART A: Tips for EHR ImplementationIT professionals Andrei Palmer andGordon Triplett, co-founders of Aertight Systems, have helped morethan 30 physician practices implementEHR systems over the past six years.They have formulated a list of recommendations for each of the five key stages of implementing or upgrading an EHR system.

5 Implementation Stages

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PAPERCAMER

A PHOTO

GRAPH

Y

Aertight Systems Co-founder and Vice President Andrei Palmer with Michelle Housley, HR/IT manager, and Jackie Goldberg, practice administrator,for Digestive Disorders Associates (DDA)

“Ideally, even before you select avendor, involve the local IT professionalsyou already use and trust in the EHRprocess,” says Palmer. “Very few vendorsare actually based in Maryland and this is a life-changing operation. The out-of-state vendor provides training for a shorttime, then is gone. Your in-house or contracted IT professional can help youassess vendors and become an active part of the process early on, minimizingheadaches.”

PART B: Tips for an EHR UpgradeJackie Goldberg, practice administrator,and Michelle Housley, HR/IT manager,for Digestive Disorders Associates (DDA)went through an EHR conversion adecade ago, long before most practiceswere on the HIT bandwagon. Goldbergattributes the early start to the practicefounder, Michael Epstein, M.D. “Dr. Epstein is very forward thinking and wasready to jump on board back in 2001,”Goldberg says.

Fast forward 10 years to June, 2011.The practice is embarking on a major upgrade to their EHR system, using the same vendor but gaining significantnew functionalities, and most importantly,making them compatible with HIPAAVersion 5010. “We’re going to a virtualenvironment, where our servers havebeen redone, with one physical box that can store five to seven servers,” comments Housley. ‘We have a firewalland our servers are behind that. We also have redundancy in our servers and secure back-up.”

Housley continues, “The look of the updated application will change dramatically for the staff and they will use a totally different approach,” shenotes. “We're about to employ a newEMR where our patients will also haveonline access to schedule appointments,request prescription refills and down-load patient forms from the website.They’ll even be able to email questionsto physicians.”

PART C: Tips for an Upgrade or InstallIn addition to concurring with much ofthe advice from Greenberg and AertightSystems, Goldberg and Housley recom-mend the following:

z Recognize that many vendors have a growing backlog of clients now –even after you’ve signed a contract, it could take several months or more to begin conversion.

z Determine whether you want to host the data onsite or off. Onsite may provide more control but also carries the onus of managing HIPAA compli-ance and providing redundancy.

z Ensure that your CMS electronic transactions are submitted using Version 5010 of HIPAA by January 1, 2012, the deadline for compliance. Until then, Version 4010/4010A or Version 5010 standards are acceptable.

z Expect staff to resist change and for some of them to be unhappy. Frequent communication can alleviate

Page 15: Maryland Physician Magazine July/August 2011

the stress. Hold staff meetings to prepare them for what will happen, including a period of lower productivity.The AMA’s website recommends providing incentives for staff, such as a special lunch.

z Help doctors in the practice prepare forhow different electronic charts are frompaper ones. “There’s a cascade of information that’s hard for some doctorsto adjust to,” notes Goldberg.

z Keep patients informed. When they call to schedule their next appoint-ment, let them know about the new system and that it may slow down their first appointment.

z Cut patient volumes during the first week of conversion to reduce stress andfrustration for patients, staff and physicians alike.

z Ensure that your contract requires the vendor to be onsite during the first business week of conversion and to provide ready support offsite after that time.

z Consider how the software will interface with the practice manage-ment software you may already have, and with other locations, such as a surgi-center. “I’ve heard from many primary care practices that they’ve had to abandon their EHR system because the financial and patient care systems don’t interface well,” says Goldberg. Other experts recommend that physicians take into account any inter face with other providers in the practice's "network" (e.g. IPA or PHO) in anticipation of global payment contracts & ACOs.

Jackie Goldberg, administrator, and MichelleHousley, HR/IT manager, Digestive DisordersAssociates (www.dda.net). Andrei Palmer, Vice President, and Gordon Triplett, president,Aertight Systems (www.aertight.com). RickGreenberg, regional sales manager, GreenwayMedical (www.greenwaymedical.com).

JULY/AUGUST 2011 | 15

“Patients willalso have onlineaccess to scheduleappointments,request pre- scription refillsand download patient formsfrom the website.They’ll even beable to emailquestions to thephysicians.”

— Michelle HousleyHR/IT manager, DDA

(continued from page 13)

z The company’s viability – number of employees, financials, longevity and growth

z Product usabilityz Technologyz Supportz Price

“Price should be the lastand perhaps least importantfactor to consider,” Greenbergadds. “A cheaper price isn’tworth it if the product doesn’tdo what you need it to.”

3Demonstration Rather than selecting onesystem that you impose onyour staff, invite the two finalists to conduct detaileddemonstrations of their systems and let all of thestaff that will be impacted bythe EHR provide input. “For

example,” says Palmer, “onesystem might provide morefunctionality but take fiveclicks to get data. And beware– if a vendor promises to makea change from five clicks totwo, make sure they can actu-ally deliver on that promise.”

Since many EHR systems come in modules,make sure you’re buying allthe functionality you need.Also determine what theuser licensing or cost modelis and whether that modelwill accommodate your practice if you add anotherphysician or office.

McNutt’s article cau-tions, “We now know thatyou must possess all themodules that a vendor usedto achieve its certificationeven if you are not usingthem to demonstrate mean-ingful use. This is furthercomplicated by the fact thatmany major vendors certified

their products only as complete EHRs, and theirmodules do not inherit thecertification when thosemodules are used separately.”

4 Prepare for ConversionTriplett recommends preparing for the actual conversion to paperless bytaking non-active charts and“practicing” the conversionon them. He says, “That lets you “stress test” the system to detect issues suchas needing more RAM because the conversion is tooslow. Or you might find thatnon-standard forms, such as allergy reports, were notincluded in your initial planning. Make sure thateverything is in synch andget the staff used to it before implementation day.”

Triplett and Palmer also

recommend getting collegestudents or interns to helpscan existing patient dataand speed the conversion.

5Go LiveJackie Goldberg, practice administrator, and MichelleHousley, HR/IT manager,for Digestive Disorders Associates (DDA) recom-mend cutting your patientvisits back by about 50% forthe first week of conversionand making sure your vendorhas contracted to be onsitefor at least a week during theactual “go live” period. Afterthat time, having a local ITprofessional and remote accessto the vendor will help tosmooth the transition.Greenberg, however, saysthat his company builds inenough advance training thatpatient volumes need be cutonly slightly the first week.

Page 16: Maryland Physician Magazine July/August 2011

Dr. Ronald Delanois, M.D., orthopedic surgeon at the Center for Joint Replacement and Preservation at Sinai Hospital

Page 17: Maryland Physician Magazine July/August 2011

OrthopedicsBEYOND THE HYPE

BY LINDA HARDER • PHOTOGRAPHS BY TRACEY BROWN

Proper Procedure Selection is Key to Outcomes

MEDIA HYPE ASIDE, ORTHOPEDICprocedures have made some truegains in recent years. We spoke with three Maryland orthopedists –Ronald E. Delanois, M.D, from Baltimore’s Sinai Hospital, William J. Sadlack, M.D, from SuburbanHospital in Bethesda, and Alex C.Speciale, M.D., from Anne ArundelMedical Center (AAMC) – about thelatest advances, to help guide yourtreatment and referrals.

Younger and Growing Joint Replacement PopulationThe typical patient getting a knee or hip replacement used to be in hisor her 70s or 80s. Now, with babyboomers wanting to stay active andnew products potentially offeringgreater durability, patients are oftenin their 50s to 60s or even younger.That trend, accompanied by the bur-geoning and increasingly obese babyboomer population entering “old”age, is expected to lead to increaseddemand for viable replacement.

Ronald Delanois, M.D., orthope-dic surgeon at the Center for Joint Replacement and Preservation atSinai Hospital, notes, “I’m seeing alot more younger patients wantingjoint replacements. The average agefor a knee replacement in our prac-tice is now approximately 58 years,down from the national average ofabout 72. Heavier people who are active – such as one patient who is a

39 year old former football playerpreviously weighing 500 pounds –are often seeking this procedure.”

Advances in Hip RepairsMetal-on metal (MoM) hip replace-ments have received some negativepress this year due to the potentialfor ion debris, hypersensitivity, andpain. However, a small number ofpatients have reported problems andonly two devices have been recalled– the ASR ™ XL Acetabular Systemand the ASR ™ Hip Resurfacing system, with many other systems stillon the market. On May 6, 2011, theFDA issued a post-market surveil-lance study of total MoM devices.

Dr. Delanois comments, “Thetrue rate of revision of these MoMhips is unknown. I’m not revisingthem very often, so I can’t say that

they’re bad. We’re participating in aclinical trial for ceramic on metal hips– a new alternative bearing surfacethat may be the best of both worlds;great durability with lower risk. In myopinion, the new plastics are as goodas they say they are, but it takes yearsto really know what is the best designand material.

“Most patients with the old plastics had hip replacements lastinggreater than 10 to 15 years; but thenewer ones have the potential to significantly decrease osteolysis,” Dr. Delanois notes.“Polyethylenehips may very well prove to last for30 years or greater. Stryker’s newMDM X3 offers two large heads thatare more stable and show less wear.That has become my hip of prefer-ence for older women and those whoneed stability.”

The multi-center clinical research trial for ceramic-on-metal hip implants is still recruiting patients, with preliminary results not expected until 2013.

William J. Sadlack, M.D., chair-man of Orthopedics at SuburbanHospital, states, “The gold standardis still a total hip replacement, andnot a hip resurfacing, which hasstrict criteria and is subject to metalon metal wear.”

Advances in Knee TreatmentsWeekend warriors tend to suffermore joint and ligament problems

“The gold standard

is still a total hip

replacement, and not

a hip resurfacing,

which has strict criteria

and is subject to metal

on metal wear.”

— William J. Sadlack, M.D.

JULY/AUGUST 2011 | 17

Page 18: Maryland Physician Magazine July/August 2011

when they are not physically fit. “Musclestrengthening during the week is mostimportant in lessening weekend injuries,”says Dr. Sadlack. “Stem cell implants maybe the solution in the future for regenerat-ing damaged cartilage, thereby decreasingthe need for joint replacements.”

Dr. Sadlack advises primary carephysicians, “If a patient comes in withknee pain, the first joint to examine is the hip, as often the hip is the culprit forthe knee pain. Also examine the entire extremity, because flat feet and otherfoot/ankle issues can affect the knee, too.”

The vast majority of baby boomerswith knee injuries have torn menisci, according to Dr. Sadlack, but this is usually superimposed on articular carti-lage damage. He notes, “Unless the kneehas mechanical symptoms of locking orgiving way, arthroscopic surgery may notbe as valuable as physical therapy, NSAIDsor hyalgan and cortisone injections.”

“Joint replacement surgery should only be performed when all conservative

measures fail and the pain compromisesthe activities of daily living,” Dr. Sadlackstates.

Computerized knee and hip replace-ments provide a true advantage in obtaining the correct alignment in joint replace- ments. Dr. Sadlack says, “The use of a computer guides the surgeon and is similar to having a guardian angel in the operating room.”

In the knee, Dr. Delanois uses techniques that include high tibial osteotomies, unicompartmental (partial)knee replacements, and cartilage transplantation procedures.

Surgical reconstruction of torn ACLligaments is typically advised when otherstructures in the knee have also beendamaged. Otherwise, conservative (non-operative) measures may prove sufficientfor most patients, especially those whodon’t participate in high-risk sports. Patients undergoing surgical reconstruc-tion have long-term success rates of 85%to 95%, with about 8% experiencing recurrent instability and graft failure.

More controversial treatments include"low intensity laser therapy" for ligamenttears, prolotherapy in which a glucosetype substance is injected, and hyperbaricoxygen, which is highly controversial atthis time.

Advances in Spinal TreatmentsMost of the advances in spinal surgeryhave revolved around less invasive sur-gery techniques as well as implants andbone grafts to improve fusion rates andoutcomes. Despite these advances however, “Patients with axial back orneck pain and even most of those withneurological symptoms, treatment is usually conservative and most people get better with physical therapy andNSAIDs,” says Dr. Speciale, medical director of AAMC Spine Center. “Forthose patients who fail to improve withnon-operative treatment, laminectomywith or without fusion can be highly successful. Red flags for urgent surgicalevaluation include profound weakness,acute bowel or bladder dysfunction andintractable pain.”

Laminectomies and discectomies for radicular pain are highly successfulprocedures with patient satisfaction rates in the 80 to 90% range. Controversyabounds, however, on the topic of fusions, especially for the treatment ofneck and back pain. Dr. Speciale notes,

18 | WWW.MDPHYSICIANMAG.COM

“A lateral approach

to back pain has revo-

lutionized our ability

to treat many patients,

especially for those

with degenerative

scoliosis involving four

or fewer segments.”

— Alex Speciale, M.D.

Alex C. Speciale, M.D., medical director of the AAMC Spine Center.

Page 19: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 19

“There’s a misconception among manypatients and some physicians that fusionsdon’t work – they’ve gotten a lot of negative press. But some studies nowshow that fusions have a similar successrates to hip replacements.

“Proper patient selection appears tobe the key,” states Dr. Speciale. “Patientswith multi-level disc disease (more thantwo involved discs) are often poor surgicalcandidates.” Smoking and obesity are also risk factors for poor outcomes withsurgical procedures. If initial conservativemeasures don’t improve their symptoms,the next step often is to refer them to apain management specialist for proceduressuch as fluoroscopically guided injections.Spinal cord stimulation can be highly effective for those patients who fail to respond to advanced pain managementtechniques and are not considered candidates for surgery.

For those patients that are deemed to be surgical candidates, the decision asto whether they need a laminectomyand/or a fusion can be complex and revolves around the degree of stenosisand instability. For those with instabilityand /or severe axial pain, fusion is still thegold standard. Less invasive techniquesare tipping the risk/benefit ratio in favor of surgery. One of the most significant

advances in spine surgery is a lateral approach to treating lower back pain.

‘This has revolutionized our ability to treat many patients, especially forthose with degenerative scoliosis involv-ing four or fewer segments,“ observes Dr.Speciale. ‘When more than four segmentsare involved, the posterior approach isstill best, though we’re working on lessinvasive hybrid approaches that involvepercutaneous screw fixation, which doesless damage to muscular tissue.

Motion-preserving devices includeflexible rods and disc replacements. Initial enthusiasm has been dampenedby the difficulty in getting insurance coverage for many of these devices. Limited indications and a greater risk of vascular or urological dysfunction forlumbar disc replacement procedures that require an anterior exposure havealso slowed its adoption. Cervical disc replacement procedures are likely to gainacceptance more rapidly as the approachand cost profile is similar to fusion for thesame indications.

Dr. Speciale continues, “The effective-ness of vertebroplasty and kyphyoplasty,which have become very popular over thelast decade, was questioned in a recentNew England Journal of Medicine article.This article, however, was seriously flaweddue to selection bias. For patients withback pain caused by osteoporotic compres-sion fractures that happened within thepast 12 weeks, we get excellent results inmost cases.”

Advances in Shoulder Treatments“In the shoulder, arthroscopic surgery hascome into vogue, but it is not the answerfor all patients. Sometimes a mini open

procedure offers the best option. Syntheticgrafts for rotator cuff injuries are beingdeveloped now, but the jury’s still out,”Dr. Sadlack notes.

With the baby boomer population increasing the demand for more andlonger-lasting orthopedic procedures, thedevelopments in stem cell research andsurgical techniques are occurring at anauspicious time. Careful selection of theappropriate procedure for each patient’sclinical situation is critical in achieving apositive outcome.

William J. Sadlack, M.D., chairman of Orthopedics at Suburban Hospital

Chlorhexidine Wash: An Easy, Low Cost Way to Reduce Infection The number one cause of hip revisions is infection and instability. In the U.S.,17% of joint replacements are revisions. A revision takes two to four times the OR time as the original procedure.Interestingly, Sinai Hospital's Ronald E. Delanois, M.D., has found that a

low-tech approach first documented in 2009 by a study he participated in atSinai provides one of the most effective ways to reduce post-op infection ratesin joint replacement patients. As a result, his practice has patients scrub withchlorhexidine gluconate the night before and the morning of their surgery.Using this approach costs a bit more, but has been proven to significantly reduce the infection rate.

Ronald E. Delanois, M.D., is a board-certified, fellowship-trained orthopedicsurgeon who brings more than 20 yearsof experience with complex hip, knee,and shoulder reconstructive surgery to the Rubin Institute for Advanced Orthopedics at Sinai Hospital.

William J. Sadlack, M.D., is a board certified, fellowship trained orthopedicsurgeon who is chairman of orthopedicsat Suburban Hospital. He is a memberof Johns Hopkins Community Physiciansand has over 25 years experience injoint replacements and sports medicine.

Alex C. Speciale, M.D., a board-certified,fellowship-trained orthopedic surgeon,is medical director of the AAMC SpineCenter. Dr. Speciale has a special interest in spinal deformity surgery. In addition to traditional techniques,he performs minimally invasive spinesurgery, balloon kyphoplasty, disc re-placement and dynamic stabilization.

Page 20: Maryland Physician Magazine July/August 2011

20 | WWW.MDPHYSICIANMAG.COM

Legacy

THEEstate Planner’sSTORYBOOK OFEveryday Tales andUNEXPECTEDEndings

BY JANE FRANKEL SIMS

Page 21: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 21

DR. MONICA GREEN WAS becoming increasingly busy managingher burgeoning practice in the face of cumbersome and ever-changingMedicare, Medicaid and insurance regulations. She sometimes neglected to check her mailbox and feared over-looking a bill or missing a credit cardpayment and incurring penalties. When a teller at the branch of her local banksuggested adding her daughter’s nameto her bank accounts so that her daughter,Cindy, could help her manage her finances, Dr. Green thought this was a perfect idea, a welcome relief.

As she approached retirement, Dr. Green began worrying about whereher assets would go upon her death. She had three wonderful children,Cindy, John and Delia. Lucky for Dr.Green, Cindy lived close by, and Dr.Green depended on her for help with financial matters. When Dr. Green con-tacted her lawyer, Ralph Barnes, to seeif her will needed to be updated, Mr.Barnes assured her that her will dividedeverything equally among her threechildren. Confident that her affairs werein order, Dr. Green turned her attentionback to her hectic medical practice.

Cindy had the time to focus on hermother’s affairs because her husband,Greg, supported Cindy and took care ofthe couple’s finances. Greg was a serialentrepreneur and though none of hisbusinesses ever took off, he managed to make a comfortable living.

When Dr. Green died suddenly atthe age of 64, it came as a shock toCindy and her siblings. Greg, however,was secretly relieved. He was countingon a substantial inheritance from Dr.Green as he had been funding his latestventure on his personal credit card andthe bills were mounting. Dr. Green’sbank statements had been coming totheir address these past few years andGreg took notice of the fact that hiswife’s name was listed on the account.

When Cindy alerted Ralph Barnes of her mother’s passing, he informed herthat she was named personal representa-tive of her mother’s estate and asked herto make a list of her mother’s assets

and gather statements of her various accounts. When Cindy presented Mr.Barnes with a recent statement of hermother’s bank account, he was surprisedto see Cindy’s name next to her mother’son the account title.

“Well, Cindy,” Mr. Barnes stated, “it looks like the bulk of the assets arealready owned by you.”

Cindy looked confused.“The only assets that pass pursuant

to your mother’s will are those ownedsolely in her name at the time of herdeath. Because the bank accounts wereowned jointly with you, they passed toyou by title automatically at yourmother’s death.”

“Do you mean John and Delia don’tget anything other than a few sticks offurniture? Mom thought everythingwould be divided equally among mysiblings and me. This is not at all whatshe would have wanted.”

“Cindy, don’t worry. Even thoughthe bank accounts are legally yours, you can write checks to each of your siblings for their shares.”

Thankful that the situation could be ameliorated, Cindy went home. Overdinner she informed Greg of the jointbank account situation and her intentionto write a check for 1⁄3 of the value of theaccounts to each of her siblings firstthing in the morning. Normally calm andslow to speak up, Greg surprised Cindywith the alacrity of his response: “No,that’s not at all a good idea.”

“What do you mean?” Cindy asked, in deference to Greg’s experi-ence in financial matters. “Am I doingsomething wrong?”

This was not the way Greg had envisioned breaking the news to Cindy of their financial straits but the prospectof losing this windfall frightened him intoaction. “Cindy, we’re in trouble. A fewbig deals I was counting on fell through.It’s impossible to get business loans thesedays and we have maxed out the equityin our house. I have been purchasingbusiness equipment on my personalcredit card and taking cash advances onthe card to pay rent and salaries. The interest alone is killing me.”

Cindy was silent.“These joint bank accounts from

your Mom are a godsend. We can getback on our feet again.”

“But what about John and Delia?Mom wanted them to be treatedequally, and they have kids to putthrough school.”

“Cindy, you took care of yourmother’s finances for years. Don’t youthink you deserve a little extra as com-pensation? John and Delia will be fine.They don’t need this money like we do.”

Overwhelmed and more fearful ofdisappointing her husband across thetable than her siblings across the country, Cindy acquiesced. “Well,” shesaid. “I suppose we could give John andDelia their shares in a few months oncewe get our finances in order.”

CHAPTER 1: The Busy Doctor and her Devoted Daughter

MORAL OF THE STORY: Titles trump wills! Do not add someone’s name to yourbank account as a co-owner as this could significantly disrupt your estate plan andunintentionally disinherit children or other family members. Instead, add the per-son to the account “for convenience purposes” only. Alternatively, sign a powerof attorney allowing someone to manage your finances for you. Be wary of relying on the generous nature of your devoted child. Accounts titledjointly with one child are often not shared with siblings due to gift tax exemptionlimitations or pressures from third parties like spouses and creditors. Having a willwith the proper terms is not sufficient. You need to inform your estate planningattorney of how each and every asset you own is titled. Remember, that assetspass by title before they pass by will.

Jane Frankel Sims is founder and managing attorney of the Law Office ofJane Frankel Sims, LLC. She can be reached at janesimslaw.com. Excerpted fromThe Estate Planner’s Storybook of Everyday Tales and Unexpected Endings, her asyet unpublished book.

Page 22: Maryland Physician Magazine July/August 2011

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Page 23: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 23

RE YOU PREPAREDfor the U.S. health care system’s changefrom ICD-9 to ICD-10 diagnosis and procedure codes? The switch to ICD-10takes effect on October 1, 2013. Leadingup to the October 1, 2013, compliancedate, Maryland physicians should alsokeep the following in mind:

z January 1, 2012, the date for Version5010 compliance; a pre-requisite forICD-10 implementationz Testing of Version 5010 transactionstandards is underway; you should betesting with trading partners now

The Centers for Medicare & MedicaidServices (CMS) says it is important toprepare now to avoid potential reimburse-ment delays. The compliance deadlinesare not changing and while they mayseem far off, the transitions require anumber of business and system changesthat will take some time to plan. At CMS, we encourage physicians to takeadvantage of the many resources on ourwebsite that can help them get started,especially on the transition to Version5010 since it is just about six months away.

If you do not use Health InsurancePortability and Accountability Act (HIPAA)Version 5010 transaction standards startingJanuary 1, 2012, and ICD-10 codes whensubmitting claims with dates of service onor after October 1, 2013, payment of yourclaims may be delayed.

What’s Changing and Who Is Affected? Unlike ICD-9 codes, ICD-10 diagnosiscodes are alphanumeric, have 3 to 7 digits, and are much more descriptive.ICD-10 will affect diagnosis and inpatientprocedure coding for everyone coveredby HIPAA, not just those who submitMedicare claims. This change does notaffect Current Procedural Terminology(CPT) coding for outpatient procedures.

In addition to the code set changes, standards for electronic administrative

transactions (such as eligibility inquiriesand remittance advices) are being updated from the current Version4010/4010A1 to Version 5010 on January1, 2012. Version 5010 accommodates boththe ICD-9 and the ICD-10 code set structures. To allow adequate time tomeet the January 2012 implementationdate, CMS says that providers shouldhave begun testing Version 5010 withtheir trading partners starting in January2011. Providers who use practice manage-ment software, a clearinghouse, third-partybiller, or some other way to transmit information between themselves and ahealth care plan, will need to upgradetheir software or work with a clearing-house or billing service whose systemscan accommodate both the Version 5010standards and the ICD-10 code sets.

Get Ready for the Version 5010/ICD-10 TransitionStart with a gap analysis to determine the impact on your organization of bothVersion 5010 and ICD-10. Use that informa-tion to develop an implementation plan,with a detailed timeline, and estimate ofcosts. CMS suggests Maryland physicianstake the following steps to prepare now:

z Check with your billing service,clearinghouse, or practice managementsoftware vendor. Your third-party billerand clearinghouse need to make surethat you will be compliant by thedeadlines. Software vendors should be developing and testing productsthat will enable Version 5010 testingwith your payers and billing services.Testing with ICD-10 should startsometime after Version 5010 imple-mentation in January 2012, to allow for full ICD-10 implementation onOctober 1, 2013.z Start planning your transition to ICD-10. Meet with your professional and support staff. Discuss wherecodes are used within your organiza-

tion to help you assess impact. Assign roles and responsibilities foraddressing the transition.z Identify needs and resources. Consider changes that might be required. Develop a budget and time-line that take into account specificworkflow needs, vendor readiness,and staff knowledge and training.

Version 5010/ICD-10 ResourcesThere are many professional, clinical, andtrade associations offering a wide varietyof Version 5010 and ICD-10 information,educational resources, and checklists.Check the websites of your associationsand other industry groups, or call them, to see what resources are available.Denise Buenning is Director of the Administrative Simplification Group in the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services (CMS). The CMS website, www.cms.gov/ICD10/, has official CMS resources to help prepare for Version 5010and ICD-10.

Compliance

Maryland Physicians,Will You Be Ready?By Denise Buenning

A

Don’t Wait, Prepare NowHere are the important dates to

keep in mind for the Version 5010 and ICD-10 transition:

January 2011 Medicare began accept-ing Version 5010 electronic claims;providers should be testing Version5010 transaction standards with theirtrading partners.January 1, 2012 All electronic claimsmust be submitted using Version 5010. October 1, 2013 You must submitclaims with ICD-10 codes only for serv-ices provided on or after this date.

Page 24: Maryland Physician Magazine July/August 2011

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Page 25: Maryland Physician Magazine July/August 2011

JULY/AUGUST 2011 | 25

NCE A MONTH, A GROUPof musicians come together at Union Memorial Hospital’s Curtis NationalHand Center. They bring their instru-ments along, but their purpose is not topractice. Instead, their goal is to allowRaymond Wittstadt, M.D., to observethem in action, and ultimately, help themunderstand why they experience painwhile playing.

For the past 11 years, Wittstadt hasoffered this free monthly clinic, helpingmusicians as they battle pain and medicalissues resulting from overuse of theirhands and arms. Participants undergo a medical history review and completebody assessment, followed by an evalua-tion of body composure as they are playing their musical instruments ofchoice. In some cases, issues with postureare a contributing factor. In other scenar-ios, weakness or over-development ofmuscles can be causing the pain; oftenthe case for those who began training at a young age and are spending as muchas four to five hours a day, or more, withtheir instruments in hand.

“There are not many people who use their hands more than musicians,”Wittstadt said. “Our goal is to look deepand understand what is causing theirpain. If their hand hurts, it might be because their hand is injured. Or, it mightbe because their shoulder is weak. Wecan figure out a solution once we can see where the problem stems from.”

Over the years, musicians from nearand afar have taken advantage ofWittstadt’s clinic, traveling from as faraway as Florida and California, and evenSpain, to attend. An average of five to six musicians participate each month; anumber that has steadily increased as

awareness about the clinic and the positive impact it is having on so manypeople has grown. Tendinitis, carpal tunnel and nerve entrapment conditionsare the most common issues diagnosed,

with medication and therapy prescribedas appropriate and surgery consideredwhen necessary.

“We try to help people realize that the‘no pain no gain’ philosophy isn’t always intheir best interest and that there are waysfor them to continue doing what they love,without the pain,” said Wittstadt, whoworks collaboratively with certified handspecialist Lauren Valdata and certifiedAlexander Technique therapist KarenGeurtler to evaluate clinic participants.

A piano player as a child and recre-ational guitar player today, Wittstadt has a personal passion for music and is happyto volunteer his time to make this resourceavailable to his patients and the commu-nity at large. He welcomes physicians

from neighboring medical institutions as ad hoc participants in the monthlymeetings, and has written and publishednumerous articles on the prevalence of injury among musicians. Trained in

orthopedic medicine, he appreciates theopportunity the clinic gives him to mergethe practice of correcting repetitive useinjuries with sports medicine.

“Musicians are athletes of the smallmuscles,” he said. “It’s rewarding to helpthem and know that we can positively impact their lives.”

For further information or to refer apatient to an upcoming musician’s clinicmeeting, call 410-235-5405.

Good Deeds

Raymond Wittstadt, M.D. – Making Music Pain Free

By Tracy M. Fitzgerald

O

Sixteen-year-old Sheila Graves, a bass guitar player who practices up to three hours per day, beganexperiencing severe pain in both wrists. She has participated in Raymond Wittstadt’s monthly clinicfor musicians to learn more about her injury and the steps that should be taken to resolve her pain.

“We try to help people realize that the ‘no pain nogain’ philosophy isn’t always in their best interest.”

Maryland Physician would like to hear about your “Good Deeds.” Please share your ideas with us by contacting us via email at [email protected].

COURTESY

OF RAYMOND W

ITTSTA

DT, M

.D.

Page 26: Maryland Physician Magazine July/August 2011

T IS RECOGNIZED AS THElargest surgical hand practice in theUnited States. But the Raymond CurtisNational Hand Center, based at UnionMemorial Hospital, has built a reputationthat accounts for much more than size.Here, it’s about a strong and stable foun-dation and history, over three decades of quality care that has revolutionized patient experiences and outcomes, and an outlook for the future that makes themost advanced techniques for treatmentof upper extremity injuries available.

Upon his return from World War II,Dr. Raymond Curtis identified a need for specialized care for upper extremityinjuries and disorders, resulting in the1975 establishment of a center focused on prevention and treatment of hand,wrist, arm, elbow and shoulder ailments.Approximately twenty years later, inrecognition of its singular experience andexpertise, the 103rd Congress designatedthe practice as the National Center forTreatment of the Hand and Upper Extremity. Today, 14 board-certified orthopedic and plastic surgeons are partof this nationally-acclaimed practice, offering treatment of carpal tunnel, arthritis, tendonitis and other congenitalproblems, as well as a wide range of emergency and non-urgent surgical proce-dures that can repair injury and restorefunctionality of the upper extremities.

Under the leadership of James Higgins,M.D., Chief of the Center, there is a con-stant focus on innovative technique andthe introduction of new procedures. One of his areas of clinical and research expert-ise is vascularized bone transfer surgery.

“This procedure allows us to movebone and its associated blood vessels fromone part of the body to another,” Higginssaid. “We have presented some of the newtechniques for treatment of wrist and hand

injuries on the national and internationalstage, and are sharing our research and undertaking clinical collaboration withphysicians around the country and world.”

Collaboration is key for Higgins andhis colleagues as they identify strategicpriorities for the future of their practice. A new partnership is underway with Operation Smile, best known for theirmission work to help people in underpriv-ileged parts of the world with cleft lip andpalate conditions. Their new partnershipwith the Curtis National Hand Center expands the scope of their services, to include treatment of hand injuries. Morework is being done with the Walter ReedArmy Medical Center, to provide care tosoldiers returning from war with hand and arm injuries. And through a partner-ship with Johns Hopkins Hospital, CurtisHand Center surgeons are currently collaborating as part of a new hand trans-plantation team.

“A hand transplant will give a patientthe ability to experience sensation andfunction in their upper extremity thatthey could not achieve through a prosthe-

sis,” said Dr. Kenneth Means, a partner in the practice since 2006. “It takes amassive team of clinicians to do this, and we are honored to be part of this collaborative effort with Johns Hopkins.”

The Curtis National Hand Center isdesignated as the official treatment sitefor upper extremity trauma cases in thestate of Maryland. Physician referrals fornon-urgent care cases can be arranged bycalling 1-877-UMH-HAND.

26 | WWW.MDPHYSICIANMAG.COM

I

Heritage

National Name, Local Roots

A recent event was held to celebrate the lifetime achievements of Shaw Wilgis, M.D., one offour physicians credited with founding the Curtis National Hand Center. (Left to right) CurrentChief James Higgins joined founders Gaylord Clark, M.D., Shaw Wilgis, M.D., and FrederikHansen, M.D., at the event.

Raymond Curtis, M.D., realized a need for aspecialized practice to treat upper extremityinjuries upon his return from World War II. Patients have benefited from his vision andexpertise since the early 1970’s.

By Tracy M. Fitzgerald

Page 27: Maryland Physician Magazine July/August 2011

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Page 28: Maryland Physician Magazine July/August 2011

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