Established in 1844, our Journal is one of the oldest in the country. To learn more about the Journal and how to submit articles, please visit https://lsms.org/page/JLSMS.
JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 173 | ISSUE 2 | SUMMER 2021
IN THIS ISSUE: Louisiana Legislature Adjourns Sine Die HB 495, HB 442 - Legislative Timeline Internal Medicine Residency Response to the COVID-19 Effects of the COVID-19 Pandemic on one Louisiana Medical School
CONTENTS
JOURNAL EDITORIAL STAFF
EDITOR D. Luke Glancy, MD
VOL 173 | ISSUE 2 | SUMMER 2021
ASSOCIATE EDITOR L.W. Johnson, MD
CHIEF EXECUTIVE OFFICER JeffWilliams
4 PRESIDENT’S MESSAGE 5 LOUISIANA LEGISLATURE ADJOURNS SINE DIE 8 LEGISLATIVE TIMELINE 9 SCOPE OF PRACTICE, NURSE PRACTITIONERS 10 ROLL CALL HB 495 11 ROLL CALL HB 442 12 COMMUNITY CONNECTOR PARTNERSHIPS 14 PHYSICIAN COALITION OF LOUISIANA 15 INFORMING OUR LEGISLATORS 16 WHAT DO PATIENTS SAY? 18 WHITE COAT WEDNESDAY 21 LEGISLATIVE RECEPTION 23 LEGISLATURE BOOTCAMP 24 AN INTERNAL MEDICINE RESIDENCY RESPONSE TO THE COVID-19 PANDEMIC IN LOUISIANA 28 THE EFFECTS OF THE COVID-19 PANDEMIC ON THE UNDERGRADUATE MEDICAL EDUCATION EXPERIENCE AT LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD
Anthony Blalock, MD D. Luke Glancy, MD L.W. Johnson, MD Fred A. Lopez, MD
LSMS 2021 BOARD OF GOVERNORS OFFICERS President, Katherine Williams, MD Past President, Lee Stevens, MD President-Elect, William Freeman, MD Vice President, R. Reece Newsome, MD Speaker of the House, T. Steen Trawick, MD Vice Speaker, William“Beau” Clark, MD Secretary/Treasurer, Richard Paddock, MD Chair, COL, David Broussard, MD COUNCILORS District 1 Member, George Ellis, Jr., MD District 1 Alternate, Anne Borreson, MD District 2 Member, Robert Chugden, MD District 2 Alternate, Gabriel Rivera-Rodriguez, MD District 3 Member, Allen Vander, MD District 3 Alternate, Mark Hebert, MD District 4 Member, F. JeffWhite, MD District 4 Alternate, Susan Veillon, MD District 5 Member, Adrienne Williams, MD District 5 Alternate, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD District 6 Alternate, Azeen Sadeghian, MD District 7 Member, Brian Gamborg, MD District 7 Alternate, Donald Higgins, MD District 8 Member, Lance Templeton, MD
Obstetrician-gynecologist Dr. Katherine Williams has trusted LAMMICO to provide her medical malpractice insurance for over 13 years.
EXPECTATIONS EXCEEDING
I left LAMMICO for lower rates that were offered at another medical malpractice insurer. I later learned that this other insurer had no follow up, risk management education or relationships. So I came back to LAMMICO.
When I was faced with a claim, which can be a difficult experience for any physician, LAMMICO went above and beyond with claim support during the defense of the claim. I felt like they cared. Throughout the claim process, LAMMICO fought beside me so that I prevailed in court when they could have chosen a simpler, less expensive path. LAMMICO maintains relationships that are far reaching and benefit all physicians. They’re more than an insurance company. – Katherine Williams, M.D., obstetrician-gynecologist
District 8 Alternate, Michael Dole, MD District 9 Member, Andy Blalock, MD District 9 Alternate, Vacant
District 10 Member, Nicholas Viviano, MD District 10 Alternate, Jeremy Henderson, MD Senior Physician Member, Robert McCord, MD Senior Physician Alternate, Greg Lord, MD Young Physician Member, Amberly Nunez, MD YoungPhysicianAlternate, Randall G.White, Jr.,MD Resident/Fellow Member, Omar Leonards, MD Resident/Fellow Alternate, Ken Ehrhardt, Jr., MD Medical Student Member, Jacob Boudreaux, MD Medical Student Alternate, Dan Frechtling
Building Enduring Partnerships 800.452.2120 | lammico.com
J LA MED SOC | VOL 173 | SUMMER 2021 3
LEGISLATIVE UPDATE LOUISIANA LEGISLATURE ADJOURNS SINE DIE Maria Bowen, LSMS - Vice President Governmental Affairs
PRESIDENT’S MESSAGE Independent Practice for Nurse Practitioners and Physician Assistants is Bad Medicine for Louisiana.
Louisiana’s 2021 regularly-scheduled, fiscal-only session of the Legislature adjourned sine die on Thursday, June 10, at 6 p.m. For LSMS andourmembership, thesessionwasdominatedbynon-fiscal legislation, but we would be remiss in not sharing the passage of five bills pushed by legislative leaders with the backing of the business community.
For physicians, the 2021 session focused on two controversial issueareas: scopeof practiceandnoncompete clauses. Incredibly, LSMS members delivered more than 75,000 messages through email and text to legislators on the following bills. We thank you for your advocacy on behalf of your profession!
The first four bills are a package including a constitutional amendment that must pass a vote of the people prior to any taking effect: • SB 159 (Act 134) by Sen. Bret Allain (R-Franklin) is a Constitutional Amendment which would remove the requirement of a federal income tax deduction and would cap the maximum individual income tax rate at 4.75 percent. It will appear on the October 9 ballot. • SB 161 (Act 389) , also by Sen. Allain, eliminates the federal income tax deduction and phases in lower franchise tax rates gradually as certain positive economic and tax revenue triggers are met. • HB 278 (Act 395) by Rep. Stuart Bishop (R-Lafayette) eliminates the federal income tax deduction and lowers individual income tax rates with similar tax revenue triggers. • HB 292 (Act 396) by Rep. Neil Riser (R-Columbia) reduces the number of tax brackets for corporate income taxes, lowers rates and eliminates the federal income tax deduction. • HB 199 (Act 131) by Speaker Clay Schexnayder (R-Gonzales) creating the State and Local Streamlined Sales andUseTaxCommissionwill alsobeon theOctober 9 ballot. If approved by the voters, this commission will be tasked with the promulgation of rules aimed at simplifying electronic filing and remittance of local sales taxes. It will also serve as the entity to perform audit functions for out-of-state businesses and develop rules to streamline the audit process for companies with a physical presence in Louisiana.
Medicare beneficiaries from 2003 to 2015, found ordering increased substantially—more than 400% by NPs and PAs during this time frame. They further found greater coordination in health care teams may produce better outcomes than merely expanding scope of practice. A 2020 study published in the Journal of Internal Medicine found, that in states that allow independent prescribing, NPs were 20 times more likely to overprescribe opioids than those in prescription-restricted states. Furthermore, while the number of NPs doubled between 2010-2017, there has been no noticeable increase of nurse practitioners within rural, underserved areas. A recent CMS study confirmed few nurse practitioners choose to work in rural areas following graduation. It’s clear: scope of practice changes do not benefit patients, they benefit for-profit entities and non- physicians. Legislators must see past the false promises and oppose continued legislative efforts to increase scope of practice for non-physician practitioners. ■
On scope of practice, we had four pieces of legislation that we focused on:
Allowing non-physicians to provide physician-level care would be a step in the wrong direction. We must continue to educate legislators and encourage their oppostion to bills like HB 495 and HB 442, which risk patient safety, increase costs, and do not improve access to care. The best way to ensure patient safety is to keep physicians at the helm of the health care team. Patients deserve the most qualified health care provider, and that is a physician, who has unmatched training, education, and experience. Scope of practice changes do not decrease costs, nor do they increase access to care. Studies from the Mayo Clinic and JAMA found nurse practitioners (NPs) and physician assistants (PAs) are more likely to make unnecessary referrals and imaging orders, resulting in higher costs for patients. A study in the Journal of the American College of Radiology, which analyzed skeletal x-ray utilization for
• HB 495 by Rep. Barry Ivey (R-Baton Rouge) would have granted full practice authority to advanced practice registered nurses. This legislation was the most contentious bill of the entire session and finally died on the calendar when the legislature adjourned. LSMS and other physician groups fought hard to educate legislators as to the dangers associated with the bill. As the legislature adjourned, the Louisiana Association of Nurse Practitioners has already challenged its membership to continue advocating and promised to return next year. It is incredibly important for our membership to remain engaged and work to educate your legislators on our concerns. • HB 442 by Rep. Larry Bagley (R-Stonewall) would have changed how all physician assistants practice by removing physician involvement from any requirement of oversight. This bill died on the house floor with a 39 to 39 tie vote. • HB 181 by Rep. Dustin Miller (D-Opelousas) was intended to provide mental health nurse practitioners the ability to admit patients to inpatient mental health hospitals among other items. The bill was amended to only allow these items to occur if authorized by a
President Louisiana State Medical Society
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collaborative practice agreement. The bill was signed by the Governor and became Act 373.
• HB 187 by Rep. Larry Bagley (R-Stonewall) allows nurse practitioners and physicians assistants to order home health. While LSMS did oppose the bill, it is reflective of changes made by CMS during COVID-19. The bill passed the legislature and became Act 181. • HCR 94 by Rep. Stuart Bishop (R-Lafayette) and SCR 73 by Sen. Patrick McMath (R-Covington) was requested by LSMS in response to many legislators who sought a different way to review scope of practice increases. The resolution would have required all healthcare professional licensing boards to review processes utilized in other states and report back to the Health and Welfare Committees which ones would work for them and which ones would not work. After being egregiously mischaracterized in House Health and Welfare, the legislation was defeated by a vote of 2 to 10. Noncompete clauses in physician contracts was the subject of two bills. Both bills addressed certain aspects of the clauses and were successful leaving the House before meeting increased opposition on the Senate side. Although HBs 483 by Rep. Mark Wright (R-Covington) and 561 by Rep. Larry Bagley (R-Stonewall) stalled out in the Senate CommerceCommittee, RepresentativeWright has filedHCR 125 which directs a joint subcommittee of the House and Senate Commerce Committees to study various aspects of noncompetition agreements relative to physicians in the state and to report the findings of the joint committee to the legislature prior to the convening of the 2022 Regular Session of the Legislature of Louisiana. Then, with less than thirty minutes left before Sine Die, Representative Bagley introduced HR 223 which directs a joint committee of the HouseCommittee onCommerce and theHouseCommittee on Health and Welfare to study the issue and report their findings to the House of Representatives. We look forward to continuing to educate the members of the legislature on the negative impacts to patients and physicians of such provisions during the interim. If you have specific ideas or stories relative to noncompete agreements please feel free to contact Lauren Bailey at lbailey@lsms.org. ■
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SCOPE OF PRACTICE NURSE PRACTITIONERS
LEGISLATIVE TIMELINE
HB 495
HB 442
APRIL 2ND
Representative Barry Ivey (R-Baton Rouge) introduces HB 495 to provide nurse practitioners with full practice authority.
House of Representatives heavily amends the bill and approves it by a 61-41-2 vote.
26 states and the District of Columbia have independent practice
APRIL 22ND
HB 495 passes out of the House Health and Welfare Committee by a vote of 10-6-1 with Representatives Kenny Cox, Raymond Crews, Julie Emerson, Jason Hughes, Travis Johnson, Wayne McMahen, Dustin Miller, Pat Moore, Joseph Stagni and Chris Turner all voting for the bill. Voting with the LSMS and the Physicians Coalition of LA – Representatives Robby Carter, Michael Echols, Ed Lavadain III, Bob Owen, Thomas Pressly, and Larry Selders. Chairman Larry Bagley did not vote, and Representative Roy Daryl Adams was absent from the committee.
24 states do not have independent practice
APRIL 28TH
NURSE PRACTITIONER BILLS FILED IN LOUISIANA 2010-2021
HB 442 passes the House Health and Welfare committee by a vote of 13-4 with Representatives Larry Bagley, Roy Daryl Adams, Kenny Cox, Raymond Crews, Julie Emerson, Jason Hughes, Travis Johnson, Ed Lavadain III, Wayne McMahen, Dustin Miller, Pat Moore, Joseph Stagni and Chris Turner all voting for the bill. Voting with the LSMS and the Physicians Coalition of LA – Representatives Robby Carter, Michael Echols, Thomas Pressly, and Larry Selders.
Year
Bill
Author(s)
Summary
Action
Authorized a NP to provide health care to a minor without the consent of the minor's spouse, parent or guardian
2010
HB1046
Wilmont
Voluntarily deferred
2012
HB951
Wilmont
Exempted certain NPs from a collaborative practice agreement
Never heard
Moved NPs under the jurisdiction of the Louisiana State Board of Medical Examiners Called for a study group between the LSBN and LSBME to look at NP's in underserved areas
2013
SB192
Erdey
Voluntarily deferred
MAY 5TH
2014
HR199
Johnson
Never heard
House of Representatives heavily amends the bill and approves it by a 61-41-2 vote.
2015
HB416
Barrow
Exempted certain NPs from a collaborative practice agreement
Never heard
The LSBME cannot limit an NPs ablity to practice via a collaborative practice agreement
Never heard in senate committee Never heard in senate committee
2015
HB486
Johnson
Created a study group to make recommendations concerning the creation of a scope of practice review committee
2016
HCR86
Hoffman
MAY 19TH
HB 495 heavily amended yet again and passes out of the Senate Health and Welfare Committee by a vote of 4-3 with Senators Regina Barrow, Gerald Boudreaux, Bob Hensgens, and Jay Luneau voting for the bill. Voting with the LSMS and the Physicians Coalition of LA – Senators Patrick McMath, Beth Mizell, and Rogers Pope. Chairman Fred Mills did not vote.
2016
HB620
Wilmont
Exempted certain NPs from a collaborative practice agreement
Never heard
2016
SB187
Barrow
Exempted certain NPs from a collaborative practice agreement
No House floor vote
2016
SB206
T. Carter
Exempted certain NPs from a collaborative practice agreement
Never heard
Created a study group to make recommendations concerning the creation of a scope of practice review committee
2017
HCR59
Hoffman
Never heard
Exempted NPs in hospitals and nursing homes from a collaborative practice agreement Exempted NPs in hospitals and nursing homes from a collaborative practice agreement
2018
HB483
Stagni
Voluntarily deferred
MAY 11TH
The House of Representatives rejects the bill with a final vote of 39-39-27.
2018
SB435
Mills
Died on Senate floor
2019
HB276
Johnson
Provides NPs with broad-based global signature authority
Died on House floor
2020
HB864
Ivey
Removes the collaborative practice agreement in its entirety.
Died in House committee
MAY 20TH
2021
HB495
Ivey
Removes the collaborative practice agreement in its entirety.
Died on Senate floor
HB 495 reported with amendments to the full senate where it sat for three weeks never to be debated as it was DOA. There was simply too much opposition to the bill and members did not want to vote. ■
2021
HB181
Miller
Expands the scope of practice for psychiatric nurse practitioners
Passed with amendments
Allows nurse practitioners to write home health orders without a physician's approval
2021
HB187
Bagley
Passed with amendments
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ROLL CALL HB 495 2021 REGULAR SESSION
ROLL CALL HB 442 2021 REGULAR SESSION
HBS FINAL PASSAGE HB 495 BY IVEY FINAL PASSAGE SEQUENCE: 269 DATE: 5/05/2021 TIME: 6:32:03 PM
HBS FINAL PASSAGE HB 442 BY BAGLEY FINAL PASSAGE SEQUENCE: 392 LOCKOUT VOTE DATE: 5/11/2021 TIME: 8:09:20 PM
YEAS
YEAS
Mr. Speaker Adams Amedee Bacala Bourriaque Brass
Deshotel Duplessis Edmonds Edmonston Emerson
Hughes Ivey James Jefferson Jenkins
Marcelle Marino McCormick McMahen Miguez
St. Blanc Stagni Stefanski
Mr. Speaker Amedee
Duplessis Edmonds Edmonston Emerson Firment
Ivey Jefferson Johnson, T. Jordan Larvadain
Marino McCormick McFarland
Pierre Riser Schamerhorn
TOTAL 61
TOTAL 39
Bacala Bagley Brass
Tarver Turner Wheat White Willard Wright
Miller, D. Miller, G. Mincey Nelson Newell
Stagni Turner White Willard
Firment Frieman Gaines Glover Goudeau
Johnson, M. Johnson, T. Jones
Miller, D. Miller, G. Mincey
Carpenter Carter, W. Cox
Gaines Horton Hughes
Lyons Mack Marcelle
Brown Bryant
Carpenter Carter, G. Carter, W. Cox Crews
Jordan Kerner Lyons Mack Magee
Moore Nelson Pierre Romero Schamerhorn
Green Hollis Horton
NAYS
NAYS
Adams Bourriaque
Coussan DeVillier DuBuisson Echols Farnum
Gadberry Garofalo Geymann Harris Huval Illg LaCombe Landry
McMahen Miguez Muscarello
Selders Tarver Thomas Thompson Villio
Bagley Beaullieu Bishop Butler Carrier Carter, R. Cormier Coussan Davis
DeVillier DuBuisson Echols Farnum Fontenot Freeman Freiberg Gadberry Garofalo
Geymann Harris Hodges Huval Illg LaCombe Landry Larvadain McFarland
McKnight Muscarello Newell Orgeron Owen, C. Owen, R. Pressly Riser Seabaugh
Selders Thomas Thompson Villio Zeringue
TOTAL 41
TOTAL 39
Brown Bryant Butler Carrier
Orgeron Owen, R. Phelps Romero Schlegel
Freeman Freiberg Frieman
Wheat Wright
Carter, R. Cormier
ABSENT
ABSENT
Hilferty Phelps
Beaullieu Bishop Carter, G. Crews Davis Deshotel
Fontenot Glover Goudeau Green Hilferty Hodges
Hollis James Jenkins Johnson, M. Jones Kerner
Magee McKnight Moore Owen, C. Pressly Seabaugh
St. Blanc Stefanski Zeringue
TOTAL 2
TOTAL 27
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COMMUNITY CONNECTOR PARTNERSHIPS Community Connector, our partnership program, provides exclusive offers, services and solutions to our members. The LSMS partners with trusted companies to build exposure and make connections with the health care community and members across the state. If you’re interested in learning more about our Community Connector Partnership Program, contact publicaffairs@lsms.org
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LAMMICO (lammico.com) LAMMICO is a policyholder-owned insurance company that provides unparalleled service and comprehensive medical professionalandgeneral liabilitycoverageatactuariallysoundrates. With our personalized claim handling, aggressive legal defense and high quality risk management education, our policyholders can focus on what matters most: their patients. LAMMICO is the largest medical professional liability (MPL) insurance carrier domiciled in Louisiana and the only “A” (Excellent) rated Louisiana domiciled MPL insurance carrier insuring physicians, hospitals and facilities. LAMMICO is licensed to underwrite insurance in Louisiana, Arkansas, Mississippi and Tennessee. Coverage is also available in these and other states through the LAMMICO Risk Retention Group (RRG). The LAMMICO RRG supports out-of-state practice expansion of existing and new LAMMICO policyholders by providing a mechanism for coverage in states beyond those where LAMMICO is licensed. The LAMMICO RRG is licensed and domiciled in Washington, D.C. and registered to write business in Alabama, Arkansas, California, Georgia, Louisiana, Mississippi, Oklahoma, Tennessee and Texas. Elatas Risk Partners, Inc. (elatas.com) For more than 30 years, Elatas Risk Partners, Inc., a wholly-owned subsidiary of LAMMICO, has provided highly personalized insurance solutions to individuals and businesses. Grounded in a vision of enduring, partnerships, Elatas provides coverage options beyondmedical professional liability andgeneral liability andhelps elevate commercial businesses by tailoring insurance portfolios to protect their unique circumstances and free them to focus on managing their business. Elatas provides a fresh perspective and an honest review of insurance options to protect your business in the event of a claim with access to extensive coverage options including Business Owner Policy, Commercial Property, General Liability, Flood, MEDEFENSE® Plus/Cyber Liability, Employment Practices Liability, Inland Marine, Workers’ Compensation, Life and Disability lines of insurance.
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In August of 2020, Advantage Physician’s Purchasing Alliance (Advantage PPA) partnered with the Louisiana State Medical Society (LSMS) to build a purchasing organization that reflected the diverse needs of Louisiana’s medical practices. Advantage PPA is the first PPG built exclusively for Louisiana’s medical professionals, providing real, local savings on everyday products and services used by practices.
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HealthSYNC of Louisiana (healthsyncla.com/Home.aspx) HealthSYNC of Louisiana is a physician-led health information network delivered in partnership with the Louisiana State Medical Society (LSMS) offering a suite of health information technology tools to help health professionals across the state of Louisiana connect, analyze, engage, and transform the healthcare industry.
Kevin Rainwater, ACGWealth krainwater@acgwealth.com 404.991.7060
FOR MORE INFORMATION:
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Before and during the session, the Physician Coalition of Louisiana educated legislators on the significant differences in the education and training requirements between physicians and other health care professionals. INFORMING OUR LEGISLATORS EXAMPLE OF MATERIALS SHARED WITH LEGISLATORS
OUR HISTORY
OUR VISION
The Physician Coalition of Louisiana formed in 2019 as a partnership between the Louisiana Academy of Family Physicians and the Louisiana State Medical Society to serve as a unified voice for all physicians and physician medical associations in the State of Louisiana. Our partner groups consist of more than 7,000 practicing physicians, residents in training, and medical students.
The vision of the coalition is to ensure that physicians continue to help shape decisions that affect patients, physician practices and the practice of medicine.
OUR FIRST CAMPAIGN – MEDICAL SCHOOL MATTERS
Nurse practitioners (NPs), and now Physician Assistants (PAs), want Full Practice Authority, also called, Optimal Team Practice, which is an aggressive, unrestricted increase in the scope of practice for NPs and PAs. Despite proposals is to destroy the medical team by removing the need for physician oversight. Medical School Matters was a collective effort by 20 physician association across Louisiana working together to defeat HB 495, which would have given NPs full practice authority and HB 442, which would have removed physician supervision over PAs.
OUR MISSION
Our mission is to provide a unified voice for all physician groups across Louisiana by educating patients, lawmakers, and the public and by influencing policy and legislation.
WORKING TOGETHER TO KEEP PHYSICIANS IN PATIENT CARE
Louisiana State Medical Society
Louisiana Dermatological Society
Louisiana Academy of Family Physicians
Louisiana Society of Interventional Pain
LA Chapter – American Academy of Pediatrics
Louisiana Eye Physicians and Surgeons
Louisiana Orthopaedic Association
Louisiana Medical Association
Louisiana Osteopathic Medical Association
LA Chapter – American College of Surgeons
Louisiana Psychiatric Medical Association
LA Chapter–American College of Emergency Physicians
Medicine Louisiana
LA Chapter – American College of Physicians
Louisiana Society of Anesthesiologists
LA Chapter – American Congress Obstetricians and Gynecologists
LA Chapter – American Academy of Otolaryngologists
Louisiana Pathology Society
Radiological Society of Louisiana ■
Louisiana Society of Addiction Medicine
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Patients are often confused about the di erences between various types of health care providers but statistics show they place a high value on physician-led teams.
Physicians bring economic health to Louisiana’s communities. Beyond their role in safeguarding the health of our communities, physicians in Louisiana are a major driver of the state economy, spurring economic growth and creating jobs across all industries. Louisiana physicians hire locally, buy locally and support the local economy. Through the creation of jobs with strong wages and benefits paid to workers across the state, physicians empower a high-quality, sustainable workforce that generates state and local tax revenue for community investments. Physicians’ economic output—the value of the goods and services provided—helps other businesses grow through their own purchasing and through the purchasing of their employees. Each dollar in direct output applied to physician services supports $1.85 in economic activity in Louisiana, and physician-driven economic activity is greater than legal services, home health care, higher education, and nursing home and residential care. View the 2018 American Medical Association Economic Impact Study to learn more about the contributions physicians make to the health of Louisiana’s economy at PhysiciansEconomicImpact.org.
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Patients want access to the highest quality care at an a ordable price. Solutions to the primary care shortage must consider patient perspectives and the high value they place on physician-led teams.
VITAL SIGNS: THE ECONOMIC IMPACT OF PHYSICIANS IN LOUISIANA 1
Jobs 119,515 Direct jobs .................................................................................................................................................48,336 Indirect jobs .............................................................................................................................................71,179 Average jobs supported by each physician ................................................................................... 11.9 $ 19.9 billion Direct economic output ..................................................................................................... $10.7 billion Indirect economic output .....................................................................................................$9.1 billion Percent of total GSP/GDP 2 ..................................................................................................................8.3% Average economic output generated by each physician................................ $2.0 million Economic activity Wages and benefits $8.9 billion Direct wages and benefits ....................................................................................................$5.9 billion Indirect wages and benefits ................................................................................................$3.0 billion Average wages and benefits supported by each physician................................ $888,745
State and local tax revenue $646.5 million Average state and local tax revenue generated by each physician................ $64,254
1. The economic impact of physicians in Louisiana (QuintilesIMS, January 2018). 2. US Bureau of Economic Analysis: Current-Dollar GDP by State, 2015.
2018 AMA ECONOMIC IMPACT STUDY
© 2018 American Medical Association. All rights reserved. 17-167526:11/17
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EXCEEDING EXPECTATIONS Family medicine physician Dr. Stephen Jones operates an urgent care clinic and nine school- based clinics. He trusts LAMMICO to provide his medical malpractice insurance.
White Coat Wednesday is an opportunity for our members to join colleagues for a day of advocacy at the Louisiana State Capitol. This is their chance to wear a white coat and be a part of the advocacy team. Members learnmore about issues their profession faces at the legislature, gain a better appreciation of what goes on at the Capitol, meet their legislators, and advocate for their profession.
Pictured left to right: JeffWilliams, LSMS EVP & CEO; Katherine Williams, MD, LSMS President; Matthew Giglia, MD, LSMS Member; Lindsey Fauveau, MD, LSMSMember; P. Page Cortez, President of the Senate
When I came to LAMMICO for medical malpractice insurance, they helped me identify ways to minimize risks in my practices. I didn’t want to be reactive if there were problems, so LAMMICO helped me be proactive in preventing risks. The Risk Management team has an amazing level of knowledge for risk mitigation. LAMMICO is a leader in this space. They
maintain a solid knowledge base and provide important communications, especially during crises like COVID-19. The LAMMICO team provides me with an abundance of valuable resources to ensure my needs as a physician are continuously met. I trust LAMMICO. As a LAMMICO insured, you know someone has your back. – Stephen Jones, M.D., family medicine physician
Building Enduring Partnerships 800.452.2120 | lammico.com
18 J LA MED SOC | VOL 173 | SUMMER 2021
LEGISLATIVE RECEPTION
Physicians and guests with the Physician Coalition of Louisiana gathered the evening before White Coat Wednesday with members of the Louisiana Legislature.
BECAUSE YOU DESERVE AN ENDURING RISK PARTNER
2021 100% GROUPS Thank you!
If you know LAMMICO, you know Elatas Risk Partners because Elatas is a wholly-owned subsidiary of LAMMICO. Elatas has provided highly personalized insurance solutions to our community for more than 30 years – from professionals with extensive knowledge of commercial business liabilities that extend beyond traditional medical malpractice insurance. Now offering expanded coverage options, Elatas is dedicated to helping your business succeed by tailoring insurance portfolios to fulfill your unique needs.
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Elatas Risk Partners One Galleria Blvd., Suite 700 Metairie, LA 70001 504.841.5255 | elatas.com
Interested in your group joining this list? Contact Terri Watson, Vice President of Administration & Member Services, at terri@lsms.org or 225.229.7222.
J LA MED SOC | VOL 173 | SUMMER 2021 21
LEGISLATURE BOOTCAMP LSMS LOOKING FOR PHYSICIAN CANDIDATES FOR OFFICE
LSMS is developing a one day “boot camp” for physicians interested in seeking political office. Why? Today, Louisiana has no physician representing medicine in the state legislature. As several groups traditionally opposed to physicians have members in the legislature, this has undermined our efforts during session. If you or a physician peer has an interest in running, please consider attending our “boot camp.” Below are two charts that represent the current makeup of the Louisiana legislature in profession and demographics. These are the people making the decisions on your profession and on the publics healthcare. Get involved, and help us help you!
LEGISLATOR LSMS BOOTCAMP
WHO’S MAKING THE DECISIONS
Chemical Industry / Oil&Gas
Nursing Home Administrators
43
8
3
1
Attorneys
Realtors
Businesspeople / Consultants Attorneys
38
8
3
1
Insurance
Farmers / Foresters
RN/APRN
Military / Law Enforcement
28
7
2
1
Public Servants/ Retirees
Religious
Chiropractors
14
5
2
Educators
Financial Services
Funeral Home Operators
Communications / Consulting
12
4
2
Non-Profits / Social Work
Veterinarian
Engineers / Contractors
8
3
2
Retailers
Pharmacy
WANTED: PHYSICIANS TO SERVE IN THE LEGISLATURE
DO THEY REPRESENT YOU?
HOUSE
SENATE LEGISLATURE VOTERS STATE
90%
80%
70%
60%
INTERESTED? IF SO, SAVE THE DATE LSMS LEGISLATOR BOOTCAMP SATURDAY, FEBRUARY 5, 2022 9:00 TO 3:00 RSVP: to jeff@lsms.org
LEGISLATOR LSMS BOOTCAMP
50%
40%
30%
20%
10%
0%
81% Male 85% 82% 45% 49%
Female
Black
White
Other
Democrat
Republican
Other
19% 15% 18% 55% 51%
26% 26% 26% 61% 33%
74% 74% 74% 63% 63%
0% 0% 0% 5% 7%
33% 31% 33% 40%
65% 69% 66% 33%
2% 0% 1% 17%
22 J LA MED SOC | VOL 173 | SUMMER 2021
J LA MED SOC | VOL 173 | SUMMER 2021 23
AN INTERNAL MEDICINE RESIDENCY RESPONSE TO THE COVID-19 PANDEMIC IN LOUISIANA Seth M. Vignes, MD; Brittany L. Boudreaux, DO; Shane E. Sanne, DO; Catherine M. Hebert, MD; and Lee S. Engel, MD, PhD Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans
400
COVID-19 CASES
200
0
APRIL
JULY
OCTOBER
2021
MONTH
FIGURE 1: COVID-19 Cases in New Orleans March 2020 to February 2021 (Centers for Disease Control data: https://covid.cdc.gov/covid-data-tracker/#county-view)
ABSTRACT
The novel human coronavirus disease, COVID-19, was first identified in Wuhan China in December 2019 and quickly spread to the entire planet. While New Orleans enjoyed Mardi Gras in February of 2020, we were unaware that the ongoing mix of tourism and gathering of large crowds would fuel the spread of the COVID-19 pandemic to our city and state. New Orleans saw its initial and largest COVID peak to date in early April 2020. At the peak, all the hospitals in the greater New Orleans area quickly became inundated with patients affected by COVID-19. The goal of this article is to share our experience, our designed responses to the multitude of issues facing our internal medicine residency program, and the lessons we learned during the COVID-19 pandemic.
two interns and a cap of twenty patients’ maximum on each team that took call every four days. A separate night float resident and intern managed admissions from the Emergency Department and general floor call. There was no cap on new patient admits because there was no other hospitalist service available. Themedical intensive care unit (MICU) was a closed unit with resident teams from LSUHSC internal medicine programs, Tulane internal medicine programs and the LSUHSC emergency medicine program. We also had residents and interns on ambulatory rotations, consult rotations, quality improvement/patient safety rotations, and interns on emergency medicine rotations. Pre-pandemic at Touro Infirmary (Touro), LSUHSC internal medicine had four medicine ward teams with one resident and one intern each that took call every four days and one night float intern on Monday through Friday. We only had enough residency cap positions to maintain the ward services. We did not have any residents on consult or elective rotations at that site due to cap limitations. Pre-Pandemic at Ochsner-Kenner Medical Center (OKMC), LSUHSC internal medicine had four medicine ward teams with one resident and one intern each took call every four days. There were two night float interns who rotated every three days. We also had five other house officers on consult rotations. INITIAL COVID-19 PEAK RESPONSE AND MODELS
would need more medicine teams devoted to COVID-19 patients. At this point, to meet the demands of the rapidly increasing number of patients with COVID-19, we shifted from a reactionary model to a proactive model that would allow us to care for a maximum capacity of patients, cohort patients, cohort at-risk house officers and faculty (those who were pregnant or had underlying health issues, etc.), and reduce the need for continual schedule changes. We created two more medicine ward teams, giving us six ward teams (Teams 1 to 6). Team 1 was staffed by faculty and residents who were either pregnant or had underlying reasons that put them at greater risk of adverse outcomes from COVID-19, and we designated this the non-COVID team. Team 1 admitted all patients who tested negative for COVID, clinically did not appear to have COVID, and had clear alternate diagnoses. Teams 2 thru 6 admitted all the COVID patients on a rotating call system. We went from an every fourth night call to an every sixth night call. The call team took admits from the Emergency Department (ED) and transfers from the MICU. Patients with COVID-19 took longer to improve; therefore, one unforeseen benefit of the every sixth night call schedule was that the medicine teams were able to achieve more patient dispositions prior to their next call. These early days were characterized by fear of transmission, feelings of helplessness over patients who were decompensating, and lack of available testing. Resident and intern wellness benefited from the decrease in call-day frequency. UMC brought in a private locums hospitalist group towards the end of April, which helped reduce the burden on our academic ward teams. The MICU took direct admits from the ED and floor transfer for patientswho requiredmore care than couldbe provided on the medicine wards. Patients who were stepped up to the MICU, would usually go back to the same medicine teamwhen stabilized. The cap for the residents and interns on the medicine teams remained at twenty. However, at times more than twenty patients were admitted to the medicine teams and these patients were seen by the faculty attending physician without the residents to abide by ACGME regulations. Similar to previously published
INTRODUCTION
first few months after evaluating genome sequencing and cell phone tracking data. 2,3 As of this writing, there have been over four hundred thousand cases of COVID-19 with over nine thousand deaths in Louisiana. The largest peak in the New Orleans area occurred in April 2020 with other smaller peaks in July 2020 and January 2021 (Figure 1). Here we share the responses that the internal medicine residency program at Louisiana State University Health Sciences Center (LSUHSC) in New Orleans made to the pandemicwith regards to resident/intern-delivered patient care, communication, resident/intern education, resident/ intern wellness, residency recruitment, and the COVID-19 vaccination efforts that have ensued since March 2020. PATIENT CARE AND RESIDENCY STRUCTURE ATOURTEACHINGHOSPITALSPRE-PANDMIC AND DURING THE PANDEMIC
The novel human coronavirus disease, COVID-19, that was first identified in Wuhan China in December 2019, represents the fifth documented pandemic since the 1918 flu pandemic. 1 The initial rapid ascent of COVID-19 in New Orleans and Louisiana was likely the result of a combination of increased global tourism in our city and the gathering of large crowds for theMardi Gras celebration that occurred in February 2020. With the subsequent availability of testing, the first reported case of COVID-19 in Louisiana occurred on March 9, 2020 at the Veterans Administration Medical Center in New Orleans. By the following day, there were two more cases at separate New Orleans area hospitals. The World Health Organization declared coronavirus a pandemic on March 11, 2020. Reported coronavirus cases rapidly increased and the first Louisiana deathwas reported on March 14, 2020. During the following ten days, schools closed, hospitals limited visitors, bars and restaurants shut down, and drive through testing sites opened. Confirmed cases increased to over one thousand, and a “stay at home” order was issued for Louisiana. By the end of March, there were over four thousand COVID-19 cases in Louisiana and a few states set up interstate checkpoints to prevent travelers from New Orleans from entering. On April 1, 2020, Louisiana had the highest per capita deaths from COVID-19 in the U.S. A pre-publication report by researchers at Scripps Research Institute, Tulane University, and LSU Health Shreveport proposes that the coronavirus most likely arrived in New Orleans about two weeks before Mardi Gras 2 . These researchers suspects that one case source exploded into 50,000 confirmed cases over those
PRE-COVID-19 PANDEMIC STRUCTURE
Residents and interns from the Internal Medicine Residency programat LSUHSC in NewOrleans rotate at three hospitals for inpatient ward rotations (University Medical Center, Touro Infirmary, and Ochsner-Kenner Medical Center) in the greater New Orleans area that includes Orleans and Jefferson Parishes. University Medical Center (UMC) is unique in that it is an academic training hospital, where both LSUHSC and Tulane Health Sciences Center have independent internal medicine rotations. Pre-pandemic, LSUHSC internal medicine had four ward teams each with one resident and
Pandemic response at UMC
Following the first reported case of COVID-19 in New Orleans onMarch 9, 2020, a rapid increase in cases occurred at all three of our hospital sites. The initial rise COVID-19 at UMC occurred during the third week of March, 2020. At first we responded by cohorting all the patients with COVID-19 on one Medicine ward team. Two days later, we had two medicine teams that were devoted to COVID-19 patients and by the fourth week of March we quickly realized we
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