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.
Established 1878
AUGUST / SEPTEMBER 2023
WHAT’S INSIDE
2 2023 LSMS LEADERSHIP 4 A MESSAGE FROM LSMS PRESIDENT RICHARD J. PADDOCK, M.D. 5 RICHARD PADDOCK, MD – PRESIDENTIAL SPEECH 9 THE LSMS WORKING FOR YOU WE NEED YOUR HELP! 10 ACTIONS OF THE BOARD OF GOVERNORS
11 HOUSE OF DELEGATES 2023 LSMS STORE - NEW 12 BEYOND MEMBERSHIP!
2023 LSMS LEADERSHIP During the 2023 LSMS Annual Meeting of the House of Delegates, new leadership was selected and new Society policies adopted.
CENTURY CLUB SPOTLIGHT: THE EYE CLINIC 13 HEALTH LAW TALK PODCAST 14 HURRICANE PREPAREDNESS RESOURCES FROM LAMMICO
Board of Governors The Board of Governors serves as the trustee and the administrative board of the LSMS and transacts all business for and on behalf of the Society in the interval between HOD meetings. 2023 LSMS LEADERSHIP
RICHARD PADDOCK, MD President
JOHN NOBLE, JR., MD Immediate Past President
RODERICK CLARK, MD President-Elect
AMBERLY NUNEZ, MD Secretary - Treasurer
THOMAS TRAWICK, JR., MD Speaker
ROBERT NEWSOME, MD Vice Speaker
MATTHEW GIGLIA, MD COL, Chair
SUSAN BANKSTON, MD Ex Officio, LAMPAC, Chair
Board of Councilors Myra Kleinpeter, MD District One Luis Arencibia, MD District Two Allan Vander, MD District Three Randall White, MD District Four Gwenn Jackson, MD District Five
Section Representatives Madison Thornton Medical Student Section Member Omar Leonards, MD Resident/Fellow Section Member Ken Ehrhardt, MD Young Physician Section Member
Michael Roppolo, MD District Six Brian Gamborg, MD District Seven Lance Templeton, MD District Eight Andy Blalock, MD District Nine Nicholas Viviano, MD District Ten
John Bruchhaus, MD Employed Physician Section Member Katherine Williams, MD Private Practice Physician Section Member
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RICHARD PADDOCK, MD – PRESIDENTIAL SPEECH On Saturday, August 5, 2023, the Louisiana State Medical Society installed Dr. Richard Paddock as the 143rd president of the organization.
I am truly honored to stand before you as your 143rd president of the Louisiana State Medical Society. In our audience as you have seen are many of our past presidents who have helped lead the society in our mission to be the trusted advocates for patients and physicians in the state of Louisiana. From Dr. Noble to Dr James Egan in 1878, I have some big shoes to fill and some great acts to follow. I may be taking the helm, however, I come aboard a ship that already has a steady course chartered with an excellent chief navigator, Mr. Williams and a phenomenal crew with the staff at the Louisiana State Medical Society. This team has had many successes regarding major medical legislation and deserves our thanks for their hard work. As we are all aware, the practice of medicine has been under constant challenges. Physician scope of practice, prescriptive rights, lessening the educational requirements to independently practice medicine, unauthorized practice of medicine, prior authorizations and denial of care and payment of needed medications and procedures are just a few. At LSMS, we will continue to be your advocates on a local and national level. However, the latest growing challenge and exciting new medical frontier is the introduction of the use of artificial intelligence in medicine. Dr. Paddock is from New Orleans, Louisiana. He obtained his medical degree from Tulane School of Medicine and completed a residency in Urology at Ochsner Medical Institutions. He then entered private practice and was board certified in 1985. Dr. Paddock recently retired in 2022 after 44 years of practice. He has held every position on the Jefferson Parish Medical Society board including President. He was also alternate delegate for Louisiana to the AMA and until recently was the Secretary-Treasurer of the LSMS for many years. Dr. Paddock has been married for 53 years to Shelia and has 2 children and 7 grandchildren. They presently split their time between their residence in River Ridge and a summer house in Pass Christian.
In recent weeks representatives from Blue Cross Blue Shield of Louisiana, including Steve Udvarhelyi, MD, BCBSLA CEO, have met with your LSMS Board of Governors and addressed our House of Delegates regarding the pending acquisition of BCBSLA by Elevance Health (formerly Anthem). On both occasions the representations made included things such as “nothing will change” or “its business as usual”. However, I believe that anything that occurs on a scale of this magnitude rarely happens without considerable change and lots of questions and concerns. In addition to our two meetings, LSMS staff members were present and monitoring the joint meeting of the Senate and House Insurance Committee on August 15, 2023, wherein many concerned parties expressed a desire for additional time and more information before the Department of Insurance grants its final decision, pending prior approval of BCBSLA policy holders. Therefore, the LSMS would like to applaud Insurance Commissioner Jim Donelon’s decision to delay, until October 5th, any possible decision on the final approval of the proposed acquisition. Additionally, we welcome the involvement and scrutiny of Attorney General Jeff Landry’s office, as the final decision of this sale impacts everyone in Louisiana and the maximum amount of due diligence should be exercised. The LSMS has serious concerns as well, as should you. All physicians should be concerned about potential lower reimbursement rates, increased denials, and additional hassle factors. Physicians who own their own business should also be cognizant of the likely possibility of paying higher rates while receiving reduced benefits for their health insurance coverage. As additional public hearings occur and more information is gleaned, the LSMS will keep you informed of how, we as a policy holder, will vote. Until then, we encourage you to do your own due diligence in order to make an informed decision for yourself, your practice, and your patients. In the interim, if anyone has any questions or concerns, they would like to share please send them to president@lsms.org . If you are interested in submitting your own public comments or reviewing those already submitted by interested parties, as well as the consultant reports being relied upon they can be located here: Public Hearing and Rulemaking Notices (state.la.us) A MESSAGE FROM LSMS PRESIDENT RICHARD J. PADDOCK, M.D.
A quick story. Has anyone gone to a quest lab lately? The reason I ask is because I recently went to have some labs drawn. I walked in, it was early, and I was the only person in the room. There was no one there but myself and a wall with four kiosks with gray TV screens looking at me. I walked up to one of the screens and it flashed touch here and I did, hoping that some sort of candy or reward would come out of a slot. It didn’t. It then flashed scan in your driver’s license which I did and then the screen read hello Richard. Then I replied hello back not realizing I was talking to a computer screen. It asked me to verify my address and date of birth then scan in my insurance cards which I did and pressed finish. It then asked me to have a seat. A TV in the waiting room area quickly displayed my name and the time I registered. Almost immediately the phlebotomist opened the door, called my name and I had my blood drawn. The whole episode took about 20 minutes. I left realizing that I had briefly seen only one human during this exchange. Most of you who know me know that I am very afraid of needles. I missed the receptionist checking me in and assuring me that it wasn’t going to hurt and that I was going to be fine. Sitting in the car I thought this was efficient and quick but very impersonal.
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Is this what we want for our patients and the future of medicine? Sacrificing compassion and reassurance of the human experience for the sake of efficiency? Or, do we want a blend of both to deliver the best healthcare we can. Artificial intelligence is the ability of machines to perform tasks that normally require human intelligence such as reasoning, learning, decision making and problem solving. AI uses computer software to simulate human cognition that drives machine learning algorithms that can teach the machine how to perform a specific task and provide accurate results by identifying patterns. It does so by developing its own algorithms from massive amounts of downloaded data. We see this in Google, Siri, Alexa, IBM Watson, directional maps and more which have permeated our daily lives such that we are absolutely in need and are dependent on them. Already, the use of AI has affected the labor force. One survey reported that 75% of the companies questioned said they expect AI technology to eliminate up to 26 million jobs over the next five years. The medical community is no different and jobs have been lost and more will or be modified in many sectors. The use of AI is also moving from hospital administrative tasks to actual clinical decision making. AI is being used in pathology, radiology, cardiology, gastroenterology, and primary care. Algorithms for diagnosis and treatment of various disease entities and emergencies are already being used and more are being formulated and tested. Amazon, last fall, launched a virtual clinic in 50 states staffed by “licensed providers.” Licensed by whom and where? The recent Covid pandemic helped accelerate AI development. Globally, AI in the healthcare market accounted for $14 billion dollars in 2020, but it is projected to reach $119.8 billion dollars by the year 2027. wAI is a wonderfully exciting complex innovation that will no doubt help but will also change the landscape of the practice of medicine to come. But, not without serious concerns about its ability to overtake and stifle the human art of medicine. The president of the artificial intelligence society stated that the medical community and society will have difficulty moving through this “transitional phase” where machines will be doing better and more efficiently than humans. There is that word again, efficient. The FDA and the AMA are taking steps to develop a model for evaluating, standardizing, and regulating the use of AI but it is still in its early days and essentially AI is unregulated. Big tech is already fighting some minor regulations. There are some phenomenal assets that AI can bring as an adjunct to the practice of medicine.
AI can provide real time data for a quicker diagnosis and decision making allowing for earlier and more personalized therapies. AI can streamline tasks such as scheduling, coding, reviewing insurance claims and even generating care paths/ By maximizing productivity and cutting healthcare costs, it can reduce the estimated $750 billion that is wasted annually. It can help monitor patient progress and alert patients and providers if a condition worsens. Recently a woman was awakened in the middle of the night by her smartwatch alerting her that she had gone into atrial fibrillation and her risk for stroke. AI can advance medical research by analyzing massive amounts of data to discover new insights patterns and correlations from large and complex datasets that would be otherwise difficult for humans to process. With limited or nonexistent healthcare access in impoverished communities exacerbated by the shortage of health care professionals, AI can improve health care by enhancing remote access to these areas. It is estimated by the year 2035, there will be a global deficit of 12.9 million skilled healthcare workers in the workforce. Although I’ve touched on a few of the phenomenal things that artificial intelligence can do to enhance the practice of medicine, there are concerns about the implementation of artificial intelligence in the healthcare arena. It comes with significant risks to the delivery of medical care, the patient doctor human relationship and the future educational experience and training of doctors and other medical allied professionals. There are major ethical concerns with the development and use of AI in health care. AI can make decisions that can have significant impacts on human lives, health, and well-being. Interestingly a recent poll showed that 67% of patients do not trust AI as being a total driving force in their healthcare. The information from portable healthcare monitoring devices is not subject to privacy laws and is used in AI databases. The data from smartphones and watches about our lifestyles, eating habits, exercise and everything we do can go directly to our insurance companies which could be used to adjust future coverage and premiums. Conglomerates like Google and Microsoft are already partnering with large healthcare providers to download massive amounts of medical data to enhance machine learning of artificial intelligence. With these partnerships between large private equities and large healthcare delivery systems one would think that there should be a moral responsibility to share these algorithms with smaller institutions, however this may not be the case in the future. With the influx of massive
amounts of private equity money, will we see a point where all major healthcare systems will be owned and operated on a for profit model and cause healthcare costs to rise? Will the new healthcare delivery team be the hospital CEO, the chief digital officer and the AI computer? Cybersecurity is paramount. With increasing amounts of patient data being stored and transmitted electronically, healthcare providers are facing growing security risks. Cyber-attacks can compromise patient data, disrupt scheduling healthcare services and potentially interrupt the delivery of healthcare altogether. A recent survey showed that in 2020 security breaches had jumped 42%. Investments in cybersecurity is expected to reach $24.1 billion by the year 2026. AI is not infallible and can be prone to mistakes or fail to perform as expected. Data shows that AI error rates are almost equal to the human error rate in medicine at present. However, when used as an adjunct to diagnose, human accuracy improves dramatically. Bias issues are another concern. Unless they are corrected, the data introduced into its algorithms may prejudice the decisions made by AI. A major discussion occurring right now is where will the impact fall for accountability and responsibility? Who is liable for the outcomes and consequences of AI’s decisions or actions. Who is responsible for the oversight and regulation and who is entitled to the benefits and risks of AI in healthcare. International medical groups are calling for the establishment of oversight of how algorithms behave in real world scenarios. It is imperative that we ensure that doctors oversee the development of the health algorithms and their implementation. These are some of the questions that need to be addressed before increasing dependence on AI in healthcare. Also, what effect will it have on the autonomy of caregivers to independently decide on treatments for their patients? The stakes are very high if things go wrong with our development and legislation of this phenomenal revolutionary new technology. To quote Dr. Deepak Chopra, “The basic nature of being is to react to unpredictability and the infinite possibilities, whereas artificial intelligence reacts on previous predictability and draws conclusions from that. Humans have the power of awareness which a computer cannot and will never develop nor possess.”
This freight train silently coming down the track at full speed cannot be left unchecked. There needs to be significant in-depth studies on its impact on the practice of medicine, the delivery of healthcare, training of future doctors as well as the present and future health care labor force. We will, as before, continue this coming year to stay focused on immediate issues that affect the practice of medicine and health care in Louisiana, however the main focus of my year will be to explore AI’s impact on our practice of medicine. To create an awareness and bring it to the forefront of discussion with doctors and legislators to recognize the obvious need for standardization and regulation before full implementation. We need to avoid the chaos we have already seen in the unregulated development of electronic medical records. I will do my best to help our society form policies and guidelines to help enhance our physician’s ability to practice better and more accurate medicine. But clinicians need to understand that these tools are to augment clinical decision making and should not be used to replace it. Yes, the landscape of medicine is changing and will continue to do so for more generations of physicians to come. Let’s not abdicate our responsibility of training the next generation of doctors to artificial intelligence. We must encourage our future doctors to continue to practice the human aspect of the Art of Medicine and to teach it for generations to come. Anyone or anything can learn the science of medicine, but it takes a human to teach how to live our oath to give compassion, empathy and your whole life and essence to another person for their well-being and healing. A computer cannot and will not ever learn how to do this. The handshake, encouragement, the touch and sometimes just your presence are all as necessary for healing as being correct with the diagnosis and treatment. As Carl Jung said.” Medicine cures diseases, doctors cure patients”. We cannot let the quest for efficiency and accuracy in medicine overshadow the human art of medicine. I will continue to advocate for the physicians of Louisiana. I hope to help us balance the delivery of efficient, accurate medicine with the extraordinarily valuable art of medicine. To quote Hypocrites “Where the art of medicine is loved there is also a love of humanity.” I wish to thank my lovely wife Shelia and my family for years of unwavering love and support and thank you for your confidence entrusting me with the responsibilities and duties of President of the Louisiana State medical society.
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THE LSMS WORKING FOR YOU
Prior to the 2023 legislative session, the LSMS surveyed its members and asked whether they experience payment issues related to prior authorization decisions from insurance providers.
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Act 312 Requires standards for prior authorization and approval procedures, including timeframes, for health insurance issuers to determine healthcare service claims submitted by healthcare providers.
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WE NEED YOUR HELP! The Governor’s Office has requested physician nominations from the LSMS for consideration to the following Boards and Commissions:
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funds for the operation of this program. Included in the Law are provisions for a Traumatic Head & Spinal Cord Injury Trust Fund Advisory Board. Please click here for more information regarding meetings, rules, and past minutes. We consider this a great honor as it confirms that our members are valuable contributors to the future of healthcare in Louisiana. To be considered for nomination, please forward your name, corresponding Board or Commission name, contact information, and CV to Terri Watson, terri@lsms.org .
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©2023 Practice Management Institute (PMI).
ACTIONS OF THE BOARD OF GOVERNORS
HOUSE OF DELEGATES 2023
August 4, 2023 • Approved submitting a resolution to the LSMS House of Delegates revising current LSMS policy and future legislative activities related to non-compete restrictive covenants until such time the U.S. Federal Trade Commission issues its final rule on the subject. • Approved future meeting dates of the board for 2023- 2024 as follows: September 13th, December 13th, March 13th, and June 5th.
The Louisiana State Medical Society (LSMS) Board of Governors met for half a day in Baton Rouge on Wednesday, June 7, 2023, at the City Club, and on Friday, August 4, 2023 at the Renaissance Hotel. The bulleted points below highlight the actions taken by the board. Draft minutes are maintained in the office of the Executive Vice President until such time they are approved by the board, signed by the secretary/treasurer, and appended to the LSMS Website. June 7, 2023 • Approved the minutes of the last LSMS Board of Governors meeting, which was held on March 8, 2023. • Reviewed unaudited financial statements for the LSMS, and its subsidiaries, through April 30, 2023. • Reviewed the 2nd quarter membership report for 2023. • Received updates and/or formal reports on: • Medication Access and Training Expansion (MATE) Act • Blue Cross Blue Shield of Louisiana Acquisition by Elevance Health (Anthem) • 2023 Legislative Session Wrap Up • Appointed Randall White, Jr., MD to fill the remainder of a vacant term as the 4th district councilor on the LSMS Board of Councilors. • Approved submitting a series of resolutions to the LSMS House of Delegates intended to create efficiencies within the House of Delegates resolution review and approval process.
ALL HOUSE OF DELEGATES DOCUMENTS HAVE BEEN COMPLETED.
Please visit House of Delegates, Louisiana State Medical Society (lsms.org) to review.
The LSMS is now offering members the opportunity to purchase logo shirts, hats, duffle bags, and cups. Our e-shop has a wide range of styles and sizes. Grab your shirt or hat today - https://stores.eretailing.com/shop/lsms LSMS STORE - NEW
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BEYOND MEMBERSHIP! Have you renewed your LSMS Membership?
HEALTH LAW TALK PODCAST The Health Law Talk podcast, presented by Chehardy Sherman Williams, one of the largest full service law firms in the Greater New Orleans area, is a regular podcast focusing on the expansive area of healthcare law. Each episode, hosted by Rory Bellina, Conrad Meyer and George Mueller, will address various legal issues and current events surrounding healthcare topics. The attorneys are here to answer your legal questions, create a discussion on various healthcare topics, as well as bring in subject matter experts and guests to join the conversation.
Affairs, Maria Bowen provided the group with a detailed legislative update. In this episode, discover the key efforts made by LSMS to establish a fair balance between providers and payors, focusing specifically on prior authorization standards for utilization review processes and transparency requirements for health plans. Gain a comprehensive understanding of Act 312 and Act 333, the groundbreaking laws signed by Governor Edwards after the 2023 legislative session, and their profound impact on providers. In February, LSMS Past President, Katherine Williams, MD visited with Rory and Conrad to discuss vendor agreements. Dr. Williams is a board certified OBGYN who practices in Covington, LA.
To continue to serve and advocate for Louisiana physicians, we need the support of engaged members like you! Renew your membership today to continue investing in your future and the future of your profession. For more information or help renewing your membership, please contact Amy Tyrrell, Director of Membership at atyrrell@lsms.org .
The LSMS remains committed to supporting Louisiana Physicians through our tenants of Advocacy, Education, Communication & Collaboration. We strive to provide a membership that connects you with peers, shares best practices, provides education to help you better serve your patients, provides access to information and resources, and helps you navigate the administrative responsibilities associated with practicing medicine. The benefits of membership continue to grow and in 2023, we have been proud to expand benefits to our members to include medical benefits through the Advantage Physician s Healthcare Trust, discounted CME opportunities, a Business of Medicine seminar & increased membership options for groups!
Two of their latest podcasts feature the LSMS. Most recently, Representative Thomas Pressly and LSMS VP Governmental
Century Club Spotlight
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MARIA BOWEN
KATHERINE WILLIAMS, MD
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Health Law Talk Interviews Dr. Katherine Williams
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Are your patients up to date on their routine shots?
The state’s vaccine database, Louisiana Immunization Network (LINKS), is a tool that helps providers ensure kids are healthy and have received all recommended age- appropriate vaccines. The utilization of LINKS reduces the risk of vaccine-preventable illnesses resulting in major outbreaks. Entering all of your patients’ vaccination records in LINKS is not only a legal requirement in Louisiana, it also helps prevent diseases from spreading in our communities. The Louisiana Department of Health Immunization Program reminds all providers that all vaccinations must be entered into LINKS within one week after administration.
HURRICANE PREPAREDNESS RESOURCES FROM LAMMICO While everyone should be concerned and plan for hurricanes and weather events, that concern is even more significant for those in the Gulf South region. In the event of a hurricane or weather event, a good disaster preparedness plan is essential to ensure continued medical care for patients by ensuring that a functioning practice still exists after the event. There is a real possibility of medical practice closure without recovery protocols and procedures, i.e., disaster preparedness planning. Now is the time to review your preparedness situation. If you have no plans, begin the process now, and if you do have a plan, review the contents, including vital staff training, and update if needed. To learn more about several essential types of planning and considerations for operations before and after weather events, read LAMMICO’s news article, “Hurricane Preparedness in 2023,” at lammico.com/article/hurricane-prep-2023 . In the midst of yet another hurricane season, LAMMICO reminds policyholders of resources available to help you prepare in the event of a weather emergency to limit disruption to your practice. LAMMICO policyholders can access a complimentary Hurricane Preparedness Manual for Medical Practices by logging into lammico.com as a Member. Encourage practice staff to download a copy for helpful tools such as checklists and emergency tips unique to medical practices. The guide is available in the “Risk Management - Reference Manuals” section in the right-hand navigation of the Member homepage. For more information, please contact the LAMMICO Risk Management and Patient Safety Department at 504.841.5211. This article contains excerpts written by Kenneth E. Rhea, M.D., FASHRM, LAMMICO Risk Management & Patient Safety Consultant.
For more information about vaccine reporting, visit LaLINKS.org
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TO THE SPONSORS OF THE 2023 ANNUAL MEETING Thank You TO THE SPONSORS OF THE ANNUAL MEETING TO THE SPONSORS OF THE 2023 ANNUAL MEETING MULTI-EMPLOYER 401(k) PLAN LSMS Thank You TO THE SPONSORS OF THE ANNUAL MEETING TO THE SPONSORS OF THE 2023 ANNUAL MEETING Thank You TO THE SPONSORS OF THE ANNUAL MEETING TO THE SPONSORS OF THE 2023 ANNUAL MEETING MULTI-EMPLOYER 401(k) PLAN LSMS MULTI-EMPLOYER 401(k) PLAN LSMS TO THE SPONSORS OF THE ANNUAL MEETING
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