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JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 177 | ISSUE 1 | SPRING 2025
A TIME FOR COLLABORATION
VOL 177 | ISSUE 1 | SPRING 2025 CONTENTS
CHIEF EXECUTIVE OFFICER Jeff Williams
JOURNAL BOARD K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD Anthony Blalock, MD
4 ACEP: LACK OF 24/7 ATTENDING PHYSICIAN COVERAGE IN US EMERGENCY DEPARTMENTS, 2022 11 2025 LSMS LEADERSHIP 12 ACP: LOUISIANA ACP HOSTS OVER 200 PHYSICIANS AND TRAINEES AT 2025 ANNUAL SCIENTIFIC MEETING 13 CAMS: CAMS BLENDS CELEBRATION WITH SERVICE IN A MEMORABLE START TO 2025 14 CENTURY CLUB, HEALTHSYNC: PAYERS SHARE DATA, TOO! SEVEN INFORMATION EXCHANGE INSIGHTS TO KNOW 15 LAEPS: LAEPS ADVANCES OPHTHALMOLOGY THROUGH REGIONAL OUTREACH AND POLICY ENGAGEMENT IN 2025 16 LPMS: LAFAYETTE PARISH MEDICAL SOCIETY WELCOMES STATE OFFICIALS AND ELECTS 2025 LEADERSHIP 17 A PERFECT STORM THAT THREATENS MEDICARE BENEFICIARIES’ ACCESS TO CARE 19 LPMA: PSYCHIATRISTS GATHER IN NEW ORLEANS FOR LPMA & MPA SPRING MEETING FILLED WITH CME, COLLABORATION, AND COMMUNITY 21 LETTER TO CONGRESS AND US SENATE REGARDING MEDICAID CUTS 22 IMMUNIZATION RESOURCES 24 WHITE COAT WEDNESDAY: REGISRATION NOW OPEN! 25 NWLMS: THE OYSTER PARTY, CIRCA 1952 26 OPMS: A YEAR OF GROWTH, ADVOCACY, AND ENGAGEMENT 27 INCREASINGLY TENDER RIGHT HEEL MASS IN A YOUNG MALE 30 COUNTDOWN TO THE 2025 SESSION
L.W. Johnson, MD Fred A. Lopez, MD
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Abstract (continued) Keywords: attending physician, emergency department, rural, critical access hos- pital, physician coverage
BRIEF REPORT Health Policy Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022 Carlos A. Camargo Jr MD, DrPH 1 , Krislyn M. Boggs MPH 1 , Ashley F. Sullivan MS, MPH 1 , Janice A. Espinola MPH 1 , Maeve Swanton 1 , Deborah D. Fletcher MD 2
1 INTRODUCTION 1.1 Background and Importance
physician (eg, a portion assume this based on the color of the clinician ’ s scrubs or whether they are wearing a stethoscope). However, the dramatic growth of nonphysician practitioners over the past 20 years 3 and the rural shortage of emergency physicians 4 have raised concerns about the declining presence of physicians in US EDs. 1.2 Goals of This Investigation The objective of the current study was to identify the per- centage of US EDs without 24/7 attending physician coverage and to investigate the location and characteristics of these EDs.
An essential characteristic of US emergency departments (EDs) is their availability 24 h/d, 7 d/wk (24/7) for anyone who seeks medical care. 1 An American College of Emergency Physicians poll from 2021 suggests that nearly 80% of the US public report that they most trust a physician to lead their medical care while in the ED compared with a nurse, physician assis- tant, or nurse practitioner. 2 This same American College of Emergency Physicians poll suggests that adults do make as- sumptions about whether their treating ED clinician is a
1 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA 2 Department of Emergency Medicine, Willis-Knighton Medical Center, Shreveport, Louisiana, USA
Correspondence Carlos A. Camargo, MD, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA 02114, USA. Email: ccamargo@mgb.org Received: August 23, 2024 Revised: December 1, 2024 Accepted: December 3, 2024 https://doi.org/10.1016/j.acepjo.2025.100050
Abstract Objectives: The growth of nonphysician emergency department (ED) practi- tioners and the rural shortage of emergency physicians have raised concerns about the declining presence of physicians in EDs. Our objective was to identify the percentage of US EDs without 24/7 attending physician coverage and to investigate the location and characteristics of these EDs. Methods: The National ED Inventory (NEDI)-USA survey is sent annually to the ED director of every nonfederal US ED. The 2022 survey (administered in 2023 to all EDs open during 2022) included the question: “ Is at least one attending physician (not resident) on duty in the ED 24 h/d? ” The NEDI-USA database includes basic ED characteristics such as annual visit volume, critical access hospital (CAH) status, rural location, and freestanding ED status. We investigated the association of ED characteristics with a lack of 24/7 attending physician coverage. Results: The 2022 NEDI-USA database identi fi ed 5622 EDs, of which 4621 (82%) responded to the 24/7 attending physician question. Overall, 344 of 4621 (7.4%) EDs reported the absence of 24/7 attending physician coverage. In several states, ≥ 30% of the state EDs lacked 24/7 coverage; the states with the highest percentages were North Dakota (58%), South Dakota (56%), and Montana (46%). Among these 344 EDs, 318 (92%) had annual visit volumes < 10,000. Most EDs (307 [89%] of 344) were in a CAH; 248 (72%) were rural, and 6 (2%) were freestanding. Conclusion: Approximately 1 in 13 US EDs lacks 24/7 attending physician coverage. The absence of 24/7 attending physician coverage was more common in low-volume EDs and CAHs. These observations highlight important gaps in ED care nationally. Changes in CAH regulations may help address this impor- tant workforce issue. abstract continues
FIGURE. Percentage of US emergency departments without 24/7 attending physician coverage by state, 2022.
Supervising Editor: Henry Wang, MD, MS © 2025 The Authors. Published by Elsevier Inc. on behalf of American College of Emergency Physicians. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
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TABLE 1. Presence of 24/7 attending physicians in US emergency departments, n = 4621.
The NEDI-USA database includes basic ED character- istics such as annual visit volume, critical access hospital (CAH) status, rural location (based on presence outside of a core-based statistical area), 7 hospital-based vs freestanding ED status, and receipt of telehealth services. EDs are further characterized by special capabilities, such as having a burn center, 8 trauma center, 9 stroke center, 10 pediatric emer- gency care coordinator (PECC), 11 or geriatric ED recogni- tion. 12 Adult trauma centers and stroke center status are further characterized as “ basic ” or “ advanced ” centers. “ Basic ” adult trauma centers have certi fi cation equivalent to that of the American College of Surgeons ’ level III veri fi - cation, and “ Advanced ” adult trauma centers have certi fi - cation equivalent to that of American College of Surgeons ’ level I or II veri fi cation. 9 “ Basic ” stroke centers have certi- fi cation equivalent to that of The Joint Commission ’ s Acute Stroke Ready Hospital, and “ Advanced ” stroke centers have certi fi cation equivalent to that of The Joint Commission ’ s Primary Stroke Center, Thrombectomy-Capable Stroke Center, or Comprehensive Stroke Center certi fi cation. 10 2.4 Data Analyses Data analysis included descriptive statistics. Speci fi cally, we determined the proportion and characteristics of EDs without 24/7 attending physician coverage. Because of the potential of confounding, we also fi t a logistic regression model to determine independent predictors of lack of 24/7 attending physician coverage. All analyses were completed using Excel (Microsoft) and Stata 15 (StataCorp). To examine the national distribution of lack of 24/7 attending physician coverage, a choropleth map was created using ArcGIS (Esri). 3 RESULTS The 2022 NEDI-USA database identi fi ed 5622 EDs, of which 4621 (82%) responded to the 24/7 attending physician question. Overall, 4277 (92.6%) responded “ yes, ” whereas 344 (7.4%) responded “ no ” (ie, these EDs reported that they did not have 24/7 attending physician coverage). Although 7.4% of all US EDs reported that they lacked 24/7 attending physician coverage, their geographic distribution revealed large between-state differences (Fig). In 15 states, zero responding EDs reported that they lacked 24/7 attending physician coverage. Two states that have recently introduced legislation requiring 24/7 in-person physician coverage in EDs, Indiana and Virginia, 13,14 had no EDs that reported a lack of 24/7 coverage. However, in several states (shown in white), ≥ 30% of the state ’ s EDs lacked 24/7 coverage. The states with the highest per- centages were North Dakota (58%), South Dakota (56%), and Montana (46%). Among these 344 EDs without 24/7 attending physician coverage, the annual visit volumes were < 10,000 for 318 (92%), whereas 23 (7%) had 10,000 to 19,999 and 3 ( < 1%)
The Bottom Line We investigated US emergency depart- ments (EDs) without 24/7 attending physician coverage. Based on a national survey of ED directors, 1 in 13 EDs did not have at least 1 attending physician on duty 24/7. In several states, ≥ 30% of the EDs lacked 24/7 coverage. Among these 344 EDs, 92% had low annual visit volumes, 89% were in critical access hospitals, and 72% were rural. These observations highlight important gaps in ED care nationally. Changes in critical access hospital regulations may help address this workforce issue.
EDs with 24/7 attending physician (n = 4277; 92.6%)
EDs without 24/7 attending physician (n = 344; 7.4%)
ED characteristic
n (%)
n (%)
P value
Annual visit volume < 10,000
< .001
Yes
1073 (25) 3204 (75)
318 (92)
No
26 (8)
Region
< .001
Northeast
501 (12)
17 (5)
Midwest
1065 (25) 1904 (45)
198 (58) 66 (19) 63 (18)
South West
807 (19)
Critical access hospital
< .001
Yes
898 (21)
307 (89)
No
3379 (79)
37 (11)
Rural location
< .001
Yes
712 (17)
248 (72)
No
3565 (83)
96 (28)
Freestanding ED
< .001
2 METHODS 2.1 Study Design
Hospital-based ED Freestanding ED Adult trauma center
3623 (85)
338 (98)
654 (15)
6 (2)
We performed a cross-sectional study of US EDs. The Mass General Brigham Human Research Committee reviewed this study and classi fi ed it as exempt.
< .001
Yes
860 (20)
2 (0.6)
No
3417 (80)
342 (99)
Stroke center
< .001
2.2 National ED Inventory-USA The National ED Inventory (NEDI)-USA survey is sent annually to the ED director of every nonfederal, nonspecialty hospital US ED. Federal EDs (eg, those af fi liated with Vet- erans Administration, military, or Indian Health Service) are excluded because they are not truly “ open ” to the general public. Specialty hospital EDs (eg, the ED of a psychiatric hospital) are not generally capable of managing the broad spectrum of injury and disease that is cared for in the vast majority of US EDs. 2.3 Outcomes: 24/7 Attending Physician Coverage The NEDI-USA survey is sent fi rst by email or mail up to 3 times, and then nonresponding ED directors are contacted by telephone to complete the survey by interview. 5,6 We iden- ti fi ed EDs with the absence of 24/7 attending physician coverage through the survey question: “ Is at least one attending physician (not resident) on duty in the ED 24 h/d? ” (yes/no) If no, ED directors were asked: “ When a physician is not on duty in the ED, is any physician available to the ED by 2-way voice communication 24/7 – from within your hospital (yes/no/not applicable [eg, freestanding ED]) or from outside your hospital (yes/no/not applicable [eg, freestanding ED]). ”
Yes
2054 (48) 2223 (52)
95 (28)
No
249 (72)
Pediatric emergency care coordinator
< .001
Yes
1036 (24) 3241 (76)
41 (12)
No
303 (88)
Receives telehealth services
.03
Yes
3056 (72) 1201 (28)
266 (77)
No
78 (23)
ED, emergency department.
had ≥ 20,000. Most EDs (307 [89%] of 344) were in a CAH; 248 (72%) were rural, and 6 (2%) were freestanding. Overall, 266 (77%) of the 344 EDs without 24/7 coverage received telehealth, and 78 (23%) did not. Compared with EDs with 24/7 attending physicians, EDs without 24/7 physicians were more likely to have annual visit volumes < 10,000, to be in the Midwest and rural areas, to be a CAH, and to receive telehealth services. They were less likely to be freestanding, to be adult trauma centers, to be stroke centers, and to have PECCs (Table 1). Regarding the special capabilities of these 344 EDs, there were no adult or pediatric burn centers. Two EDs were adult trauma centers (both basic); none were pediatric trauma
centers. Ninety- fi ve (28%) were stroke centers, with 89 basic and 6 advanced. Only 41 (12%) of the 344 EDs reported having a PECC. None were recognized as a geriatric ED. In multivariable analysis, independent predictors of the absence of 24/7 attending physician coverage included annual visit volume < 10,000 and CAHs. Rural location, hospital- based (vs freestanding) ED status, receipt of telehealth ser- vices, and lack of adult trauma center certi fi cation were also associated with a lack of 24/7 coverage (Table 2). Among the 344 EDs without 24/7 attending physi- cian coverage, 50% did not have 2-way voice communi- cation 24/7 with any physician within the hospital, and 19% did not have this with any physician outside the
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6. Boggs KM, Augustine JJ, Sullivan AF, Espinola JA, Camargo CA Jr. Changes in the number of US emergency departments and their annual visit volumes since 2001. Ann Emerg Med . 2023;82(6):760-762. 7. US Census Bureau. Core-based statistical areas. Accessed December 1, 2024. https://www.census.gov/topics/housing/housing-patterns/about/ core-based-statistical-areas.html 8. Lu LY, Boggs KM, Espinola JA, Sullivan AF, Cash RE, Camargo CA. Development of a uni fi ed national database of burn centers with co- located emergency departments, 2020. J Burn Care Res . 2022;43(5): 1066-1073. 9. Bedell BR, Boggs KM, Espinola JA, et al. Development of a uni fi ed national trauma center database, 2018. Injury . 2023;54(2):461-468. 10. Boggs KM, Vogel BT, Zachrison KS, et al. An inventory of stroke centers in the United States. J Am Coll Emerg Physicians Open . 2022;3(2):e12673. 11. Boggs KM, Espinola JA, Sullivan AF, et al. Availability of pediatric emergency care coordinators in US emergency departments in 2018. Pediatr Emerg Care . 2023;39(6):385-389. 12. Herscovici DM, Boggs KM, Swanton M, et al. Development of a uni fi ed geriatric emergency department database, 2022 [abstract]. Acad Emerg Med . 2024; in press. 13. 2024 Indiana Code Title 16. Health Article 21. Hospitals Chapter 2. Licensure of Hospitals 16-21-2-14.5 Physician to Be on Site and on Duty While Emergency Department Is Open. Accessed January 29, 2025. https://casetext.com/statute/indiana-code/title-16-health/ article-21-hospitals/chapter-2-licensure-of-hospitals/ section-16-21-2-145-physician-to-be-on-site-and-on-duty-while- emergency-department-is-open#: :text=Section%2016-21-2-14.5% 20-%20Physician%20to%20be%20on%20site,at%20all%20times% 20the%20emergency%20department%20is%20open 14. Virginia Senate Bill 392. Hospitals; emergency departments to have at least one licensed physician on duty at all times. Accessed January 29, 2025. https://legiscan.com/VA/bill/SB392/2024 15. Magi JN, Chen A, Guo R, et al. US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis. BMJ Open . 2022;12(4):e055138. 16. Chekijian SA, Elia TR, Horton JL, Baccari BM, Temin ES. A review of interprofessional variation in education: challenges and considerations in the growth of advanced practice providers in emergency medicine. AEM Educ Train . 2020;5(2):e10469. 17. Zachrison KS, Boggs KM, Hayden EM, Espinola JA, Camargo CA Jr. Understanding barriers to telemedicine implementation in rural emergency departments. Ann Emerg Med . 2020;75(3):392-399. 18. Code of Federal Regulations. 42 CFR 485.618. Accessed October 9, 2024. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/ part-485/subpart-F/section-485.618#p-485.618(d)(1)(ii) SUPPLEMENTARY MATERIALS Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j. acepjo.2025.100050 How to cite this article: Camargo CA, Boggs KM, Sullivan AF, et al. Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022. JACEP Open. 2025;6:100050. https://doi.org/10.1016/j.acepjo.2025.100050
TABLE 2. Associations between emergency department characteristics and lack of 24/7 attending physician coverage; n = 4621 US emergency departments. ED characteristic Unadjusted OR (95% CI) a Adjusted OR (95% CI) b Annual visit volume < 10,000 36.52 (24.34-54.8) 9.84 (6.17-15.69) Critical access hospital 31.22 (22.02-44.26) 4.67 (3.01-7.24) Rural location 12.93 (10.08-16.59) 1.79 (1.33-2.41) Freestanding ED 0.10 (0.04-0.22) 0.38 (0.15-0.93) Receives telehealth services 1.34 (1.03-1.74) 1.36 (1.01-1.83) Adult trauma center 0.02 (0.01-0.09) 0.16 (0.04-0.66) Stroke center 0.41 (0.32-0.53) 1.07 (0.80-1.43) Pediatric emergency care coordinator 0.42 (0.3-0.59) 0.90 (0.61-1.31)
J.A.E. provided statistical advice and analyzed the data. C.A.C. drafted the manuscript, and all authors contributed substan- tially to its revision. C.A.C. takes responsibility for the paper as a whole. FUNDING AND SUPPORT By JACEPOpen policy, all authors are required to disclose any and all commercial, fi nancial, and other relationships in any way related to the subject of this article as per ICMJE con fl ict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. CONFLICT OF INTEREST All authors have af fi rmed they have no con fl icts of interest to declare. ACKNOWLEDGMENTS The authors thank Olivia Chen for assisting with data collection and management, Carson Clay for creating the map, and the thousands of ED directors who respond year after year to the National Emergency Department Inventory-USA survey. DATA SHARING Adeidenti fi ed version of the National Emergency Department Inventory-USA data, the data dictionary, and the analytic code are available on reasonable request to Dr Camargo (ccamargo@ mgb.org). ORCID Carlos A. Camargo https://orcid.org/0000-0002-5071- 7654 REFERENCES 1. American College of Emergency Physicians. Emergency department planning and resource guidelines. Accessed August 10, 2024. https:// www.acep.org/siteassets/new-pdfs/policy-statements/emergency- department-planning-and-resource-guidelines.pdf 2. American College of Emergency Physicians. Public opinion on the value of emergency physicians. Accessed November 24, 2024. https://www. emergencyphysicians.org/siteassets/emphysicians/all-pdfs/value-and-sop- august-2021-poll- fi nal.pdf 3. Christensen EW, Liu CM, Duszak R Jr, Hirsch JA, Swan TL, Rula EY. Association of State share of nonphysician practitioners with diagnostic imaging ordering among emergency department visits for Medicare bene fi ciaries. JAMA Netw Open . 2022;5(11):e2241297. 4. Bennett CL, Sullivan AF, Ginde AA, et al. National study of the emergency physician workforce, 2020. Ann Emerg Med . 2020;76(6): 695-708. 5. Sullivan AF, Richman IB, Ahn CJ, et al. A pro fi le of US emergency departments in 2001. Ann Emerg Med . 2006;48(6):694-701.
OR > 1 indicates higher odds of lack of 24/7 attending physician coverage. ED, emergency department; OR, odds ratio. a Association between individual factor and outcome (n = 344 cases); 8 models. b One model with all factors liste.
hospital. Ten EDs (3%) reported “ no ” to both sub- questions (ie, they lacked 24/7 2-way voice communica- tion with any physician). 4 LIMITATIONS The study limitations include self-reported data from ED leadership and an 82% national response rate. We speculate that many ED directors are reluctant to report a lack of 24/7 attending physician coverage and, for similar reasons, that nonresponding EDs are more likely to lack this coverage. That said, compared with responding EDs, nonresponding EDs were more often freestanding adult trauma centers and stroke centers. They were less often CAHs and less often in rural areas (Table S1). Some of these characteristics suggest that nonresponding EDs are more likely to have 24/7 attending physicians, and others suggest that they are less likely. 5 DISCUSSION Based on a national survey of ED directors, we found that at least 7.4% of US EDs lack 24/7 attending physician coverage (approximately 1 in 13 EDs). This percentage varied widely by state. EDs that were rural and were in CAHs were more likely to lack 24/7 attending physician coverage. The geographic distribution of the 344 EDs lacking 24/7 coverage revealed a disproportionate number in the central US Indeed, the Figure closely resembles our prior work on the emergency physician workforce, where we reported lower numbers of emergency physicians in this same geographic area. 3 This prior work also found a lack of emergency physicians in rural areas, which was again consistent with the lack of 24/7 physician coverage in rural EDs, as reported in the current study. As reported previously, there has been a rise in nonphysician practitioners over the past 20 years, and they are supplementing the lack of physicians in rural EDs. 3,4 This re- mains potentially concerning, given differences in training and care patterns between physician and nonphysician practitioners. 15,16
The characteristics of EDs without 24/7 coverage are not surprising: they are low-visit volume EDs ( < 10,000 visits/y) located within a CAH and a rural area. Although 77% of these EDs receive telehealth, 23% do not. Furthermore, a small percentage (3%) of these EDs reported a lack of 2-way voice connection 24/7 with any physician, either within or outside of the hospital. In a prior survey of rural EDs, we found that most ED directors without telehealth reported that their ED, hospital, or health system leadership had considered it, but the start-up and maintenance costs were often cited for the lack of telehealth adoption. The current results remind us of this persistent, untapped opportunity for quality improvement. 17 Most (89%) EDs without 24/7 attending physician coverage were in a CAH. Brie fl y, CAH designation is given to eligible rural hospitals by the Centers for Medicare and Medicaid Services. The goal of the CAH program is to reduce the fi nancial vulnerability of these designated hospitals and to improve access to health care by keeping these hospitals open. By de fi nition, CAHs provide access to health care in areas that otherwise would have a dearth of local hospital-based care. Although CAH regulations require that each facility operates a 24/7 ED, they do not require that the ED be staffed by an attending physician 24/7. 18 A revision in CAH policy, including fi nancial support for 24/7 attending physician coverage, may help to reduce the number of EDs operating without this coverage. In summary, approximately 1 in 13 US EDs lack 24/7 attending physician coverage, which is more common in low- volume EDs and CAHs. These observations highlight critical gaps in emergency care in the US Changes in CAH regula- tions, along with increased public awareness, may help address this important workforce issue. AUTHOR CONTRIBUTIONS C.A.C. and D.D.F. conceived the study, and C.A.C., K.M.B., A.F.S., J.A.E., and M.S. designed the study. C.A.C., K.M.B., and A.F.S. supervised the study. K.M.B. and M.S. obtained the data, and K.M.B., J.A.E., and M.S. managed the data.
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BRINGING LOUISIANA’S BEST IN MEDICINE TOGETHER: Louisiana ACP Hosts Over 200 Physicians and Trainees at 2025 Annual Scientific Meeting
MARDI GRAS SPIRIT MEETS MEDICAL MENTORSHIP: CAMS Blends Celebration with Service in a Memorable Start to 2025
What does Spring bring in the Capitol city? Mardi Gras and Crawfish. The Capital Area Medical Society celebrates both very well. One of our own, Dr. Susan Bankston (past CAMS and LSMS President) is the reigning Queen of Artemis XXIV. Several members’ (Drs. Everette Bonner, Elise Scallan and Randy Vick) children were in the 2025 court. This year marks the 9th annual Spring Crawfish Boil for CAMS members and their families. This has become our signature event with live music, door prizes and great food. A great time was had by all attendees. CAMS has awarded over $30,000 in scholarship funds to deserving Louisiana medical students who have been nominated by our membership. This year’s recipients are Omar Azmeh, son of CAMS member, Warif Azmeh, MD, Brea Bonin, referred by CAMS member Eliott Hardy, MD, Hunter Schwab, son of CAMS member Kyle Schwab, MD and Jolan Taylor, daughter of CAMS member Jim Taylor, MD. They will all be honored at the Spring Social. Our newest initiative is the Medical Mentorship Program. CAMS has collaborated with LSU School of Sciences to develop mentoring opportunities with our members and pre-med students. In some cases, students are able to get hands on experience and others meet with members to discuss future plans in medicine. Several of our members look forward to representing CAMS and the LSMS board at the LSMS Annual meeting in Destin, Florida in August. A good productive time to reconnect with physicians from across the state and spend time with family and friends.
Mystery Case Competition: The top two resident/fellow abstracts were presented to a panel of judges without revealing the full abstract. As the case unfolded, the judges attempted to guess the diagnosis. • Mystery Case Winner – Neha Bapatla (Tulane), who will represent the Louisiana Chapter at the national ACP Poster Competition in April. The event concluded with a thrilling Jeopardy-style Doctor’s Dilemma contest, where seven Louisiana internal medicine residency programs competed. After two rounds and Final Jeopardy, Willis Knighton (Shreveport) defended their title for the second consecutive year and will represent the Louisiana Chapter at the national ACP Doctor’s Dilemma Competition in April. The Louisiana Chapter ACP is a diverse community of over 2000 internal medicine physicians, subspecialists, residents, fellows and medical students. The Chapter offers a professional home to physicians along with advocacy, educational, networking and professional development opportunities. Membership in the state Chapter includes membership in the national College, which offers a global network of over 161, 000 members, along with extensive avenues for professional development, educational resources and national advocacy opportunities.
The Louisiana Chapter of the American College of Physicians (ACP) recently hosted over 200 physicians and trainees during its 2025 Annual Scientific Meeting and Annual Resident and Student Meeting in New Orleans. The hybrid Annual Scientific Meeting offered 7 hours of CME and MOC points featuring speakers from across the state of Louisiana. The meeting offered a large group of internal medicine and related specialty physicians updates in cardiology, pulmonology, neurology, gastroenterology and hospital medicine. The educational program also included great reviews of the latest in food allergy diagnosis, lifestyle medicine, Best Papers and the ACP’s legislative priorities. The Chapter also honored three distinguished physicians with the 2025 Louisiana Laureate Award, recognizing their exceptional contributions to the ACP and the field of medicine:
• Dayton Daberkow II, MD, FACP – Leonard J. Chabert Medical Center, Houma
• Philip Haddad, MD, MPH, FACP – Overton Brooks VA and LSUHSC, Shreveport
• Joseph Landers, MD, FACP – St. Tammany Parish Hospital, Covington.
The 2025 Annual Resident and Student Meeting was an outstanding showcase of the scholarly work of residents, fellows and medical students from across the state. Approximately 200 abstracts were submitted for consideration from which 120 abstracts were chosen to be presented at the in-person competition. Medical Student Abstract Competition: • Oral Presentation Winners: 1st – Dana Bruce (Tulane), 2nd – Rithvik Vutukuri (Tulane)
We are looking forward to a great 2025!!
• Poster Presentation Winners: 1st – Margaret Conrad (LSU NO), 2nd – Max Shteiman (Ochsner), 3rd – Vincent Pham (Tulane)
Resident/Fellow Abstract Competition: • Oral Presentation Winners: 1st – Ross Dies (LSU NO) and Swesha Shrestha (St. Francis Medical Center)
• Poster Presentation Winners: 1st – Amit Rajkarnikar (LSU Lafayette), 2nd – Allen Byl (LSU NO), 3rd – Gurtaj Mahil (LSU NO)
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CENTURY CLUB
2025 Renewals
CONNECTING OPHTHALMOLOGISTS ACROSS LOUISIANA: LAEPS Advances Ophthalmology Through Regional Outreach and Policy Engagement in 2025
• Acadiana Family Physicians • Vascular Specialty Center, LLC • Mid Louisiana Anesthesia Consultants • BR GENERAL • LSUHS MONROE • GastroIntestinal Specialists, A.M.C.
• Radiology Consultants of West Monroe • The Pathology Laboratory • Gastroenterology Group AMC • Access Radiology Associates - Lake Charles • Cardiovascular Institute of the South • BR Clinic-quarterly
Payers share data, too! Seven information exchange insights to know Health Data Management
During the legislative session LAEPS monitors legislative importance to ophthalmologists. The 2025 Regular Session of the Louisiana Legislature will convene for a 45-day fiscal only session that is slated to end no later than 6 PM on June 12th. Each of the 144 state lawmakers can only file up to five (5) non fiscal bills. If you would like more information about LAEPS, feel free to contact Cindy Bishop at 225 933 5435 or by email at cindy. bishop@checkmate-strategies.com
By way of introduction I am Cindy Bishop, Executive Director & Lobbyist for the Louisiana Academy of Eye Physicians and Surgeons. LAEPS is a statewide membership organization representing the interest of the specialty of ophthalmologists. LAEPS hosts seven regional dinners throughout the state starting in August 2025 and ending in December 2025. Our regional dinners provide a great opportunity for ophthalmologists and residents to gather and get the latest information on issues impacting ophthalmologists. For more information or to RSVP, visit our website at laeps.wildapricot.org/events During February, the Louisiana Academy of Eye Physicians and Surgeons participated in the New Orleans Association of Ophthalmology Symposium in New Orleans. Additionally, LAEPS hosted a reception in the French Quarter for LAEPS members, residents and our sponsors. During January 2025, LAEPS hosted a three-hour ophthalmology coding course for our members and their coding staff with the latest updates in CPT codes and modifiers. If you are interested in obtaining a copy of the 3-hour recording, please contact LAEPS.
Please welcome these new practices in 2025:
Payers are increasingly participating in Health Information Exchange (HIE). From the payers perspective they are likely already receiving health data from many different sources related to managing their quality programs. The flow and maintenance of this data can be costly and time-intensive for them as each data source requires a one-off exchange and integration into their own data warehouse. HIE eases this burden for payers by eliminating the need for many data sources making data integration seamless for payer operations. This also reduces the burden on providers reporting quality measures to payers. The HIE can calculate those quality measures in real time for all parties. Scan the QR code for more insights into the sharing of health care data among payers and be on the lookout for the follow up articles.
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Pediatric Center of Southwest Louisiana
Pontchartrain Pediatrics
ACT ONE Health
HealthSYNC and the LSMS anticipate beginning a Value Based Contracting arrangement with LHCC in the first quarter of 2025.
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MEDICARE REIMBURSEMENT AND INFLATION: A Perfect Storm that Threatens Medicare Beneficiaries’ Access to Care
Lafayette Parish Medical Society Welcomes State Officials and Elects 2025 Leadership
Medicare Economic Index (MEI). It is a significant step towards recognizing the inadequacy of the current Medicare physician payment system and paves the way for short and long-term solutions in reforming Medicare, offering a brighter future for all stakeholders. Physicians, are not immune to the impact of inflation. The overhead cost of running a practice has skyrocketed by 47% in the past 20 years, while Medicare reimbursement, when adjusted for inflation, has plummeted by 26% in the same period. This alarming trend, coupled with CMS’s projected increases in the MEI and a reduction in the MPFS, is placing an unbearable strain on our healthcare economic environment. The gravity of this situation, which directly affects the healthcare providers we rely on, cannot be ignored. In the short term, the Strengthening Medicare for Patients and Providers Act (H.R. 2474) provides a means of updating the annual MPFS equal to the MEI, which is vital in offsetting inflationary costs. However, we must address the provision included in the Omnibus Budget Reconciliation Act of 1989, which mandates any estimated increase of $20 million or more to the MPFS created by upward payment
Medicare, signed into law by President Lyndon B. Johnson, has provided insurance to millions of American families and has served to save lives and provide economic security to our nation through access to care. 1 Nearly sixty years later, it has non- sustainable flaws that Congress must address to ensure those tasked with providing care to beneficiaries can do so sustainably. Despite the United States spending more on healthcare, in total per capita, than other developed countries and the growth of healthcare expenditures outpacing average gross domestic product (GDP) growth consistently, physician reimbursement continues to decline, creating an economic environment that poses a risk to beneficiaries’ access to care and our nation. 2 Original Medicare, formally known as Part A and Part B, includes hospital stays and medical services coverage. Medicare Part B utilizes a fee-for-service model (FFS) responsible for physician reimbursement through the Medicare Physician Fee Schedule (MPFS), updated annually. 2 In contrast, Part C, or Medicare Advantage, provides benefits through private insurers via federal contracts. Part D grants prescription drug benefits through stand- alone plans or as part of Medicare Advantage plan benefits.
The Lafayette Parish Medical Society (LPMS ) held its annual meeting and social on Thursday, November 21, at Marcello’s Restaurant . LPMS was honored to welcome Dr. Ralph Abraham , the newly appointed Louisiana Surgeon General , and Dr. Wyche Coleman , the Deputy Surgeon General . Dr. Abraham and Dr. Coleman discussed their roles in these newly established positions within the state. The event followed a Q&A format , allowing LPMS members to engage directly with both officials. Members asked insightful questions, which Dr. Abraham and Dr. Coleman answered to the best of their ability. Given that
these positions are new, both doctors were also eager to hear from attendees about what support Louisiana physicians hope to receive from their offices. This gathering was a valuable opportunity for members, and many took full advantage of it. In addition to the discussion, LPMS also elected new officers for 2025 :
President : Dr. Frankie Rholden Vice President: Dr. Philippe Prouet
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Secretary: Dr. Kim Drew
The MPFS uses relative value units (RVUs) and a conversion factor (CF) to formulate reimbursement rates for professional services rendered by physicians in the FFS model. RVUs account for physician work, practice expenses, and professional liability insurance. Given that resource components of a practice vary based on locality, the Centers for Medicare and Medicaid Services (CMS) assign a Geographic Practice
adjustments or the addition of new procedures or services be offset by cuts elsewhere. 5 Though Medicare covers slightly less than 20% of the population, CMS policies affecting physician reimbursement impact the entire economic environment of healthcare as commercial payers often decrease reimbursement as well. CMS’s attempt to curb spending poses a potential
“Medicare reimbursement has dropped 26% in 20 years—while practice costs have soared by 47%.”
Cost Index (GPCI) to the parts of an RVU. Each current procedural terminology (CPT) code is assigned an RVU multiplied by a CF. It translates to a locality-adjusted maximum allowable amount that Medicare will reimburse a provider for a particular service to a Medicare Part B beneficiary. 2 Despite the use of the MPFS, objectivity in physician reimbursement is absent due to budget neutrality requirements by statute and a nonexistent mechanism to account for inflation. The Strengthening Medicare for Patients and Providers Act (H.R. 2474), introduced by Rep. Raul Ruiz, MD [D-CA-25], and original cosponsors Rep. Ami Bera, MD [D-CA-6], Rep. Larry Bucshon [R- IN-8], and Rep. Mariannette Miller-Meeks [R-IA-1], is a beacon of hope in the current Medicare landscape. This critical piece of legislation, currently under review by the Subcommittee on Health, aims to amend Title XVIII of the Social Security Act to provide a single conversion factor under the MPFS based on the
unintended consequence of decreased access to care for Medicare beneficiaries. Some physicians will be forced to see a higher volume of commercial payers to offset the continued decreased reimbursements by CMS and inflation that threatens the vitality of their practices. Physicians must advocate for the systemic reform of Medicare to ensure that access to care for all Americans remains unhampered. Solutions, targeting waste, fraud, and abuse, must be highlighted in our efforts to protect the integrity of our profession and American families dependent on Medicare for access to care. Previously identified waste domains by the Institute of Medicine and Berwick and Hackbarth highlight the failure of care delivery, care coordination, overtreatment and low-value care, pricing failure, fraud, abuse, and administrative complexity. The estimated cost of waste in the U.S. healthcare system ranged from $760 to $935 billion, and the estimated potential cost
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savings from interventions to reduce waste without including administrative complexity, for which no current studies have been performed, were from $191 to $286 billion according to Shrank et al. 6 Congressional solutions are a must to prevent the Medicare Trust Fund from becoming insolvent, and continued declining adjustments to the MPFS are not and should not be the sole answer. Without change, the current business model, which is inundated with waste, fraud, abuse, and consistent cuts in Medicare reimbursement to physicians, will most certainly have a negative impact, particularly on physicians in private practice and those who care for the underserved and rural populations such as those in my home state of Louisiana. Our current healthcare and economic environments are not the time for physicians to incur a second hit when a record number of physicians are nearing retirement age and an expected physician shortage of 86,000 by 2036 looms. The time for action is now. Omar Leonards, MD LSU Health Sciences Center New Orleans Cardiovascular Disease Fellow
UNITING MINDS, ADVANCING CARE: Psychiatrists Gather in New Orleans for LPMA & MPA Spring Meeting Filled with CME, Collaboration, and Community
The 2025 Louisiana Psychiatric Medical Association (LPMA) and Mississippi Psychiatric Association (MPA) Spring Meeting, held from February 14 to 16 at the University Medical Center Conference Center in New Orleans, was a resounding success. The event brought together mental health professionals from across the region for a weekend of education, networking, and celebration. Kicking off on Valentine’s Day, attendees were treated to a festive social event that set a warm and collegial tone for the weekend. Early career psychiatrists and resident fellows also had the opportunity to connect during a dedicated social hosted by the American Professional Agency, fostering mentorship and collaboration among emerging professionals. The conference offered 13 hours of Continuing Medical Education (CME), covering a diverse range of topics pertinent to contemporary psychiatric practice. Sessions included a grassroots advocacy panel, discussions on kratom, risk management strategies, insights into traumatic brain injury, and advancements in behavioral sleep medicine. These sessions provided attendees with valuable knowledge and practical tools to enhance patient care. A poster symposium was also hosted on Friday morning where judges Jean Simpson, MD, Phil Scurria, MD and Mark Wright, MD had the opportunity to speak with over 25 medical students and residents from LSU New Orleans, LSU Shreveport, and UMMC about their case studies or research projects.
Citations:
1. Centers for Medicare & Medicaid Services. “History.” www.cms.gov, 6 Sept. 2023, www.cms.gov/about-cms/who-we-are/history.
2. O’Shea, John , et al. “The Medicare Physician Fee Schedule: Overview, Influence on Healthcare Spending, and Policy Options to Fix the Current Payment System.” 24 May 2023.
“Legislative Search Results.” Congress.gov, 2019 , www.congress.gov/search?q=%7B%22source%22%3A%22legislation%22%7D.
3.
4. “AMA: MedPAC’s Call for Higher Medicare Payments Should Spur Congress.” American Medical Association, 15 Mar. 2024 , https://www.ama-assn.org/press-center/press-releases/ama-medpac-s-call-higher-medicare-payments-should-spur-congress. Accessed 2 March 2024.
5. “How Medicare’s Budget-Neutrality Rule Is Slanted against Doctors.” American Medical Association, 7 June 2023 , www.ama-assn.org/practice-management/payment-delivery-models/how-medicare-s-budget-neutrality-rule-slanted-against.
6. Shrank, William H., et al. “Waste in the US Health Care System.” Journal of the American Medical Association , vol. 322, no. 15, 7 Oct. 2019, jamanetwork.com/journals/jama/fullarticle/2752664?utm_source=The+Dispatch&utm_campaign=09e7060f28- Dispatch041&utm_medium=email&utm_term=0_6d0e869d45-09e7060f28-41071053, https://doi.org/10.1001/jama.2019.13978.
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We are thrilled to invite members and non-members to our revamped meeting. In 2025, we are introducing a new format with a strong focus on CME, alongside fun social gatherings. The 2025 Annual Meeting, hosted August 1 – 2, 2025 at Baytowne Conference Center, will include the traditional House of Delegates and Inauguration activities with a mix of CME presentations and family activities, all bundled at a fantastic resort in Miramar Beach, Florida. We are excited about the new programing and location. Plan your family vacation and earn CME credit - we can’t wait to see you at the beach! 2025 Annual Meeting
Why Attend
• Acquire practical skills for your medical practice
• Stay updated on healthcare policies • Expand your professional network • Relish the sun and sea in beautiful Sandestin • Create lasting memories with your family
• Mergers & Acquisitions • High Risk Case Mitigation • Battling Obesity in Louisiana • Media Training • Compensation and Employment Models • Mental Health Crisis in Louisiana • Next Steps After Receiving a PCF or LSBME Complaint • Is There a Physician on Board? Responding to Urgent Calls in Public Environments Book Confirmed Topics:
ONCE ON THE RESORT PAGE, CLICK “CHECK AVAILABILITY” IN TOP RIGHT CORNER TO ENTER DATES, # OF BEDROOMS DESIRED, ETC. LSMS SPECIAL CODE: 2509XX ROOM BLOCK ENDS: JUNE 30
Letter to Congress and US Senate Regarding Medicaid Cuts
Join us in celebrating the installation of Thomas “Steen” Trawick, MD on Friday, August 1 as LSMS’ 145 TH President. Your registration fee includes a ticket to the Inauguration Luncheon and Party. Dr. Trawick is a Board-Certified Internal Medicine physician in the Shreveport-Bossier community for over 22 years.
LSMS, along with members of the Coalition of State Medical Associations, submitted a letter to Congress and the US Senate urging both to protect Medicaid in the House Budget Resolution. All states agree that “If these cuts are enacted millions of our Medicaid patients will lose their coverage and we expect all Medicaid patients to lose some of their existing benefits and access to essential health care services. Once our patients lose coverage, their health conditions will worsen and the financial burden will shift to the states, physicians, emergency rooms, hospitals, and all other patients.” To read the full letter, scan the QR code.
Register Today Scan the QR code
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