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September 2013

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September 2013 Update


Inside this Issue:

  • Letter from IHP President
    Webinar: The TWO-MIDNIGHT Rule
  • IHP Pharmacy Committee Update
  • Low-dose CT Lung Screenings Available
  • The Health and Mental Health Benefits of Exercise
  • New IHP Physicians










 Dear Colleagues,

“I never hear anything from IHP”

Nothing disappoints me more than the statement above. If you are reading this, I suspect you have never said this. In the age of instant communication it seems impossible that we can’t effectively communicate with a group of physicians. In September I spoke at five of the seven hospital boards in the INTEGRIS system and at other venues with IHP doctors in attendance. I heard this sentiment from several physicians. OUCH!

Communication is quite difficult with 900+ physicians. Many of us have multiple email addresses to manage, maybe Facebook and Twitter accounts, too. IHP utilizes email, phone calls and in-person office visits, and we still have significant holes in our coverage. Sometimes it feels like our map looks like the Cheapo Cell Phone Company. Maybe we will just have to “friend” you on Facebook.

We need your help. If you are reading this or hear of an IHP initiative or event, share the news with your group or call partners. Talk about it in a doctor’s lounge. Have your office manager print it out and post it in the break room or physicians’ entrance to your office. It takes all of us communicating to make this work.

We have two physician liaisons dedicated full-time to IHP who regularly visit our member physicians. They share information, educate office staff and physicians and solve problems. When they call on you, make some time to speak with them. Matt Henderson and Deidre Horn will work around your schedules to make it convenient. They are here to help you or your staff with anything related to IHP. Matt reaches out to physicians in south Oklahoma City, Yukon, Norman, Mustang, and Midwest City. He can be reached at matthew.henderson@integrisok.com or 405-593-9850 (call or text). Deidre works with physicians in Oklahoma City north of I-40 and in Edmond. You can get in touch with her at deidre.horn@integrisok.com or at 405-550-3499 (call or text).

There will be a lot of new information pushed out to our members in the next two months regarding scorecard performance and IHP opportunities. Please share it with anyone in IHP that you can. Don’t assume they already know. Our commercial product with Coventry will be on the insurance exchange in central Oklahoma and there is the potential for many more covered lives being added to our panel. We will all need to be paying attention and be engaged to fulfill the potential of IHP.


Carl Raczkowski, M.D.
President, INTEGRIS Health Partners

The Two-Midnight Rule
Understanding Admission Criteria Changes in CMS FY2014 IPPS

Important documents attached to this newsletter:

  1. CERNER EMR UPDATE – Patient Placement Process
  2. Patient Placement Alerts

Get the FACTS, ANSWERS to your QUESTIONS, and information you need about the TWO-MIDNIGHT RULE and physician certification requirements.

Webinar presented by Executive Health Resources
Panel to include:

  • Steven Leitch MD
  • LeRoy Southmayd III MD
  • Shirley E Dearborn MD
  • Jim Lynch, director, Nursing Informatics
  • Lisa Anderson, Case Management
  • Anne Stinson, Compliance and Privacy

INTEGRIS Baptist conference rooms J, K, and L (lunch provided)
Noon – 12:30      Panel Discussion
12:30 - 1 p.m.    Webinar


IHP Pharmacy Committee Update

Drug interchanges recommendations for August:

  • Crestor - atorvastatin instead of Crestor for dosage sizes 5, 10, and 20 mg. The corresponding atorvastatin doses are usually 10, 20 and 40 mg. We do not recommend interchanging the 40 mg Crestor dose.
  • Lyrica - The task force is recommending the following interchange, gabapentin instead of Lyrica. Not all patients will find gabapentin to be equally efficacious or tolerable, but many will. Gabapentin is not a controlled drug – Lyrica is. The dosage range is quite wide, from 100 mg twice daily to 1200 mg three times daily. At higher dosages, doubling the dose does not double the effect.  
  • Oxycontin - The task force is recommending the following interchange, morphine sulfate ER instead of Oxycontin. Due to the significant cost differences between capsules and tablets, the task force strongly encourages interchanges for Oxycontin to be made with the morphine tablet. As a general rule, 30 mg of morphine sulfate is equivalent to 20 mg oxycodone in analgesic potency.  
  • Pristiq ER - The task force is recommending the following interchange, venlafaxine HCL ER instead of Pristiq ER.

Drug interchanges recommendations for September:
Tamiflu - to curtail prescriptions and therefore costs, the task force is asking for our physician partners to consider these before prescribing Tamiflu to your patients:

  • Tamiflu is generally not recommended for prophylaxis. Exceptions include persons with serious chronic illnesses who have not been vaccinated (this should be a very small number of persons) who have been exposed in the home to documented influenza.
  • Efficacy of Tamiflu in patients who begin treatment after 48 hours of symptoms has not been established.
  • Tamiflu is not a substitute for early influenza vaccination on an annual basis.
  • Tamiflu is ineffective in the common cold. Persons treated empirically should have a combination of cough, fever and muscle aches and NOT sore throat/stuffy nose.
  • Influenza viruses change over time. Emergence of resistance has been documented where Tamiflu is prescribed frequently and indiscriminately.

Celebrex - The task force is recommending the following interchanges, etodolac or meloxicam. Both of these agents have COX-1 and COX-2 inhibition activity, but are more selective for COX-2 in modest therapeutic doses. This is a possible advantage over ibuprofen and naproxen without the cost of Celebrex.

Low-dose CT Lung Screenings Available

Dear Physician,

Beginning Sept. 4, 2013, all INTEGRIS metro radiology departments will offer low-dose CT lung screenings to the general public. The ACS (American Cancer Society) and the National Comprehensive Cancer Network have published guidelines based on the NLST (National Lung Screening Trial) for low-dose computed tomography.

Criteria guidelines for screening are as follows:

  • High risk patients age 55 to 74 years, have a smoking history equivalent to a pack a day for 30 years, and currently smoke
  • Have quit smoking within the past 15 years
  • Have a smoking history equivalent to a pack a day for 20 years, and a secondary exposure such as asbestos exposure, radon exposure, family history of lung cancer, or lung disease history.

Lung cancer is one of the most common cancers diagnosed. In 2012, the ACS estimated that lung cancer accounted for approximately 28 percent of cancer deaths in the United States. The NLST found that people who fit the screening criteria and had a low-dose CT had a 20 percent lower chance of dying from lung cancer than those who received chest X-rays.

Although there is a national movement to recognize the low-dose CT as a wellness screening tool, it is not currently covered by most insurance plans. The cost to the patient will be $225.

If any of your patients fit this criterion and would benefit from a low-dose CT lung screen, please call our scheduling office at 951-5000.

Thank you,
James P. White, M.D.
Managing Director, Medical Affairs
Chief Medical Officer

The Health and Mental Health Benefits of Exercise

[Download Attachment]

A recent American Medical News article by Tanya Albert Henry provided details of a study which helps physicians understand what kind and how much physical activity in best for patients. Over the past decade, there has been much research demonstrating the benefits that exercise has for patients with depression. This new study helps physicians prescribe the right dose. After reviewing data from nine randomized controlled trials that evaluated the link between exercise and mood enhancement, the study offered several recommendations for a broad list of diagnoses and conditions, not just for depression. To read more about the article and related studies see the attached summary, The Health and Mental Health Benefits of Exercise.

New IHP Physicians

Please see IHP website for practice locations.    

Shripal Bhavsar MD

Radiation Oncology

Meredith McKee MD

Internal Medicine

Mrudula Munagala MD

Cardiovascular Disease

David Neumann II MD


Valeriu Neagu MD


Anita Phancao MD

Cardiovascular Disease

Venkata Raman MD



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Oklahoma's largest hospital network
3300 N.W. Expressway
Oklahoma City, OK 73112 Phone: (405) 951-2277
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