Memphis Medical News August 2013

FOCUS TOPICS ORTHOPEDICS PHYSICIAN/HOSPITAL ALLIANCE IMAGING

August 2013 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

David Deneka, MD ON ROUNDS

MEMPHIS on the MEND

BY PAMELA HARRIS

Tom Webb Leads the Local Arthritis Foundation in Education A wise man once said, “Everything is dependent on everything else. Everything is connected, nothing is separate.” In our bodies, joints are vital connectors. You know … the ankle bone’s connected to the leg bone, and the leg bone’s connected to the knee bone, the knee bone’s connected .... 6

Orthopaedic Surgeon Helps Saint Francis Bring MAKOplasty to Memphis As an orthopedic surgeon, Apurva R. Dalal, MD, was immediately interested when he heard about MAKOplasty®, a new, robotic-assisted partial knee replacement surgery. He got his first look at it in detail at a meeting of the American Academy ... 19

ONLINE: M.MEMPHIS MEDICAL NEWS.COM

Acadia Positions Delta as Med-Psych Facility

New CEO Sees Benefits for Patients in Offering Both Services

standing behavioral health facilities, chemical dependency units, hospitals, mental health facilities The February purchase of Memphis’ Delta not doing medical, and medical facilities not doing Medical Center by a company that operates bepsych support that Delta can help. The medical staff havioral health facilities quickly raised an important at Delta consists of psychiatrists, internal medicine question: Would the new acquisition be converted to physicians and specialists. a full-service psychiatric hospital?

“It is not unusual for a patient to be admitted by The answer, according to Bill Patterson, Dela psychiatrist and then receive a consult from a myrta’s new chief executive officer, is no. Delta is both iad of medical specialists during their stay at Delta,” a medical facility and a psychiatric facility, and PatPatterson said. “We also serve a pretty high number terson said plans are to keep it that way, despite the of indigent and geriatric patients referred from nursfact that the company that acquired the hospital is ing homes. With age and advanced dementia come Acadia Healthcare, an aggressive growth firm based other circumstances and comorbidities. There are in Franklin, Tennessee, that specializes in psychiatric considerable medical safety issues that having the and chemical dependency services. medical support here allows us to manage.”

Bill Patterson Of the 45 entities acquired by Acadia in the past When asked about the increasingly competifew years, Delta stands out for offering both services. tive nature of the Memphis market due to dwindling reimbursement, “I think (Acadia) saw in Delta the opportunity to realize the benefits shortage of physicians and the ever-changing regulatory environment, of a combined operation. I would classify Delta as a med-psych hospital Patterson maintained that Delta is “Switzerland,” even in the presence serving an estimated 200-mile radius,” Patterson said. “There are so of Lakeside Hospital, a freestanding behavioral facility, and St. Francis, many situations clinically where individuals with behavioral health isa healthcare system with medical services and a behavioral component. sues need immediate access to medical support and vice versa.”

He said Delta is focused on providing access to care for the zip Patterson added that Delta has tried to carry the message to free(CONTINUED ON PAGE 12)

By GINGER PORTER

HealthcareLeader

Daniel J. Hein

Co-CEO MSK Group, PC CEO Memphis Orthopaedic Group

By JUDy OTTO

Jumping out of military aircraft can have farreaching effects on a person. One example is Dan Hein who, after a U.S. Army service that included rappelling out of helicopters, became a fearless and focused champion of effective and accessible healthcare service in the face of formidable obstacles.

After an education that included a bachelor’s

Coming Soon!

degree in biology from The Citadel, The Military College of South Carolina, and an MBA from the University of South Carolina, Hein pursued an 11year career with the Army. He reached the rank of major prior to his return to civilian life in 2002, when he joined the Memphis Orthopaedic Group and played a leadership role in integrating three independent orthopedic groups into one practice —

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PhysicianSpotlight

David Deneka, MD

Orthopaedist’s Work Keeps Him Close to His First Love: Sports

By RON COBB

David Deneka, MD, knew from the time he decided to become a doctor that sports medicine was going to be his specialty. He had grown up in Millington with a keen interest in baseball, and he also played basketball.

Coming out of high school, he passed up a scholarship in chemical engineering to go into pre-med at Ole Miss. It was a decision he made after having a talk with his older brother, who believed Deneka had the ability to absorb all the different sciences, not just the science of chemical engineering. Becoming an orthopedist would allow him to combine his interests in sports and medicine and to fulfill his desire to take care of people.

First came college at Ole Miss, then medical school and internship at Vanderbilt, followed by his residency at the University of Washington.

And then came another key decision. Should he spend another year of specialty training in a fellowship program or start practicing? Deneka tended to be a perfectionist and wanted to be among the best-trained physicians in sports medicine. So when he was selected for a fellowship at the American Sports Medicine Institute, he jumped at the chance. There, in Birmingham, Alabama, he studied for a year under Dr. James Andrews. Deneka couldn’t have had a more respected and accomplished mentor.

While the average sports fan doesn’t

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pay a lot of attention to the medical side of sports – or at least those who practice it – he or she probably can cite the names of two important doctors. One of them is Frank Jobe, who performed the first Tommy John surgery in 1974 and was team doctor for the Los Angeles Dodgers for 40 years. The other is Andrews.

When heralded athletes suffer serious, career-threatening injuries, they often find themselves on an airplane headed to Birmingham to see Andrews. His patients have included Jack Nicklaus, Michael Jordan, Drew Brees, Bo Jackson, Emmitt Smith, Brett Favre, Robert Griffin III and Nerlens Noel.

“He’s a giant in the sports world,” Deneka said. “He was a mentor and a phenomenal surgeon and person. I considered it a privilege to spend my year learn-

ing under him.

“I adopted his philosophy that all patients are treated like the famous quarterback. It is just as important for moms to be able to carry their children as it is for players to return to their sports.”

Deneka, now one of a team of 17 doctors at OrthoMemphis, has been practicing sports medicine for 16 years and staying close to the sports world by serving as a team doctor for most of that time.

While practicing in Murfreesboro for seven years, Deneka was one of the team doctors at Middle Tennessee State University. He returned to Memphis nine years ago and has been team doctor at Evangelical Christian School for the past eight.

“I love my role being a team doctor,” he said. “Taking care of injured players and then seeing them playing on the field is both professionally and personally very rewarding.”

Being a team doctor has its upside but also its downside. Married for 22 years, with three sons ages 11, 15 and 17, Deneka acknowledges there’s a price to be paid.

“The biggest challenge is always being accessible and the time commitment in being away from your family,” he said. “My kids are playing their own sports, and it’s hard to miss their games or practices at times. On the other hand, it’s also very gratifying to see one of your patients throwing a pass into the end zone after a shoulder injury or scoring a goal after a knee injury.

“Another reward is the relationship formed with the kids and their families.”

While he sees patients in the office Monday, Wednesday and Thursday and

operates on Tuesdays and Fridays, his role as a team doctor isn’t restricted to certain hours of the week.

“I have an open-door policy for the players, coaches and trainers, so I can’t really gauge the amount of time it requires,” he said. “If they need anything, I am there for them whether it be 24-hour access on the cell phone, time on the sidelines, or visits in the office during clinic time.”

In the office, Deneka sees all types of patients “from athletes to weekend warriors to couch potatoes like me. All the patients are given the ‘sports medicine treatment.’ The sports medicine treatment is to get that patient back to their activities safely and as quickly as possible. All my patients are treated like the professional athlete who needs to get back on the field.

Many times it just means physical therapy and NSAIDs, and sometimes it requires surgery.”

Across more than two decades, Deneka has seen sports medicine evolve dramatically.

“The number of procedures that we are able to do arthroscopically instead of open is the biggest evolution,” he said.

“Even during my fellowship, we did all of our rotator cuff repairs mini-open with a 2-to 3-inch incision. In the last nine years, I have probably only had to do two open rotator cuff repairs due to the size of the tear.

“With the increase in arthroscopic procedures and sports-specific physical therapy, most patients are able to recover faster and return to their sport or activity in fewer weeks. For those high school seniors who want to finish their last season, it can make a huge difference.”

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Memphis CMSA Presents

Under the Sea...

CMSA that is.

8th Annual Conference and Vendor Fair Friday, October 4, 2013

Annual Conference Holiday Inn and University of Memphis Vendor Fair

3700 Central Ave, Memphis, TN Friday, October 5, 2012 7 am – 4 pm Holiday Inn Speakers: University of Memphis Judy Bookman, 3700 Central Avenue LCSW – Professional Boundaries Memphis, TN Betsy Friedman, RHC – Motivational Interviewing Angela Mitchell, MBS, RN, PLNC, PAHM, CCM – Patient SPEAKERS: Dr. George Lucas, U.S. Learning – Let’sMBA/Larry get motivated! Turner, BS, CTRS Joanne Lowe, Sharon Perry, West Tennessee Family Services - Special needs of the Autism community.

Key Features the Affordable Care Act Dr. Clarence Davis from BCBST, Update - changesofcoming to healthcare.

Fourroux- prosthetics and special needs of amputees.

Safety

To Register Contact Tammy Ellard Phone: 901 761 3013 x 13 Memphis Chapter

Email: tellard@selectmedical.com

Reform, Regulation & Reimbursement

Tennessee MGMA Legislative/Payer Conference August 22-23, 2013 The healthcare landscape has changed drastically over the past decade, and with the implementation of new reforms, the creation of Health Benefit Exchanges, and evolving payment models, the next year will be a pivotal one in healthcare management.

Session Topics Include: Payer Contracting in an Era of Evolving Payment Models Step by Step Approach to Implementing ICD-10 and Administrative Simplification Standards New HIPAA Privacy Requirements: Critical Compliance Issues Medicare Updates from CMS & Cahaba including PECOS, Modifier 59 changes, and sequestration Health Benefit Exchange Panel Health eShare Direct Pilot project Payer overview and Q&A sessions

Downtown Marriott - Memphis, Tennessee Make Your Hotel Reservations Now at 901-527-7300 Online Registration Available at www.tmgma.com 4

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by Bill Appling

Hurdles on the Track of the Affordable Care Act Most people, including policy makers in Washington don’t know the hurdles that healthcare providers face regarding the issues and regulations already in place.

Now there are new issues about to hit with the Affordable Care Act. An overwhelming amount of time is being spent on EHRs. The Health Information Technology for Economic and Clinical Health Act (part of the American Recovery & Reinvestment Act aka The Stimulus bill) was passed in 2009 before the Affordable Care Act passed in 2010. The costs resulting from this first act with its never-ending changes (costs) in meaningful use have been sorely misrepresented to healthcare providers. Many of the EHR systems ( I am not referring to local EHR resellers, support and technology companies such as PCS Medical Solutions, a reseller of Intergy EHR or SergeMD, a reseller of NextGen EHR) have not been able to keep pace with the software changes and many times send out updates to their software. Sometimes these changes/ updates are sent to the end-users untested and physician groups with the support of the resellers end up doing the “debugging” of the “updates” the EHR companies send out. (If it appears that I am being negative on this, you are right.)

The extra costs of people and resources involved in this, on top of dealing with other issues and regulations, have been overwhelming for providers and their employees. Yet, healthcare providers are still expected to be the real implementers in healthcare reform.

The adoption of ICD-10 has the potential to affect physician practices to a greater extent than many of the recent HIPAA transitions. While the costs of implementing ICD-10 will vary depending on practice size, technical infrastructure, staff training requirements, and other factors, it is critical for practice professionals to identify these costs well in advance of the Oct. 1, 2014, compliance date, and budget accordingly. Optimizing your existing EHR and continued physician buy-in and establishing meaningful use becomes frustrating. Overcoming recent HIPAA transitions have presented major hurdles.

Cash-flow disruption can and will directly impact organizational operations during the transition from HIPAA 4010 electronic transactions to the 5010 version.

Contingency plans, such as setting aside cash reserves or postponing large capital investments close to the compliance date, should be drafted to ensure that your practice can continue to meet its financial commitments to staff and vendors in the event of significant increases in denied or pending claims.

The national MGMA sent a letter to the Center for Medicare and Medicaid Services regarding Recovery Audit Contractors (RACs) requesting that their auditors begin to audit Evaluation and Management (E&M) services and extrapolate their findings to reflect incorrectly paid claims. A number of problems still remain, particularly from the Connoly region – the group that audits our

region. MGMA does not believe the RAC program – Connolly in particular – are equipped to appropriately evaluate E&M coding accurately. A RAC audit requires a lot of resources on your part and has a costly appeal process as well.

Dealing with rising operating costs was ranked among the top problems in a survey conducted by the MGMA. Controlling costs has always been a challenge as they steadily increase each year.

The No. 1 challenge on applicability scale is “assessing current operations to identify opportunities for improvement,” and the No.1 challenge on intensity scale is “preparing for reimbursement models that place a greater share of financial risk on the practice.”

MGMA members lament the “David vs. Goliath” scenario faced by providers in their dealings with payers. There are too many rules, and they vary from carrier to carrier. Understanding the total cost of an episode of care from the payer’s perspective can be quite challenging.

Interest has spread outside the primary care camp. “There is momentum,” said David N. Gans, MSHA, FACMPE, senior fellow, MGMA-ACMPE Industry Affairs. “We are now seeing mainstream recognition of models that focus on the patient-centered medical home which are the future of medicine. It’s no longer news. The question now is, how do you have to change your processes?”

Other challenges that groups are concerned with are; • Managing finances with the uncertainty of Medicare reimbursement rates, • Maintaining physician compensation levels, • Collaborating with payers to implement new payment models, • Optimizing an existing EHR, • Modifying physician compensation formula to more heavily emphasize quality metrics, such as population-based outcomes, patient health status, patient satisfaction and patient safety, • Attracting skilled professionals.

Does it not make sense that in addition to all these distractions, there will be significant hurdles to jump through over and over for the success of the Affordable Care Act? Again the paper pushers in Washington do not know what working for a living is all about or they would have taken in consideration everything they have already placed on the providers.

I will go on record and say that if the Affordable Care Act. does not do what it was meant to do, then it is the fault of the paper pushers and under-qualified policy makers in the “Emerald City on the Hill.” It is apparent that the right hand and the left hand don’t know what each other is doing.

Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author.

He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at appj54@aol.com.

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Experience

The necessary component to ensure optimal outcomes for your patient.

Breast Specialists: Ron Mattison, M.D. Christine Mroz, M.D. Photography by Jaffe Studios

Experience. Dr. Christine Mroz is a pioneer in the Physicians, Case Managers and UltraSonographers. They

diagnosis, treatment and survival of breast cancer. Her read their own mammograms and formulate and execute Memphis clinic opened in 1986 and is one of the first the treatment plan. dedicated breast centers in the world.

Experience. After treating over 45,000 new patients Expertise. Uniquely, Dr. Mroz and her associate, Dr. over the past 20 years, we’ve gained the experience to Ron Mattison, are Surgeons certified by the FDA and the diagnose and offer your patient a treatment plan in one American College of Radiology as Supervising Interpreting day…not weeks or months, and without needless biopsies.

Experience & Expertise. It’s what the Mroz Baier Breast Care Clinic has to offer your patients. It’s what makes us…

Clearly Superior.

Accepting Virtually All Insurance Plans (please check to make sure)

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Tom Webb Leads the Local Arthritis Foundation in Education MEMPHIS on the MEND

BY PAMELA HARRIS

A wise man once said, “Everything is dependent on everything else. Everything is connected, nothing is separate.” In our bodies, joints are vital connectors. You know … the ankle bone’s connected to the leg bone, and the leg bone’s connected to the knee bone, the knee bone’s connected to the thigh bone…. and so on.

When a good connection fails in any of these areas, the result is pain and immobility, and often the culprit is arthritis.

If you have it, you know it can stop you in your tracks. Anyone with arthritis will tell you that that joint pain can be debilitating.

One such person is Tom Webb, president and CEO of Vista Care, a medical supply and equipment company. Eight years ago, Webb underwent a total shoulder replacement after arthritis ravaged his shoulder joint. Today, at age 62, in spite of the fact that he practically has a bionic upper arm, you’d never know he’s had a problem. Webb is an avid runner who participates in Ragnar Relay Races (www. ragnarrelay.com). He’s no longer in pain

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and is now the Chair of the Leadership Council of the Arthritis Foundation of West Tennessee. Yes, today, Webb leads the charge in educating Memphians about preventing and controlling the disease that took his shoulder joint. Webb says that if you have arthritis, you need to keep moving because when it comes to joints, “motion is lotion.” One of the biggest myths involving arthritis is that when you have it, you should avoid exercising. Au contraire. According to the U.S. Department of Health and Human Services there is strong evidence indicating that both endurance and resistance types of exercise provide considerable disease-specific benefits for people with osteoarthritis (OA) and rheumatic conditions. In addition, a growing body of research indicates that exercise, weight management and the avoidance of joint injury can go a long way in helping to prevent OA. In addition to promoting exercise, the mission of the Arthritis Foundation includes improving lives through leadership in the prevention, control and cure of arthritis and related diseases. Their website (www. arthritis.org/tennessee) is full of information including nutritional advice, tips on managing pain, and recommendations on proper exercise for people with arthritis.

The medical community is aware of

How Big is the Problem?

One in three people on average has arthritis. And we’re not just talking about senior citizens. In this country, 300,000 children under the age of 18 are affected by arthritis. Two thirds of Americans with arthritis are under age 65.

Arthritis affects our economy and our healthcare system. Arthritis and related conditions cost the U.S. economy $128 billion per year in medical care and indirect expenses, including lost wages and productivity. The disease annually results in 44 million outpatient visits, about one million hospitalizations and over 9,000 deaths.

The Research

Tom Webb finishes his leg in a Ragnar Relay Race in 2011 in Chicago.

the fact that patients must be educated on health issues like these, so they will know when it is appropriate to seek medical advice and care. We all know that many people wait too long to do just that.

The Arthritis Foundation estimates that unless the current trend is reversed, 67 million Americans will have arthritis by the year 2030. The foundation’s research arm is doing remarkable work in the areas of drug development, genetic and environmental predictors, and personalized treatment plans for rheumatoid arthritis, osteoarthritis and juvenile arthritis. There are 11 research programs funded by the Southeast Region of the Arthritis Foundation of which West Tennessee is a part. Currently three of those scientists are in Memphis – one at St. Jude and two at UT Health Science Center.

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Cancer Wars: New Therapies Join Chemotherapy Memphis Radiologist: Changing Biology of Tumor May Be Next Step

By JUDY OTTO

Although cancer is directly or indirectly the leading cause of disease-based death in the U.S., and a great deal of effort has been devoted to developing innovative treatments and cures beyond chemotherapy, awareness of impressive alternative options to chemotherapy – such as tumor ablation – seems still to be quite limited, says Dr. Phillip Zeni of Memphis Interventional Radiology Clinic and its parent, Mid-South Imaging and Therapeutics, P.A. “With cancer, people Dr. Phillip most often think about Zeni systemic chemotherapy,” he said. “Although chemotherapy is a lifesaving therapy option, the side effects are horrible and include nausea, vomiting, hair loss and weight loss – versus many of the latest therapies that have no systemic effect, so the patients fare much better. Overall, I don’t think patients are even aware of other ablation methods – treatments that can destroy tumors without removing them surgically.”

Clearly they should be. Since as early as the ’90s, technology has been in place for radio frequency ablation (RFA) – a procedure that uses a needle-like probe inserted through the skin to heat and destroy cancer cells with high-frequency radio waves.

Although the method works well, its greatest limitation is the heat that it employs to kill the cells. Everything else within the immediate vicinity of the probe is destroyed by the heat – including major blood vessels or the spinal cord, for example. “It’s a good technology for the right person at the right time, but its application has been limited because of the modality that it uses,” Zeni said.

Some 10 years ago, serious clinical trials began using cryoablation, a method that harnesses cold to freeze and destroy tumors – the “polar” opposite of the RFA’s heat method. Zeni, who has used kidney cryoablation successfully to treat as many as 200 cases of renal cancer, notes that cryoablation has become the current standard of care for small renal masses.

“We can get almost the same success rate freezing the tumor as we can with nephrectomy, or kidney removal,” he said.

“Cryoablation has been a revolution in the treatment of renal cancer.”

The cryo technique is also being used on tumors in other parts of the body, where its safety profile is better than RFA. Patients tolerate it better, Zeni said, since the cold not only preserves the underlying structure of the tissues but has a numbing effect that prevents pain response. And where RF probes can burn through delicate tissues like the diaphragm, a cryoablation probe will freeze the cancerous tissue while leaving the diaphragm itself intact, he said.

Newer methods have continued to evolve. More recently, microwave ablamemphismedicalnews

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tion, which employs the needle-like probe to emit point-source microwaves from its tip, has been very successfully used to treat early stage lung cancer. Since the source is so specific and concentrated, and since a tumor is surrounded by air in the middle of the lung, the microwave heat does not affect the surrounding lung tissues.

Even more impressive is the latest and most exciting state-of-the-art ablation technology: Irreversible Electroporation (IRE),

also known as the NanoKnife© technique, which employs two probes inserted side by side into the affected area, each generating short, intense electrical currents that pass between the probes, killing the cancerous cells by breaking open the cell walls rather than by heating or freezing the tumor cells.

Unlike other treatment methods described, this technique does not produce potentially damaging extremes of heat or cold that could also affect healthy tissue.

Computed tomography (CT) technology is used to map the area and create a model of the tumor, Zeni explains. The probes are placed under CT scan guidance that assists doctors in inserting the needles exactly where they need to be, while tracking the patient’s respiration and movement and compensating as necessary.

IRE is so state-of-the-art, says Zeni, that although it is FDA approved (like the (CONTINUED ON PAGE 16

Advances in Hip Replacements for a Faster Recovery

By JARED PATTERSON, M.D. The most frequent cause of chronic hip pain is arthritis.

Hip arthritis can be treated with medication, physical therapy and other conservative methods to help relieve pain.

But for patients who are still in pain despite conservative treatment, total hip replacement may be recommended. Total hip replacement helps relieve pain and may allow patients to perform some activities that were previously limited.

Historically, doctors had advised patients to put off hip replacement operations as long as possible due to limited life expectancy of the prostheses. However, Americans rising expectations of quality of life have meant having surgery sooner. Fewer people are willing to tolerate years of pain or limited activity. And with newer, more advanced technology and longer lasting prostheses, getting a hip replacement at a younger age is an option.

Each patient is different and has different needs, so surgical approaches are chosen with those needs in mind.

However, the direct anterior approach (from the front) for hip replacement is gaining in popularity.

For the patient, there is reduced tissue trauma and less muscle damage, because an interval between the muscles is used—the muscles actually spread apart. So, unlike other hip surgical approaches, there is no detachment or cutting of the muscles during surgery.

The hip has more normal mechanics because you have not disrupted muscle connections, and the patient can have a more normal gait (walk). There is usually a smaller incision and less scarring, less usage of pain medication, a quicker return to function, reduced physical therapy requirements and a reduced dislocation rate.

Benefits of this approach to surgery include: potentially an easier recovery since the muscles have not been cut, allowing the patient to get a head start with physical therapy; lying on the back instead of the side; using X-rays during surgery to ensure proper alignment of the prostheses; better equalization of leg length during the procedure; decreased chance of dislocation.

The standard risks for a hip replacement regardless of the type of procedure are: bleeding, infection, scar tissue, dislocation, blood clots, and weakness. With anterior hip replacement, one risk factor is lessened— the chance of sciatic nerve damage. The surgeon is not near the sciatic nerve since it is located on the back side of the hip joint.

I tell my patients that it is not wrong to do the surgery one way or the other. This is just another technique to use. Physicians are taking extra courses and visiting other physicians to learn the direct anterior approach.

This technically difficult procedure has gotten easier due to new technology and modifications in hip replacement tools. Refinements in implants lend themselves better to placement from the direct anterior approach. All of these modifications mean a less invasive procedure for the patient.

Discover more about relief options for chronic hip pain at: www.orthomemphis.com.

Jared Patterson, M.D. Fellowship Trained Orthopaedic Surgeon

901.259.1600 www.orthomemphis.com 6286 Briarcrest Avenue

Memphis, TN 38120

A division of MSK Group, P.C

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You’ve Got (Secure) Mail

State Expands Health eShare Direct Project after Successful Pilot

By CINDy SANDERS

As the nation’s healthcare delivery system moves toward integrated care models where teams of providers work in concert to keep patients well or restore them to health, having the ability to securely share information across care settings is vital.

Achieving this goal is one step closer in Tennessee as the Health eShare Direct Project moves from the pilot stage to a broad-based program open to all providers. Working in partnership, the Office of eHealth Initiatives and Qsource, a Tennessee-based nonprofit healthcare quality improvement and information technology company, are encouraging the adoption of health information exchange (HIE) utilizing Direct technology. Direct is a secured messaging system that allows healthcare providers, facilities, clinical labs, patients and public health officials to send and receive encrypted electronic health information.

George Beckett, HIT coordinator for the Office of eHealth Initiatives, said Direct, which is available nationally, is meant

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to be one of the universal information exchange methods for healthcare providers.

“It really is ‘medical mail’ for everyone,” he explained.

Beckett continued, “It was always a HIPAA violation to send patient information through email before Direct. Now, providers do have permission to use this secured messaging system.” Beckett added the technology is also available for patient use.

By January 2014, all certified electronic health records will be required to have Direct built into their system. However, even facilities or providers without an EHR can access the technology as a stand-alone component.

George “In fact, many of the proBeckett viders we worked with in the pilot did not have an EHR, and it still worked,” Dawn FitzGerald, CEO of Qsource, said of information sharing.

For those taking advantage of HITECH incentives, she added, the ability to securely share patient data is a key component of meeting Stage 2 meaningful use requirements.

In fact, FitzGerald continued, “There are several elements of meaningDawn ful use that can be met FitzGerald through Direct.”

Five healthcare organizations in Chattanooga and Memphis participated in the pilot phase of the Health eShare Direct Project. The four Chattanooga organizations were HealthSouth Chattanooga Rehabilitation Hospital, Erlanger Health System, Southeast Tennessee Area Agency on Aging and Disability and Home Health Care of East Tennessee, Inc. and Hospice.

In Memphis, Health Choice LLC, a joint venture between MetroCare Physicians and Methodist LeBonheur Healthcare, also participated. Health Choice has developed a patient-centered medical home model for their region called Memphis Accountable Care Home (MACH1).

FitzGerald said working with the Office of eHealth Initiatives to roll out the Direct technology was a natural extension of the relationship that already existed

between the state and Qsource, the authorized Tennessee’s Regional Extension Center (tnREC) charged with helping providers statewide integrate HIT and adopt EHRs. “It was the perfect marriage to create the technical last mile for meaningful use to get EHRs to talk to each other rather than live in a physician office silo,” she said.

FitzGerald added the pilot program provided a number of lessons regarding implementation and usage. Once participants got used to relying on the technology, they found a lot of efficiencies in replacing the fax machine with Direct transmission.

“The healthcare industry demands greater efficiency and cost reduction, and sharing health information is needed to operate in this new environment,” said FtizGerald.

Beckett said the expectation is that Direct will catch on for the same reasons email has become so popular. Unlike the fax machine where an employee must print out information, leave his workstation, key in a phone number, feed the documents and then call to verify the information was received and delivered to the appropriate person, Direct messaging allows that same information to be transmitted securely to the intended recipient without the sender ever having to leave his keyboard.

“Transmitting health information (CONTINUED ON PAGE 16)

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Hey Doc, Don’t be like Joe

By TIM NICHOLSON

My father-in-law, let’s call him Joe, is eighty something years young. He still enjoys a robust life. Well, except for the part that he’s missing. The part where his vision has declined to the point that he’s unable to focus on what’s ahead in the road or read anything that’s NOT IN LARGE PRINT. Or the part of life he’s missing because the television volume is too high for conversation with others.

Sure there are proven methods for diagnosing and dealing with these two issues.

Each backed by science and enough bits of anecdotal evidence to convince even the most skeptical patient. But some people just don’t get it.

Maybe Joe’s reluctance to address the issue(s) is in part due to misinformation regarding the tests. Perhaps it’s the negative reviews (i.e. glasses make me look old, hearing aids squeal) shared by some users. Maybe it’s the notion that the solution is too expensive. But it could also be the ostrich putting his head in the sand and choosing to ignore facts because he doesn’t want to know what he’s missing.

Oops. That got a little personal didn’t it?

But patients aren’t alone in this sort of “If I can ignore it then I don’t need it” approach to some things. Take for example the idea of you using social media in your healthcare practice. What if your approach to that was similar to my fatherin-law’s approach to his issues? It might look a little like this: Misinformation. The notion that you can’t create a plan and measure its effectiveness is not true. You need some software and a little experience but it’s not nearly as difficult as your board exams.

There are ways to measure interactions as simple as the preview window on the Facebook administrator’s page. And methods to analyze the flow of traffic from there to your website are as easy and free as Google Analytics. So Joe, you can see and hear if you want to.

Negative Reviews. Like that pair of glasses Joe needs, everything takes a little getting used to. Smudges on the lens in the form of negative comments on your page are a matter of attention and adjustment. You need a plan to proactively address negative comments and to avoid accidental HIPAA violations. Listen to what Dr. Jeff Livingston, OB/GYN and social media pioneer says about it all, “I don’t think it’s that hard (to avoid HIPAA violations). If you step out of technology and just think about how doctors communicate throughout the day, they do it very naturally and never think about it.”

So Joe, other people are wearing glasses and doing just fine.

Costs. Being on Facebook is expensive. Forget that. The applications are free. Yes, you’ll need a communicamemphismedicalnews

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tions person on your team but you may already have that person in the form of a marketing partner or staffer. Think about it this way, it’s less an issue of cost than it is opportunity lost. A study once showed that each Facebook “like” is worth $125.

Maybe it’s more or less depending on the industry you’re in. But a doctor told me, “If we add one new patient through our social media spend, we’ve paid for one year of service.” That’s his math. Can you hear me now, Joe?

Nobody really cares. Maybe you think that your generation of patients isn’t interested in what you have to tweet but the evidence runs to the contrary. The older patient that you’re caring for may be part of the fastest growing demographic on Twitter. That platform saw a 79 percent increase among those 55 to 64 since last year and grew by nearly 50 percent on Facebook during that same time. So even an old-timer like you cares, Joe. Don’t be like Joe. Find someone you

trust to talk about the health of your practice marketing, patient education, and patient satisfaction programs. Until then, can you recommend a good vision and/ or hearing specialist for my father-in-law?

Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email tim@gobigfishgo.com

Ankle Sprains Vary in Severity and Treatment

By MATTHEW B. MASSEY, M.D. Most people have “twisted” an ankle at some point in their life. It hurts for a few moments and then you are able to “walk it off”. However, if your ankle becomes swollen and painful after you twist it, you have most likely sprained it.

An ankle sprain is an injury to the ligaments in the ankle. These ligaments are structures that control excessive movement of the joint. When an ankle sprain occurs, the ligament is stretched too far and is either partially or completely torn.

An ankle sprain is a very common injury. It is estimated that there are 25,000 ankle sprains per day making it one of the most common orthopaedic injuries.

This affects many people during a wide variety of activities, such as sports and physical fitness. It can also happen when one simply missteps off a curb or an uneven surface. Even though ankle sprains are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Therefore, proper treatment of a sprained ankle should be sought to prevent ongoing ankle problems.

The most common type of sprain is an inversion injury which means the foot rolls underneath the ankle. Patients will have pain, bruising, and swelling on the outside of the ankle. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot. It is important to note that a broken bone or fracture can have similar symptoms, so x-rays are taken to make sure that the bone has not been broken and the ligament has not been torn completely.

Ankle sprains are more common in people who have high arches or heels that turn to the inside (hindfoot varus) and people with weak peroneal muscles that run along the outside of the ankle. These injuries are also more common in people who have sustained a severe sprain in the past.

Ankle sprains can be diagnosed fairly easily given that they are common injuries. However, it is very important not to simply dismiss any ankle injury as a sprain because other injuries can occur as well. For example, the peroneal tendons can be torn. There can also be fractures in other

areas of the leg or foot. In very severe or chronic cases, an MRI may be obtained to rule out other problems in the ankle such as cartilage or tendon damage. However, an MRI is not necessary to diagnose a sprain.

The severity of the injury and the patient’s ability to walk will dictate treatment. Those that can walk normally after the injury are likely to return to activities very quickly.

In contrast, patients who cannot walk comfortably are treated in a removable walking boot until they can walk without a limp. In either case, physical therapy is an important part of treatment to restore range of motion, strength, and flexibility. It is important to incorporate motion during the healing process to prevent stiffness.

Motion may also aid in being able to sense position, location, orientation and movement of the ankle, which is called proprioception. An ankle brace should be used until the ankle is strong enough to return to activity without it.

Outcomes for ankle sprains are generally quite good. Most patients heal from an ankle sprain and are able to return to their normal activities. However, some patients who do not properly rehab their ankle or have a severe injury may develop chronic instability. Chronic instability can be dangerous because repeated sprains can lead to damage within the joint. These patients should be identified and considered for surgical repair.

Surgery may also be needed in a patient who has cartilage or tendon damage. Surgical options include arthroscopy, where a small camera is used to look inside the joint for loose fragments of bone or cartilage, or ligament reconstruction to improve stability.

Following surgery, a good physical therapy protocol will speed up the recovery and return patients back to an active lifestyle.

Discover more about ankle sprains and instability at www.orthomemphis.com.

Matthew B. Massey, M.D.

Fellowship Trained Orthopaedic Surgeon

901.259.1600 www.orthomemphis.com 6286 Briarcrest Avenue

Memphis, TN 38120

A division of MSK Group, P.C

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Healthcare Leader, continued from page 1

FE ATU R IN G

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the MSK Group, which he currently serves as co-CEO. The MSK Group has 35 physicians, eight midlevel providers and 25 physical therapists, with a total of 300 employees, and Hein regards his role in the successful 2009 merger that created it as one of his proudest accomplishments.

He credits his military school education and service background with the struc- Dan Hein (with hat and dark T-shirt, leaning against helicopter) flew in tured and focused approach to remote parts of Central America to set up Army mobile medical clinics to to challenges that has led to serve local populations in 1993 Panama. his successes. coming at us at such a rapid pace, and they’re “I actually do well under circumstances coalescing with such intensity and energy all with a lot of pressure and time constraints,” at the same time, it’s like a perfect storm in he said. healthcare. These dimensions have always As an officer in the Army’s Medical Serbeen there, but right now they’re swirling at vice Corps, Hein was involved with medical the same time, much more so than they ever operations, support, logistics and personnel. have.

“It was a unique experience for me “When reform and its changes hit the because I got to see healthcare from the ground next year, we’re going to have to perspective of the front-line medic on the learn how to operate in that environment, debattlefield, all the way back to Walter Reed termining how our business models are going Army Medical Center in Washington, D.C.,” to work as we transition from fee-for-servicehe said. “I was able to work in a lot of differtype payments to being paid for delivering ent environments and get a really good pervalue in outcomes.” spective of how healthcare is delivered on a During the transitional process, he broad spectrum. It enabled me to glean a lot warns, practices will have to be adept at dealof life experience in a very short time.” ing with both types of reimbursement, which His training included both airborne is where the value of belonging to a professchool and air assault school, where he sional organization will be truly realized. learned to rappel out of helicopters; during As TMGMA president, his focus will be on his service in Central America, Hein learned arming practices with the set of skills they will to speak fluent Spanish as he accessed remote need to navigate the new landscape. jungle locations with his team, flying in heli“We’re going to have to figure out how copters to set up temporary clinics. to work in a new paradigm in healthcare, The transition from military to civilian and none of us knows exactly how,” he said. life was challenging, Hein acknowledges. “I “We’re going to have to rely on each other a went from a world with one model of healthlot more to glean expertise and insight from care delivery to a world that was completely our peers and counterparts and learn from different, and I had to learn from the ground one another — because none of us in isolaup,” he said. “Fortunately I had good mention is going to figure this out.” tors, who educated me regarding technical That’s why he identifies himself as a aspects — the CPT codes and ancillary serhuge proponent of people getting involved in vices. That’s a knowledge base that I had to these organizations, which also aid the indiacquire as we went along.” vidual’s professional development and their Hein quotes Gen. Colin Powell— ability to excel in their jobs.

“Leadership is the art of accomplishing more A certified medical practice executive, than the science of management says is possiHein is working on obtaining his fellowship ble” — and takes the responsibility seriously. in the American College of Medical Practice “Leadership is really about being a serExecutives, preparing his final paper on the vant,” he said, “and one of my philosophies merger of independent medical practices — is that your ability to lead is only constrained based on his own experience. by your willingness to serve. As leaders we’re He takes great pride in the group and servants to the organization, to the people in the physician leadership team that thought the organization, and to the owners and the ahead almost five years to consider how best physicians. If you have that mindset, you reto align themselves to combat the coming alize leadership is not about asserting power, storm. “That was a conscious decision,” he it’s about inspiring and trying to elevate the said. “We did some very intense, purposeful performance and inspiring those around you things to put us where we are now; I feel that to do well.” we’re positioned as well as we can be.”

It’s a philosophy that has propelled him Hein’s high energy level colors his perto presidential roles in both the Mid-South sonal life as well. Not content with one or two Medical Group Management Association in leisure interests, Hein does weight training, is 2008, and, starting next year, in the Tennesa self-taught guitar player, enjoys landscapsee Medical Group Management Associaing, working with plants and cooking, and is tion, where he currently sits on the board as writing a novel. president elect.

Most important, however, is spending “Next year is a pivotal transitional year time with his daughters, ages 16 and 18, and in healthcare,” he said, using the analogy of a building on their relationship, which is one of perfect storm fueled by the three R’s: reform, the sources of his inspiration. reimbursement and regulations. “All are memphismedicalnews

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Making the Marriage Work

Alignment & Integration Strategies to Strengthen Physician, Hospital Unions

By CINDY SANDERS

… And they all lived happily ever after.

In fairytales, the two protagonists manage to overcome many barriers to ultimately ride off into the sunset … presumably for a lifetime filled with sunshine and roses. In the real world, we only have to look to divorce statistics to know that ‘wedded bliss’ frequently dissolves into angry recriminations, mistrust and broken vows.

As it turns out, marriage makes for an interesting analogy to the wave of physicians, practices and hospitals rushing to the altar under the new world order of healthcare reform. Thanks to economic strain, the market has seen quite a few shotgun weddings lately. In other cases, such as some ACO affiliate agreements, the parties have opted to cohabitate rather than legally wed. And in some instances, the belief is that the union completes and complements each party to the ultimate benefit of both.

No matter how the parties entered the relationship, once the honeymoon phase wears off, both are left to figure out how to navigate this new partnership and work as a team. Of course if that was easy, there wouldn’t be such a high divorce rate. You only have to look back to the rash of mergers and buyouts in the ‘90s to know that many of these marriages between practices and hospitals don’t end harmoniously.

So what can you do to beat the odds?

Medical News had the opportunity to chat with Ken Hertz, FACMPE, principal with MGMA Health Care Consulting Group, about the keys to creating a lasting union. Hertz, who has nearly 40 years of management experience, has held leadership positions with primary care and multispecialty care orgaKen Hertz nizations, as well as large integrated systems. He works with practices and hospitals on strategic planning, integration, operational improvements, compensation, conflict resolution and governance issues.

Marry in Haste, Repent at Leisure

In the current transformational landscape, Hertz has seen a lot of hasty mergers and alignment contracts executed without taking the time for proper due diligence … the ‘chicken little’ syndrome. “I tell people I’m not necessarily sure the sky is falling or that the world is ending. What we’re dealing with is this funny word called ‘change,’ and some of us can barely say it without stroking out,” he noted.

Hertz was quick to add that change is scary, but that’s all the more reason to take time to prepare properly on the front end to ensure each partner stays commitmemphismedicalnews

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ted when the relationship hits an inevitable rough patch down the road. He noted the rush to ‘do something’ happens on both sides with physicians worried about the changing regulatory and reimbursement landscape and hospitals snapping up practices before a competitor has the opportunity to grab them.

It’s probably wise to note, however, that few couples married at a Las Vegas drive-thru chapel at 3 a.m. make it to

their golden anniversary celebration. Instead, many of them wake up the next day with the question of ‘Now what?’ hanging heavily in the air.

Premarital Counseling

“It’s like the Yogi Berra line, ‘If you don’t know where you’re going, there’s a good chance you won’t get there,’” Hertz said. “When we work with physician practices and they say, ‘We need to get aligned

with the hospital or need to merge with another practice,’ the first thing we ask is why?”

It’s important, he said, to really explore what each partner hopes to accomplish through the alignment or merger.

How does each of you define success?

Once the ‘why’ has been sufficiently vetted, the attention shifts to the ‘who.’

Hertz said it is essential to honestly evalu(CONTINUED ON PAGE 15)

DIVING CATCHES CAN LEAD TO SHOULDER PAIN Text by David G. Brown, M.D. With the return of football season, we look forward to the cooler weather of autumn and watching our favorite teams chase down a championship. No matter which team you support, football always seems to provide us with fun and entertainment. Unfortunately, football season also brings many unwanted injuries.

Intense shoulder pain can be the consequence of a diving catch or an aggressive football tackle. Oftentimes, you hear about a player “dislocating” his shoulder or “separating” his shoulder following one of these plays.

Contrary to popular belief, these terms do not mean the same thing. They are different and distinct injuries.

When a player “dislocates” his shoulder, the head of the humerus (upper arm bone) comes out of its normal socket in the shoulder. It is exceedingly painful and often requires a trained medical professional to put the shoulder back in place. The shoulder has an extremely wide range of motion which increases the likelihood of dislocation. In fact, the shoulder is the most commonly dislocated joint in the body. Depending on how the shoulder is injured, the shoulder can be dislocated in many different directions. Yet over 90% of the time, the head of the humerus moves forward out of the socket causing an anterior dislocation.

Initial treatment consists of promptly putting the shoulder back in place since the blood supply to the shoulder and arm may be compromised. Once stabilized, treatment for the shoulder ranges from conservative measures to operative treatment. Conservative measures consist of an arm sling, physical therapy, and activity modification. Surgery is not always needed for an uncomplicated, first-time shoulder dislocation.

However when surgery is necessary, it typically involves arthroscopic repair of the torn and stretched soft tissues of the shoulder joint.

On the other hand, when a player “separates” his shoulder, the junction of the collar bone and shoulder blade is disrupted. Contrary to a dislocation, the ball

23 Aug– 08 Nov

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and socket of the shoulder joint remain in place. The disruption or separation of the collar bone and shoulder blade typically causes pain at the front part of the shoulder. It usually occurs after a direct fall onto the shoulder and does not need to be put back in place on the field or in the emergency room.

The injury can range from a mild sprain to severely torn ligaments (soft tissue). Usually, a shoulder separation can be treated non-operatively with an arm sling and proper physical therapy. However, when the injury is severe and multiple ligaments are torn, a surgical reconstruction is required.

If you have concerns about a shoulder injury, I would recommend that you be seen and evaluated by a fellowship-trained sports medicine orthopaedic surgeon with extensive experience in treating shoulder problems.

At OrthoMemphis, your treatment program will be tailored to your individual needs. One particular service we offer during football season is our Friday Night Football Clinic for non-emergent injuries occurring during the games.

Clinic hours are from 9:00–11:00 pm on Friday nights from August 23rd-November 8th.

The athlete will be evaluated by a fellowship-trained orthopaedic sports medicine specialist.

To discover more on shoulder injuries or our Friday Night Football David G. Brown M.D. Clinic, please visit Fellowship Trained www.orthomemphis.com.

Orthopaedic Surgeon

901.259.1600 www.orthomemphis.com

6286 BRIARCREST AVE. P / 901.261.STAT (7828) Memphis, TN 38120ORTHOMEMPHIS.COM MEMPHIS, TN 38120

A division of MSK Group, P.C

AUGUST 2013

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Acadia Positions Delta as Med-Psych Facility, continued from page 1 codes making up their market area of just over 100,000 people and is not planning to expand to tertiary level services in the near term.

“In the Memphis area, we are trying to meet the needs of this local area, building relationships with those hospitals and the physicians who serve them. Regulation and competition are overriding factors, but we don’t see ourselves as competitors as much as we see ourselves in a position to complement others,” he said.

Patterson does differentiate one area in which Delta will compete unilaterally: quality.

“Our size is such that the physical setting provides ease of access, ease of use, and our staff is magnanimous in their empathy toward the patients they serve,” he said.

“We are proud of the quality of service we provide and feel that is a distinguishing factor.”

The fact that Delta Medical Center is telling the competitive environment it is neutral does not mean it is without an ambitious agenda. Its focus is on physician recruitment, technology and facility enhancement. A surgical suite renovation has been completed, and an expansion of the emergency department is planned as well as a remodeling of the behavioral health facilities. Technology will be upgraded for imaging, surgery and other areas.

As for the recruitment Joy Bowenof physicians, Vice President Delta is looking for both primary care and Cash Management surgical specialties. Patterson said theySales have Tennessee Bank a fine medical staff, butFirst in this day and age, it

is “too few in number.” Delta has employed to rejoin a company I had a great history in “Now all that has changed, as we have rerecruiters to bring physicians in from outworking with, and I had confidence in their sources we can employ to meet needs and side areas, and it is reaching out to the entire leadership and support,” he said. reach out to the medical community first, Memphis medical community to see who What is his message to Memphis? “Prethen the lay community next to say we are might want a presence on their campus. vious Delta ownership and management the new and improved version of Delta.”

Few staff changes have been made, and were constrained financially and were not those have been at the senior level. Middle often able to meet existing needs,” he said. management and hospital associates have been unscathed. Besides Patterson coming in as the new chief executive officer, the forcontinued from page 6 mer chief financial officer retired and was re• Jackson, Tennessee, November 16, at How Can You Help? placed with Joy Fergie, previously employed Pringles Park

by Community Health Systems. John Ray Camp Acheaway is a week-long sumDONATE joined Delta as chief operating officer remer camp near Nashville for children ages Your contribution goes to support cutcently, coming full circle from a wholesale seven to 15 with juvenile arthritis. Activities ting edge research and scientifically proven pharmaceutical distributorship career and help campers build confidence, make lifeprograms designed to help people with arother positions at hospitals across the countime memories and develop lasting friendthritis. All money raised by the West Tentry, including a time as chief executive ofships. This year seven campers from the nessee Arthritis Foundation is distributed in ficer of Methodist North years ago.

West Tennessee region were able to attend. three ways: Patterson hails from Memphis. His faCitywide – there are “Programs for Bet• 77 percent goes to local and national ther and brother were surgeons in the Memter Living” at various locations in the greater programs and research phis area. His previous Memphis medical Memphis area that offer aquatics, Tai Chi • 12 percent goes to fundraising and center experience was on Baptist Memoand other exercise programs that are benefievents rial Health Care’s administrative team in cial to those suffering from arthritis.

• 11 percent goes to administration the early 1980s. He came to Acadia as a Donations can be mailed to: group CEO for the Mid-South market, and VOLUNTEER Arthritis Foundation of West a couple of months ago it was determined You can also help by serving on event Tennessee; 5352 Estate Office Dr. No. 1; he would take the helm of the day-to-day committees, sharing your professional skills Memphis, Tennessee 38119 operations of Delta. He had prior experieither as an “e-advocate” online or on the ence with Psychiatric Solutions, a precurlocal Leadership Council.

PARTICIPATE sor to Acadia, working in Meridian, Miss., For more information, call the local ofIn Memphis, there are several fundrunning a similar facility there. His history fice at 901-685-9060. raising events in which you can participate. in hospital administration goes back more LaterCyrus this Purnell year, there are two Jingle than 20 Gustafson years for a total of about Angela Chris 30 Webbyears Grant Boucek If you know of a non-profit or charitable organization worthy of being spotlighted Bell RunsVice scheduled: President Vice President President Vice President inVice healthcare.

Cash Management Relationship Manager Corporate in Memphis on the Mend, contact Pamela Family Office Service December • Memphis/Collierville, 14, Retirement “This was a unique opportunity for me Sales Manager First Tennessee Bank at the Carriage Planning Harris at pharris@medicalnewsinc.com.

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Healthcare Delivery Institute

Tennessee, Mississippi graduates of HORNE’s charter ATP class better prepared for post-reform era

By LYNNE JETER

Just before Thomas Prewitt, MD, relocated to the University of Mississippi Medical Center (UMMC) as associate professor of surgery and director of health policy, a breast surgical oncologist, an educator, and a health policy advisor to the vice chancellor, he detoured to Salt Lake City, Utah, to complete Intermountain Healthcare (IHC)’s Institute for Health Care Research and Advanced Training Program (ATP), the international standard bearer for healthcare delivery improvement training programs.

“I was so very inspired by my time spent in that program, and I wanted to do that sort of work,” said Prewitt, who

True North

still practicing medicine,” explained Prewitt, “but more from a macro than micro level. It’s very rewarding.”

For the ATP, participants meet twoand-a-half-days a month for four months to complete the training program, of which a total of 80 CME hours are available.

“This is for people who are going to be true leaders in healthcare, and that was certainly the case for the people I trained with at Intermountain,” said Prewitt,

noting that all learning takes place in a classroom, not online. “Face-to-face relationship building of participants is very important. So much of learning occurs at the participant level, with the cross-talk about experiences taking up a large part of training.” Cost of the ATP is $5,000, with incremental discounts for multiple participants from the same institution. It’s a bargain compared to $10,500 for a 20(CONTINUED ON PAGE 14)

Football & Soccer Score Highest in ACL Injuries

By DAVID DENEKA, M.D.

When Healthcare Delivery Institute (HDI) instructor Larry Grandia served as Intermountain Healthcare’s director of information systems, he was intimately involved in ways to increase quality and reduce cost by collecting and analyzing operational data in search of ways to eliminate unnecessary or inefficient processes.

“The results were consistently astonishing,” he said. “Higher quality, lower cost, and more consistent and predictable care were always the outcome. It’s hard work, but with the right data, right tools and right people involved, improvement is assured.”

The good news: operational data in healthcare is abundant.

The bad news: typically data are isolated within discrete, operational systems.

“Extracting and linking these data to each other in a nimble enterprise data warehouse exposes the collective data to analytic tools like Key Performance Analysis, resulting in real insight into performance improvement opportunities,” he said.

The only question about inevitable industry change involves how much will come from externally-imposed change, compared to internally-driven performance improvement through systematic elimination of waste, Grandia said.

“Interestingly, the more internally-driven change that occurs, the less externally-driven change is required,” he said. “Further, whichever healthcare provider seriously initiates the data-driven improvement journey, the better that organization will be prepared for future success, regardless of the transformation approach ultimately selected. The ATP approach will never lose its value with the passage of time. Data-driven continuous process improvement will be a – if not the – sustainable winning strategy for all future healthcare organizations.”

memphismedicalnews

joined HORNE on Jan. 2, 2012, to launch the Healthcare Delivery Institute (HDI).

HORNE is among the nation’s top 100 accounting and business advisory firms, and represents one of the southeast region’s top 10.

Patterned after IHC, the HDI has two components: the ATP focusing on healthcare delivery improvement training, and clinical improvement services with HORNE partner, Health Catalyst. “I’m

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Football season and fall soccer season have just begun.

Given the amount of cutting, twisting and pivoting in these sports, we are seeing a higher incidence of knee injuries among participants. Of all major injuries to the knee, anterior cruciate ligament (ACL) tears are the most common. These knee injuries can adversely affect a player’s long term involvement in the sport and lead to long term knee issues.

The incidence of ACL tears is 2-8 times higher in female athletes compared to male athletes participating in the same sport. There are many theories trying to explain this ranging from hormonal differences to anatomic risk factors such as a narrower opening for the ACL, differences in the shape and slope of the bones, differences in knee laxity, and neuromuscular differences. The highest incidence comes in women’s team sports such as soccer and basketball.

Obviously, preventing an ACL tear is ideal. There are some ACL Prevention rehab protocols that strive to improve neuromuscular control, coordination, and core stability to try to prevent the injury from occurring. bone (tibia) to the thigh bone (femur). The function of the ACL is to help stabilize the knee by resisting translational and rotational forces acting on the knee. If you are performing straight ahead activities like running, the ACL plays a minor role. However, with cutting, twisting, and pivoting activities, the ACL plays a major role. The ACL is the primary restraint to resist forward (anteriorly) directed forces of the shin bone (tibia) on the thigh bone (femur). It is also the primary restraint resisting rotational forces about the knee. Your knee also has secondary restraints which include the meniscal cartilages, the shape and contour of the bones, and the collateral ligaments.

When the forces applied to the knee are greater than the forces that the ligament can handle, the ligament tears. This can be seen not only in contact injuries, but also increasingly in non-contact injuries where approximately 70% of ACL tears occur. When the ligament tears, the patient will typically feel a giving way, shifting, or buckling type of sensation. This shifting sensation is not only felt, but many times is also heard as a loud pop. Other symptoms include pain with standing or walking, swelling, decreased range of motion, and a feeling of looseness about the knee.

Every time that the knee gives way, there is a 70% chance that some other structure in the knee will also be

23 Aug– 08 Nov

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injured. The other structures include the ends of the bone and soft tissues such as the meniscal cartilages, the joint surface, and other ligaments. These injuries can be evaluated with a thorough history, physical exam, and imaging studies such as an MRI. Repeated episodes of instability can lead to devastating consequences over time including osteoarthritis for young people. Therefore, if your goal is to return to cutting, twisting and pivoting type activities, stabilizing the knee is crucial.

There are various methods of treatment to stabilize the knee ranging from conservative, nonoperative measures to operative treatment. Conservative treatment includes type activities. Braces tend to work well with lower level activities; however, you can still have giving way episodes with higher level activities. Bracing also does not address related injuries such as meniscal tears or joint surface injuries. Operative treatment involves anatomic reconstruction of the ACL. Surgery is followed by an extensive rehab program. Typical time to return to play is six to nine months. Reconstruction does not guarantee returning to sport at the same level, but in general gives you your best chance to return to your sport.

If you have concerns that you may have injured your knee, I would recommend that you be seen and evaluated by a fellowship trained Sports Medicine Orthopaedic Surgeon with extensive experience treating knee injuries.

At OrthoMemphis, your treatment program will be tailored to your individual needs. One particular service we offer during football season is our Friday Night Football Clinic for non emergent injuries occurring during the games. Clinic hours are from 9:00-11:00PM on Friday nights August 23 – November 8. You or your child will be evaluated by a fellowship trained Orthopaedic Sports Medicine Specialist.

Discover more on knee injuries or our Friday Night Football Clinic, visit www.orthomemphis.com

6286 BRIARCREST AVE. MEMPHIS, TN 38120

David Deneka M.D. Fellowship Trained Orthopaedic Surgeon

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Healthcare Delivery, continued from page 13

Evidence Based Rehabilitation Emphasis of manual therapy focusing on underlying mechanical issues, and customized plans of care for every patient.

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Presenter Thomas D. Burton, senior vice president and co-founder of Health Catalyst. Well known as a clinical quality improvement guru, he was a member of the team that led Intermountain Healthcare Institute’s nationally recognized improvements in quality of care delivery and reductions in cost.

day executive session at IHC, and a similar program at the Institute for Healthcare Improvement in Cambridge, Mass.

Graduates of the inaugural ATP include healthcare leaders and physicians from Mississippi and Tennessee.

“It’s encouraging to meet a group of medical leaders who see the innovation challenge as an opportunity rather than an unwanted burden,” said HDI instructor Andre Delbecq, DBA, the J. Thomas and Kathleen A. McCarthy University Professor at Santa Clara University.

HDI instructor Niall Brennan, director of the Office of Information Products and Data Analytics, Office of Enterprise Management for the Centers for Medicare and Medicaid Services (CMS), was inspired “seeing the energy in the room of frontline care providers as they realized the potential of data to improve care.”

HDI instructor Larry Grandia, a Health Catalyst board member, said techniques taught in the ATP have eliminated “spotty” results of applying classic performance improvement techniques to clini-

cal care processes by offering a solution to data access and also focusing on quality.

“Clinicians welcome performance improvement when high quality is the desired outcome,” he said. “Experience … has proven that consistent higher quality actually reduces cost, not the reverse.”

(See page 13 sidebar for detail.)

HDI is gearing up for the fall and winter sessions, which can accommodate up to 30 participants per term. The geographic reach for the next classes will include Medical News’ 14 markets.

“No pre-requisites needed,” explained Prewitt. “Participants are those likely to be leading improvement teams while also reducing costs. They’re two sides of the same coin; it reduces variation at the level of the clinical enterprise. I just returned from a health data conference, and it’s amazing how some major players still don’t understand some of that messaging. It’s the overarching goal we’re striving to communicate.”

For more information, visit www. horne-llp.com.

The 4-1-1 on the HORNE Healthcare Delivery Institute ATP The Advanced Training Program (ATP) provides healthcare providers, administrators and executives the essential tools needed to prepare for posthealth reform change.

Ideal participants include clinicians in physician practices, hospitals and health systems; C-suite administrators; elected officials responsible for health policy; government healthcare policymakers; healthcare attorneys, consultants and educators; health system data professionals; improvement team leaders; midlevel administrative managers; nursing home managers; and risk management professionals.

Under the tutelage of HDI staff, each participant conducts an improvement project at their home institution over the duration of the course.

The curriculum overview includes: • Managing Clinical Processes: An Introduction to Clinical Quality Improvement • Features of Effective Teams • Quality Controls Cost • Understanding Variation • Data Types: Which Statistical Process Control Chart Should I Use? • Deployment: Clinical Integration • Tracking Healthcare Costs • Understanding New Delivery Models: ACO, Bundles, Capitation • Data Driven Improvement with Key Process Analysis • Leadership and Diffusion of Change “The curriculum provides the participant a knowledge base and skill set to take a leadership role in quality and policy in virtually any healthcare environment with a focus on improvement theory, data and measurement, delivery model change, and leadership skills,” said Thomas Prewitt, MD, director of the HORNE Healthcare Delivery Institute. memphismedicalnews

.com

Making the Marriage Work, continued from page 11 ate your core values and deal-breakers and then see how those align with your potential partner.

“The key to any relationship is you’ve got to understand what makes you tick and what’s important to you … and … you’ve got to understand what makes your partner tick and what’s important to them,” Hertz said.

Ultimately, Hertz noted, each party is aligning themselves to a vision. “It’s really critical, I think, that there be a shared vision … and the shared vision can’t be just about money.”

Prenup

Chances are not everyone is going to get everything they want in any relationship, but both parties should address the ‘must haves’ and ‘won’t dos’ and write those into the contract. The reimbursement plan, governance structure, conflict resolution protocol, and practice pattern expectations should all be thoroughly discussed on the front end and clearly outlined in the final agreement. Equally, the repercussions for both parties of not living up to the agreement should be spelled out.

Making the Marriage Last

Although it might seem like the heavy lifting happens in the planning stage, anyone who has been married long knows that once the honeymoon is over, the real work begins. “Each party has to put in a hundred percent. It is the only way this works,” Hertz said.

For physicians used to making snap decisions and having their orders carried out, following the maze of corporate protocols that are inherent in most health systems and large practices can be frustrating.

For hospitals shifting from a volume-based to an outcomes-based reimbursement model, it can be equally difficult to understand how less truly can mean more.

The best antidote for frustrations that build up and fester over time is open communication. Hertz pointed out, “Communication is broadcasting, but it’s also receiving. The notion of two-way communication is critical.”

Not only does there have to be communication, but it must also be meaningful. “Most of the physicians I know were absent the day they taught mind-reading in their training programs,” he said. It does no one any good to have an administrator walk into a physician’s office at the end of the month, tersely tell the doctor the numbers aren’t where they ought to be, and walk out … which Hertz has witnessed. Instead, he said, the two need

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to work together to figure out where the problem lies and what steps could be taken to fix it.

Being open to different viewpoints allows both physicians and administrators to see care delivery issues in a new light.

It’s one reason why physician governance is critical to the health of the overall organization. Having physicians involved in planning for the future keeps them engaged in the mission and shared vision.

Having a voice, however, doesn’t always mean one party gets their way.

Hertz noted, it’s better to hear an honest ‘no’ than a sugar-coated answer that

is meaningless. Trust and transparency, he said, are the cornerstones of any good relationship.

“Do what you say you’re going to do when you say you are going to do it,” he stated, noting the axiom is equally true for physicians as it is for administrators.

Hertz continued, “If I’m a system, and I’m going to pay you based on work RVUs or based on charges or visits or collections or whatever, I need to make sure I can do a really good job of collecting that information; that it is accurate; that it’s timely; and that you trust it. If we don’t trust each other, it doesn’t work so well.”

FAST PROCEDURE TREATS TENNIS ELBOW ™

Chronic elbow pain for tennis players, golfers, and fly fishing enthusiasts can usually be resolved with rest, physical therapy, bracing, injections, and/or medication in about 90% of patients. But in 10% of patients, this elbow pain is progressive and doesn’t resolve with conservative measures.

In the past, this group of patients had to make a choice whether to undergo a big surgery or forgo their favorite activities.

Now, these patients have a minimally invasive surgical option called the FAST (Focused Aspiration of Scar Tissue) procedure.

OrthoMemphis’ fellowship trained upper extremity surgeons, Drs. Jeffrey Cole & Daniel Fletcher, are the only surgeons in the MidSouth performing this minimally invasive surgical procedure for patients with chronic elbow pain or tennis elbow. For those patients who have failed conservative measures, the FAST procedure was developed to speed up recovery time.

The FAST procedure uses conventional ultrasound to visualize the location of the diseased tissue. Then a toothpick sized instrument is inserted into the diseased tissue and delivers precise ultrasonic energy to break up and remove the diseased tissue. Since the average time for the procedure is 20 minutes with a topical anesthetic, the FAST procedure is done in a surgery center as an outpatient procedure.

“The older procedure used to require us to disturb the healthy tendon just to get to the unhealthy

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Ultimately, those who have realistic expectations and are willing to put in the work to achieve the shared vision enjoy the strongest partnerships. “You’ve got to know what is going on in the world around you … so you’ve got to be informed. You must do your due diligence.

You must know yourself, and you’ve got to do this with your eyes open — wide open — and never assume. Those are the top five things,” Hertz said.

“The bottom line is none of this is brain surgery, but there is no silver bullet, no magical answer. It’s darn hard work,” he concluded.

portion of tendon. This required much more tissue dissection, the patient being put to sleep, and the recovery was slow and far more painful. Our early results of the FAST procedure are very promising.

So far, our patients have been able to recover much quicker than those who have undergone the traditional open procedure.

The FAST procedure has the potential to reduce the recovery time dramatically” said Dr. Cole.

Dr. Fletcher comments, “Since this technology was used in cataract surgery for years, we know that it works well. It is just a smarter way to perform the definitive treatment for patients with chronic tennis elbow. This technique is really the future of tendon repair in other areas of the body as well.”

For more information on the FAST procedure, check out Dr. Cole’s video at: www.facebook.com/OrthoMemphis Discover more about our team and how we can get you back to an active lifestyle by visiting us at www.orthomemphis.com or call for an appointment at 901-259-1600.

Memphis, TN 38120

Jeffrey Cole, M.D.

Daniel Fletcher, M.D.

901.259.1600 www.orthomemphis.com A division of MSK Group, P.C

AUGUST 2013

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Get Back to

your family .

You’ve Got (Secure) Mail, continued from page 8 electronically can reduce clerical errors and provide a full picture of a patient’s status for all involved in the continuum of care,” said FitzGerald. She added the ease of sharing information could also eliminate duplicate testing and procedures to reduce overall costs. Other benefits of Direct include the ability to quickly and reliably send orders to labs and receive results, streamline office workflow and simplify reporting to payers.

During the pilot program, Qsource worked with a couple of leading technology companies and helped individual providers register, authenticate and verify their Direct address. However, FitzGerald said more certified vendors are being added to the website and noted Qsource is ‘vendor agnostic.’

Although there is no charge for the support services provided by Qsource, the Direct license typically costs between $10-$15 a month. However, Beckett said

the program is offering a one-time incentive per participant per account for those signing up and demonstrating use of their Direct address. “Providers will actually get a check for $500, which will pay for two to three years of their Direct license,” Beckett noted.

In order to tap into the maximum efficiency of interoperability and secure messaging, both Beckett and FitzGerald stressed the need for broad adoption across the continuum of care. The program, therefore, is open to a range of individuals and facilities delivering healthcare including mid-level providers, long term care facilities, hospice providers, rehabilitation facilities, eye doctors and dentists. “We are looking for about 4,000 providers to come forward between now and next January,” said Beckett. Added FitzGerald, “Our goal is by September of this year that everyone will have heard of Direct.”

Interested in Direct?

Go online to www.HealtheShareTN.com.

Now with five convenient locations, we're 10 minutes from wherever you are.

In addition to the online information, there are a number of upcoming educational conferences across the state for those who want to learn more about the technology. The Health eShare Direct Project will also have a presence at several association meetings including the TMGMA Legislative/Payer Conference in Memphis in late August, the TN HIMSS Summit of the Southeast in Nashville in September, and the THA meeting in Nashville in late October. For a full list of conferences and dates click on the “Events” tab of the website.

Cancer Wars, continued from page 7

Whether it’s during the day or after hours, our board certified physicians are on hand for life’s unexpected moments.

other treatments described here), outcomes data is not yet available. “The IRE has been out for three or four years, but it takes a long time for some really good, valid clinical studies to come out,” he said. “But the initial studies are very exciting.”

Chemotherapy still has an essential role in cancer treatment; systemic cancers such as lymphoma and leukemia require systemic chemotherapy, since there is no local tumor to ablate. In cases where ablation is the primary therapy, chemotherapy is also often used as an adjunctive therapy, used in a follow-up program to eliminate remaining cancer cells or to treat metastatic disease after ablation of the primary

tumor.

In such combined approaches, the chemotherapeutic dose – and its damaging side effects on a patient – can be significantly reduced.

In the future, Zeni said, thermal energy therapies will give way to biological mechanisms for killing the tumor – inserting a probe that delivers DNA fragments that incorporate themselves into the tumor and stop its growth, for example.

“There’s exciting research in progress on gene therapies that can be inserted and can change the biology of the tumor, and I think that’s going to be the next step,” he said.

Coming Soon!

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edition of Medical News optimized for your tablet or smartphone!

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BlueBin Bound

Hospitals embrace lean supply system as part of ‘continuous improvement’ process

By LYNNE JETER

Expensive technology not needed.

Barcodes are the key. Get rid of the warehouse. And take doctors and nurses out of the inventory control process.

In 2009, Charles Hodge gave that advice on ways to streamline hospital supply inventory, when he served as chief procurement officer and vice president of supply chain management at Seattle Children’s Hospital, a major pediatric referral center in Seattle, Wash.

At the time, Hodge was in the midst of a four-year journey to implement BlueBin, a smarter inventory process involving barcodes, simple bins and basic wire racks at key traffic areas and points of care. He had developed BlueBin after working in the automotive industry for 15 years, and transferring its lean manufacturing processes to the healthcare industry’s supply management realm.

Hodge’s just-in-time inventory system eliminated the hospital’s need for its $5 million, 40,000-square-foot warehouse and millions in inventory. In its first year, the $200,000 system achieved a $2.5 million return, said Hodge.

Particularly because the supply management process was new to the hospital industry, executive sponsorship was critical for BlueBin to succeed, said Hodge.

“There’s no substitute for executives who are firmly committed to continuous process improvements,” he said. “Make sure you secure their strong support and communicate your results early and often to keep the momentum in place.”

Supply Chain Process Redefined

Hodge, the primary architect of BlueBin, may perhaps seem to be an unlikely source of such an innovative, low startup cost supply management system.

His career began in 1993, after earning a business administration degree from California State University. An MBA from the same university in 2001 helped him traverse growing roles of responsibility in capital equipment, electronic chemicals, and automotive manufacturing sectors.

Before joining Seattle Children’s Hospital and Research Institute, he served as regional director in charge of supply chain management operations for Sutter Health’s peninsula coastal region, and a member of the health system’s corporate strategic sourcing group.

“I took the lessons learned from kanban systems and applied them to elements of patient flow and care delivery,” said Hodge. “After I implemented the BlueBin system at Seattle Children’s Hospital, other hospitals started calling me, asking how we did it, and the timing seemed right to start my own consulting firm.”

With the BlueBin system in five hospitals across the nation, from brand new to nearly 160 years old, Hodge said consulting groups are keen to learn more about memphismedicalnews

.com

Charles Hodge from BlueBin touring healthcare/hospital representatives during the GEMBA Walk at Nemours.

the kanban conversion from the automotive to the healthcare industry.

“For example, Joan Wellman & Associates, the consulting firm for Nemours Children’s Hospital in Orlando, brought us together,” he said. “When hospital leaders start to think about hospitals more like a manufacturing environment, the supply chain bubbles up as a problem because traditional management systems (like the par cart and automation methods) haven’t been changed in decades, and they just don’t work very well. They only work because clinicians and technicians are heavily involved in managing their own supply chains.

“Our program says no to that. Get those folks back to the patients, the bedsides, and the families. Let the supply chain do it all, and more efficiently. No inventory. No stat calls. No urgencies.

No ‘hey, where is this?’ No off-contract purchases. It saves a lot of money, space and time, and gives that time back to the patient.”

One Hospital’s Lean Journey

When Nemours began its lean healthcare cultural transformation journey in 2008, the executive team huddled to define very specific and focused strategic goals, while also aligning all associates in the organization around those goals.

“We’ve achieved great results but still had variation in those results, and we wanted to find something that would really help us catapult our work in a constant quest for perfection in everything we do – the highest quality, no safety errors, a 100 percent engaged workforce. Clearly, we’re focused around quality and patient care and safety, engaged people, and stewardship,” said Mariane Stefano, vice president of service and operational excellence for Nemours, whose healthcare career began “as a nurse, rummaging through supply closets.”

As part of this quest, hospital leaders began seeking a more efficient and effec-

tive management system for medical supplies, the second largest expense for most health systems, accounting for up to 20 percent of hospital costs. They were encouraged to learn about Seattle Children’s Hospital recapturing an estimated 48,000 hours for patient care instead of scavenger hunts for needed supplies. The executive team embarked on a study trip to Auto-

liv, a manufacturer of air bags and other components for the automotive industry, followed by a “totally fascinating” tour of the Toyota plant in Kentucky to see how lean tools and principles impacted the end product, said Stefano.

The team’s next stop: Seattle Children’s Hospital, now a 400-bed pediat(CONTINUED ON PAGE 20)

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AAOS Updates Clinical Practice Guidelines for Osteoarthritis of the Knee

By CINDY SANDERS

The American Academy of Orthopaedic Surgeons (AAOS) recently released a revised clinical practice guideline for treatment of osteoarthritis of the knee with key changes to recommendations regarding the dosage of acetaminophen and use of intra-articular hyaluronic acid (HA).

David S. Jevsevar, MD, MBA, chair of the AAOS Evidence Based Quality & Value Committee and chair of the workgroup for OA of the knee, said the 2013 edition of the clinical practice guideline (CPG) contains 15 recommendations and replaces the first edition of the CPG, which had elicited some concern over the methodology employed in garnering some of the evidence … specifically that attached to the use of HA. Jevsevar, a boardcertified orthopedic sur- Dr. David S. Jevsevar geon at Intermountain

Zion Orthopedics & Sports Medicine in St. George, Utah, said it is the policy of the AAOS to do all CPG data analysis in-house. However, the earlier guideline utilized synthesized data from three outside sources — the Agency for Healthcare Research and Quality, Osteoarthritis Research Society, and Cochrane Database of Systematic Reviews.

Both those who sell and manufacture HA, as well as a number of AAOS members, were specifically concerned about the issue of viscosupplementation, which

garnered an ‘inconclusive’ recommendation in the first issue.

Jevsevar said the committee was clear that a more vigorous internal review of the use of intraarticular hyaluronic acid could result in the same outcome, a stronger recommendation backing the use of HA … or a reversal recommending physicians not use the treatment option. “When we actually did the analysis, that’s what happened,” he said of the reversal, which resulted in a ‘cannot recommend’ designation for the use of HA for patients with symptomatic OA of the knee.

“When you use clinical significance as your bar for recommendation — and we took the 14 best studies out there — it really doesn’t support the use of viscosupplementation, or HA,” he said. “Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis, the evidence did not meet the minimum clinically important improvement thresholds.”

Jevsevar went on to explain there is a difference in statistical significance and clinical significance. He noted that on the

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clinical pain analysis where 0 is no pain and 10 is the worst pain, having patients move from a 9 to an 8.8 after treatment could be considered statistically significant but wouldn’t feel much different to the person with OA. “We use the higher bar of clinical significance,” he continued. ”We feel that’s the one most important to patients.”

Perhaps not surprisingly, the strong recommendation against the use of HA has created some pushback from physicians. “They feel like we have very few treatments for osteoarthritis that work so they are always concerned when we take one away,” he said. However, Jevsevar continued, “Doing something that is expensive and hasn’t been proven isn’t the right thing either.”

He said it’s hard to gauge the true effectiveness of various treatments in the clinical setting for a couple of reasons.

“Arthritis research is hard because osteoarthritis patients don’t have the same level of pain everyday,” he explained. “Many of those patients want to do anything but surgery, which is understandable,” Jevsevar continued. “They want the treatment to work, but that creates a placebo effect or bias for whatever is being used.” More research, he added, is certainly needed.

One concern for physicians using HA is that insurance companies will quit reimbursing for the treatment. “We synthesize the evidence, but we don’t make recommendations for insurance,” Jevsevar said. However, he admitted insurance companies could misapply the guidelines for financial purposes. Still, he noted, discontinuing reimbursement for viscosupplementation might not be to a payer’s benefit since it could drive more OA patients to opt for the much more expensive knee implant.

Furthermore, Jevsevar said treatment decisions should replicate the foundation of a three-legged stool — 1) the evidence, 2) physician expertise and experience, and 3) patient preferences and values. “You have to take all three into account when treating a patient. One doesn’t trump the other,” he said.

In addition to the controversial HA ‘no’ recommendation, the work group also reduced the recommended dosage of acetaminophen from 4,000 mg to 3,000 mg a day, which mirrors an overall change made by the Food and Drug Administration for individuals using acetaminophen for any purpose. In patients with symptomatic OA of the knee, Jevsevar said, “Actually, there’s not a lot of evidence to support the use of acetaminophen.”

Other important recommendations that remained the same in the revised guidelines included: • Patients who only display symptoms of OA and no other problems, such as loose bodies or meniscus tears, should not be treated with arthroscopic lavage.

(CONTINUED ON PAGE 24)

memphismedicalnews

.com

Orthopaedic Surgeon Helps Saint Francis Bring MAKOplasty to Memphis

By RON COBB

As an orthopedic surgeon, Apurva R. Dalal, MD, was immediately interested when he heard about MAKOplasty®, a new, robotic-assisted partial knee replacement surgery. He got his first look at it in detail at a meeting of the American Academy of Orthopaedic Surgeons in 2008.

“I was fascinated by this technology,” he said.

Four years later, Saint Francis Hospital approached the doctor with a proposal. Dalal already was an experienced surgeon with ex- Dr. Apurva R. Dalal tensive training in knee and hip replacement surgery.

“They were interested in bringing this robot to our area and were looking for surgeons who would like to be trained in this and were willing to go through rigorous training. I jumped at the first opportunity and couldn’t wait.”

Now St. Francis is the only hospital in Memphis that offers MAKOplasty, and Dalal, the CEO of Tri-State Orthopaedics, is the only surgeon in the city with significant experience in performing it. A second surgeon, Peter B. Lindy, MD, of East Memphis Orthopedic Group, was certified as of July to begin doing MAKOplasty at Saint Francis.

MAKOplasty is a product of MAKO Surgical Corp., which was founded in 2004 and is based in Fort Lauderdale, Fla. The first MAKOplasty uni-compartmental knee procedure was done in 2006. As of last December, according to the company, about 23,000 MAKOplasty procedures had been performed, with the vast majority of them in the U.S. but also some in Turkey, Thailand and Italy. The company lists MAKOplasty surgeons in all but about a dozen U.S. states.

MAKOplasty is a minimally invasive surgery designed for patients who do not have severe arthritis all over the knee.

Most patients are bone on bone, but only in one or two compartments of the knee, not all three. With the RIO® (Robotic Arm Interactive Orthopedic System), accuracy and precision are two of MAKOplasty’s top selling points.

While robotic technology is not new to medicine in general, Dalal points out, it is new to orthopedics. He lists the benefits of MAKOplasty as, • smaller incision; • precise surgery with accurate placement of implants; • real-time alteration if needed during surgery on gap balancing; memphismedicalnews

.com

• early recovery – one of his patients went back to work just three days after discharge; • minimal bleeding, which minimizes need for blood transfusion; • implants and surgery are planned before making an incision; • minimal bone loss compared to total knee replacement.

If a patient is found to be a candidate for MAKOplasty rather than total knee replacement, the doctor orders a CT scan, and that information is fed into a computer.

“This helps us in surgical planning,” Dalal said. “We can determine the size and slope of implants and other parameters to match patient anatomy most accurately. During surgery I confirm all pre-operative planning and accurately place the implants with the help of the robot.

“This is an amazing surgery for the right candidate. Robots can see all around the knee when our eyes cannot. It makes me a better surgeon. It also is 100 percent reproducible so we can keep on giving the best results for our patients.”

Saving bone, Dalal added, is very important.

“In any knee replacement surgery, we want to preserve as much bone as we can.

If we have to go back and do a revision surgery 15 or 20 years later, we don’t want to have sacrificed a lot of bone before.”

During the surgery, data is constantly fed to the computer, Dalal said, “about the knee position and the gaps in the knee and the tension in the ligament. You can look at it during the surgery and see it accurately if your gap is increasing or decreasing or the knee is feeling tighter or looser, or we should change the slope of the implants.

“All of that is done during the surgery. I can change anything depending on the patient’s anatomy. What happens is, I have to put some markers in the femur and the tibia; those markers are connected by an infrared camera to the computer, and that is the way the computer constantly analyzes how the knee is going. It’s almost like a satellite picture.”

The training that Dalal went through initially was difficult, he said, because the procedure is more complicated than traditional surgery. He took a course in Dallas, then visited a surgeon in Fort Lauderdale to observe live surgery. He performed his first MAKOplasty last November.

“It’s like learning to eat food with your left hand for a right-handed person,” he said.

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BlueBin Bound, continued from page 17 ric hospital that’s been on a lean journey since the late 1990s.

“We saw firsthand how these tools that were being used in the automotive manufacturing industry could easily be applied to a healthcare environment,” said Stefano. “We knew the tools and principals of a lean environment could really help in terms of problem solving, removing waste and inefficiencies from our system, and making sure that everything stays focused on the customer.”

When the team returned to the east coast and gathered around the Nemours table, “we knew this is exactly what we needed as part of our organizational transformation journey. We were sold on it once we saw how it worked.”

Nemours implemented BlueBin three months before the children’s hospital opened last October, a timeline that

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proved challenging and in hindsight was “way too fast,” said Stefano, primarily because of changes in the vendor and supplier distribution flow.

“It was a very fast process and we had bumps in the road,” she explained. “We had to change our main supplier to make sure we had suppliers that would work in this type of Demand Flow system and would be willing to deliver supplies daily rather than weekly, and in the quantity we needed instead of bulk. If we need 10 Band-Aids for a supply unit, that’s now what we get.”

The investment of upfront manpower implementing the system “will be recouped 10 times over,” said Stefano.

“One, you’re no longer holding inventory so that cost decreases; two, the most powerful point of the BlueBin system is that it takes the clinical staff totally out of the

supply management work.

Demand-Flow Supply Replenishment Model

In early June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health – converged at Nemours in Orlando to see BlueBin in action.

• A dedicated supply technician uses barcode scanning to initiate the automated supply management process.

• Supply areas are stocked with two bins for a particular supply.

• The front bin holds a specified level of supplies.

• When the last item of the front bin is used, nurses place it in a designated hold-

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ing area, triggering a replenishment order.

• Then, nurses pull the second bin to the front.

• Before the second bin is emptied, the first bin’s supplies will have already been reordered, restocked and replaced in the supply area.

BlueBin has also been implemented at Mercy Hospital and Medical Center, Chicago’s first hospital, and Presbyterian Hospital in Albuquerque, NM. “Before we implemented BlueBin, our store rooms were being overused and we weren’t centralizing the purchase of supplies,” said Rick Cerceo, executive vice president and COO of Mercy, a 410bed acute care facility – Chicago’s first hospital – that transitioned to BlueBin in mid-2011. “Our staff was running out of supplies, which delayed procedures and patient care. This forced nurses to start ordering their own supplies and supply rooms began bulging at the seams because they were so afraid of running out. Now I can say these problems are completely gone; the process has been amazing.”

When Martin Health South implemented BlueBin, the rollout schedule began last summer in various ICU areas and concluded in February.

“Before, things were just wherever there was a spot for it,” said Linda Landers, a patient care technician in the surgical intensive care unit (SICU) at Martin Health South in Stuart. “Now there’s a flow to it.”

Nemours’ Alfred I. duPont Hospital for Children in Wilmington, Del., is the sixth location deploying BlueBin technology.

Orthopaedic Surgeon Helps Saint Francis, continued from page 19 As of mid-July, Dalal had done 33 of the procedures. He said it takes about the same amount of time as traditional knee replacement surgery and costs about the same for the patient.

Memphis, Lebanon and Knoxville are the only cities in Tennessee doing MAKOplasty, and in each of those cities only one hospital offers it.

“The MAKO company, once a robot is sold in a certain area, would not sell another robot to the same area within a 15mile radius for four to five years,” Dalal said. “I think the company wants the buyer to be successful. If too many people have the same technology, it would be difficult for each company to be that successful and get their investment back.

“So in Memphis this is a start, and it is going to continue to grow. MAKO is going to come out with an option for total knee replacement for 2015. They already have the hip replacement. So they are moving in a direction to become a total joint replacement surgical option using the help of a robot.”

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HAI ‘Kryptonite’

Novaerus technology called ‘the most significant development in HAI prevention in decades’

By LYNNE JETER

TAMPA – When West Gables Health Care Center Administrator Marco Carrasco learned about a new technology to reduce healthcare-acquired infections (HAI) at the 120bed skilled nursing facility in Miami, where the median age is 86 and the average short-term stay is 32 days, he immediately contacted the Tampa-based company that developed it.

Soon after, Carrasco implemented Novaerus, the first scientifically-proven system for airborne infection control, HAI and disease prevention. Encased in small, inconspicuous units, Novaerus provides continuous airborne infection control by passing air through its patented disruptive plasma field. The process emits billions of harmless electrons that destroy the protein bio-films of viruses. It also breaks down the cell walls of bacteria, and denature mold, allergens and odors.

Cost effective, each unit requires less energy than a 40-watt light bulb. Environmentally, Novaerus eradicates nearly 100 percent of all airborne pathogens and

reduces microbial surface counts by up to 90 percent.

“We’re on the cusp of the next significant advancement in medical technology, and once healthcare facilities across the country are able to follow our lead, I expect we’ll finally see a reversal in the ever-growing numbers of HAI cases,” said Carrasco.

For a before-and-after comparison, West Gables Health Care Center had 485 admissions, of which eight patients were

re-hospitalized for pneumonia during the second half of last year. During the first two months of this year with Novaerus technology, Carrasco noticed enhanced quality outcomes and a significant reduction in re-admissions. Of 115 total admissions during that time frame, only three patients were re-hospitalized for pneumonia.

But the real eye-opener, Carrasco said, occurred in the room of a tracheotomy patient who was highly susceptible to infection as the opening in her neck healed.

“Every case is unique, but these patients are at a high risk of infection because of the openings and tubes in their necks,” he said. “The fact … this patient recovered and went home sooner than what we consider to be the standard length is remarkable.”

Odor control is a bonus, said Carrasco.

“When you first enter our building, you notice the air feels fresh and is completely absent of any odor,” he explained.

“The Novaerus units eliminated odors in the common room and hallways, allowing us to forgo the use of harsh chemicals that simply masked smells.”

Standard HAI Prevention Practices • Isolating infected patients; • Requiring staff to wash their hands after each patient examination and ensure hand hygiene stations are numerous and easily accessible; • Minimizing the use of invasive devices, such as catheters; • Wearing protective gowns, masks, gloves and other equipment; and • Cleaning surfaces with harsh chemicals.

SOURCE: Novaerus.

U.S. Rollout

Launched just before Christmas in Florida, the response to Novaerus has been incredible, said company CEO Kevin Maughan, who met Carrasco during the Florida Health Care Association’s (FHCA) annual convention last year. By late spring, 15 percent of Florida’s skilled nursing facilities (SNF) had implemented Novaerus.

“Ninety-five percent of those who’ve tried the Novaerus system are customers,” said Maughan, who stumbled across the (CONTINUED ON PAGE 22)

Anterior Hip Replacement Approach Provides Positive Outcomes Less-invasive technique can help some patients get back to their lives quicker

By Dr. Patrick toy, camPBell clinic Since the inception of total hip replacement surgery decades ago, thousands of patients in Memphis have had their lives restored through this life-changing procedure. Historically, patients presenting with severe hip pain related to degenerative joint disease, avascular necrosis or other conditions were urged to postpone hip replacement until age 65 or older. We still try to delay hip replacement as long as possible, but newer technologies potentially imply better long-term outcomes for patients who require the procedure at an earlier age. Ideally, we perform one joint replacement with the goal that it will last a lifetime.

Patients undergoing primary total hip replacement historically have been admitted to hospitals as inpatients, and they required at least a two or three night postoperative stay before being

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discharged home or to a rehabilitation facility. In addition, hip replacement patients faced a lengthy recovery period, as well as activity limitations that in some cases prevented their return to work for a short time.

Recently, there’s been an interest in primary hip replacement using a different surgical approach – an anterior method – that hastens recovery time significantly. We’ve even been able to perform these procedures in an outpatient setting at Campbell Surgery Center, located on our campus in Germantown.

Primary total hip replacement using an anterior surgical approach may not be suitable for all patients, but for those with limited comorbidities and who are not significantly overweight, it can be a successful alternative. Similar to the traditional, posterior approach, patients undergoing this procedure often begin walking on their operative day. I’ve observed a rapid recovery with patients who have undergone anterior total hip replacement, and those

patients are often discharged after one day or less at the surgery center.

Because the procedure utilizes an anterior approach, the large, posterior muscles (those used in walking) and soft tissues are not disturbed; and patients typically experience a more favorable recovery. In addition, limitations on the patient’s postoperative activities may be able to be lifted sooner after surgery. Even patients that are not candidates for surgery in the outpatient setting may benefit from the favorable recovery related to the anterior surgical approach.

Surgery centers have a more strict focus in regard to the types of patients they may admit, and not all patients who seek outpatient hip replacement are target candidates for an anterior procedure. ASCs must make a medical decision based on certain sets of health information in order to adhere to industry standards, thereby narrowing the patient population who can utilize such facilities.

Both methods, anterior and posterior, are widely used elsewhere in the

country, but the anterior approach in a surgery center setting is new to Memphis and is a true benefit for some patients who may want to get back to life sooner and who meet the outlined necessary health guidelines.

With more than 400,000 hip replacements performed nationally each year, now, more than ever, patients are educating themselves before they enter our practice and are seeking out techniques and options that are the right fit for them. As an orthopaedic surgeon, we share their goal: identifying the best possible therapy to deliver positive outcomes, restore range of motion and eliminate or significantly reduce pain.

It’s imperative that we keep the patient’s best interest at heart, and our total joint team at Campbell Clinic is equipped to provide anterior or posterior surgical approaches in both hospital and surgery center environments.

Our goal continues to be prescribing the right method for the patient to get them “back in the game” the best way possible.

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Alternative Dynamic Bracing for Pediatric Neurological Based Muscle Imbalances Parents of children with lower extremity hypertonic muscle imbalance face treatment of Crouch gait and long term bony deformities of the knee, ankle and foot. Traditional bracing has focused on immobilization which does not prevent the deformities in adolescent children.

Ambulation for children becomes very difficult when the knee and ankle are locked. Their energy expenditure is increased and the child experiences decreased step length, Proprioception and balance. The lack of motivation to walk, run or play leads to more weakness and dysfunction along with possible deformity from absence of muscle use.

More parents of physically challenged kids are embracing the concept of using night time dynamic bracing and less rigid functional daytime bracing to enhance their child’s life and activity level. Advanced technology in components of limb braces using concentric torsion adjustable tension allows us to block unwanted movement in one direction and stretch the shortened muscle in the other direction. Protocol for parents or caregivers is focusing at night long term prolonged stretch therapy for 8-10 hours.

Human Technology, Inc. recently opened a pediatric specialty clinic in Germantown, Tennessee working closely with orthopedics, physical therapy and neurological clinics focusing on improving functional outcomes for better ambulation and development of physically challenged kids in the area.

Pediatric patients are evaluated in a team approach including the parent, physician, Physical/Occupational Therapist and Orthotist to determine an optimal bracing plan for achieving goals. Patients with crouch gait are managed with concentric knee extension night time bracing to improve length, muscle strength and function, while at the same time using more dynamic bracing on the foot and ankle with a controlled motion system that focuses on improving balance, Proprioception and muscle function.

Advocating for children to obtain the best technology for overall improvement should be high on the list for parents, caregivers and medical professionals. Advancements made in orthotics and prosthetics over the years can change the development, growth and life of physical disabilities and deformities.

By Frank Caruso, CO/LO – Director of Orthotics - Human Technology, Inc. Prosthetics & Orthotics

HAI ‘Kryptonite’ continued from page 21 technology being used in the aerospace industry in 2008. “I’d eyed it for the infection control industry, of which some $15 billion is spent on surface cleanliness and hand hygiene. Yet the negative outcomes based on HAIs cost about $40 billion. It seemed the market had a problem with that. As I did more research, I learned that almost no one was treating the air.”

Maughan rolled out Novaerus in the U.K. and Ireland in 2009. After a clinical trial showed a 68 percent reduction in environmental MRSAs (Methicillin-resistant Staphylococcus aureus) at a London hospital with Novaerus, the U.K. National Health Service selected it as last year’s leading air Smart Solution for HAIs. “We see ourselves as a complementary and cost-effective component of good nursing care,” said Maughan, noting that HAIs kill more people annually than breast cancer, prostate cancer, and automobile accidents combined.

Maughan expedited the introduction of Novaerus to the market at an affordable price after a family member of a scientist working on the technology required a leg amputation from an HAI. The company’s medical model involves leasing the equipment to healthcare facilities for three to five years. The typical cost to a SNF is roughly $2,500 a month, Maughan said.

“There are no startup fees or hidden costs or expenses,” he added. “It’s Medicare cost reportable, and we also have a money back guarantee.”

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Without thinking about it consciously during his formative years, Maughan’s foray into searching for a better way to fight HAIs began in childhood, after hearing tales of frustration about it from his medical family– his father, an MD; his grandfather, a pediatric surgeon; and his great grandfather, a general surgeon.

“There hasn’t been one significant development in infection control since the late 19th century,” he said, knowing early on that “as bacteria become more resistant to traditional medicines and procedures, technology must play a role in their eradication.”

Infection control companies have developed technologies that create hydrogen peroxide-based fogs or vapors to reduce the risk of cross-contamination of infectious diseases associated with using a rag, wipe or sponge. Because they’re labor-intensive, Novaerus doesn’t consider those solutions competition in the marketplace.

“Time is money, more than ever,” said Maughan. “Labor is so expensive, and time spent on HAI control by the nursing staff could be spent on other patient care needs. This technological solution requires no labor costs. By comparison, our solution is very inexpensive.

It works 365/24/7.”

To prevent aerial dissemination, technology can accomplish what medicine and standard HAI prevention practice cannot, such as eradicating airborne and surface pathogens and significantly reducing microbial surface counts, said Maughan.

A Brief History of Infection Control Advances • In 1867, British surgeon Joseph Lister began using carbolic acid as an antiseptic in surgical procedures, significantly reducing mortality rates from infection by 30 percent within a decade. Before, a patient could undergo a procedure successfully only to die from a postoperative infection, ward fever.

• In the mid-to-late 19th century, various infection control protocols were developed and adopted, which remain vigorously enforced today: hand-washing, using heat to sterilize surgical instruments, and surgical masks.

Medicine won significant battles against infectious diseases, including the eradication of tuberculosis.

• But in the mid-20th century, bacteria started fighting back. In 1947, only a few years after the advance of mass production penicillin, Staphylococcus aureus was discovered, one of the earlier bacteria indicating penicillin resistance. In 1961, Methicillinresistant Staphylococcus aureus (MRSA) was first detected in Britain. Now, half of all MRSA infections in the U.S. are resistant to penicillin, methicillin, tetracycline and erythromycin.

• More recently, worldwide outbreaks of infectious diseases such as H5N1, severe acute respiratory syndrome (SARS), and H1N1 have emerged. Earlier this year, the Centers for Disease Control and Prevention (CDC) issued a warning around the growing threat of “nightmare superbugs” that are untreatable because they’re resistant to even the most powerful antibiotics.

The CDC reports this class of superbug – Carbapenemresistant Enterobacteriaceae (CRE) – has been found only in nursing homes and hospitals.

• About 4 percent of acutecare hospitals, and 18 percent of long-term acute care hospitals in America, reported at least one case of dangerous CRE bacteria – germs that are resistant to most ‘last-resort’ antibiotics.

SOURCE: Novaerus.

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ICD-10: Are You Ready?

By BILL HEFLEY, MD

With the rapidly approaching ICD10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition. With implementation of ICD-10, physician offices accustomed to the 13,000 ICD-9 codes must be prepared to transition seamlessly to a new set of 68,000 codes. More specifically, a physician or billing clerk currently using ICD-9 to properly code the diagnosis of ‘patella fracture’ must choose between two possible codes; when utilizing ICD-10 that number explodes to 480 codes. Yes. Get ready.

In 1992 the World Health Organization (WHO) published the International Classification of Diseases, Tenth Revision. The U.S. made modifications to the WHO ICD-10 creating the ICD-10-CM (Clinical Modification) which is the diagnosis code set that will replace ICD-9-CM Volumes 1 and 2. The Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 and later pushed back the compliance date one year to October 1, 2014. Farzad Mostashari, MD, the National Coordinator for Healthcare Information Technology, asserted last month that there would be no extension of the deadline.

While many physicians see the transition to ICD-10 as an unnecessary burden, other physicians and industry stakeholders believe that the ICD-9 code sets are obsolete and inadequate. ICD-10 codes have more characters and a greater number of alpha characters creating space for new codes and flexibility for future medical advances. ICD-10 has increased specificity that will improve the ability to identify diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.

In addition, ICD-10 will improve claims processing, quality management and benchmarking data.

A successful ICD-10 transition requires exhaustive preparation by medical practices. Yet recent research by the Medical Group Management Association indicates that only 4.7 percent of practices reported that they have “made significant progress” when rating their “overall readiness level for ICD-10 implementation.”

The research was derived from respondents in 1,200 medical practices in which more than 55,000 physicians practice.

Preparing to practice medicine in the world of ICD-10 is no small undertaking.

It will require time and money. Having an experienced billing clerk “coder” in the practice will no longer be sufficient to generate accurate codes. Simply converting the practice’s ICD-9 superbill to ICD-10 is problematic. Many industry experts don’t see the superbill being preserved at all.

The American Academy of Professional Coders (AAPC) recently issued a two page ICD-9 superbill which when crosswalked to ICD-10 became nine pages long. Another industry consultant sites an example of a two page ICD-9 superbill translating memphismedicalnews

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Myths Associated with ICD-10 The Go-Live date will most likely get delayed again The only staff members affected will be coders and billing specialists My EMR and PM vendor will be automatically compliant General Equivalence Mappings are a good solution to coding an individual clinical chart After October 1, 2014 payers and clearinghouses will aid practices by automatically cross-walking submitted 9 codes to 10 codes

into a 48-page ICD-10 superbill.

Preparation for the medical practice begins with internal training and testing of all parties involved in producing proper coding. Administrators must establish a training and implementation schedule; set deadlines; create a project team; identify training resources; perform documentation gap analysis; evaluate and modify the practice’s forms; budget for transition expenses; communicate with practice management (PM) software and EHR vendors; assess hardware and software update requirements; and arrange testing with clinical and billing staff, PM and EHR vendors, clearinghouses and major health plans. Providers must be trained on the changes in clinical concepts and the level of detail in ICD-10, so that their documentation supports the ability to code to the highest level of detail.

For many specialties, it is highly recommended that physicians take anatomy and physiology refresher courses. Billing staff must increase their knowledge of anatomy and physiology, learn and adopt a completely different coding system and be able to code to the greatest level of detail.

Training options include sending staff for offsite training, hiring an outside trainer to come to the practice, online training, webinar training and book-based training. Frequent testing and trial coding for all staff is also highly recommended in the months leading up to the ICD-10 ‘go live’ date.

In addition to internal preparation, medical practices must also arrange testing with their PM vendor, EHR vendor, clearinghouse and major health plans.

Many PM vendors and EHR vendors will not be ready to meet the October 1, 2014 ICD-10 compliance date. Practices must communicate with their vendors months in advance to schedule software upgrades and testing to assure readiness. If the practice’s PM or EHR vendor is not going to be prepared for the ICD-10 launch, the practice will need to make plans to switch in time for the transition date. Many prac-

Your Practice – Your Brand

The PR Perils of People

By Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding

What a summer it has been for people and personality based public relations challenges, from Paula Deen to George Zimmer (the Men’s Warehouse guy, not the Florida neighborhood watch guy) to Captain Crunch.

As a medical practice, it is easy to overlook these celebrity issues as unrelated to anything you might face. After all, one is a television cooking superstar, one is a high profile national business founder and spokesman, and one is a cartoon. But, I see lessons in each of them.

Deen: She rode a cult following to stardom. Yet, at the heart of it, she was just a chef. There are many medical practices in which a single personality has risen to community or even greater prominence.

Perhaps it is based on a talent and reputation in the surgical suite, or an innovation or entrepreneurial endeavor, or just because this individual has done an excellent job integrating him or herself into the local community through community boards, media or some other attention getter. Just being part of a large and respected hospital system can create a level of stardom. The question is, “What happens when that person slips up, big time?” I remember years ago hearing about a local specialty practice where a doctor found himself in the midst of a sex-related scandal. Every location where this doctor practiced found itself “accused” of wrong doing by association, and his primary practice was particularly embarrassed.

People are human and mistakes will be made – minor and major. You never know how the media will react, but you can control how you respond. Honesty is always the best path. Don’t try to hide or create an artificial wall between the practice and the person. Also realize that time is not on your side. Silence is the breeding ground of speculation, rumor and assumed guilt. First; decide if the “personality” involved is staying with the organization or leaving. From there you can build your message around what you knew, what you did, what you are doing now and how you feel about it. Seeking professional independent communications and crisis management advice would be a good step.

Zimmer: This is a lesson in how to mess up an uncomfortable changing of the guard. Zimmer is the “I guarantee it” founder of Men’s Warehouse who was unceremoniously ousted by the board of directors. I have no idea if Mr. Zimmer is the tyrant the board claims him to be or if the board is the unreasonable gang that Zimmer makes them out to be. All I know is that it looked sloppy and the brand suffered. Every practice will eventually move on to the next phase of leadership.

Whether this is due to mutual understanding, retirement or forced resignation, crafting messages that do not demean either side is wise, and finding mutual ground is always helpful. Sometimes that means things will move more slowly than you want, but that is almost always a lesser evil than a public battle.

Crunch: If you happened to miss this one, Captain Crunch, on the 50th anniversary of his Cap’n Crunch cereal launch was “uncovered” as an imposter because his uniform shows him to be only a commander. In the face of accusations, the Captain and his company, Quaker Oats, stood together and stated, “I stand before you today to answer the ridiculous accusations leveled against me… You may have noticed a few other things about me. I have four fingers. My first mate’s a dog. My eyebrows are attached to my hat, for crunch sake! We don’t feel [the fourth stripe is] necessary—the Cap’n is after all a Cap’n, as he mans the S.S. Guppy.” The lessons here for all of us; when standing together you are stronger and don’t take everything too seriously.

To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com

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GrandRounds You’ve spent thousands on your “image.”

How about a Professional Portrait to go with it?

Sheila T. Champlin Promoted to Assistant Vice Chancellor for Communications and Marketing at UTHSC Sheila T. Champlin has been named the assistant vice chancellor for the Communications and Marketing Department at the University of Tennessee Health Science Center (UTHSC), effective July 1. Since May 2006, she has served as director of the department, Sheila T. Champlin managing a staff of seven professionals and a variety of freelancers

and consultants.

Champlin holds a bachelor’s degree in communications from St. Louis University, where she graduated summa cum laude. She was inducted into both Alpha Sigma Nu, the national Jesuit honor society, and Phi Beta Kappa, the oldest honor society for the liberal arts and sciences in the United States. Subsequently, Champlin earned a master’s degree in journalism from the University of MissouriColumbia. She later served as a member of the national Alpha Sigma Nu Board of Directors for 10 years

AAOS Updates, continued from page 18 OFFICE EXPENSES: Fixtures & Furnishings: $30k Interior Designer: $250/hr.

Advertising: $36k/yr.

Cleaning Crew: $5k Staff Portraits: Take ‘em yourself! (It’s FREE!)

...OR you can have a professional portrait by Jaffe for only $125 per person!

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We can help guide your path.

Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR. Through special funding, tnREC is offering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds.

We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply online www.tnrec.org This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Office of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reflect ONC policy. 90RC0026/01 13.TREC.04.049

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• Patients with a body mass index (BMI) greater than 25 should lose a minimum of five percent of their body weight.

Jevsevar noted telling patients to lose weight and get active are “tough discussions” to have but important ones. Low impact exercises including swimming, walking and using an elliptical machine have been proven effective to slow the progression of OA of the knee.

The work group strongly recommended against the use of glucosamine and/or chondroitin sulfate or hydrochloride and against the use of acupuncture.

A “strong” strength of recommendation means the quality of the supporting evidence was high with an implication that practitioners should follow strong recommendations unless a clear and compelling rationale for an alternative approach exists. Jevsevar added the ‘no’ recommendations were based on a lack of efficacy rather than a potential for harm. The group also had a moderate recommendation against custom lateral wedge insoles.

A moderate recommendation also is compelling, but the quality or applicability of the existing evidence is not as strong.

Due to a lack of research, the CPG was unable to recommend for or against the use of physical agents including electrotherapeutic modalities, manual therapy, bracing, growth factor injections and/or platelet rich plasma.

In the second edition, all included studies had to have a sample size of at least 30 participants and a follow-up period of at least four weeks. More than 10,000 separate pieces of literature were reviewed during the evidence analysis phase. When completed, Jevsevar said the updated OA knee CPG was subjected to the most extensive peer review to date for any AAOS CPG. Ultimately, 16 peer reviewers representing multiple specialty societies submitted formal reviews. “Each meticulously dissected the final recommendations of the document and, based on their well-informed and insightful comments, important changes were made to the final document,” Jevsevar said in an AAOS editorial.

For more information on the second edition OA knee CPG, go online to: www.aaos.org/research/guidelines/ GuidelineOAKnee.asp

ICD-10: Are You Ready? continued from page 23 tices with in-house billing departments will weigh the benefits of outsourcing the practice’s revenue cycle management.

Costs associated with the preparation for the ICD-10 transition are not insignificant. Industry experts suggest budgeting $200,000 to $280,000 for an eight-physician practice. Expenses include training, testing, hardware upgrades and PM/EMR software upgrades. In addition to the one-time costs associated with implementation, many practices will experience ongoing, recurring costs related to the need for increased coding staff, consulting services, subscriptions to print and software-based coding aids and reduced productivity as a result of increase need for documentation and coding complexity.

The ICD-10 transition will undoubtedly eclipse Y2K and the HIPAA 4010 to 5010 transition in terms of the impact on the healthcare industry. Unprepared practices will face painful disruptions in cash flow and a chaotic scramble to regain practice productivity. Even well-prepared

practices that execute ICD-10 implementation flawlessly will likely experience some disruption in cash flow. Remember, a successful revenue cycle requires every entity in the claims processing chain to be fully prepared for ICD-10. The PM system, EMR system, clearinghouse and payer must all communicate properly electronically and adjudicate ICD-10 claims correctly. Some bugs are inevitable. Practices should have in place a line of credit sufficient to cover three months operating expenses prior to ‘go live.’ Preparation will take considerable planning, time and money and should begin immediately.

October 1, 2014 is just around the corner.

Bill Hefley, M.D., is President and CEO of MedEvolve, providers of Practice Management Software, EHR, and billing services to thousands of physicians across the US. In addition, he has an orthopedic surgery practice in Little Rock, specializing in minimally invasive surgeries for the knee, hip and shoulder including arthroscopic and joint replacement procedures.

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GrandRounds

Ob/Gyn Specialists Joins Methodist Ob/Gyn Specialists has joined the Methodist Healthcare family as part of its physician alignment strategy. The group consists of five physicians.

• Yvonne Moore, M.D. – Dr. Yvonne Moore attended Washington University in St. Louis, Mo. where she received a Bachelor of Arts degree in science. She continued her education at St. Louis University School of Medicine earning her medical degree and completed her residency with the University of Tennessee Health Science Center in the Department of Obstetrics and Gynecology.

Dr. Moore is board certified in obstetrics and gynecology. She is a member of the Memphis and Shelby County OB/ GYN Society, the Bluff City Medical Society, and the Shelby County Breastfeeding Coalition. Dr. Moore is an instructor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis.

• Paula Pilgrim, M.D. – Dr. Paula Pilgrim received her Bachelor of Science degree in molecular biology from Vanderbilt University in Nashville, Tenn., and earned her medical degree from the University of Tennessee Health Science Center, Memphis. She completed her residency with the University of Tennessee Health Science Center in the Department of Obstetrics and Gynecology.

Dr. Pilgrim is board certified in obstetrics and gynecology. She is a Fellow with the American College of Obstetrics and Gynecology and is a member of the Memphis and Shelby County OB/GYN Society and also the University of Tennessee Obstetrics and Gynecologic Society.

Dr. Pilgrim is an instructor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis.

• Susan Lacy, M.D. – Dr. Susan Lacy attended Williams College in Williamstown, Mass. where she earned her Bachelor of Science degree in biology. She received her medical degree from Johns Hopkins University School of Medicine in Baltimore, Md. and completed her resimemphismedicalnews

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dency with the University of Tennessee Health Science Center in the Department of Obstetrics and Gynecology.

Dr. Lacy is board certified in obstetrics and gynecology. She is a Fellow with the American College of Obstetrics and Gynecology and is a member of the Memphis and Shelby County OB/GYN Society. She is also an instructor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis.

• Jessica Ruffin, M.D. - Dr. Jessica Ruffin earned a Bachelor of Science degree in biological sciences from Stanford University in Palo Alto, Calif. She received her medical degree from the University of Tennessee Health Science Center and completed her residency with the University of Tennessee Department of Obstetrics and Gynecology.

Dr. Ruffin is board certified in obstetrics and gynecology. She is a Fellow in the American College of Obstetrics and Gynecology and is a member of the Memphis and Shelby County OB/GYN Society, Bluff City Medical Society, and American Association of Gynecologic Laparoscopists. Dr. Ruffin is an instructor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis.

• Leslie Mayo, M.D. – Dr. Leslie Mayo received her undergraduate training at the University of Alabama in Tuscaloosa, Ala. where she earned a Bachelor of Science degree in biology. She earned her medical degree from the University of Tennessee Health Science Center, Memphis and completed her residency with the University of Tennessee Health Science Center in the Department of Obstetrics and Gynecology.

Dr. Mayo is board certified in obstetrics and gynecology and is a Fellow with the American College of Obstetrics and Gynecology. She is also a member of the Memphis and Shelby County OB/GYN Society. She is an instructor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis.

Ronald C. Bingham, M.D. Miles M. Johnson, M.D.

WE’RE THE EXPERTS OF YES. EMG Clinics of Tennessee specializes in state-of-the-art nerve and muscle testing (electromyography or EMG). Our clinics have become the standard for accurate and comprehensive evaluations of the peripheral nervous system (the “electrical system” of the body). We evaluate patients with pain, weakness, or numbness.

Our friendly staff is committed to giving our patients the very best care. With new technology and the special techniques developed by Dr. Bingham, this test can be performed with very little discomfort for both adults and children. Our physicians, Ronald C. Bingham, M.D., and Miles M. Johnson, M.D., are board certified in Physical Medicine and Rehabilitation and Electrodiagnostic Medicine. Additionally, all the technicians are Certified Nerve Conduction Technologists. We have devoted our careers exclusively to electromyography and the evaluation of nerve and muscle disorders. This narrow focus has given our staff a unique depth of experience, allowing us to make an accurate diagnosis for our patients.

EMG Clinics of Tennessee was founded by Ronald C. Bingham, M.D., in 1989. Our clinics in Memphis and Southaven are the only accredited EMG laboratories in the Memphis area. We welcome patients with all forms of insurance including Medicare, TennCare, and TriCare.

Memphis. Southaven. Jackson.

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GrandRounds Throckmorton Named Orthopaedic Residency Program Director at UTCampbell Clinic The Campbell Foundation is pleased to announce the selection of Campbell Clinic physician Thomas W. “Quin” Throckmorton, M.D. as Orthopaedic Residency Program Director in the University of Tennessee – Campbell Clinic Department of Orthopaedic Surgery.

Dr. Thomas W. Throckmorton Dr. Throckmorton earned his medical degree from the University of Iowa College of Medicine. He completed a residency in orthopaedic surgery at Vanderbilt University, followed by a fellowship in shoulder and elbow surgery at the Mayo Clinic in Rochester. Dr. Throckmorton is an Associate Professor in the University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and is a member of the Board of Trustees for The Campbell Foundation.

He joined the staff of Campbell Clinic in 2009 and serves as head of the Shoulder Arthroplasty service and as a member of the Sports Medicine team.

Dr. Throckmorton has been active in clinical teaching at all levels, including medical students, orthopaedic residents and fellows.

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Emergency Department Construction on Methodist Germantown Hospital Campus To help meet patient demand, the emergency department at Methodist Le Bonheur Germantown Hospital is expanding. Construction is currently underway to add 5,000 square feet. An additional 4,000 square feet of the existing emergency department is being renovated.

To accommodate the growth in the number of surgeries performed at the hospital, a second floor will be built above the emergency department to better serve patients and families while also allowing room for future expansion.

The project will take 10 to 11 months to complete.

Advisory Board Formed to Embed UTHSC COM in the Community Eighteen high-profile Memphis cognoscenti – including Shelby County Mayor Mark Luttrell, State Senate Majority Leader Mark Norris, current and retired CEOs, and civic leaders -- recently gathered in the Hamilton Eye Institute board room at the University of Tennessee College of Medicine to share their concerns about health care and higher education in Memphis. Participants were drawn together by David M. Stern, M.D., executive dean of the UT Health Science Center (UTHSC) College of Medicine, and David L. Levine, a business consultant who is the former chairman and CEO of ResortQuest International.

At its first meeting, the group formed an ongoing Advisory Board for the UTHSC College of Medicine. Its mission: to provide health care and an approach to wellness that exceeds expectations of the neighboring communities and region. Its goal: to provide evidence- and value-based approaches that address current needs and reach into the future through research and educating the next generation of physicians.

The board wants to embed the College of Medicine in the city, making it a more vibrant part of the ecosystem, said Levine, who was chosen to serve as the Advisory Board’s first chair.

With their next meeting scheduled for the fall, board members are working in the interim in small teams, moving ideas forward and forging mutually beneficial relationships for the college and the community. Other members of the UTHSC College of Medicine Advisory Board are: George Alvord, CEO (retired), Lenny’s Corp.; Ron Belz, COO, Belz Enterprises; Don Colleran, executive vice president for Global Sales & Solutions, FedEx; Ken Glass, chairman/CEO (retired), First Tennessee; Rabbi Micah Greenstein, Senior Rabbi, Temple Israel; Estella Greer, president and CEO, Mid-South Food Bank; Pat Halloran, president and CEO, Orpheum Theatre; Bob Hester, senior partner, Deloitte and Touche; Kevin Kane, president/CEO, Memphis Convention and Visitors Bureau; McNeal McDonnell, co-owner/chief manager, Brussels Bonsai; John Moore, president/CEO, Greater Memphis Chamber of Commerce; Ron Pope, director, Student Engagement, Memphis City Schools; Mearl Purvis, evening anchor, Fox13 News; Jill Steinberg, attorney/shareholder, Baker Donelson Memphis, and City of Memphis Mayor AC Wharton.

Modern EMR implementation ensures close collaboration between providers.

All referring physicians will be acknowledged and kept up to date.

Major private health insurance plans accepted Fee for Service / Easy Payment Plans Concierge Services Available

To refer a patient, please call 901.730.0575 7505 Capital Drive, Corporate Centre Germantown, TN 38138 www.germantownpsychiatry.com Dr. David Stern, standing, addressed Memphis leaders at the first meeting of the newly formed UTHSC College of Medicine Advisory Board.

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GrandRounds The MED Announces Three New Hires

Sarah Colley, JD, MHA, PHR, has joined Regional Medical Center in the position of Senior Vice President of Human Resources. In this role, Colley is responsible for personnel, recruitment, labor relations, training and development, and occupational health.

Colley joined Sarah Colley Regional Medical Center after serving in Human Resources leadership positions at health systems in Little Rock, Arkansas for 8 years. Colley also practiced law in Arkansas, working for The Health Care Law Firm from 2002 to 2005.

Colley earned her undergraduate degree from Guilford College in Greensboro, North Carolina; her Juris Doctorate from the University of Arkansas School of Law; and her Masters in Health Administration from Webster University, Little Rock Campus. She also holds a PHR Designation (Professional in Human Resources).

Kathleen Healy-Collier, DHA, MHA, CSSBB, is the Vice President of Business Line Operations at Regional Medical Center. Prior to this new role, she had been at Le Bonheur Children’s Hospital for 15 years in various Dr. Kathleen Healy-Collier executive leadership roles including information technology, clinical

systems, access services, managed care, health information management, finance, revenue cycle, and support for business development. She also served as the Vice President of Operations (Interim) and Administrative Director of Performance Improvement and Assessment. Kathleen holds a doctorate in Health Administration from the Medical University of South Carolina, a Masters in Health Administration from the University of Memphis and Bachelors from Saint Louis University.

She is a Six Sigma Black Belt and was a recipient of the Memphis Business Journals Top 40 under 40 in 2010.

Renee Trammell is the Service Line Director of Burn and Reconstructive Plastic Surgery at Regional Medical Center.

Renee spent 17 years in various leadership positions within Baptist Memorial Healthcare Corporation, 6 years in the insurance managed care industry including BlueCross Renee Trammell BlueShield of Tennessee and the last three years with UT Medical Group, Inc. Her experience encompasses physician practice management, managed care contracting, population health management, business development, credentialing, enrollment and privileging, and hospital based program development. Renee holds two Masters Degrees, is on the Board of Directors of the Memphis Chamber of Commerce, and actively

participates on several advisory committees.

The West Clinic, UTHSC, and Methodist Healthcare Announce Formation of West Cancer Center

The West Clinic, a leader in the fight against cancer in the Mid-South for more than three decades, in partnership with University of Tennessee Health Science Center and Methodist Healthcare, announced today the formation of West Cancer Center. The naming of the Center marks a critical step in accelerating joint efforts for the comprehensive cancer center. Together, the three organizations are advancing efforts to provide leadingedge treatment, extensive clinical trials, and cutting-edge research in the fight against cancer. In general use, the new name is West Cancer Center, but all partners are incorporated in the program’s new logo to reflect the important role each partner plays in bringing the best possible cancer care to our region.

The combined mission is to Leave No Stone Unturned in the diagnosis, treatment, and care of every patient the center treats, providing care to patients fighting cancer at home with their families in Memphis, according to Erich Mounce, CEO of West Cancer Center and SVP for the Methodist Healthcare Cancer Service Line.

The new campaign, “Memphis Fight

On,” features patients who share stories of their own personal cancer journeys, and how having West Cancer Center partner with them in their fight against cancer made a difference. One patient is a local Deputy Sherriff, who at the age of 30 was diagnosed with testicular cancer.

With a wife and two small children, and a third on the way, he was in the fight of his life. He chose The West Clinic as his fighting partner. A video where he tells his story can be seen at MemphisFightOn.com.

Others are encouraged to share their own cancer survival stories on that site. Additional videos feature physicians sharing what motivates them to do their best for cancer patients and their families.

In January 2012, Methodist Healthcare, The West Clinic and UT Health Science Center formed a partnership to transform cancer care in the Mid-South area. The West Clinic, the region’s premier cancer practice and a nationally-recognized leader in cancer research, joined forces with Methodist and UTHSC to create a comprehensive, fully integrated cancer service for the benefit of Mid-South residents. As part of that partnership, the University of Tennessee Health Science Center (UTHSC) moved its Oncology Fellowship Program to The West Clinic and was provided $5 million annually over seven years, for a total of $35 million, to enhance cancer research, care programs, and innovation.

THE 3RD ANNUAL

MEMPHIS RESE ARCH AND INNOVATION EXPO

Meet the area’s top scientists and learn about their cutting-edge research. Join the conversation about local entrepreneurship, hear about managing global risk, and listen as the head of Procter & Gamble — one of the world’s most innovative and successful corporations — discusses his experiences growing a $100 billion company.

THE 3RD ANNUAL MEMPHIS RESEARCH AND INNOVATION EXPO Thursday, October 3 | 9 a.m.–3 p.m.

FedEx Institute of Technology on the University of Memphis Campus Admission is FREE | memphis.edu/fedex | 901.678.5105

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Parking is available, for a fee, in the Innovation Drive Garage, across from the FedEx Institute.

Seating is limited for the speakers portion of the event.

A Tennessee Board of Regents Institution • An Equal Opportunity/Affirmative Action University.

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GOOD NEWS

The Behavioral Health Services of Delta Medical Center introduces a new crisis management unit for Medical Detoxification. · Withdrawal from an addictive substance is safely managed in a medical facility that specializes in treating addictions. · Typically inpatient detoxification treatment is between 3 to 5 days · Treatment offers a multidisciplinary team approach and includes a comprehensive evaluation and counseling as well as a medication regimen · Aftercare could include a continuation of therapy through inpatient or outpatient treatment

Delta is committed to working with you or someone you love to make positive life changing decisions. Sobriety comes only with commitment and time. We want to help.

Give our Behavioral Health Admissions a call for more information.

Don’t hesitate…Call Today 901.369.6021

www.DeltaMedicalCenter.com 28

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AUGUST 2013

GrandRounds Baptist Breaks Ground on Pediatric Emergency Department at Women’s Hospital In July, Baptist broke ground on a pediatric emergency department at Baptist Memorial Hospital for Women, the latest addition to the hospital’s pediatric services.

The emergency room is slated to open in the spring of 2015 and will be staffed by pediatric emergency medicine physicians, hospitalists and an array of specialists who will care for patients, who will range from birth to age 18.

In May 2012, Baptist began transitioning pediatric services from its flagship hospital, Baptist Memorial HospitalMemphis, to Baptist Women’s Hospital, to provide a full continuum of care for area families, according to Baptist leadership.

The emergency department will compliment the pediatric diagnostic and inpatient and outpatient surgery services already available at the hospital. Three pediatric hospitalists, pediatricians who work mainly in hospitals, staff the hospital’s pediatric services and provide 24hour care.

Offering pediatric services at Baptist Women’s Hospital was a natural fit, according to Jason Little, executive vice president and chief operating officer at Baptist. They wanted to respond to a community need by making services more streamlined and convenient for patients.

So far, the hospital has performed almost 1,600 outpatient diagnostic procedures and close to 500 surgeries.

And recently, the Baptist Memorial Health Care Foundation awarded a $550,000 grant to help Baptist Women’s Hospital establish the Pediatric Eye Center, the area’s first comprehensive eye center for babies and children. For the first time, families will be able to access the full continuum of care under one roof, including prevention, diagnosis, treatment, surgery and follow-up care.

Baptist Women’s Hospital opened in May 2001 and is the area’s first and only freestanding women’s hospital. The hospital offers labor and delivery, gynecological surgery, a 40-bed Neonatal Intensive Care Unit and is a regional referral center for high-risk pregnancies, mammography diagnostics and urogynecology.

Three Physicians Join Campbell Clinic In August Campbell Clinic announced the hiring of three new medical doctors who will begin working at the 104-year-old orthopaedic practice in August.

Dr. Gregory D. Dabov rejoins the Campbell Clinic family after one year of practice in Montana. Dabov, a knee, shoulder and total joint specialist, was previously employed by Campbell Clinic from 2000-12. A Dr. Gregory D. Board Certified surgeon, Dabov

the California native attained his degree in medicine from The University of Tennessee-Memphis, where he also completed an orthopaedic residency and internship with Campbell Clinic. Dabov also served as an assistant professor of orthopaedic surgery with The University of TennesseeCampbell Clinic program during his previous tenure. He is a member of several national and local professional organizations, including the American Academy of Orthopaedic Surgeons.

Dr. Douglas T. Cannon is a fellowshiptrained physical medicine and rehabilitation physician who joins the clinic after serving for 13 years at the Pain and Spine Medicine Center of the Central Coast in Templeton, CA. Cannon is a 1993 graduate of the Dr. Douglas T. Cannon Washington University School of Medicine in St. Louis, and he completed his residency in physical medicine and rehabilitation at the Northwestern University Medical School’s Rehabilitation Institute in Chicago. He is certified by the American Board of Physical Medicine and Rehabilitation.

Dr. Benjamin J. Grear, a foot and ankle specialist, begins with Campbell Clinic after completing a fellowship in Foot Surgery at Baylor University Medical Center. He earned his Doctor of Medicine in 2007 from The University Dr. Benjamin J. of Tennessee-Memphis. He Grear completed his residency in orthopaedic surgery with Campbell Clinic in 2012, where he was elected Chief Resident. During his previous time in Memphis, he served as a volunteer physician with The University of Memphis, Rhodes College, the Memphis Redbirds and area high schools. He is a member of the American Medical Association and Tennessee Orthopaedic Society.

Dr. John R. Hill Joining Pediatrics Associates Pediatric Associates announces that Dr. John R. Hill is joining the practice.

Hill, who has been practicing medicine for 31 years, earned his bachelor’s degree from Princeton University and his Medical Degree from Yale. His pediatric training was at Vanderbilt, Yale and UTHSC. He has served as Dr. John R. Hill president of the Tennessee Chapter of the American Academy of Pediatrics and has served on staff at Methodist, Le Bonheur, Baptist, St. Joseph’s/St. Francis and is now on staff at Methodist and Le Bonheur.

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GrandRounds Florida And Tennessee Hospital Associations Recognized For Leadership In Quality Improvement The Florida Hospital Association (FHA) and the Tennessee Hospital Association (THA) were the 2013 recipients of the Dick Davidson Quality Milestone Award for Allied Association Leadership for their work to improve health care quality, the American Hospital Association (AHA) announced. The award, given to state, regional or metropolitan hospital associations that demonstrate leadership and innovation in quality improvement and contribute to national health care improvement efforts, was presented July 25 at the 2013 Health Forum-AHA Leadership Summit in San Diego.

The THA identified three major areas of focus for the association: quality and safety, physician alignment and efficiency.

The commitment to patient safety and quality led to the launch of the Tennessee Center for Patient Safety (TCPS) in 2007.

The 126 hospitals actively participating represent more than 90 percent of all Tennessee hospital admissions. The TCPS encourages Tennessee hospitals to adopt proven strategies that enhance the reliability, safety and quality of care received by patients. Successful initiatives include working toward a strategic board aim of zero preventable harm, reducing health care-associated infections, decreasing early elective deliveries (EEDs) before 39 weeks and the Tennessee Surgical Quality Collaborative (TSQ) to improve surgical outcomes.

The EED project launched in Tennessee was part of the Hospital Engagement Network (HEN) funded by Centers for Medicare & Medicaid Services and its Center for Medicare & Medicaid Innovation. The program was so successful that the THA board endorsed expanding the project to all hospitals in Tennessee with obstetrical services. Participating hospitals had significant reductions of early EEDs, decreasing from a baseline 15 percent in May 2012 to 6 percent in November 2012. The number of EEDs decreased from 71 in baseline May 2012 to 17 in November 2012.

Ten Tennessee hospitals take part in the TSQ surgical quality collaborative.

They share surgical process and outcomes data to improve patient surgical outcomes, using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). TSQ was the first NSQIP state initiative coordinated and led by a state hospital association and has proven very successful in aligning surgeons and hospitals to work collaboratively to improve surgical care.

The award is named for AHA President Emeritus Dick Davidson, who strongly promoted the role of hospital associations in leading quality improvement during his tenure as AHA president and as president of the Maryland Hospital Association.

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UT Medical Group Names Dr. Aaron Waite Director of Cataract, Cornea, and Refractive Surgery

Dr. Aaron N. Waite has joined UT Medical Group, Inc as director of cataract, cornea, and refractive surgery.

He is noted for his expertise in advanced corneal transplant procedures, including deep anterior lamellar keratoplasty (DALK), Descemet mem- Dr. Aaron N. Waite brane endothelial kera-

toplasty (DMEK), and Descemet’s stripping automated endothelial keratoplasty (DSAEK), in addition to cataract surgery, LASIK vision correction, and contact lens implantation. He also specializes in treatments for dry eyes and corneal ulcers.

After earning his medical degree from the University of Utah School of Medicine in Salt Lake City, Waite completed ophthalmology residency at the University of Tennessee Health Science Center and fellowship training in cornea, external disease, and refractive surgery at the University of Colorado at Denver. He is board certified by the American Board

of Ophthalmology and is associate professor of ophthalmology at the University of Tennessee Health Science Center.

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GrandRounds Memphis VA Medical Center Director Announced

The Department of Veterans Affairs is pleased to announce the appointment of C. Diane Knight, MD, CMD as Director of the Memphis VA Medical Center (VAMC). Recently, Dr. Knight served as Interim Medical Center Director at this facility from SeptemDr. C. Diane ber 2012 to April 28 2013.

Knight Dr. Knight began her new appointment in July.

In November 2009, Dr. Knight joined VISN 9 as Deputy Chief Medical Officer.

During that time she provided oversight of ambulatory practice operations at Network facilities as an Ambulatory Practice Manager. In this role, she served as Patient Aligned Care Team (PACT) Champion for VISN 9 and she coordinated PACT activities for VISN 9 medical centers. In addition, she was responsible for the implementation and achievement of a “medical home” for each Veteran served in an outpatient setting.

Dr. Knight has a long history of providing dedicated service and leadership within the VA. Her VA career started at the Biloxi VAMC in 1995 as a primary care physician in the Geriatric clinic and on the Nursing Home and Intermediate Care wards. Other positions include Chief of Geriatrics and Extended Care in the Gulf Coast Healthcare System, Biloxi, MS and Medical Director at the Armed Forces Retirement Home in Gulfport, MS. The Memphis VAMC consists of one main campus, which includes a 60-bed Spinal Cord Injury Unit, nine community based outpatient clinics (CBOC) and a newly renovated Women Veterans Healthcare Center. The Memphis VAMC is a tertiary care facility classified as a Clinical Referral Level I Facility and one of the most complex medical centers in the VA system.

Memphis Orthopaedic Group Announces The Addition Of Dr. Kevin Coates

ORTHOPEDIC SURGERY - SPORTS MEDICINE J. Ted Galyon, M.D. W. Lee Moffatt, M.D. Peter B. Lindy, M.D. W. Randy Fly, M.D. EAST MEMPHIS LOCATION LOEWENBERG BUILDING 6005 PARK AVENUE, SUITE 309 MEMPHIS, TN 38119 901-682-5642 Physical Therapy Suite 300 901-881-6766

BARTLETT LOCATION MEDICAL ARTS PAVILLION 2996 KATE BOND RD, SUITE 301 BARTLETT, TN 38133 901-791-0347 Physical Therapy Suite 311 901-791-9333

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Memphis Orthopaedic Group is proud to announce that Dr. Kevin Coates has joined its team of medical professionals.

Dr. Coates comes to MOG with many years experience gained from a diverse medical background. He is a graduate of Dr. Kevin Duquesne University and Coates the University of Pittsburgh School of Medicine, where he joined the United States Army and received his Master of Physical Therapy degree. Following his service as the orthopaedic surgeon on the 126th and 759th Forward Surgical Teams in Afghanistan and the 947th Forward Surgical Team in Iraq, he served as an assistant team physician for the Wake Forest University Athletic Teams.

Dr. Coates is a member of the Arthroscopy Association of North America, The American Orthopaedic Society for Sports Medicine, The Association of Military Surgeons of the United States, and is a Fellow of the American

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When it comes to

PATIENT SAFETY,

We’re all on the

SAME TEAM.

That’s why the Tennessee Hospital Association and BlueCross BlueShield of Tennessee teamed up to create the Tennessee Center for Patient Safety. This program provides ongoing training and support to eliminate infections and help keep patients across the state healthy and safe.

So everyone who provides care can provide it better. BlueCross BlueShield of Tennessee is for Tennessee. See how BlueCross is impacting your community at bcbst.com/impact A not-for-profit, Tennessee-based company.

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