Memphis Medical News February 2016

FOCUS TOPICS CARDIOLOGY • INTERVENTIONAL RADIOLOGY • HEALTHCARE LAW • HIT

February 2016 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

Dharmesh Patel, MD ON ROUNDS

Prevent, Protect, Improve Healthways Continues Expansion of Ornish Heart Disease Reversal Program When two wellness giants joined forces in 2013, the hope was that millions of people would benefit.

Nearly three years later, the partnership between Dean Ornish, MD, and global well-being improvement company Healthways continues to expand, bringing evidencebased lifestyle programming to ever-increasing numbers of individuals across the nation ... 4

More Memphis Area Liver Patients Receive Y-90 Treatment Therapy Isn’t a Cure But Slows Disease, Improves Quality of Life For the last couple decades, intra-arterial yttrium-90 radioembolization, or Y-90, treatment for liver cancer has been gaining ground in medical communities across the country ... 5

ONLINE: MEMPHIS MEDICAL NEWS.COM

MidSouth eHealth Alliance Turns Focus to Office-Based Physicians Goal: Bring More Doctors into Health Information Exchange

BY BETH SIMKANIN

After successfully committing most major Mid-South hospitals to its community health information exchange during the past eight years, the MidSouth eHealth Alliance (MSeHA) this year has begun expanding its initiative to office-based physicians in West Tennessee.

MSeHA, a non-profit initiative that provides the electronic exchange of health information across multiple platforms in the Mid-South, plans to integrate physicians into its health information exchange (HIE), which contains medical information for more than 1.5 million patients.

Currently, 16 area hospitals share a patient’s medical informa-

tion electronically through the MSeHA. The list of hospitals involved includes Baptist Memorial Health Care, Methodist Le Bonheur Healthcare, St. Francis Hospital, Regional One Health and St. Jude Children’s Research Hospital.

Already this year MSeHA has signed 16 office-based physicians to its HIE and plans to bring onboard an additional 50 practices and clinics by the end of 2016.

“We want to provide physicians with a solution where they can have immediate access to their patient’s medical information in one place without having to go to multiple sources to find out what happened to their pa(CONTINUED ON PAGE 6)

HealthcareLeader

From CPA to Corporate Strategist, Bill Griffin Guides Financial Evolution at BMHCC

BY JUDY OTTO

The opportunity to resolve problems from a variety of perspectives can be a major plus, as Bill Griffin, senior vice president and chief financial officer for Baptist Memorial Health Care Corporation, can testify.

He credits his promotion in January to the CFO’s chair not only to his 23 years of growth and advancement within the Baptist system, but also to his previous

professional experience in public accounting with Arthur Andersen and KPMG Peat Marwick, during which he served Baptist as a senior manager of its account for six years before accepting an invitation to join the organization.

“The mid-’80s is when Baptist started growing outside of the Memphis area,” Griffin said. As its KPMG CPA, he was involved in many of its acquisitions and/or expansions, doing financial due-diligence (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Cardiologist from England Likes the Heartbeat of Memphis

Dharmesh Patel Brings International Perspective to Stern Cardiovascular Foundation

BY RON COBB

His grandparents were from India. His parents were born in Africa. He was born and raised in London. His children were born in Memphis.

That’s four generations, four continents for Dharmesh Patel, MD, a cardiologist at Stern Cardiology Foundation. No one knows what the future may bring, but for now the doctor has roots firmly planted in a city that has been his home since 2004.

“I’ll be honest with you, I like Memphis,” Patel said. “I don’t have anything negative to say about it. It’s got the perks of being a city without the headaches of being a city, such as significant traffic. On the flip side, Memphis has been very good to me in terms of career. I like being here and I have no intention of moving.”

Patel came to Memphis originally because his wife, Purvisha, was doing her dermatology residency at UT Memphis.

She now is the owner and a staff physician at Advanced Dermatology & Skin Cancer Associates in Germantown and Olive Branch. They met in 1996 in Charlotte, North Carolina, at an annual convention of Patels from around the United States (Purvisha was also a Patel). They were married in 1999 and have a son, Kushal, 8, and a daughter, Amrita, 5.

Dharmesh recalls his youth in London as a humble beginning, sharing living quarters with another family as well as sharing a room with his parents. His father was born in Uganda, his mother in Kenya.

“Things weren’t easy at times,” Patel said.

His mother worked for 35 years in banking at Barclays. His father was an accountant. Eventually his father acquired two Indian restaurants that Patel said were among the most famous in London.

“Growing up I was spoiled on eating very good Indian food,” he said. “We had guests like Freddie Mercury, the royals, all kinds of people.”

His parents were able to send Patel to London’s exclusive Emanuel School, founded in 1594 by Anne Sackville, aka Lady Dacre, whose great-grandfather, William Boleyn, was an uncle of the ill-fated Anne Boleyn.

At Emanuel, Patel was a standout academically and athletically. He was a house captain, a prestigious assignment, and led Emanuel to the equivalent of a league championship. His main sports were rugby and cricket. In the summer after his final year at Emanuel, Patel went on a world rugby tour, playing in Fiji, Singapore, Australia and New Zealand.

Emanuel is coeducational now, but was all boys during Patel’s time there.

“I didn’t have too much exposure to girls until I went to university,” he said.

“Maybe that’s one of the reasons I didn’t do very well my first year. Until age 18 it memphismedicalnews

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Dr. Dharmesh Patel and his wife, Dr. Purvisha Patel, during their hike up Mount Kilimanjaro last summer.

was all academics and sports, and getting into medical school was a big achievement.

But that was when I started enjoying myself a bit more than I should have.”

He decided on a career in medicine at the urging of his father.

“I think I wanted to be a trader,” Patel said. “But my dad said you can always do business as a doctor, but you can’t be a doctor if you’re in business. I think in retrospect he was right.”

After medical school in London, Patel came to the United States for internship at the Medical Center of Delaware, for residency at the University of Virginia and for a cardiology fellowship at Penn State before arriving in Memphis. Working in America, he said, “was always a thought, but meeting my wife was the pivotal point.”

“I was living paycheck-to-paycheck on a resident’s salary and supporting both my wife and me at the time. Those were very humble times.”

His primary focus now as a cardiologist at Stern is prevention of heart disease.

“Forty percent of people feel great the day before they die,” he said. “So we have to have other measures that can help us identify patients who are at risk.”

Patel is excited about a new advancement in controlling cholesterol levels.

“It’s called PCSK9s,” he said. “This is the first time in cardiology that we’re giving an injectable form of a cholesterol-lowering medicine, and the results are quite staggering. I have patients whose cholesterol has not been controlled for literally decades, and now their cholesterols are being halved if not reduced by 60 percent. It will change the way we treat lipids.”

The challenge to live a healthy lifestyle is one that Patel says he faces on a daily basis.

“You try to lead by example, and that’s why I work out at least two or three times a week,” he said. “That’s the reason I did Kilimanjaro, because you can’t preach what you don’t practice. I have a healthy lifestyle, exercise, eat well and try to make a difference.”

Ascending Mount Kilimanjaro in Tanzania is such a daunting task, he and Purvi-

sha trained for a year before tackling it last summer with two colleagues.

“It’s challenging to the very last day,” he said. “It’s a 20,000-foot hike, the largest free-standing mountain in the world. I was just relieved that we could make it to the top because I can understand why about 25 percent of people don’t make it.”

Patel called the event “life-changing,” but then he was reminded of something that was far greater in significance and danger. It was the birth of daughter Amrita in 2010.

“She was born at 23 weeks, at 1.5 pounds,” he said. “My wife broke her water at the clap of a thunderstorm that awakened us both suddenly. She said ‘I think I have broken my water.’ There was a point where I nearly lost my wife and my daughter in that whole process when my wife had such high magnesium levels she could not breathe. My daughter was in the Baptist Neonatal ICU for three months, but now she is as strong and feisty as they get. But that was probably the most challenging, scariest time I’ve ever had.”

Among the many awards Patel has won, he counts being voted a “top cardiologist in DeSoto County” for two years in a row as his most satisfying, because the voting was done by patients.

“You go to work every day and I try to treat patients like family,” he said, “and for the patients to give you an award is the highest honor you can have.”

And now he has set himself another goal – to win a soccer game in 2016.

“I’m playing on a team and we’ve lost 15 matches in a row,” he said. “But we’re taking it seriously now – we’ve got a coach.

That’s high on my priority list.”

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Prevent, Protect, Improve

Healthways Continues Expansion of Ornish Heart Disease Reversal Program

BY CINDY SANDERS

When two wellness giants joined forces in 2013, the hope was that millions of people would benefit. Nearly three years later, the partnership between Dean Ornish, MD, and global wellbeing improvement company Healthways continues to expand, bringing evidence-based lifestyle programming to ever-increasing numbers of individuals across the nation.

Based in Franklin, Tenn., Healthways is a provider of well-being and health improvement solutions to nearly 68 million people on four continents. The company entered into an exclusive agreement with Ornish in July 2013 to operate and license his Lifestyle Management Programs, which included interventions addressing early-stage prostate cancer, type 2 diabetes, and heart disease.

A cornerstone of the partnership is Dr. Ornish’s Program for Reversing Heart Disease™ (Ornish Reversal Program), which is scientifically proven to not only treat … but also to reverse … the progression of heart disease through comprehensive lifestyle changes.

“What’s different about it is recogniz-

ing lifestyle is a viable treatment alternative for cardiac disease that can actually reverse the disease at its root cause,” said Robert Porter, managing director of the Ornish Reversal Program for Healthways.

He added integral parts of the program focus on diet and nutrition, ex- Robert Porter ercise, stress management and group support. “One of the unique things about the program is that it is offered to people in cohorts of eight to 15,” Porter said. “The reality is we are social animals.

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support and community in helping individuals make and sustain a behavior change.”

Each small group participates in 18 four-hour interactive sessions. In addition to learning new strategies and techniques from a staff leader, participants also use group time to share suggestions and practical solutions to incorporating new habits into daily ‘real’ life. During a session, the group might share a meal, practice yoga together, work on stress reduction exercises and learn how to choose wisely from restaurant menus. “They don’t just learn what they should do … they actually do it,” Porter said. “They’re actually living the program during those 18 sessions.”

He pointed out the support system functions in much the same way as having a workout buddy, mixing social interaction with a degree of accountability. “It’s a really powerful way to provide support, a bond and a covenant among the group that helps them build (program elements) into their new lifestyle,” he explained.

Porter added the bond is so strong that participants formed alumni groups to continue to foster encouragement and maintain interaction. The Ornish Reversal Program website (ornishspectrum. com) states 87.9 percent of participants continue to get together regularly after finishing the 72 hours of active programming. In fact, Porter noted, some of the participants from the early research studies, which go back decades, continue to keep in contact.

“Dr. Ornish, over 30 years, has done the most rigorous research you can imagine,” Porter said of the science behind the program. Starting with the notion that it’s easer to turn off the faucet than to mop up the floor, Ornish began formulating ideas about how to improve health while he was still in medical school. By 1978, Ornish and colleagues at the University of California, San Francisco showed heart disease could be reversed after only 30 days, as demonstrated by improved blood flow to the heart, in a pilot study that utilized the tenets of the Ornish program.

Based on nearly four decades of ongoing research, which has been widely published in peer-reviewed journals, the program was approved for Medicare reimbursement under the category of ‘Intensive Cardiac Rehabilitation’ beginning in 2011. In addition to nationwide reimbursement through Medicare, commercial payers in 17 states also cover the program for heart disease.

“As the evidence grows, as we gain experience, the science would seem to predict there is the possibility for this program to expand to a larger number of chronic diseases,” said Porter. He added a few payers have extended the criteria for coverage to include those with diabetes and early-stage prostate cancer.

The core program, however, is currently focused on heart disease. With the exception of congestive heart failure, which Porter said he hopes will be added in the near future, the program is approved under Medicare for the same diagnoses as traditional cardiac rehabilitation.

The six qualifying conditions are: • Acute myocardial infarction in the preceding 12 months, • Coronary Artery bypass surgery, • Current stable angina pectoris, • Heart valve repair or replacement, • Percutaneous transluminal coronary angioplasty or coronary stenting, and • Heart or heart-lung transplant.

A focus on lifestyle modification and prevention has increasingly become more mainstream in healthcare, but transforming the delivery system remains an ongoing challenge.

Phil Newbold, CEO of Beacon Health System in Indiana, which launched the program in August 2015, noted, “If you look at the mission and vision statements of most hospitals and health systems, the word ‘health’ is all over them … but if you look at where we spend our resources, about 99 percent goes to the medical side of things and very little actually focuses on health.

When we looked at the Ornish Reversal Program, we saw that it was the best way for us to really embrace health in a scientific way and better align ourselves with our mission of creating a healthier community.”

Echoing the sentiment, Porter said, “I think our whole healthcare system was built around passively waiting to treat people when they presented with a problem.

We’ve found that is unsustainable. It’s unsustainable financially, and we’re not optimizing the health status and qualify of life for people.” He continued, “The best way for us to promote health is to adopt a healthy lifestyle that prevents the onset of chronic disease.”

The Ornish Reversal Program is rapidly gaining a foothold in the medical community since rolling out nationally about 18 months ago. At the end of 2015, four new partner sites were announced in Texas, Florida, North Carolina and Virginia. At press time, Healthways had implemented the program in 22 sites across 14 states with two more programs in the process of being launched and numerous others in the discussion phase.

While Porter said it was too early to have hard financial figures in terms of savings to the health system, he noted early indicators have been impressive. “We’re certainly seeing incredibly solid clinical results,” he said. “Based on those clinical results, the predictive variables would indicate we expect to see solid results in other outcomes like readmissions and costs.”

Physician groups and hospitals interested in learning more about the program and research behind it should go online to ornishspectrum.com or call Healthways at 877-888-3091. memphismedicalnews

.com

More Memphis Area Liver Patients Receive Y-90 Treatment

Therapy Isn’t a Cure But Slows Disease, Improves Quality of Life

BY JAMES DOWD

For the last couple decades, intra-arterial yttrium-90 radioembolization, or Y-90, treatment for liver cancer has been gaining ground in medical communities across the country.

In use across Europe for many years, the therapy was introduced in the United States in 2000 and has been available in the Mid-South for several years.

In 2006, the Memphis Interventional Radiology Clinic (MIRC) opened an office at Baptist Memorial Hospital-DeSoto and in the years since the treatment has been offered to growing numbers of Memphis-area patients.

“There are more than 140,000 cases of metastatic colon cancer diagnosed in the United States every year, and many of the patients we see are those whose colon cancer has spread to the liver,” said Dr. Henry J. Dalsania, MD, an interventional radiologist at MIRC. “The Y-90 treatment is primarily for patients whose cancer can’t be treated through chemotherapy Dr. Henry J. Dalsania or surgery.”

The treatment option is becoming increasingly utilized because of educational efforts within the Baptist system, Dalsania explained. No longer considered an unproven or experimental treatment, Y-90 is becoming a more mainstream therapy for patients whose conditions aren’t appropriate for other therapies.

“The growth in our Y-90 therapy is directly related to our multidisciplinary approach and our collaborative efforts,” Dalsania said. “We have a great deal of communication between physicians to discuss all possible treatments for patients, and our interventional oncologists are skilled in determining a variety of treatment options that benefit our patients.”

In addition to the MIRC, which is affiliated with Baptist, Dalsania said other area medical facilities such as Methodist Le Bonheur Healthcare, St. Francis Hospital and West Clinic offer Y-90 treatments.

For many patients suffering from this type of liver cancer, surgery isn’t an option because tumors may be too large or numerous. The Y-90 treatment is less invasive, doesn’t generate many of the negative side effects often associated with chemotherapy, and typically is performed on an outpatient basis.

“This is a different kind of treatment memphismedicalnews

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because it isn’t curative, but instead it’s intended to slow the progression of the disease,” Dalsania said. “This treatment helps improve the quality of life.”

A 2011 report published by the Society of Interventional Radiology (SIR) deemed the treatment safe and effective.

“We knew that this unique interventional radiology treatment, done on an outpatient basis, which combines the radioactive isotope Y-90 into microspheres that deliver radiation directly to a tumor, was one of the best ways to give patients a treatment that doesn’t harm healthy cells,” Riad Salem, MD, said in the study.

Salem is a professor at Northwestern University. “Now we know that patients can actually tolerate much higher doses of radiation than previously thought, which provides results in patients progressing on standard chemotherapy. While patients aren’t cured, their lives are being extended with less down time and their quality of life is improving.”

A 2014 SIR study found the treatment is similarly beneficial for breast cancer patients whose cancer has spread to the liver. The results were remarkably effective.

The study examined Y-90 treatment results of 75 women with breast cancer liver metastases. The study found the treatment “provided disease stabilization in 98.5 percent of the women’s treated liver tumors.”

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Robert J. Lewandowski, MD, associate professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, explained the findings and promoted the therapy’s use.

“Although this is not a cure, Y-90 radioembolization can shrink liver tumors, relieve painful symptoms, improve the quality of life and potentially extend survival,” Lewandowski said in the report. “While patient selection is important, the therapy is not limited by tumor size, shape, location or number, and it can ease the severity of disease in patients who cannot be treated effectively with other approaches.”

While radioembolization is palliative rather than curative, some doctors are using it as a second line treatment in conjunction with chemotherapy, Dalsania said. The procedure takes one to two hours in the medical facility, followed by a

few hours of rest and recovery before the patient returns home.

During treatment, millions of microspheres of glass or resin beads filled with Y-90 are injected through a catheter from the groin into the liver artery leading to the tumor. The blood supply to cancer cells is blocked, and high doses of radiation target the tumor without damaging healthy tissue.

Common side effects include flu-like symptoms and body aches, spikes in temperature and fatigue.

Unlike chemotherapy, Y-90 does not typically cause nausea or hair loss.

Benefits of the treatment include the ability to direct higher doses of radiation at tumors and the nonsurgical, minimally invasive procedure. Risks include the chance of allergic reactions, infection and ulcers.

“We’re seeing some cases where Y-90 can shrink tumors to the point that surgery is an option,” Dalsania said. “This treatment is not a replacement for chemo or an alternative option, but it can sometimes assist with treatments to benefit patients without some adverse side effects.”

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MSeHA Turns Focus to Office-Based Physicians, continued from page 1 tient outside their four walls,” said Cameron Brackett, executive director for the MSeHA. “We want to streamline the point of care, avoid any duplication of tests, which lower costs, and provide the right information the physician needs on the patient at the right time.”

National trends show that many office-based physicians have adopted an electronic health record (EHR), which is the digital form of a patient’s medical information. According to the Office of the National Coordinator for Health and Information Technology in the U.S. Department of Health and Human Services, eight in 10 office-based physicians had adopted an EHR by the end of 2014.

These records can be uploaded into a HIE so physicians, hospitals and ambulatory clinics can access a patient’s health information and determine where the patient has been treated as well as exchange a baseline of pertinent patient information such as: • Immunizations • Allergies • Lab results • Medications • Admissions, discharge and transfer data • Progress reports • Cardiology and radiology reports • Discharge summaries Brackett says MSeHA’s relationship with the regional hospital systems gives them a solid foundation because most

“We want to streamline the point of care, avoid any duplication of tests, which lower costs, and provide the right information the physician needs on the patient at the right time.”

– Cameron Brackett

patients in the Mid-South visit one of the many regional hospitals in the area for treatment. Physicians who sign up can access a variety of up-to-date medical data on their patients through MSeHA’s HIE. In addition, Brackett says that by signing up local physicians, the exchange will create an added value across the board for all providers in the Mid-South.

“We expect the amount of information will improve drastically on patients,” Brackett said. “This will be more helpful for the provider. For instance, if a patient changes insurance companies and must see a physician affiliated with a new hospital system, the information will be in one place.”

Michael Cates, president of the Memphis Medical Society, a local professional membership organization representing Mid-South physicians in conjunction with the Tennessee Medical Association, agrees that this strategy can work for physicians.

“Physicians need more immediate access to a patient’s records, and it’s easier for them to access it in one place than to have to go through different channels,” he said. “An HIE works because there is no lapse in care and physicians access the patient information they need directly and quickly.”

Brackett says the key to getting physicians onboard is to learn how they access and share a patient’s medical information.

“Healthcare providers can get easily overwhelmed in managing their EHR,” he said. “Some don’t even have an EHR; they still store their medical records in paper files. It’s a complex issue, and each practice does things differently. Also, many practices do not have an IT staff, and the technology aspect of a HIE can seem daunting.

It’s our job to reduce the number of challenges to make it easy to connect them to the HIE and gain interoperability throughout the community.”

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MARCH 17: Doral Jacobsen, MBA, FACMPE, Senior Manager, DHG Healthcare: Financial Impact Countdown: CMS Value-Based Payment Modifiers and Quality and Resource Use Reports (QRURs) APRIL 21: Andrew Cates, Value Acquisition Fund, LLC, Memphis Rising: Exciting changes in our city MAY 19: Cato Johnson, SVP, Methodist Healthcare: Legislative Update

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According to Brackett, it is a twophased process. Phase one is connecting physicians to the data already in the system.

“When a physician signs an agreement with us, he or she is connected immediately,” Brackett said. “The physician doesn’t have to download software. They can log on to our secure website portal and see their patient’s medical information from outside the practice.”

Brackett says office-based practices do not have to have an EHR to participate in phase one.

“We don’t want to alienate practices,” he said. “The physician can print off the patient’s information and place it in a paper chart in the office. This cuts down on the extra time it would take calling or faxing a hospital for a patient’s medical information.”

For the practices that have adopted EHRs, they can upload portions of clinical information into the system as part of phase two. A hospital, clinic or physician’s office integrated in the HIE will be able to access and exchange the patient’s information.

Last year, MSeHA launched a new service within its HIE called admissions, discharge and transfer (ADT) alerting.

This direct messaging mechanism alerts participants when their patient is admitted to a hospital or discharged or transferred from a hospital.

“The physician can look up any lab results or discharge reports from the hospital or emergency room and schedule a follow-up visit for their patient the next day,” Brackett said.

According to Brackett, MSeHA’s expanding segments are local primary-care physicians, specialists, nursing homes and skilled nursing facilities.

Also, he says MSeHA’s HIE will work well for referral management, which will lower costs and improve efficiency over time.

“When a patient is referred to a specialist from his or her primary-care physician, the specialist can access a patient’s results right away,” Brackett said. “This will alleviate any tests from being duplicated. As the fee for value market grows, MSeHA will become even more significant in providing efficient quality of care.”

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From CPA to Corporate Strategist, Bill Griffin Guides BMHCC, continued from page 1 work on Oxford, New Albany and Booneville in Mississippi, and Blytheville and Osceola in Arkansas, as well as construction of the new DeSoto-Southaven facility. “Golden Triangle, to that date, was the largest acquisition I had worked on -- a 300-bed hospital and regional referral center in Columbus, Mississippi.”

Following that acquisition, he signed on in 1993 as chief financial officer for Baptist Memorial Hospital-Golden Triangle and served there for two years before being offered the job of CFO at the “big hospital” in Memphis — BMHC’s major downtown medical center, serving as part of a 1,900-bed dual campus tertiary center with Baptist East.

When their managed care division was formed, he served as the division’s CFO. In 2000, he became vice president of corporate finance and also served as corporate privacy and security officer before taking this most recent step to the senior vice presidency and the corporate CFO’s desk.

His path seems almost predestined, with regular advancements and new roles throughout the system leading inevitably to this conclusion — and now that he has arrived, Griffin has an acquired treasury of invaluable eyewitness and hands-on experience and successes to delve into, not to mention a deep understanding and commitment to the organization’s philosophy and policies.

“It’s been an interesting 29 years,” he

said, having been involved in the expansions of the Baptist East area, witnessing the historic closing and demolition of the big hospital, and supporting the formation of an integrated delivery system resulting from their aggressive acquisition of physician practices and development of that network.

There were nostalgic moments, as well: He recalls the aggressive plundering of the old hospital’s “Elvis Suite,” discovered during a final tour of the hospital before demolition: “Tiles off the floor, the thermostat off the wall, doorknobs, light switches, even the toilet seat was gone — and they started popping up on eBay!” In retrospect, the University of Mississippi graduate said the proudest accomplishments of his career are the length of his tenure with Baptist and his many accomplishments benefiting the BHMC system. He points to a recent “heavy focus” on centralization and standardization of different areas that have historically been handled in-hospital but are now centralized in the corporate center of the system: namely, coding for all 14 of the hospitals, clinical documentation and transcription functionality, as well as managed care finance (which models and manages payer contracts and all the terms associated with it).

“We’ve also centralized our supply chain, so that all of our contracting — for vendor contracting and capital purchases — is handled by teams of experts,” he said.

During this turbulent period, rocked

by vast changes ignited by the Affordable Care Act and the changes and challenges in reimbursement it has brought about, with shrinking revenue from Medicare and third-party payers, Griffin has also seen the dramatic transformation of his own job responsibilities.

“The CFO role in healthcare has changed a lot in recent years,” he said.

“It’s definitely become more of a strategic role, with strategic implications — to be able to work with the rest of the senior team. We have a strategic officer here, overseeing strategy for the organization, as well as our operations officer, and it’s definitely a team effort. We’re not just counting beans anymore.”

“Hospital systems are caught in a tough spot,” he added. “Continuing to grow and at the same time trying to manage revenue reductions and counteract them by trying to contain costs is a real balancing act.”

Griffin cites recent “very tough financial decisions” that had an impact on the system’s bond rating, dropping it slightly. He stresses that there’s nothing unhealthy about an “A-” rating, and points out that those decisions were hugely expensive but arrived at “very consciously — and with purpose.”

The roughly $250 million investment to establish its epic electronic health record (EHR) system — aggressively and successfully implemented — and its equally aggressive physician practice ac-

quisition strategy both helped to better position Baptist for dealing with the new directions healthcare is likely to take.

“While it certainly put a crimp on our financial performance for a bit,” Griffin said, “we’re starting to see improvements come back around. We’re in a very good position, looking forward, to be able to move and address issues as they arise.”

His “to-do” list of priorities is a long one, he admits, including restructuring and internal changes that will focus on the overall revenue cycle, explore ways to adapt lean accounting concepts to healthcare, exercise dedicated diligence in controlling costs, and enhance revenue through improved processes or innovative approaches.

He speaks optimistically of re-examining financial reporting, the budget process, closing the books, and communication overall.

“The biggest component is going to be just working strategically with the rest of the executive team as we plan things out going forward,” he said. “I think this young team is really going to come together. It’s starting to gel; I see nothing but good things for Baptist.”

A scholarship-winning musician, Griffin plays a variety of instruments, including guitar, piano, drums, banjo, mandolin and clarinet. He is married to his college sweetheart; their daughter attends Washington University Medical School in St. Louis.

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The 7th Character

CMS Clears Confusion Concerning New Feature in ICD-10-CM

BY LYNNE JETER

The tempo of physician practices has been disrupted since the Centers for Medicare & Medicaid Services (CMS) changed the International Classification of Diseases (ICD) code set from 9 to 10, effective Oct. 1, 2015.

But changing from using a 30-year-old coding system with a few thousand codes and few characters, to the expanded coding system with tens of thousands of codes containing up to 7 characters, has made the transition difficult.

Another stumbling block: the new 7th character.

“Yes, it’s confusing,” admitted optometrist Jeffrey P. Schultz, OD, of Asheville Eye Associates in Asheville, NC. “The 7th character isn’t always needed, but if the claim isn’t submitted correctly, it gets kicked back. We can’t afford that.”

Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), concurred with Schultz: “Codes for which a 7th character applies are invalid if the 7th character is missing.”

Bowman explained the 7th character is used in chapters concerning musculoskeletal, obstetrics, injuries, and external causes. The most common 7th characters are for initial encounter, subsequent encounter, and sequelae, Bowman noted.

“The 7th character for initial encounter is used as long as the patient is receiving active treatment for the condition,” said Bowman, citing these examples: surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or a different physician.

tus, regardless of same or different provider.

The 7th character for sequela is used for the residual effect or conditions that arise as a direct result of an acute condition, such as scar formation after a burn, said Leon-Chisen, noting other examples: traumatic arthritis following a previous gunshot wound; quadriplegia because of a spinal cord injury; auricular chondritis due to previous burns; and chronic respiratory failure following a drug overdose.

An Appropriate Application

Bowman traced the steps for the appropriate application of 7th Character use with a patient seen in the Emergency Department after falling down a flight of stairs.

“The patient was diagnosed with a displaced fracture of the medial malleolus of the right ankle,” she said. “In step 1, we look up the term in the alphabetic index: fracture, traumatic, ankle, medial malleolus (displaced) and we get code S82.5 DASH, with the DASH indicating that additional characters are needed, which we’ll find in the tabular list.”

In step 2, the code is verified in the tabular list.

“At S82 fracture of the lower leg, including ankle, there are a couple of notes to provide guidance,” Bowman pointed out.

“First, there’s a note stating that a fracture not indicated as displaced or nondisplaced should be coded to ‘displaced.’ Second, a fracture not indicated as open or closed should be coded to ‘closed.’ There’s also a note that instructs … the appropriate 7th

More Specifically …

Nelly Leon-Chisen, director of coding and classification for the American Hospital Association (AHA), explained the 7th character for subsequent encounters is assigned after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.

“For aftercare of injuries, the acute injury code with the appropriate 7th character for subsequent encounter should be assigned rather than the aftercare ‘Z’ codes, which are reserved for non-injury related conditions,” she explained. “Fracture malunions and nonunions are assigned the appropriate 7th character for subsequent encounter for malunion or nonunion, unless the patient delayed seeking fracture treatment.”

Leon-Chisen rattled off several examples where a 7th character for “subsequent encounter” would be applied: • Rehabilitation therapy encounters; • Cast or splint adjustment; • Dressing changes; • Suture removal; • Removal of external or internal fixation device; • Medication adjustment; • Follow-up x-rays to determine healing status of fracture; and • Follow-up visits to check healing stamemphismedicalnews

.com

character is to be added to all codes from category S82.”

In the next step, S82.5 fracture of medial malleolus “confirms that we’re in the right place,” said Bowman. “We selected S82.51 for displaced fracture of medial malleolus of right tibia. Depending on the code book used, there may be a symbol or figure to indicate that a placeholder character ‘x’ is needed before assigning the 7th character. In some code books, the publisher has already pre-populated the character ‘x.’ This is an initial encounter and the correct code assignment is S82.51xA.” Concurrently, the same patient was referred to an orthopedist for further evaluation and treatment. The same ICD-10-CM code is assigned since treatment remains active.

“When the same patient returns to the orthopedist for follow-up to assess the healing status, a malunion is diagnosed,” said Bowman. “Now the code has changed and we’re using the 7th character for subsequent encounter with malunion. Notice the 7th character is ‘P,’ rather than ‘D.’ Although ‘D’ is the most common 7th character for subsequent encounter, it’s not the only one.

Check the tabular list to determine which 7th character value is applicable as they may vary from category to category.”

Bowman noted that when the same patient was admitted for surgical treatment of the malunion, the code S82.51xP remains in effect.

“The only exception is in the case of delayed treatment … so the first presentation for care is a malunion or nonunion,” she explained.

Post-surgery, the same patient returns to the orthopedist for follow-up to assess the healing status.

“The 7th character for this visit is now changed to ‘D’ for subsequent encounter, closed fracture, routine healing, since the malunion is no longer present and the fracture is healing well,” Bowman emphasized.

“When the same patient has an outpatient physical therapy encounter, the same code with the 7th character of ‘D’ (S82.51xD) is assigned.”

Still Confused?

Coding questions may be submitted to Coding Clinic Advisor (see link below), a free service that used the same process for ICD-9-CM questions.

“Be sure to formulate an actual coding question and not just ask us to code your entire superbill or an entire record, validate your code assignment, or (ask) ‘what’s the code for XYZ?,’” cautioned Leon-Chisen. “We can only address specific coding problems submitted with supporting medical record documentation.

Along with your question, specify whether it refers to a certain setting – for example, skilled nursing facility, home health, or acute hospital inpatient. We cannot answer questions on payment or coverage issues, or on the general equivalence maps (GEMS).”

Leon-Chisen emphasized that the pro bono arm of the organization isn’t able to support requests for ICD-10-PCS coding advice related to hospital outpatient procedures, since ICD-10-PCS is the HIPAA standard for inpatient hospital procedure coding only.

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A COMMENTARY

Insure Tennessee Meeting Becomes One-Way Conversation last year voted against a plan to cover state residents in similar financial circumstances.

‘No’ votes by a bloc of Republicans on two Senate committees kept the Insure Tennessee proposal from getting to the Senate floor.

Whether the states decide to use it or not, federal money to expand Medicaid is available under the ACA. Insure Tennessee is Republican Gov. Bill Haslam’s proposed alternative to Medicaid expansion that would cover an estimated 280,000 uninsured residents who don’t qualify for TennCare, the state’s Medicaid program, and have incomes under 138 percent of the federal poverty level. About half of those uninsured residents work.

Morris is immersed in the “coverage gap.”

“Over 90 percent of the patients at Church Health Center are working and un-

BY PEGGY BURCH

Scott Morris, MD, thinks people’s ability to get healthcare shouldn’t have to depend on which side of the Mississippi River they live on.

“Why do people east of the Mississippi have less than those west of the Mississippi?” Morris, CEO of the Church Health Center, asked a group of about 75 people who had gathered at Baptist Memorial Hospital in January to talk about Insure Tennessee.

The answer depends on state lawmakers. On the west bank, the Arkansas legislature approved a plan to use funds provided under the Affordable Care Act to purchase health insurance for low-income residents on the government healthcare exchange.

More than 200,000 of those eligible signed up after the program began in 2014.

To the east, Tennessee lawmakers

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insured,” Morris said. “They’re in that position where they don’t qualify for anything.”

And there are 900 people on the waiting list to become CHC patients.

The forum at Baptist Hospital regarding Insure Tennessee had nearly 30 supporting hosts, including Shelby County Mayor Mark Luttrell, newly elected Memphis Mayor Jim Strickland, former county Mayor Jim Rout and CEOs of Baptist Memorial Health Care, Methodist Le Bonheur Healthcare and Regional One Health.

The audience heard from Cyril Chang, PhD, economics professor and director of the Methodist and Le Bonheur Center for Healthcare Economics, who said many of the 280,000 “Swiss cheese people” who fall through the holes of insurance coverage in Tennessee work in food service, construction, maintenance and transportation.

A page in his PowerPoint presentation said “Medicaid expansion would have brought an estimated $352 million of federal dollars to Shelby County between 2014 and 2016 at no extra cost to the state.” (The italics are Chang’s.)

According to academic estimates, Insure Tennessee would have brought more than $1 billion to the state each year and created 15,000 jobs.

Greater Memphis Chamber CEO Phil Trenary said a unanimous 120 members of the Chamber’s Chairman’s Circle support it.

But the speakers were preaching to the converted. The forum was designed to win over Republican state legislators who must approve Insure Tennessee. They weren’t there.

Rout, the Republican former mayor who’s now president and CEO of BankTennessee, invited seven members of

Shelby County’s Republican delegation to attend the forum. None did.

A Memphis Medical News reporter called the lawmakers to ask why they didn’t attend.

State Rep. Mark White said he supports Insure Tennessee but couldn’t get to the forum because he was having a tooth extracted at the time. Rep. Curry Todd didn’t return email or phone messages; an aide who answered the phone in his Nashville office said, “Not one of his constituents in Germantown and Collierville has called asking why he didn’t attend.”

Rep. Steve McManus didn’t reply to an email or phone calls. Rep. Jim Coley’s office aide said he didn’t go because of “health issues.” Rep. Ron Lollar wrote in an email that he had a previous appointment: “Sorry I couldn’t make it. Thanks for asking. Ron.” Sen. Mark Norris said via email that he had been contacted by two hosts but regretted because of a “prior commitment out of state.”

Sen. Brian Kelsey, an outspoken opponent of Insure Tennessee, had intended to go but had to work in his law office until midnight Jan. 7, according to an aide in his office.

As the legislature convened for its 2016 session, Lt. Gov. Ron Ramsey, speaker of the Senate, told the Times-News in Kingsport that Insure Tennessee wouldn’t be reconsidered during this legislative session since a new U.S. President is going to be elected in November and a new administration might change the healthcare program: “The timing is bad now,” Ramsey said.

Morris told the audience at Baptist about a patient he had seen at Church Health Center that day – a construction worker who needs a knee replacement and had been using duct tape to stabilize his knee.

“We have the ability to get his knee replaced,” Morris said. “We have a thousand doctors who volunteer with us, and as long as doctors volunteer, the hospitals provide facilities. Smith & Nephew will give us a knee. It’s a wonder to behold how this all works. But he (the patient) asked if he’d have to miss work if he had the surgery. He doesn’t get paid if he doesn’t work. What doesn’t exist is the means for him to pay his light bill in the winter if he doesn’t work.”

Morris, who’s also a minister, says Insure Tennessee makes sense financially “without question,” but he thinks it shouldn’t be an economic or political issue. “If we view this as a question of what is the morally right thing to do, it certainly changes the tenor of the conversation when that happens,” he said.

Based on attendance at the recent forum, it would have to be a one-sided conversation.

Peggy Burch has served as a former government and politics editor at The Commercial Appeal during a 35-year career as a reporter and editor at two major newspapers.

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GrandRounds UTHSC Executive Vice Chancellor Honored by Rainbow/PUSH Kennard Brown, JD, MPA, PhD, FACHE, executive vice chancellor and chief operations officer of the University of Tennessee Health Science Center, has been named the 2016 Rainbow/PUSH Coalition Dr. Kennard Memphis Health Care Brown Executive of the Year in recognition of his leadership and excellence in the healthcare arena.

The award was presented during the 47th annual Rainbow/Push Coalition Memphis Dr. Martin Luther King Jr. Celebration last month.

Joseph B. Kyles, president of Rainbow/PUSH Memphis, said Brown has made “huge and transformative changes in the landscape of healthcare and education” in Memphis. Kyles cited Brown’s continued efforts to help young people learn about opportunities for careers in healthcare and to have access to the education that will help them achieve.

Campbell Takes Reins of Memphis Medical Society Tommy J. Campbell, MD, an internist at Consolidated Medical Practices of Memphis, has been installed as the 139th president of the Memphis Medical Society, filling the position of outgoing president O. Lee Berkenstock, MD. Campbell was installed during the organization’s annual dinner last month.

Other officers for 2016 are: • president-elect – Phillip R. Langsdon MD, The Langsdon Clinic; • vice-president – Dr. Tommy J. Campbell Autry J. Parker, MD, Semmes-Murphey Clinic; • secretary – Andrew T. Watson, MD, Sutherland Cardiology Clinic; • treasurer – Sri I. Naidu, MD, MidSouth Ear, Nose & Throat.

New board members are: David L. Cannon, MD, Campbell Clinic; James E. Klemis, MD, The Stern Cardiovascular Foundation; Jimmie Mancell, MD, Methodist Le Bonheur Healthcare; Brian J. McKinnon, MD, Shea Ear Clinic; Christopher M. Pokabla, MD, Memphis Orthopaedic Group; and Lisa S. Usdan, MD, endocrinology – UT Methodist Physicians. Returning board members are Frederick A. Fiedler, MD.; Danielle H. Hassel, MD; and Justin Monroe, MD. Campbell, a native of Ruleville, Mississippi, received his medical degree from the University of Mississippi, Jackson in 1983. He did his residency in internal medicine at Baptist Memorial Hospital, Memphis. He is board certified by the American Board of Internal Medicine. Campbell has served as a delegate to the Tennessee Medical Association (TMA) since 2010.

Founded in 1876, the Memphis Medical Society, a professional membership organization for physicians, currently has 2,223 members.

UTHSC Associate Professors Receive Grant for Taste Sensory Research John Boughter, PhD, an associate professor in the University of Tennessee Health Science Center Department of Anatomy and Max Fletcher, PhD, assistant professor in the university’s Department of Anatomy and Neurobiology have received a $418,000 grant from the National Institute on Deafness and Other Communication Disorders.

The grant is part of the National Institutes of Health’s effort in taste sensory research.

The award, which will be distributed over two years, will support a project titled, “Taste Responses in Defined Cell Types in Gustatory Cortex.”

The study may help reveal how taste quality plays a crucial role when evaluating conditions such as obesity, diabetes, anorexia, hypertension and coronary artery disease. In this research, the focus will be on how taste quality is encoded in the gustatory cortex, an important area of the brain involved in ingestive decision making. The researchers use stateof-the-art imaging techniques to visualize the response of individual John Boughter (left) and Max Fletcher neurons to taste stimuli of different qualities.

“We will try to understand whether single cells respond to just one or multiple tastants,” said Boughter. “The location of these neurons in different cortical cell layers will be considered, and we will investigate taste responses in different cell types as well. Together, we anticipate that these approaches will allow for a new understanding of how the sense of taste is organized in the brain.”

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Physician Compensation: Key Focus in False Claims Act Enforcement

By Denise Burke and J. D. Thomas

The Department of Justice announced yet another multi-billion dollar recovery year from False Claims Act enforcement – totaling over $3.5 billion for FY 2015. Although lower than last year, this is the fourth year in the row that the Department has recovered more than $3.5 billion. Of that total, the majority, or $1.9 billion, came from the healthcare industry for claims related to allegedly unnecessary or inadequate care, kickbacks to providers to induce referrals, or overbilling for goods and services paid for by Medicare, Medicaid, or another federal healthcare program.

While these settlements and recoveries ran the gamut of the healthcare industry, hospitals were hit unusually hard regarding compensation to physicians. The most prominent resolutions this year involved the Stark law, with major settlements against Adventist Health System ($115 million); North Broward Hospital District ($69.5 million); and Columbus Regional Healthcare System ($25 million plus contingent payments up to an additional $10 million). The Department also resolved the long running Tuomey case for $75 million after prevailing at the Fourth Circuit. A careful review of these recent cases provides some insight into About the Authors: “red flags” that may prompt governmental scrutiny. For example, all of these cases involved physician compensation in excess of the 90th percentile and involved compensation greater than revenue from personally performed services. Most also contained compensation based on services performed by others, inflated RVUs or other fees not directly generated. Notably, all of the recent cases had independent fair market value analysis opinions, although most also included some indication of “shopping” for favorable opinions or other Denise Burke is a partner with Waller and focuses evidence that the valuations raised issues regardexclusively on healthcare ing high compensation. These cases are concerning investigations, regulatory because clearly there are cases where it is appropriand operational issues. ate to pay physicians more than is collected for their Denise is the current professional services, such as areas with high indigent chairman of the Tencare rates or where recruiting efforts have been unsuc- nessee Bar Association cessful. These cases, however, contain much guidance Health Law Section, ranked by Best Lawyers for hospitals and physicians as well as their legal and and featured in Memphis valuation advisors.

By the Department’s own admission, much of its False Claims Act enforcement is driven by whistleblower, or qui tam, lawsuits filed under the False Claims Act - and this year’s results were no exception. Whistleblower’s counsel have certainly taken note of these settlements, particularly some of the eye-popping resolutions against hospitals charged with Stark violations. As such, additional qui tam actions in these areas are likely, as is a continued focus by the Department. With the recent issuance of the “Yates Memorandum” by Deputy Attorney General Sally Quillian Yates demanding that, absent extraordinary circumstances, all settlements against corporations should include actions against the individuals responsible for the conduct, we can expect future investigations and settlements to focus on individuals, including physicians and hospital executives.

As such, attention to these issues, and documentation to support decisions, is more important than ever.

Waller is ranked as one of the ten largest healthcare law firms by Modern Healthcare, representing scores of physician practices and companies that own or operate approximately 450 hospitals and 150 ambulatory service centers.

Medical New’s InCharge magazine.

J.D. Thomas is a partner with Waller and a member of the Firm’s Healthcare Compliance and Government Enforcement Group. He represents and advises healthcare companies and providers with regard to myriad fraud and abuse issues including investigations and litigation involving the False Claims Act, Anti-Kick Statute and Stark law.

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GrandRounds 2016 LEGISLATIVE SESSION

Physicians Involved at Tennessee’s Capitol Hill (PITCH) Join physicians from across the state convening on Capitol Hill.

Tuesday, March 1, 2016 • 6:30 a.m. - bus will depart from the Medical Society • There is NO COST to attend and participate. (Lunch will be provided compliments of TMA.) • Non-physicians, spouses of physicians and practice managers are welcome to attend.

• Bus will depart from the Medical Society offices at 6:30 am.

• Return trip (leave Nashville) to Memphis will be at approximately 4:00 pm.

• If you are a physician, please WEAR YOUR WHITE COAT. ____YES, I will participate in the 2016 Physicians on the Hill. ____YES, I (we) will be riding the bus. ____NO, I will provide my own transportation The following individuals will be attending: 1._______________________________________________________________________ 2._______________________________________________________________________ 3._______________________________________________________________________ Practice Name ____________________________________________________________ Address __________________________ City ______________ State ____ Zip _________ Office Phone______________________ Email ___________________________________ or register online - www.tnmed.org Please send this form to: The Memphis Medical Society 1067 Cresthaven Road | Memphis, TN 38119 | 901.761.0200 phone | 901.761.2944 fax

UTHSC’s Lynda Wilmott Wins Grant to Study Alzheimer Disease and Dementia Lynda Wilmott, PhD, a postdoctoral fellow at the University of Tennessee Health Science Center (UTHSC), has received a $52,500 grant to explore proteins in the brain that play a key role in controlling the communication of nerve cells that are important for encoding and storing memories. The grant from the Glenn/AFAR Postdoctoral Fellowship Program for Translational Research on Aging will allow her to explore how changes in these proteins affect aging and Alzheimer’s disease.

Wilmott works in the laboratory of Catherine Dr. Lynda Wilmott Kaczorowski, PhD, assistant professor in the Department of Anatomy and Neurobiology in the College of Medicine at UTHSC. Her research will clarify the role Kcnh3, a protein coding gene, plays in memory function, neuro responsiveness and communication between areas of the brain that are involved in memory. At the onset of memory decline in Alzheimer’s disease, this protein has been shown to be enriched in the hippocampus, which is the structure in the brain that aids in encoding memories. The expectation of the study is that administering an antagonist drug will improve memory function, including neuron responsiveness and communication between brain areas.

“This project seeks to determine the role of Kcnh3 in memory formation and decline, and also test the efficacy of Kcnh3 modulators to prevent or reverse memory failure in Alzheimer’s disease,” said Dr. Wilmott.

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GrandRounds Hamilton Eye Institute’s Morales-Tirado Wins Research Grant

Donna Lanier Named Director for Methodist Hospice Residence

Vanessa Morales-Tirado, MS, PhD, assistant professor in the Hamilton Eye Institute at the University of Tennessee Health Science Center, is using her background in immunology to investigate diseases of the eye that lead to vision loss.

Dr. Vanessa She has received Morales-Tirado $50,000 from the Alcon Research Institute Young Investigator Grant program for research that focuses on a specific molecule in the retinal ganglion cells, which communicate visual signals from the eye to the brain.

Morales-Tirado hopes to provide insight into the survival and death of these cells, to identify potential drug targets in the cells for possible treatment, and to better understand how glaucoma affects them.

“Our results are expected to have a positive translational impact, as they will provide novel therapeutic targets in the treatment of glaucoma. We are very fortunate to have a collaborative team where researchers and physicians are working together to translate our findings,” said Morales-Tirado. “Glaucoma is the leading cause of irreversible blindness in the world.”

Methodist Hospice has named Donna Lanier, RN, BSN, as director for Methodist Hospice Residence. Lanier has extensive health care experience with over 35 years working in public and private hospital settings.

Throughout her career Donna Lanier she has focused on nursing and hospital administration.

Lanier will lead a team of about 70 associates and additional volunteers to care for hospice patients in the 30-bed Methodist Hospice Residence.

Previously, she worked for Delta Medical Center as Chief Nursing Officer, Quality,ED, OR, Infection Prevention.

Lanier earned a BSN from the University of Central Arkansas, Conway. She is a member of the National Association for Healthcare Quality and the American Nurses Association.

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Baptist Reaches Milestone in Electronic Health Record Adoption

Baptist Memorial Health Care has been recognized by the Healthcare Information and Management Systems Society, an organization focused on better health through information technology, for reaching “Stage 6” status on its Electronic Medical Record Adoption Model.

All 14 Baptist Memorial hospitals and 120 Baptist Medical Group clinics are using Epic, Baptist’s electronic health record system which was rolled out in phases beginning in January,2014, and has been branded as Baptist OneCare. Baptist joins just 26 Tennessee hospitals, 15 Mississippi hospitals, and 12 Arkansas hospitals in reaching Stage 6, the second highest level possible.

Among other accomplishments, achieving this status means Baptist: • Has almost fully automated/paperless medical records when implementing its information technology applications across most of the inpatient care settings • Is either starting to evaluate data for care delivery process improvements or has already documented significant improvements in this area • Is well positioned to provide data to key stakeholders, such as payers, the government, physicians, consumers, and employers, to support electronic health record environments and health information exchanges

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We are your chest pain center when seconds count.

Baptist is the only health care system in the Mid-South that offers the full spectrum of heart care, from noninvasive cardiology to adult heart transplants. And when seconds matter, we use technology that provides rapid diagnostics and treatment for our patients.

There’s only one smart choice when it comes to advanced care for your heart. Get better with Baptist.

memphis.baptistonline.org

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901-226-5000

Get Better.

FEBRUARY 2016

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15

Pioneers & Leaders for over

When your patient has a problem with pain, refer them to a specialist with the expertise to assist you. Your patient will see one of our physicians on every visit. We provide the most comprehensive services in the Mid-South including the most clinical experience treating pain, an on site ambulatory surgery center, and physical therapy department. Kit S. Mays, M.D. and Moacir Schnapp, M.D.: When the problem is pain,

we’re here to help.

Pioneers & eaders in nt L In PainPManagement e m e g a n a M ain 30 Years forYoevaerrs 30

We’re the only clinic CARF certified in the MidSouth since 1995 in outpatient pain rehab.

maysandschnapp.com 901-747-0040 55 Humphreys Center Drive, Ste 200, Memphis, Tennessee