Memphis Medical News July 2013

FOCUS TOPICS ADVANCED PRACTICE CLINICIANS RECRUITING ELECTRONIC HEALTH RECORDS

July 2013 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

Robert Riikola, MD ON ROUNDS

Ranks and Roles of Nurse Practitioners Accelerating With the Affordable Care Act pushing cost-effective healthcare and coinciding with a shortage of primary-care physicians, nurse practitioners are becoming more numerous ... 4

MEMPHIS on the MEND

BY PAMELA HARRIS

BGCM: This Club Can Be a Real Life Saver When you hear Vinny Borello tell his wife, “If you need me, I’ll be at the club,” visions of a sprawling neighborhood country club and golf course may pop into your head. ... 7

Electronic Health Records: How Far Have We Come?

By SUZANNE BOyD

Much progress has been made, but much work remains to be done, in getting healthcare providers to embrace electronic health records as a way to improve patient care.

Among those pushing hard for EHR adoption are the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technology (ONC).

The U.S. Department of Health and Human Services reported that as of the end of April, more than half of all doctors and other eligible providers had received incentive payments for adopting, implementing, upgrading or meaningfully using EHRs. More than 80 percent of eligible hospitals and critical access hospitals have demonstrated meaningful use. That equates to $14.6 billion in incentives having been paid to Medicare and Medicaid providers and hospitals.

According to data collected by the state of Tennessee, 3,197 eligible professionals and 127 eligible hospitals have received incentive payments totaling more than $78 million since the program began in January 2011.

A survey from CMS indicated that the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 has dramatically accelerated providers’ use of key health IT capabilities across the nation. Office-based physician use of e-prescribing has increased from less than 1 percent in 2006 to 53 percent in early 2013, with more than 94 percent of all pharmacies actively e-prescribing. Physicians are also exchanging information (CONTINUED ON PAGE 8)

HealthcareLeader

David Baytos, CEO Leading Methodist Olive Branch Hospital by exceeding expectations

By JUDy OTTO

Come August, a new hospital will open its doors in Olive Branch, Mississippi – one of the area’s most eagerly anticipated healthcare events in recent memory.

Besides its welcome presence, the distinctively different details that give it its unique signature are due in large part to the vision,

ONLINE: M.MEMPHIS MEDICAL NEWS.COM

Coming Soon!

persistence and commitment of CEO David Baytos. Far from merely standing by to take the helm of this trend-setting ship at its scheduled launch, an August 21 ribbon cutting, Baytos has been intimately involved in devising, drafting and detecting state-of-the-art solutions to maximize its service potential long before its timbers were ever hewed.

(CONTINUED ON PAGE 12)

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JULY 2013

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PhysicianSpotlight

Robert Riikola, MD

Mountain-climbing Pediatrician Gladly Keeps Feet Firmly Planted in Memphis

By RON COBB

He grew up in Oak Ridge, Tennessee, earned a bachelor’s degree from the University of Tennessee and then crossed the state to receive his medical degree from the University of Tennessee Health Science Center.

Since then, he has practiced pediatrics in Memphis for more than 40 years. Robert Riikola, MD, is a Tennessean through and through, and says he wouldn’t have it any other way.

“There is no question that if I had a redo, I’d stay right here in Memphis,” he said. “I’ve lived in Tennessee for all but two years of my life. My family and my wife’s family are all Tennesseans.

“I love my work here; my friends and family are here in Tennessee. I’ve pretty much been all over the world. The grass really is not greener elsewhere. You couldn’t pry me out of Memphis with a crowbar.”

Yes, Riikola is a dedicated Tennessean, but he hardly has been confined within the state boundaries. He has pursued two of his passions – mountain climbing and golf – around the globe. He has ascended the Himalayas and trekked with the legendary Sir Edmund Hillary. He has chased his golf ball around the sacred sod of St. Andrews in Scotland.

“I’ve seen scenery on top of some mountains that have brought tears to my eyes,” he said. “Life has been good.”

But at the core of it all is a dedication to pediatrics and children’s health. His association with Memphis Children’s Clinic began early in his career. The group recently celebrated its 60th anniversary.

“I’m proud of the development of our group,” Riikola said. “When I started there were five of us, and we had one office. Now we have 32 pediatricians and six offices and provide high-quality pediatric care to all segments of our community.

Additionally, we are active participants in training medical students and pediatric residents.

“It is a requirement,” he added, “that each of our pediatricians is smarter, better-looking and funnier than me.”

The doctor clearly has a sense of humor, so being funnier may be a tall order. He says his upbringing in Oak Ridge “may explain why I glow in the dark at night.”

His mother was a stay-at-home mom and later a schoolteacher. His father was head of operations of the Cyclotron at Oak Ridge National Laboratory.

“I had medicine in mind as early as high school but entered college as a pre-law student with a major in history – don’t ask me why,” he said. “In my junior year my mother, sister and brother were involved in a serious auto accident. The doctors who cared for them and pulled memphismedicalnews

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them through were nothing short of magnificent. I immediately changed my major.

“I actually started medical school with the thought of becoming a pediatrician. I loved children and admired my own pediatrician growing up. However, each rotation in medical school caused me to question my career choice. I decided to do a rotating internship, and after spending time in each of the major specialties, it became obvious to me that I was meant to be a pediatrician.”

When asked what inspires him on a daily basis, he says it’s the relationships he develops with patients and families over years.

“I probably shouldn’t admit it,” he said, “but on two occasions over the past year or so I have entered an examining room with a grandmother, mother and infant. On each occasion the grandmother said, ‘Dr. Riikola, you took care of me, my daughter and now you’re seeing my grandchild.’ That’s very nice, but I guess it means I’m getting old.”

When the subject turns to his greatest moments as a doctor, Riikola says, “There are many really neat moments on a daily

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basis. It may be nothing more than a smile of relief from a new mother whose concerns you have allayed or a hug from a 3-year-old that has forgiven you after having received a shot.”

As most doctors would, Riikola acknowledges the challenges of keeping up with changes in technology.

“There have been enormous changes,” he said. “Imaging advances have been nothing less than amazing with CTs and MRIs. Almost all subspecialties have shown remarkable advances. But with these changes the costs have risen dramatically. In spite of this, the relationships between patient or parent and pediatrician have pretty much remained constant.

“My goals for the future center pretty much around passing the torch to the younger members. Much of this has already been done. They are much more conversant with information technology, websites, etc. I am confident that our group is in good hands with these superb young leaders.”

At age 69, Riikola is in active practice 3 ½ days a week. But even with more free

time on his hands, his days as a mountain climber appear to be over. He started fairly late, around age 40, when he went on a trek to the Himalayas in Nepal at the urging of a friend.

“I loved it,” he said. “The next year I went back on a trek led by Sir Edmund Hillary, the first man along with Tenzig Norgay to climb Everest. There were six or seven climbers on the trek and they got me interested in climbing. I took several mountaineering courses and would take one major trip per year.

“I always went with a friend – usually Dr. Don Watson, a pediatric heart surgeon. We always took a skilled guide – we’re not totally stupid. We’ve climbed mountains in New Zealand, South America, Russia, Antarctica, the USA, Canada, the Alps. Pretty stupid endeavor, really, but mildly addictive.

“Last climb was three or four years ago – an ice climb in the Canadian Rockies. It was great, and I decided to stop on a high note – no pun intended. Now I’m too old, too fat and too lazy to continue. I play golf and still love it. Even an old, fat, lazy guy can do that.”

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Ranks and Roles of Nurse Practitioners Accelerating

By GINGER PORTER

With the Affordable Care Act pushing cost-effective healthcare and coinciding with a shortage of primary-care physicians, nurse practitioners are becoming more numerous.

Brett Snodgrass, MSN, APRN, FNP-BC and two-term president of the Greater Memphis Area Advanced Practice Nurses, believes the role of the nurse practitioner will be even more pivotal over the next few years.

“NPs will be the face of primary care,” she said. “We assess, diagnose and treat acute and chronic illness. We will still be working with a team approach, but more physicians will be going into specialties and be in a referral capacity.”

Changing reimbursement is also dovetailing with the expanded role of the nurse practiBrett tioner, Snodgrass said.

Snodgrass Primary care providers have been paid on a fee-for-service basis for years. Movement toward a quality-

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based payer system – in which a patient’s staying healthier means more reimbursement – is the correct fit, she said.

“The healthier I keep my patients, I will see more reimbursement. It goes perfectly with the NP philosophy of treating the whole patient instead of the disease process,” she continued. “Where a physician is trained in the disease process, the nurse is trained to focus on the whole patient – what can I do besides medicine to make this better? How can I give them lifestyle choices to aid in their health?

How does this challenge affect their family and that dynamic?”

A primary concern for nurse practitioners in Tennessee is designation as a “supervisory state,” meaning they have to have a supervising physician. Nineteen other states do not have this restriction.

In Tennessee, NPs can have their own offices and practice in their own settings, but they have to have a supervising physician available to answer questions and sign 10 percent of their charts.

What the physician is supervising is the nurse practitioners’ prescriptive authority, not overseeing their ability to order tests. The concern is the expense of paying the physician, which makes access to healthcare in rural areas a concern. If small towns can’t afford to pay a physician, then they can’t afford to pay a supervising physician and a nurse practitioner, Snodgrass said.

“It’s not going to change our role . . . we want to be a team with our physician counterparts. Changing the language in our governance will just allow better access to care. The team approach will never change, as physicians and nurse practitioners need each other,” she said.

Her role as a nurse practitioner activist is paramount for Snodgrass, who has

worked at the capitol in Nashville and in Washington, D.C., to communicate how NPs can best be used to the extent of their education. Calling for changes in legislation restricting practitioners, she goes armed with studies and white papers, speaking about patient satisfaction under the care of nurse practitioners and the quality of care rendered by NPs. Snodgrass was a hospital nurse for 10 years before returning to school to become a family nurse practitioner. She joked she ate her words when she said she would never be an NP because it was not fast-paced enough for her. She found she thrived on the hands-on approach and getting to know each patient better. These days she finds the pace invigorating.

She has had her NP practice within the offices of Clay Jackson, MD, in Atoka and Bartlett for eight years. Functioning as a preceptor there as well, she calls their sites “teaching offices” as nursing, nurse practitioner and physician assistant students from Union University, University of Memphis and University of AlabamaBirmingham rotate in and out. She also functions as a legal consultant, expert witness and lecturer, speaking at least once or twice a month on a speaker’s bureau for a (CONTINUED ON PAGE 9)

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Training APNs to Meet Coming Demand

By JUDY OTTO

The cliché is true, especially in the medical field: The only constant is change.

If you hope to have a career as an advanced practice nurse, it behooves you to remain fleet, alert and flexible — because things change quickly.

Education is evolving to keep pace as well, explains Patricia Cowan, PhD, RN. Cowan is associate dean of academic affairs at UTHSC (University of Tennessee Health Science Center) School of Nursing.

Early UT nurse practitioner certificate programs were available as 28-week continuing education programs; content and length of programs expanded when the school transitioned to the master’s program. In 1997 it began focusing on doctoral programs for nurse practitioners as well. In response to the national trend, in 2010 all UT APN programs became doctoral level, Cowan said.

“Our students now graduate with a doctor of nursing practice degree; last year we graduated 65 students from our DNP program, and this year we’re going to admit over 100 new students into that program.”

As program registration increases, six faculty positions are being added for the DNP program. “One of the impetuses for that is the start of the pediatric nurse practitioner program — that is new for us,” Cowan said.

Why the sudden significant growth?

Susan Patton, DNSc, APN, PNP-BC, forensics, pediatrics and neonatal nurse practitioner option coordinator, points out that the need for more primary-care providers is not new.

“Increasingly you find that medical doctors are going into specialties and less into primary care. But overall there’s just an increased need for primary-care providers — including MDs, DOs, APNs and PAs. There are certain specialties that are tremendously in need, and we are responding to the call from our own community and statewide for specialty care, including the inpatient and acute care practitioner.”

The UTHSC doctoral program uniquely reflects that need, offering options leading to specialties such as adult gerontology acute care, family care, mental health, neonatal care, anesthesiology and pediatric care.

Patton points out that there are five neonatal intensive care units in Memphis alone, with similar large neonatal ICUs across the state, including Chattanooga and Knoxville — all of which have 24-hour-aday staffing needs. “We are answering the appeal statewide and will have the only public university neonatal nurse practitioner program in Tennessee, Arkansas and Mississippi,” Patton said.

“The technology is increasing so much,” Cowan said, “that an infant born at 24 weeks’ gestation is actually a patient that now is being resuscitated and given intensive care, where in the past that was just not true. The top technology is there now to take care of an ever broader group of patients.” memphismedicalnews

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In serving that need, the neonatal nurse practitioner is accepting a role once filled by medical residents, she adds.

Patton, who operates her own clinic, observes that APNs have also owned and operated their own practices for several decades, often in collaboration with other primary-care providers. This role is not a new one for APNs, but it may be evolving.

“With the Affordable Care Act, not only are nurse practitioners beginning to associate with hospitals and large practice organizations, but physicians groups are doing the same. I think we’re going to see relationships change because of the need for reimbursement agreement,” Patton said.

Cowan points out that the ACA will offer access to primary care to individuals who may seldom or never previously have seen medical providers, further fueling the increasing demand for nurse practitioners to deal with potentially complex medical cases.

The Institute of Medicine’s report on the future of nursing, released in 2010, emphasized the need for nurses to be allowed to practice to the full extent of their training and education. Cowan observes that UTHSC School of Nursing graduates have demonstrated their ability to lead patient care teams and operate their own practices, and Patton also expects that reimbursers will be looking at the things their programs emphasize: evaluation of practice, healthcare economics, health policy — all of which prepare doctor of nursing practice graduates to take leadership roles in primary care with regard to assuring quality and patient safety.

Cowan says their curriculum includes courses in business ethics and legalities associated with ownership, and students also learn how to develop business plans for their future practice.

Across the board, everyone in medicine is going to have to be a better businessperson, Patton agrees. “That’s one reason that the federal government, under increasing scrutiny to justify expenses to ensure that quality care is being given, continues to stipulate that the advance practice nurse will be a leader in providing service to programs such as Medicare and Medicaid.”

UTHSC’s unique program, which uses on-line education for didactic courses, also arranges clinical experiences accessible to students where they live — regionally or nationwide. It allows candidates who reside in rural and inner city areas — where the shortage of primary-care providers is most severe — to obtain a doctoral degree, become an APN and serve where they are most needed — at home, Cowan said.

The program continues to pioneer innovative techniques including simulation laboratories with standardized patients paid to provide feedback to students, and a recent $1 million grant provides inter-professional education between the Colleges of Nursing, Dentistry and Dental Hygiene. “(Such innovations) … make full use of all the technology in other colleges that we interface with in these experiences,” Patton said, “and that’s very cutting edge.”

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A HIPAA Compliant Physician Portal: it slices, it dices, and it even lets the dogs out in the morning. Well, it should with all the adjectives in this headline, shouldn’t it? But, in all seriousness, Health Information Exchanges (HIEs) promise to eliminate the back and forth between referring doctors, reduce unnecessary tests and improve patient care while practice professionals question the probability of a system working across the healthcare spectrum. We all know that new ways to exchange useful information can be challenging.

This is why the Pediatric Independent Practice Association (PIPA), (135 primary care pediatricians in the Greater Memphis Area) is facilitating discussions between physicians, disseminating information and alerts (such as letting the other physicians know that a supply of a certain vaccine is low in Memphis and there most likely will be a shortage) and communicating group purchasing discounts that have been secured, since they are a group purchasing organization.

Because of the current Health Reform environment and the different pieces of clinical integration, PIPA decided to build and phase into another application that will become a part of our Physician Portal. We went through much due-diligence and research and consulted with different technology experts during our decision making process. During discussions PIPA had with different resources, PIPA decided on internal venues. Since PIPA’s membership is exclusively general pediatricians, our organization can move faster in our development of the physician portal.

With 135 primary care physicians who practice independently, both small and large groups can communicate and build tools that will keep this group of pediatricians connected in order to share outcomes of PIPA initiatives such as asthma, obesity, type II diabetes and other diseases, behavioral issues and patient centered medical homes.

Collaborative work (don’t let the term “independent association” fool you) such as this has been going on for 10 years. PIPA started out as a insurance contracting entity focused on building toward more clinical integration – particularly with the amount of TennCare pediatric patients and now with a direction toward accountable health care.

Obviously, healthcare reform as it is now was not even part of our initial planning.

But, I guess unintentionally on our journey we have built an infrastructure which as positioned us very well. I love when unintentional consequences turn out positive instead of negative like most of them usually do.

As I mentioned a couple of articles ago, “Gallup continues to find that for more than 75 years, having a lot of money is rarely the solution to the big problems. Sometimes, in fact, the bigger the problem, the less expensive the

solution. What’s more expensive is trying to fix after-the-fact outcomes rather than creating the strategies that get at the behaviors and cause.

PIPA operates void of a discussions about what insurance company may be paying our members for a certain procedure and communicating that to another provider. The fact that physicians cannot discuss their fees with each other has been driven into our heads by our council, Denise Burke with Butler Snow at the full PIPA membership meetings.

What our physician members can do is discuss the costs that other groups are experiencing with a certain type of episode of care. We can discuss the cost of the resources we incur and what resources and protocols etc. Having these types of educational discussions with physicians PIPA has accentuated the benefit our members have in working with a group purchasing organization. Are the physicians receiving discounts which have been previously negotiated by the Group Purchasing Organization which we are a part? Keeping up with the costs of immunizations and other injectables is like trying to trade on a daily commodity exchange. The prices can vary so much.

Through the previous negotiations from the GPO, PIPA physicians usually get better prices and faster delivery.

We’ve chosen to focus on the following: Work toward medication adherence.

According to a number of publications, there are three reasons patients aren’t adherent.

• They don’t understand the importance • They are afraid of the side effects • They can’t afford it There are certain applications that are free or very low cost that we can put into our portal. To help address the unaffordability, there is an application called Lowest Meds. With this you can put in the medication name and your area code, and it will list the medication prices at which locations and sort them by lowest price.

As most of you that read my article know, I have almost 20 years experience in healthcare, and I have never worked with a group of physicians and their staff (and I have worked or consulted with physicians all over the country) who are always looking to do the right thing and collaborate and work as ladies and gentlemen, like PIPA physicians do.

As you can imagine, we wanted be sure about who we chose to be our technology/solutions partner. We wanted to feel comfortable with them and wanted them to be a strong local company with experience and staying power. One of our major criteria was this partner knew the medical community, so there would not be a learning curve, (CONTINUED ON PAGE 10)

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BGCM: This Club Can Be a Real Life Saver MEMPHIS on the MEND

BY PAMELA HARRIS

When you hear Vinny Borello tell his wife, “If you need me, I’ll be at the club,” visions of a sprawling neighborhood country club and golf course may pop into your head. But Borello’s wife knows better. She realizes that he’s talking about one of the seven local branches of the Boys & Girls Club of Greater Memphis (BGCM.) After all, where else would Borello be? At age 50, he’s a proud, card-carrying BGC member and has been since he was six years old. The day I met him, Borello pulled from his wallet two of the original cards that got him into his neighborhood club in Utica, New York, where he grew up. He tells a story of being only four years old when his older brother, Peter, was first able to go to the BGC that was literally located across the street from his childhood home. “It was painful,” said Borello as he describes the time when he watched his brother go, yearning to go there himself. Finally on his sixth birthday, Vinny Borello entered a BGC for the first time.

Borello doesn’t really need a card to get into a club these days. That’s because with the help of a couple of very special

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BGC mentors, he turned his childhood love into a career. At age 11, he won “Boy of the Year” and his prize was a $25 savings bond and a job working in the coat room. At 16, he was promoted to gym director and was sent to New York City headquarters for training, thus becoming the youngest Unit Director at the BGC. Eventually, Borello ended up working at the National Headquarters of BGC in Washington, DC, where he worked for 11 years until the position of President/CEO of the BGC of Greater Memphis opened up. A true BGC success story, Borello hopes to help cultivate a whole new generation of BGCM success stories from some of our youngest Memphians who need the safety, structure and guidance that BGCM has to offer.

BGCM not only offers young Memphians a fun and safe place to spend their summers and after school hours, but also a place where they can get a meal, learn something, gain confidence and grow into responsible adults. They serve approximately 4,000 young members each year.

The membership fee is only $10 a year.

No child is ever turned away, so if they don’t have the money, they can work at the club to pay for the fee.

What Impact is BGC Making?

The facts tell the story. BGCM has six different clubs throughout Memphis, plus a 24,000-square-foot Technology Training Center (for ages 16-21) with three main training focuses: Culinary, Logistics and Automotive Care. For the past two years, 100 percent of young adults in this program have either entered college or found employment. All the clubs offer five core development programs: Character and Leadership, Education and Career, Health and Life Skills, The Arts and Sports, Fitness and Recreation. In addition, they learn career training, job hunting skills, financial planning and how to handle money.

More facts: • In 2012, BGCM graduated 100 per-

cent of its seniors, compared to Memphis City Schools’ average of 72 percent • 68 percent of its seniors attended college this fall on scholarship, eight enlisted in the armed forces • 100 percent of Technical Training Center graduates have been placed in jobs or higher education two years running • 81 percent experienced an increase in homework completion • 87 percent experienced a decrease in school absences • 50 percent experienced a decrease in teen pregnancy • 57 percent of alumni say that the Club saved their lives • In neighborhoods where there is a Boys & Girls Club present, there is a 25 percent reduction in the presence of crack cocaine, a 22 percent reduction in overall drug activity and a 13 percent reduction in juvenile crime

How Can You Help?

DONATE. Remember that I mentioned that member’s pay a low ten dollar fee to join? Well, the actual cost of each membership is $500, so with 4000 members, there is a little bit of a deficit to make up. The cost of training one student at the (CONTINUED ON PAGE 10)

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Electronic Health Records, continued from page 1

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much more often. Some 62 percent of physicians said they receive clinical results in their EHR system.

EHRs are also supposed to make practices more administratively efficient and therefore lower the cost of care. But on this measure the results are mixed. Only 57 percent of EHR adopters nationwide report that their systems have made their practices more efficient, and only 43 percent report that they have yielded a return on their technology investment.

“When done right, bringing an EHR into a practice can streamline workflow to make a practice more efficient. Efficiency doesn’t occur when a practice tries to make the EHR fit their paper record workflow,” said Amanda King, manager for the Direct Project, who also works for Qsource, a nonprofit healthcare quality improvement and information technology Amanda King consultant group headquartered in Tennessee. “Many practices end up doing more work to make this happen.”

While patients will ultimately benefit from improved practice-workflow efficiencies, a more direct advantage to patients is promised as part of a modernized, interconnected and improved system of care delivery, according to Dawn FitzGerald, Qsource’s CEO. “By putting in place EHR systems that meet Dawn rigorous functionality and FitzGerald ease-of-use standards, both providers and patients will reap tangible benefits in quality and affordability such as easy access to health records and data, reminders and alerts for providers and patients, and reductions in medical errors,” she said. “As we move forward with implementing the next Stage (2) of meaningful use, you’ll see a continued focus on increasing health information exchange between providers and care settings, but also a heightened level of patient engagement by giving patients secure online access to their digital records and health information.”

The Department of Health and Human Services has moved the start date for Stage 2 of the EHR meaningful use program from 2013 to 2014. As providers move into Stage 2, they will need to demonstrate they are effectively using electronic health records and securely sharing patients’ health information with other providers.

“There are a lot of initiatives coming up that impact hospitals and providers,” King said.

“I believe delaying Stage 2 until 2014 was a necessary step in order for providers and vendors to be prepared.”

The Direct Project, a nationwide effort by the Office of the National Coordinator of Health Information Technology (ONC), is designed to help providers meet Stage 2 requirements. The simple, affordable and secure technology known as Direct satisfies these requirements by allowing doctors access to various healthcare data sources and offering data exchange at transitions of care.

The Tennessee Office of eHealth Initiatives (OeHI) has adopted Direct protocols for secure messaging of health information.

The mission of the Tennessee OeHI is to facilitate improvements in Tennessee’s healthcare quality, safety, transparency, efficiency and cost effectiveness through statewide adoption and use of electronic health records (EHR) and health information exchange (HIE).

OeHI received grant funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to support the Direct Project and other projects to implement secure health information exchange. Through these stimulus funds, ARRA gives Tennessee the opportunity to advance the secure exchange of health information and to expand the adoption and meaningful use of EHRs and HIE. The project is spearheaded by the Tennessee Regional Extension Center, or tnREC, a division of Qsource. “Qsource works with providers to familiarize them with Direct technology, an email-like service that will be the infrastructure that facilitates secure health information exchange among trusted providers across Tennessee,” King said.

“Providers who register for a Direct email address can securely send and receive messages containing health information to each other. The project provides a way for healthcare providers to comply with federal requirements governing health information exchange.”

For eligible providers and hospitals that have not adopted an EHR or made meaningful use a priority, 2015 might bring a cut in Medicare reimbursements due to payment adjustments built into the EHR Incentive Programs.

“Starting in 2015, Medicare providers and hospitals will be subject to a payment adjustment for not meeting meaningful use by 2014,” King said. “The payment adjustment is 1 percent per year and is cumulative for every year that a provider is not a meaningful user. It could reach as high as 5 percent.”

The Tennessee, the OeHI website (www.tn.gov/ehealth) is a resource for hospitals and healthcare providers seeking to understand meaningful use criteria for EHR adoption and Health Information Exchange (HIE). The site can also direct stakeholders to resources that identify best practices for successful adoption, allowing them to receive Medicaid and Medicare incentives available under the act. It is also a resource for Tennessee consumers to increase awareness of the benefits of EHR adoption and HIE by the Tennessee hospitals and providers who serve them.

“Websites I recommend as excellent resources for understanding meaningful use and implementation are www.healthit. gov and www.cms.gov,” King said. “They have links to information on implementation timelines. It can get confusing looking at the graphs. The CMS website has a page that will walk the provider through their personal timeline to see where they should go next. It is an excellent tool, as it is per provider and not practice. Of course, if anyone needs assistance in understanding this information, tnREC can assist providers with meaningful use.” memphismedicalnews

.com

Hey Doc, Pay it Forward

By TIM NICHOLSON

Every Sunday night physicians from all over the globe gather online to participate in a community twitter chat. They use the hashtag “hcsm.” It stands for healthcare social media.

It’s like a speakeasy’s not so secret password used to connect the stream of tweets between the medical pros.

Mostly the conversation revolves around what should be shared, protecting patient confidentiality and which social platforms work best. But every few weeks the question of money comes up. Specifically, should doctors get paid for using social media?

The deft communicators work around the subject with carefully phrased tweets. It’s a little boring. So, I tried to imagine what the responses might be if the conversation was happening at a cocktail party and not online. I think it might go a

Ranks and Roles, continued from page 4 drug company. She also is doing a guest lecture series.

“I love to speak and teach – it is a passion. It keeps you current. It keeps you on your toes,” she said.

Snodgrass also loves technology, which she says enables her to juggle things.

She developed a blog in 2011 to answer common medical questions. Covering well over 50 topics, TheNPMom.wordpress. com has won the “100 Best of 2012 Nurse Practitioners, Online Nurse Practitioner Program,” as well as the “Top 30 Nursing Blogs of 2012, Best Nursing Masters” two years running.

The blog arose from her experiences with people stopping her with questions as soon as they found out she was a nurse practitioner. “It was also a thought I had, as I would leave the pediatrician’s office – ‘Oh, I forgot to ask this,’” she said. “So the motivation was I want to give you answers to the questions you always forget to ask whether it be for your kid, yourself or your spouse. It is not to be substituted for a real healthcare consult, but at least empower the patient with more information to ask educated questions or seek more help.”

She also uses printouts on blog topics to reinforce teaching with her patients.

She has some providers who use them with their clinics as well. Topics range from menopause and bioidentical hormones to heart disease and hair loss. The blog does not keep her as busy as it did in development, as the maintenance is just responding to inquiries and adding topics. She is going to add opportunities for people to guest post and looks to add advertising in the future as the readership grows. memphismedicalnews

.com

little like this: The early adopters like my friend Dr. Howard Luks might say, “I think we have a responsibility to be part of the conversation. All of us should be participating in some way. Ideally we should be making the stuff that starts conversation. At a minimum we should be contributing to the dialog.”

His friend who leads a successful OB/ GYN practice might answer, “But there are only so many hours in a day. Turning my ideas and experiences into tweets and posts takes time and energy that’s hard to work in between my clinic work, deliveries and family obligations. I don’t have time to whip up even the fifteen-second videos now seen on Instagram.”

“Oh, you two,” the communications person from the office noses in to say, “that kind of work is just part of maintaining a professional reputation. The marketplace belongs to whoever finds the time or resource to translate what they know and share it with others.”

Look, I believe that some providers should be paid to participate professionally. Maybe the big health systems and larger practices should dedicate staff to sharing, curating, talking and making content for social media. It would be more than a public relations move.

They’d be able to share their expertise in such a way they become a sort of resource for the smaller practices, patients and family members of those with chronic health concerns.

Sharing information that is helpful to others via social media and providing hands-on patient care should not be seen as mutually exclusive, but rather as complementary.

And so, as my imaginary cocktail party winds down, one physician might say to another, “Hey Doc, only you know whether or not a public presence is the best use of your time but people value our voice and wisdom. And whether or not there’s a billing code for it, until we can get paid, I say let’s pay it forward.” And the other would reply, “Let’s do.”

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

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Healthcare Economics, continued from page 6

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

Carmon Heilman, President of PCS Medical Solutions, (standing far right) discusses the development of a physician portal for PIPA.

since we planned to move fast. PIPA selected PCS Medical Solutions as our technology partner. Their 25 years in our community and their physician base had a lot to do in helping us reach our decision.

They have a very strong team and a breadth of talent, including Paul Cheek, who helped start up the Tennessee Regional Extension Center and other professionals who understand Electronic Health Interchanges and the importance of moving data which is compliant with privacy, security and HIPAA regulations.

Before any work was done, PIPA and PCS Medical Solutions sat down and discussed what we wanted to do, where to start, and looking at possible next areas we wanted this physician portal to do.

In his book, Managing Transitions, 3rd Edition, 2009, William Bridges says: “Transition is the gradual psychological process individuals and groups go through to reorient themselves so they can function and find meaning in a changed situation.

Change is emergence of a new

situation, likely made up of one or more external events.

Change and transition are dependent upon one another to make the change successful. As changes are implemented in organizations, it is often assumed that people will adjust to them. Experience suggests that the psychological process that changes initiate is more like distress and disruption than adjustment.”

Surely Mr. Bridges has heard of disruptive technologies.

Experience as discussed above sounds too academic and clinical. Let’s eliminate the work experience (we all know what that means) and get out of the neutral zone; that time where we are between what has been and what will be in the future.

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.

BGCM, continued from page 7 Tech Center is $1200 a year. In addition, Vice President of Resource Development and Marketing, Megan Klein explains that government grants have all but dried up and in the current economy, individual donations are down as well.

Plus, there are plans for new clubs and parks, picnic pavilions, a walk in cooler/ freezer for the Tech Center, a new minivan for transportation, and enhancements for Camp Phoenix, the BGCM summer camp that happens to be closed this summer as it is in need of repairs.

So with all that in mind and with BGCM celebrating its 50 year anniversary, they have embarked on a Capital Campaign in which they hope to raise 13 million dollars. And for the first $500,000 raised, they have a matching donor to help them reach the one million dollar mark!

Here are a few things your donations can do: $500 will sponsor one child at a club for a year $1200 = a one year scholarship to the BGCM Tech Training Center $5000 right now will get the BGCM a $10,000 donation toward their capital campaign – thanks to the matching donor. $10,000 matched by the angel donor gets the BGCM $20,000 for the capital 10

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JULY 2013

campaign.

PARTNER. Sponsor an established event or come up with your own idea for sponsorship. This is a way to get your medical practice or facility’s name associated with this fine organization. For more information on this, go to http://bgcm. org/ourpartners or call Megan Klein at 901-278-2947.

VOLUNTEER. Your time is a wonderful way to enrich the life of a child.

Let us count the ways you can volunteer: 1. Mentoring 2. Homework/Tutoring 3. Referees and Coaches 4. Arts and Crafts 5. Computer Lab Supervisors 6. Vocational Training 7. Fundraising Events 8. Meal Preparation Fill it out the volunteer application http://bgcm.org/assets/1689/volunteer_ application2.pdf and email to Charles Griffin at charlesg@bgcm.

For any other information about BGCM, see the website www.bgcm.org.

To nominate a non-profit or charity to be highlighted in Memphis on the Mend, contact Pamela Harris at pharris@medicalnewsinc.com.

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.com

Recruiting in an Era of Reform New Landscape Requires Different Leadership Skills

By CINDY SANDERS

As healthcare continues to transform and evolve, the skill sets needed to be an effective leader and provider are changing, too. From HIPAA and HITECH to the Affordable Care Act, the regulatory and reimbursement environments have impacted the recruiting process by demanding that physicians, nurses and management teams be able to provide the best outcomes in the most efficient manner possible.

“The hospital model is changing so those leaders don’t look the same anymore,” said Brian Kelley, a partner with The Buffkin Group, LLC. “You better have a deep bench,” he continued of the need to have an executive team with different areas of expertise.

Just as the ideal applicant is changing, the Brian Kelley most effective way to recruit that candidate is also undergoing a transformation.

“We’re doing a lot of things differently than we did five or six years ago,” noted Susan Masterson, national vice president of provider recruitment for TeamHealth. “The day of placing an ad and waiting for the right candidate to Susan appear is long gone.”

Masterson As for the true impact of health reform on job recruitment, the experts all agreed that has yet to fully play out. “We’re building the plane engine as we fly it,” Masterson said wryly.

So how are recruiting and management firms attracting and retaining the right people in a period of great transition, and what skills should candidates hone to answer new challenges posed by the nation’s complex healthcare system? Medical News asked a number of recruiters to share their insights.

Physicians

In addition to her national provider recruitment duties with TeamHealth, Masterson is a past board member and committee chair for the National Association of Physician Recruiters and a current committee member for the Association of Staff Physician Recruiters.

On the national front, she said the need for primary care physicians is anticipated to rise dramatically. Yet, she continued, only about a quarter of the applicants coming out of training are headed that direction. “We need more family practice and internal medicine physicians,” she said.

“The government is going to have to make more slots for internship and residency, and they’re going to have to incentivize physicians to be primary care doctors,” Masterson added of anticipated demand in the wake of ACA. “Regardless of the specialty,” she conmemphismedicalnews

.com

tinued, “I think there are different competencies for doctors that are a ‘must have’ today than (were necessary) years ago.” A focus on quality, prevention and evidencebased medicine were included on her list.

Masterson also noted the need to be comfortable with technology and said two of the biggest skills were to be team-oriented and effective in mentoring and working alongside advanced practice clinicians (APCs).

“Another thing I think we’ll see is there will be a lot of physicians that are in small, private practices that will choose to join larger companies or hospitals,” Masterson said. She added that her company is recruiting many physicians who are ready to hang up their shingle because of heavy workload, decreasing reimbursements, increased regulation and uncertainty over how healthcare reform will impact their practice. Another factor driving this trend, she added, is that the ‘new millennials’ (born between the early 1980s and 2000s) are very focused on a work-life balance and value personal time as much as career … which often translates into a willingness to be hospital employees rather than taking on the stress of owning their own practices.

In her own company, Masterson said they have taken a much more proactive strategy to recruit residents for their key focus areas of emergency medicine, anesthesiology, urgent care and the ‘ists’ — hospitalists, laborists, surgicalists.

TeamHealth has created a number of support services … from online resources to

shadowing opportunities to hosting discipline-specific boot camps … to help the young recruits settle into their new roles.

“We’re also signing many more APCs … probably three or four times more than we did just four or five years ago,” she noted of the increased demand for physician assistants, nurse practitioners, nurse anesthetists and other mid-level providers.

As demand increases for providers, it has become increasingly competitive to fill open spots. Locum tenens companies have been springing up, said Masterson. Where those temporary providers had been filling in for short periods during vacation or maternity leave, Masterson said it is increasingly common to see them in place for months at a time while the search continues for a permanent hire. TeamHealth has their own internal group known as Special Ops physicians to answer this need.

Hiring, however, is only one part of the puzzle. “It’s one thing to recruit the doctors, but then we have to retain them so there is a tremendous focus on retention,” Masterson said.

Advanced Practice Providers

MedPlacer, a national recruitment and operational process improvement firm, places healthcare providers and executives in a variety of positions. However, said Jeff E. McCracken, founder and managing director, the company’s core business is on emergency, surgical and cardiovascular service placement. “When we originally founded our company, we

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had a broader approach,” he noted. Over time, he continued, “We’ve really focused in more on a couple of key niche areas, and it’s really driven by the market.” McCracken added, “About 90 percent of the professionals we place have a nursing background of some sort.”

Jeff The company, he McCracken explained, has three main divisions — permanent nursing leadership recruitment, staff nursing recruitment, and interim departmental leadership. Although MedPlacer doesn’t always put an interim director on site, when the company does have a leader on the ground, that person helps clients assess operations, identify weaknesses, outline process improvements, set departmental objectives and align staff appropriately to achieve those goals.

McCracken said the strategy has been to not only glean the technical needs of a department but to understand the culture to recruit the right person. “The retention rate has been much higher because we’ve had an on-the-ground experience within the hospital,” he noted.

Like physicians, McCracken said nurses are now recruited nationally. As the housing market has improved, he has found an increased willingness among nurses to consider positions in other parts of the country. An area of rapid growth has been placing staff level nurses in de(CONTINUED ON PAGE 14)

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Healthcare Leader: David Baytos, CEO, continued from page 1 For the last four years, Baytos, a veteran of a number of healthcare facility design-andbuild triumphs, has been drawing on those experiences to build the best at Olive Branch Hospital — not just the best structure, but the MGMA’s best patient experience inside it.

Mission: To improve the His 15 years of developeffectiveness of ing clinical services and facilities medical group began with (then) Holy Cross practices and the knowledge Parkview Hospital in Plymouth, and skills of Indiana, and included the 2002 the individuals expansion of Methodist’s Gerwho manage/ lead them. mantown Hospital from 120 to 309 beds and enhancement of its cardiac and orthopedic services, as well as the 2010 addition UPCOMING LUNCHEONS of its Women’s and Children’s The new hospital’s spacious main lobby is one of the first in the nation to feature an adjustable ultraviolet light-controlling AND SPEAKERS: Pavilion. As CEO of Method- window system. ist’s Germantown Hospital, he also spearheaded the creation of the Germantown Outpatient Diagnostic the United States to be designed and • The congregational health network Imaging Center, the Germantown Outconstructed under the Integrated Project at Olive Branch Hospital is also the first TH patient Rehabilitation Center, the MethDelivery (IPD) system, which has recently of its kind to be developed prior to a faTim Finnell of odist Breast Center and the Methodist proved highly successful on industrial concility’s opening. By mid-June, the hospital Germantown Surgery Center. struction enterprises. It requires architect, had already established covenants with 40 CB Group Benefits Baytos’ credo — like that of Methodconstruction manager and owner to comchurches in northwest Mississippi to enist Le Bonheur — emphasizes the impormit to ensure the successful completion of courage continued community support of will be speaking on tance of community-centered healthcare, the facility on time and on budget. “Havpatients both during and following hospiHealthcare Reform and many of his efforts foster community ing everybody focused on the same goal talization — and the number was rapidly outreach, not just care within the four has been a wonderful process and a great expanding. walls of the hospital. But the unique enexperience for everybody,” Baytos said.

Meanwhile, the hospital will continue tries on a list of novel “firsts” make Olive • The first newly licensed hospital in to recruit physicians, although Baytos has RSVP: 761-0200 OR BLEE@MDMEMPHIS.ORG Branch Hospital a must-see stop on one’s Mississippi since 1983, Olive Branch Hoslargely resolved what he identified as one way to experiencing that care: pital will help fill a clearly defined need in of his major challenges, and has 80 per• The hospital is one of the first in the community, as Methodist Le Bonheur cent of his staff in place as of this writing.

Memphis hospitals currently serve 47,000 Recruitment was addressed with typical patients from Mississippi. efficiency: Methodist Le Bonheur held a • Olive Branch Hospital will be the job fair May 4; 903 applicants — most of first LEED (Leadership in Energy and whom were local — were screened and Environmental Design)-certified hospital about 500 were interviewed during that in Mississippi — and probably the third four-hour period. or fourth in the United States, Baytos A total of 1,300 applicants have been said. One of the reasons is his decision reviewed for 250 available positions, and to use a geothermal system for heating Baytos expects that by mid-July all posiand cooling the hospital, which will sigtions will be filled, with the full staff onnificantly reduce its energy costs. Its geo site by Aug. 12, preparing for the Aug. 21 field includes 200 wells, each drilled 3,300 ribbon-cutting and open house. feet deep, with 23 miles of piping through A native of northeast Ohio, Baytos which water courses instead of air, more is married with four children; his wife is efficiently transmitting the earth’s heat to a pediatric nurse and one son and a sonthe building’s interior, as needed. in-law are also working in the healthcare • In keeping with the hospital’s arena. (impressions and/or clicks) “green” commitment as well as its comHis lifelong interest in healthcare and munity-centered mission, the building is strong belief in service to the community LOCAL one of the first facilities in the nation to inare evident. “The delivery of healthcare is stall an adjustable ultraviolet light-controlone of those ways I can make a difference ling window system in its spacious lobby in the community in which I live, work and — an energy-saving system designed by raise my family — so this has been a very View Industries in Olive Branch. The rewarding experience for me,” he said. tint can be turned up to block heat during As an international healthcare conbright summer days and dialed down to sultant for Methodist, Baytos also served allow sunlight to warm the facility during as interim chief operating officer for Bothe winter. kamoso Hospital in Gaborone, Botswana, • Baytos has paid more than lip serfrom May 2010 to January 2011, assisting vice to the concept of patient and famwith the opening of the new 200-bed interIncrease web traffic Powerful branding opportunity ily-centered care. While other hospitals national hospital. nationally involve patients and families in His proudest accomplishment is that Any metro market in the U.S. regular meetings to help improve care and whatever facility he has guided, he has Preferred, certified brand-safe networks only comfort, “we’re the first hospital to have not only met but exceeded expectations in a family partners council in place prior providing healthcare services and bringing Retargeting, landing pages, SEM services available to the actual opening of the hospital,” he new clinical services to that community. said. “They helped in the design of the Along that road, Olive Branch Hospihospital, specifically in the unique designs tal is shaping up to be another outstanding of our patient rooms.” achievement.

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State Pharmacy Board Strengthens Oversight of Drug Compounding

By CINDY SANDERS

In the wake of another suspect drug case with reports of adverse patient events, the Tennessee Board of Pharmacy has announced actions to better assure the safe, sterile compounding of drugs by state-licensed entities.

The latest incident found officials with the Tennessee Department of Health (TDH) and other state and federal agencies working through the Memorial Day weekend to investigate problems with methylprednisolone acetate (MPA) products produced by Main Street Family Pharmacy, LLC, in Newbern, Tenn.

Reports of adverse events first surfaced in Illinois and North Carolina from patients who received injections of preservative-free MPA (80 mg/mL) after Dec. 6, 2012. By May 24, seven reports of illness had been logged with no report of meningitis or other life-threatening infection. The suspect MPA was shipped to physicians and clinics in 14 states. In Tennessee, seven facilities received the questionable drug — Quality Care, Jackson; Pinnacle Pain Management Clinic, Union City; Getwell Family Clinic, Jackson; Walker Pain Management Center, Jackson; First Choice Clinic, Dyersburg; Christian Care Clinic, Newbern: and Axis Medical Clinic, White House.

The Tennessee Board of Pharmacy first licensed Main Street Family Pharmacy in 1985, with a license as a manufacturer/wholesaler/distributor being added in 2010. State officials reported the staff of Main Street Family Pharmacy had fully cooperated with the investigation and launched a voluntary recall of all its sterile products even though no known adverse effects have occurred from any other

product. The pharmacy is currently on probation as a result of this investigation.

The new measures adopted by the Tennessee Board of Pharmacy collectively address the need for safe, effective medicines while preserving access for patients.

“The board is working cooperatively to identify solutions to improve safeguards for public health while not placing unnecessary barriers on sterile compounding pharmacies that would hamper production of much-needed drugs already in short supply,” said Charles E. “Buddy” Stephens, DPh, president of the Board of Pharmacy. “We believe our actions enhance existing safeguards and offer new steps to ensure safe and effective medications are there when needed.”

The board has taken action to: • Expedite suspension of sterile compounding by a pharmacy or manufacturer when a serious problem is discovered.

With cause, a sterile compounder’s license can be suspended jointly by an officer of the Board of Pharmacy, its authorized executive director, and the commissioner of the Tennessee Department of Health without having to wait for a full Board of Pharmacy meeting.

• Enhance oversight and regulation of drug manufacturing operations in the

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state. The license for manufacturers will be a separate category. Prior to this move, manufacturers were included in a combined classification with wholesalers and distributors.

• Work more closely with the U.S. Food and Drug Administration. The new requirements call for drug manufacturers in Tennessee to show proof their operations are registered with the FDA. • Add a sterile compounding registration to the regular pharmacy license, to the manufacturer license, and to the wholesaler/distributor license.

These initial actions are not expected to be the last. A workgroup from the Board of Pharmacy is collaborating with staff at the TDH to identify additional measures and improvements to address the manufacturing and distribution process. Items under consideration include more proac-

tive inspection with additional emphasis on critical reviews of maintenance and quality control records, interim self-assessment and applicable reporting by the licensed entities, and adoption of applicable U.S. Pharmacopeia Standards. Additionally, three more licensed pharmacists are being recruited by the Board of Pharmacy to serve as inspectors and another administrative staff person will be added to facilitate the new self-assessment and reporting responsibilities.

“It’s a great challenge to strike a thoughtful, protective balance between addressing the daily drug shortages faced by patients and healthcare providers across Tennessee with the absolute need to assure safety and Dr. John effectiveness in the com- Dreyzehner pounded product,” said TDH Commissioner John Dreyzehner, MD, MPH. “While we wish the current situation associated with a Tennessee pharmacy had not happened and that patients had not been affected, the actions taken by the board, along with legislation passed recently, are moving us forward in assuring the safety and availability of important medications.”

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RE InCharge HEALTHCA lending after joining Fifth ing national healthcare of healthcare banking.

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A Clint Adams CFO Ardent Health Services Suite 250 One Burton Hills Blvd., Nashville 37215 615.296.3000 ardenthealth.com

Dave Alexander, MD

in 2003, brings more Adams, who joined Ardent and healthcare experithan 20 years of accounting role for the health services ence to the lead financial was an audit senior mancompany. Previously, he where he managed large ager for Ernst & Young, engagements of multiple and medium-sized audit companies. He also SEC healthcare and technology Inc. and was an PathGroup served as controller for accountant for Deloitte. audit manager and staff of the Healthcare A CPA, Adams is a member Association.

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Robert Adams

Chairman & CEO National HealthCare Corp.

100 East Vine St. Murfreesboro 37130 615.890.2020 nhccare.com

President Alliance Tennessee Orthopaedic 301 21st Ave. N. Nashville 37203 615.329.6600 toa.com and hand surgery, Specializing in sports medicine of TOA. The board-certified Alexander is president who holds a certificate orthopaedic surgeon, in surgery of the hand, of added qualification from Vanderbilt, received his medical degree surgical and orthopaedic where he also completed was recognized residencies. Recently, Alexander ‘Top Doctors in Orthopaedic as one of the nation’s Medical, a healthcare Surgery’ by Castle Connolly former chairman of the is he research company. He Corporation.

Physicians board for Ortholink

Co-founder Mainland Morgan & Co. Floor 3100 West End Ave., 7th Nashville 37203 615.312.7118 After serving as managingMartin firm The director with private investmentMainland Morgan launched Companies, Andrews with interests in health& Co., a holding company and real estate, in care, information technology entrepreneurial vision, 2011. Recognized for his advisory services Andrews provides strategic in the healthcare to a variety of companiesindustries. In addition, technology and services for Care Team Connect, he serves on the boards Nashville Medify, SurgiChart and Ink, Shareable Andrews launched Capital Network. In 2007, ultimately sold to he a Data Advantage, which He began his career as The Martin Companies. healthcare attorney.

Nancy Anness

Don Alexander

for 35 years – 18 of them Adams has served NHC and five as president and as senior VP, 10 as COO of the board on Jan. CEO. He became chairman since Nov. 1, 2004. He CEO 1, 2009, and has been care experience, including has extensive long-term center administrator serving NHC as a healthcare 76company grew into a and regional VP as the 10,000 beds in 12 states. unit chain with almost

Sharon Adkins, MSN

Hal Andrews

RN

Executive Director Tennessee Nurses Association Suite 405 545 Mainstream Drive, Nashville 37228 615.254.0350 tnaonline.org

CEO Tennessee Medical Association 2301 21st Ave. S. Nashville 37212 615.385.2100 tnmed.org the Tennessee Medical Alexander has been with the organization as a Association since joining named to the top was field agent in 1973. He announced his intentions staff spot in 1995 but of 2012. The organization to retire before the end his successor. During his as has named Russ Miller the TMA, Alexander has nearly four decades with physician members on advocated on behalf of educational and practice a variety of legislative, the staff, he worked briefly issues. Prior to joining GA-TN Regional Health as a consultant for the Service in Chattanooga.

for the state’s Prior to assuming leadership in 2006, Adkins professional nursing organization at Vanderbilt, positions at held various leadership adjunct faculty position where she maintains an School of Nursing. She the Vanderbilt University in nursing from the holds a bachelor’s of science a master’s of science in University of Minnesota, from VUSN, and is a 1997 nursing administration Nurse Preparation Institute graduate of the Parish College of Nursing. at the Marquette University

Clifford Adlerz

President & COO Symbion Healthcare Suite 500 40 Burton Hills Blvd., Nashville 37215 615.234.5900 symbion.com

by Vanderbilt to 1n 1991, Anness was recruited Clinic. Four years start the Vine Hill Community Health to launch Thomas later, she joined Saint serve the poor. After 13 community clinics to director of the Saint years as the executive Centers, she moved into Thomas Family Health 2008. her current position in

Tom Anderson

Co-founder, Vice Chair Capella Healthcare Suite 200 501 Corporate Centre Drive, Franklin 37067 615.764.3000 capellahealth.com

Capella with Dan Slipkovich Anderson co-founded focus is on development. in April 2005. His current VP of acquisitions and Previously, he was senior Healthcare, where he development for Province involving 18 hospitals completed transactions to LifePoint. He began before Province was sold service with the Tenneshis career in 1975 in public see Division of State Audit.

of Symbion since its Adlerz has served as president and a board director since May 2002 and as COO he was COO of UniPhy, inception in 1999. Previously, clinics, independent an operator of multi-specialty related outpatient services. practice associations and VP of HCA Inc. and He also served as division with responsibility for the regional VP of HealthTrust, two states. in operations of 14 hospitals

VP of Advocacy and Outreach Saint Thomas Health Suite 800 102 Woodmont Blvd., Nashville 37205 615.284.7847 sths.com

Doug Andrews

Co-founder & President Lam-Andrews Advertising 1201 Eighth Ave. S. Nashville 37203 615.297.7717 lam-andrews.com

this healthcare Andrews, who co-founded is responsible for in 1991, communications firm operations and strategic business development, as the firm’s technology planning. He also serves of online marketing exdirector, applying a range maximize brand awareness pertise to help clients web-based tactics. and lead generation using

Doug Ardoin, Jr., MD CMO TriStar Health System Floor 110 Winners Circle, First Nashville 37203 615.886.4900 tristarhealth.com for the TriStar division Ardoin was named CMO came from New Orleans in November 2011. He same capacity for HCA’s where he served in the responsible for continual is Delta Division. Ardoin and patient safety outimprovement of clinical physician engagement comes, as well as greater of physician leadership and alignment in the areas across the diviand clinical variation reduction as physician-in-chief sion. Previously he served Healthcare System and in of Memorial Hermann Northwest Hospital CEO of Memorial Hermannboard-certified family the Houston. Prior to that, practice. physician was in private

Mark Awh, MD

Founder & President Radsource, LLC 200 8 Cadillac Drive, Suite Brentwood 37027 615.376.7500 radsource.us

resonance imaging, An authority on magnetic Radsource, a joint venture Awh was a founder of Partners International between United Surgical PLLC, in 2001. Awh and Imaging Specialists, management company, oversees the imaging ranging from interpretation which offers services centers. Prior to founding to developing imaging as director of MRI at Saint Radsource, Awh served president of one of the as Thomas Hospital and private practices. nation’s largest radiology

research at Centerstone, As director of clinical of nationally known Ayer works with a team on clinical trials focusing researchers managing older adult needs, schizophrenia, depression, and nicotine, conduct disorders, homelessness, abuse. He alcohol and methamphetamine analysis at behavior received a doctorate in and is a member of Western Michigan UniversityAssociation. the American Psychological

B Buddy Bacon CEO Meridian Surgical Partners 420 5141 Virginia Way, Suite Brentwood 37027 615.301.8140 meridiansurg.com

Shari Barkin, MD

Division Chief of General Pediatric Monroe Carell Jr. Children’s Hospital at Vanderbilt 2200 Children’s Way Nashville 37232 615.936.2425 childrenshospital.vanderbilt.org

also her post in 2006 and Barkin was named to professor. Her research serves as a pediatrics and preventing instances focuses on improving a She recently received of childhood obesity.

Grant to test for Tennessee State Implementation intervention program the effect of an obesity children.

Latino families with young

was CEO and CFO From 1996 to 2003, Bacon healthcare informalocal for Medifax-EDI Inc., a that was acquired by tion technology company Capital for $117 million.

Atlanta-based Crescent with Surgical Alliance Bacon then teamed up and Cathy Kowalski co-founders Kenny Hancock run Meridian, which now to assemble a team to in 12 states in manages 16 surgery centers partnership with physicians.

Ben Baker COO CareHere Suite 204 215 Jamestown Park Drive, Brentwood 37027 615.661.5680 carehere.com

of Precision Data Baker is the former president markets information which Management Systems, services. He is a certified technology consulting Six Sigma quality manmaster black belt in the

by General Electric. agement process pioneered healthcare clinics in 17 CareHere runs 90 on-site to about 160 people states. Its payroll has risen from 90 a year ago.

Medicine graduate, Balser A Vanderbilt School of an associate dean in as joined his alma mater chair of VUMC’s Depart1998 and was named three years later. In 2004, ment of Anesthesiology officer and led the he became the chief research into the top 10 in NIH moved the medical school Balser was named funding. In October 2008,for Health Affairs and associate vice chancellorthe School of Medicine of became the 11th dean Eight months later, he since its founding in 1875. the retirement of Harry took on the top job upon selected Balser as his Jacobson, MD, who hand closely with him for a successor and worked smooth transition.

Lee Barfield

memp

was named to oversee In December 2011, Barton including healthcare, specialized industries 2009. Previously, he was which he had led since co-head of the Nashville managing director and Robinson Humat healthcare group at SunTrust management positions phrey. He has also held National Bank.

CRC Equities and Third

for growing Bartholomew was responsible startup in 1991 to one Staffmark from a one-office He companies in America. of the largest staffing and focuses on its domestic of joined HCCA in 2009 Anesthesia, a provider division, including HCCA anesthesia services for certified registered nurse centers and hospitals; physician offices, surgical Tennessee-based NRS Healthcare, a Middle staffing; and HCCA provider of per diem medical He is a past chairman Clinical Research Staffing.Association. of the American Staffing

615.936.3030 medschool.vanderbilt.edu

Hea lt H car e

regions.com

President & CEO HCCA International 210 405 Duke Drive, Suite Franklin 37067 615.255.7187 hccaintl.com

Vice Chancellor for Health Affairs & Dean Vanderbilt University School of Medicine 1161 21st Ave. S. 37232 D-3300, MCN, Nashville

Member Bass Berry & Sims 2800 150 Third Ave. S., Suite Nashville 37201 615.742.6200 bassberry.com

Executive VP – Specialized Banking Industries Regions Bank 315 Deaderick St. Nashville 37201 615.770.4242

David Bartholomew

Jeff Balser, MD, PhD

Pro feS Sio nal

John Barton

and nurses in defended hospitals, doctorsHe has also counseled medical malpractice cases. hospital operational healthcare providers on fraud and abuse and issues, child abuse reporting,issues. other healthcare regulatory

new S

h is

Thomas Bartrum Shareholder Baker Donelson Bearman Caldwell & Berkowitz 800 211 Commerce St., Suite Nashville 37201 615.726.5641 bakerdonelson.com

areas Bartrum works in the A practicing attorney, and transactional law as of healthcare regulatory allegations. He has dewell as fraud and abuse to hospital-physician voted much of his practice collaborations and writes joint ventures and other of healthcare law. extensively on the subject

Samuel W. “Bo” Bartholomew III CEO PharmMD 200 5200 Maryland Way, Suite Brentwood 37027 615.346.0880 pharmmd.com

Matt Bassett

Senior Vice President Revive Public Relations 404 209 10th Ave. S., Suite Nashville 37203 615.742.7242 revivepr.com

PR firm, listed among The California healthcare nation, opened its in the the top 15 such firms 2011 and tapped Bassett, second office in March to oversee the new along with Kriste Goad, has more than 15 years Nashville location. Bassett Previously, he was of public policy experience. for dialysis service policy vice president of public that, Bassett served as to provider DaVita. Prior Cabinet of Health and chief of staff for Kentucky’sadvisor to Governor Family Services and senior and insurance policy.

Ernie Fletcher for health

PharmMD, Bartholomew Prior to helping launch of business development served as vice president Inc. He also served for Integration Management of Integration Ventures as managing partner of Integration LLC, a joint venture partner Bartholomew was associate Management. Earlier, Medical Center in administrator for Centennial administrator at HCA’s Nashville and associate Medical Center. He serves then-new StoneCrest the Minnie Pearl on multiple boards including Tennessee Center for Cancer Foundation and Bioethics and Culture.

Regina Bartlett CEO Center Hendersonville Medical Road 355 New Shackle Island Hendersonville 37075 615.338.1000 hendersonvillemedicalcenter.com is part of HCA’s Prior to joining HMC, which served as the chief TriStar network, Bartlett Pittsburg Hospital (now nursing officer for South and as several other Grandview Medical Centers), Parkridge Medical leadership positions with where she started her Center in Chattanooga, career with HCA in 1978.

Dale Batchelor, MD Executive VP & CMO Saint Thomas Hospital 4220 Harding Road Nashville 37205 615.222.2111 stthomas.org

was named CMO of Saint In May 2006, Batchelor has more than 20 years, he Thomas Hospital. For patients and physicians served the hospital, its physician executive, interim through roles of chief and and interim president chief operating officer 2006). Board-certified CEO (January 2005-May University Medical Cenand trained at Vanderbilt of Saint Thomas medical ter, Batchelor, a member ophthalmology in staff since 1986, has practiced Nashville since 1979.

Bill Bates, MD

Chairman & Founder digiChart Inc. 450 100 Winners Circle, Suite Brentwood 37027 615.777.2727 digichart.com

obstetrics and gynecology A clinical professor of Medical Center, Bates at Vanderbilt University HIT solutions and services to launched digiChart, an women’s health. Prior company in the field of of obstetrics and digiChart, he was a professor of the College of Medicine gynecology and dean

InChar WHO’S IN CHARGE? ge Karen Ahern

Senior VP, National Healthcare Fifth Third Bank 424 Church St. Nashville 37219 615.687.3115 53.com

In July 2011, Ahern stepped

4

Finance

into the role oversee-

David Ayer

Director of Clinical Research Institute Centerstone Research 280 44 Vantage Way, Suite Nashville 37228 615.463.6240 centerstoneresearch.org

law with Bass since 1978 Barfield has practiced litigation and healthcare and is a member of the the firm. He has of industry practice areas

NEWS // NASHVILLE MEDICAL 2012 // InCharge Healthcare

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nashvillemedicalnews.com

// 2012 NEWS // InCharge Healthcare NASHVILLE MEDICAL

Heal tHCa

re

2013 This December, the 2014 edition of InCharge Healthcare will answer that important question. mfs.13inch

arge.cvr.in

dd 1

12/6/12

In Memphis’ powerful healthcare industry, one constant is change. This is a city where thought leaders are always willing to make strategic moves ... not to keep pace with the latest trends ... but to set them.

2:39 PM

Keeping up with Memphis’ dynamic healthcare industry can be challenging, which is why this annual issue will be a resource readers turn to again and again. Make sure your message is seen by advertising in this important guide that has a 12-month shelf life.

For more information, contact: Pam Harris, 501.247.9189, pharris@medicalnewsinc.com

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SALES DEADLINE: November 15 CREATIVE DEADLINE: November 22

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partments to help alleviate dependence on travel nurses. He was quick to add that travel nurses play an important role in helping a facility staff up for seasonal peaks or to meet the needs of increased patient populations for short periods of time.

However, he added, hospitals ultimately want staff members who are engrained in their community.

Kipper Latham, RN, chief clinical officer for MedPlacer, is the person on the inside. “It helps the nurse understand that hospital before they pick up and move from Pittsburgh to Texas,” he said of being embedded in the hospital while assessing a department’s operations, staffing and processes.

Additionally, he spends his time learning about the area … schools, activities, the housing market, and quality of life … to best match a job candidate with both the hospital and community. He added finding the right match is more than just aligning skill sets. “You have to look not only on paper but also understand that professional’s long-range goals and motivation,” he said.

Like McCracken, Latham said travel nurses play an important role in staffing solutions but likened them to renters vs. owners. “Travelers are needed, but it’s not the same as if 80-90 percent of your nurses are part of the community,” he explained.

During a seven-month stint in the emergency department at a Texas hospital, Latham saw the number of travel nurses decrease from 25 to two, and the Press Ganey hospital scores rise from the bottom 25th percentile to the top 15 percent.

“Patient satisfaction scores went through the roof because now you had ownership in the community,” Latham noted.

As with physician recruitment, retention is a key to success. McCracken reiterated turnover not only hurts the bottom line, but it takes a heavy toll on key areas impacting quality and efficiency including morale, institutional knowledge, cultural sensitivity, and patient and employee satisfaction.

He added there is no crystal ball to know exactly how ACA will impact hospital staffing, but McCracken pointed out increased volumes are often seen in the Emergency Department first and then have a domino effect in other areas of operation. He said MedPlacer is working collaboratively with colleagues in other firms to try to prepare for increased demand.

“We’re continuing our strategic alliance with other recruitment companies nationally. That way we can scale appropriately,” he concluded.

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The Buffkin Group focuses primarily on placements at the C-suite level for service providers and end payers. The landscape … and the skills needed to successfully navigate the new terrain … are definitely changing.

“When you’re in the heat of your business, it’s sometimes difficult to take a strategic look at your executive team and ask, ‘Do we have the team in place to meet the regulatory demands that take place

in 2014?’” said Craig Buffkin, managing partner and founder of the firm.

For non-profit hospitals, he added, that could mean a shift in attention. Previously, these facilities were much more focused on outcomes than on cost factors.

Now, both must be equally weighed. “It’s put a lot of pressure on having a different type of leader in different parts of their organizations that didn’t exist five years ago because not only do they have to worry about outcomes but also on driving costs and efficiencies,” Buffkin said.

The new regulatory environment and shifts in reimbursement models have brought about some consolidation of acute care facilities and hospitals taking over physician practices. In the short run, said Buffkin, consolidation shrinks the leadership market. However, he continued, “In the long term, it typically increases the need as companies get bigger.”

In fact, he continued, “We’ve doubled the number of searches we’ve been completing on an annual basis in the last several years, and the majority of that demand has come from our healthcare clients because of regulatory pressures.”

Brian Kelley, a partner based in the firm’s Connecticut office, added the complex delivery and regulatory environment has made it nearly impossible for one person to have all the skills necessary to meet the hospital’s or practice’s needs.

Three areas he identified as ‘critical in any management setting’ are knowledge and experience of healthcare services, profit and loss expertise to understand reimbursement challenges and a robust understanding of IT from both a quality and efficiency perspective.

“You have to have a team … it’s not one person,” he said. “For one person to have all three of those skill sets is few and far between.” That, however, has opened the door for others to break into healthcare. In hospitals, Kelley said, “The old world was to build from within … not so much anymore. They are willing to recruit from outside the hospital’s four walls,” he continued, noting this is particularly true in terms of technology positions.

Buffkin added it has also opened a greater need for marketing professionals … both to draw patients and to reach healthcare professionals as demand begins to exceed supply. “We work with academic medical centers, and one of the areas we’re seeing an increase is in chief marketing officers. They are increasing their marketing departments as they try to attract more applicants to medical school and nursing school to meet the rising demand.”

On the flip side, the push for quality has also opened the door for more physicians to take on leadership roles. Kelley said he is seeing more doctors return to school to get a graduate degree in business.

Ultimately, he noted, you have to look at the leadership in place at any given facility and fill in the gaps.

“We all are seeing more candidates who are taking the time to be better educated,” he added. “Healthcare has a lot of complexities, and I think people are preparing themselves better for the changes.” memphismedicalnews

.com

Skin Cancer Treatment Advancement

Non-surgical alternative for treatment of NMSC eliminates scarring, better choice for older patients

By LYNNE JETER

Terri Hayes Henson, MD, was aware of the underutilization of superficial radiation therapy (SRT), a non-invasive alternative treatment for non-melanoma skin cancer (NMSC) approved by the FDA in 2007. After thoroughly discussing the new modality with Mohs surgeons across the country, the dermatologist from Southaven, Miss., invested roughly $230,000 for the mobile device and room preparation expenses and began offering the modality on June 7.

“Lack of awareness is the only reason why it hasn’t been widely introduced,” said Henson, the first dermatologist to offer SRT in a tri-state area.

“Dermatologists in general have a knee-jerk reaction to surgery. But SRT is making a resurgence because there’s a need for this optional treatment.”

Nationwide, targeted photon therapy is a favorable NMSC treatment option, thanks to improved technology and treatment protocols that allow treatment to be done on an outpatient basis for patients who are considered suboptimal candidates for surgical procedures.

“The improved therapeutic modality gives us a lot of flexibility and versatility in the treatment and management of non-melanoma skin cancers,” dermatologist David Kent, MD, told members of the American Academy of Dermatology (AAD) at its recent annual meeting.

“Until recently, all the radiation therapy treatment was 30 to 40 years old, without the production of newer machines or any new research and development performed. The quality of the older machines became somewhat dated and devices became temperamental, requiring effort to perform radiation treatments.”

Older SRT systems once used for treating various types of cancer conditions require long set-up procedures and larger space, and are challenged with costly maintenance and lack of parts availability.

With the development of newer, safer and more efficient radiation machines that undergo rigorous annual inspections by state departments of health, along with dosimetry of the doses made much simpler with total fraction tables, targeted photon therapy is much easier to administer. An important note: The equipment emits less radiation than a dental x-ray.

“One of the benefits of radiation therapy is that we can concurrently treat multiple lesions in one sitting,” said Kent, memphismedicalnews

an instructor in the Department of Internal Medicine at Mercer University School of Medicine in Macon, Ga. Henson, founder of The Dermatology Clinic of North Mississippi PLLC, said the investment represents “a good ROI” because “if I brought a Mohs surgeon into my practice, it would cost a lot more.” She refers patients requiring Mohs surgery to Mohs surgeons in Memphis.

The SRT process, a less expensive alternative to Mohs micrographic surgery, takes about two minutes per treatment in

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a series of 5-12 sessions on an outpatient basis in Henson’s office. It’s adaptable to nonambulatory patients in wheelchairs; their head may be immobilized with foam blocks.

It’s also a good option for patients taking blood-thinning medication.

Henson was quick to caution that SRT, made by a Boca Raton, Fla.-based company that sold 60 units in 24 months worldwide, “isn’t for everybody.”

“The ideal patient is 65 or older,” she explained.

“There’s a risk down the line – a delayed reaction 25 to 30 years later – of dyschromia, a disorder of pigmentation in the irradiated field.”

Every case must be individualized, said Henson.

“In certain situations, for example a 60-year-old who doesn’t want to face surgery, as long as they’re aware of the risks, I’d do it,” she said.

Most insurance providers – and Medicare – approve the procedure.

“Some insurers might require prior authorization,” she said. “But it’ll be less costly than the alternative, which is Mohs micrographic surgery. It’s simply another modality to treat these common malignancies.”

In cases where patients have tumors with aggressive histologic growth features, such as often seen in morpheaform basal cell carcinoma, Mohs surgery may be a better treatment option.

“For select patients and tumors, targeted photon therapy is an excellent

option to consider,” said Kent. “In my experience, the new and improved radiation therapy technology offers us a viable, cost effective and cosmetically attractive treatment option for nonmelanoma skin cancers, and is a wonderful addition in our armamentarium.”

Henson’s interest in dermatology was sparked after 1995 AAD president Rex Amonette, MD, FAAD, founder of the Memphis Dermatology Clinic and the tri-state area’s inaugural Mohs surgeon, talked to pre-med honors students at the University of Memphis. By the time she completed a rotation in dermatology during her elective fourth year at the University of Tennessee Health Science Center (UTHSC) College of Medicine in 1993, Henson was hooked.

However, to get into the very competitive field, Henson worked hard to graduate third in her class. She completed her dermatology residency at UTHSC. “I liked the lifestyle opportunity that comes with dermatology, though I’m on call often since we’re the only dermatology clinic to do hospital consults with Baptist (Memorial Hospital) DeSoto,” said Henson, who has a nurse practitioner and physician assistant on staff.

With research showing one in five people will develop skin cancer, and the massive baby boomer generation morphing into senior status, Henson runs a very busy practice.

“I’m thrilled to offer SRT,” she said.

“It won’t replace surgery by any means, but it’s a good non-invasive option for my patients who don’t want surgery. It’s a painless, wonderful treatment with excellent cure rates (98 percent effective) and cosmetic outcomes.”

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GrandRounds Board Announcements Trezevant recently announced the addition of three new members to its board of directors including Dr. James Calandruccio, an orthopedic surgeon at Campbell Clinic; Merilyn Mangum, CAO and executive vice president of Peabody Hotel Dr. James Calandruccio Group; and Deborah Schadt, Ph.D. Trezevant is a continuing care retirement community in the heart of Memphis, located at 177 North Highland. Trezevant Merilyn has recently completed Mangum a $120 million renovation and expansion project which signifies Trezevant’s effort to consistently provide world-class service to current and future residents while continuing to Dr. Deborah be an anchor in the comSchadt munity.

West Clinic Receives Asco’s Quality Oncology Practice Initiative (QOPI®) Recognition For High Quality Cancer Care The West Clinic, a world-class center of excellence in oncology, hematology, radiology, and other advanced cancer care, announced today that it has been recognized by the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI® Certification Program provides a three-year certification for outpatient hematology-oncology practices that meet the highest standards for quality cancer care.

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According to Lee S. Schwartzberg, MD, FACP, Medical Director, one of the most important recognitions of quality in cancer care is ASCO’s QOPI certification. West Clinic was one of the original sixteen practices approved for this three years ago, and they are very pleased to have been recertified for this initiative which now includes a broader set of quality standards. By participating in QOPI certification and other organizational performance projects, they are in a mode of continuous quality improvement for cancer care.

QOPI is a voluntary, self-assessment and improvement program launched by ASCO in 2006 to help hematology-oncology and medical oncology practices assess the quality of the care they provide to patients. Quality metrics are assessed in a broad array of areas including documentation; communication; delivery of chemotherapy; appropriateness of drug selection; attention to supportive care; patient-related outcomes, survivorship, and end of life issues. Additional core quality standards evaluated are: treatment planning, staff training and education, patient consent and education; and monitoring and assessment of patient well-being.

Methodist Le Bonheur Healthcare Signs Agreement with HealthTrust to Provide Total Cost Management Solutions Methodist Le Bonheur Healthcare and HealthTrust announced a new multiyear relationship that began in March.

HealthTrust, a business unit of Parallon Business Solutions, a leading provider of healthcare business and operational services, was selected for its total cost management solutions including immediate contract value, custom sourcing expertise and progressive supply chain solutions.

Under the terms of the agreement, HealthTrust is partnering with Methodist Le Bonheur Healthcare to help it achieve its cost savings goals across its seven-hospital system in the Midsouth, comprising six adult hospitals and a children’s hospital.

Chris McLean, CFO Methodist Le Bonheur Healthcare said they were looking for a partner with unique shared services expertise and selected HealthTrust for its contract value, clinical operations experience, value analysis capabilities and proven track record in driving custom contracting results for large IDNs.

John S. Thomas, MD, Joins Semmes-Murphey Clinic John S. Thomas, MD, Neurologist, has joined Semmes-Murphey Clinic in Memphis. His areas of interest include neuromuscular diseases, movement disorders, sleep disorders, and clinical neurophysiology.

Dr. Thomas graduDr. John S. Thomas ated from the University of Miami in Coral Gables, FL in 1991. While

attending the University of Miami, his interest in neuroscience began and he took an opportunity as a research assistant at the Miami Project to Cure Paralysis before starting medical school. Dr. Thomas then attended Emory Medical School in Atlanta, followed by an internship and neurology residency at the University of Virginia.

He sought additional training by returning to Emory to complete a clinical neurophysiology fellowship, which he completed in 2000. Dr. Thomas remained in the Atlanta area practicing clinical neurology until 2013 when he moved to Memphis to join Semmes-Murphey.

Baptist Breaks Ground for Cancer Center Officials at Baptist Memorial Health Care broke ground in June for an $84.8 million, 153,211-square-foot cancer center near the main campus in East Memphis. The facility is scheduled to open in mid-2015.

The Baptist Cancer Center will offer diagnostics, radiation oncology, chemotherapy and infusion services, Cyberknife, stem cell transplants and supportive services and survivorship care all under one roof. The facility will also have integrated electronic health records developed by Epic Systems.

Jason Little, executive vice president and chief operating ofDr. Stephen Edge speaks to those gathered at the June 10th groundbreaking. ficer of Baptist Memorial Health Care, said the Cancer Center will be the first of its kind in the area and will focus on delivering integrated care from start to finish across the Baptist system. The center will bring together cancer providers in all medical disciplines.

According to data from the Memphis chapter of the American Cancer Society, 35,610 new cancer cases were diagnosed in Tennessee in 2012, a figure that is expected to grow in the next few years.

Stephen Edge, MD, currently the medical director of the Breast Center at the Roswell Park Cancer Institute in Buffalo, N.Y., will be the cancer center’s medical director.

During the groundbreaking ceremony he said he hopes to study new ways to effectively and affordably deliver cancer care through Baptist Memorial’s partnership with Vanderbilt University.

Second Largest Kidney Swap in History Begins at the Methodist University Hospital Transplant Institute According to the National Kidney Registry, the successful completion of Chain 221, the second largest kidney swap in history and the largest swap to be concluded in under forty days began with an altruistic donation at Methodist University Hospital Transplant Institute

by Shelby County Commissioner and law professor Steven Mulroy. Chain 221 involved 56 participants and 19 transplant centers.

The Methodist University Hospital Transplant Institute operates in partnership with the University of Tennessee Health Science Center.

The speed of chain 221 illustrates the enormous progress that’s been made Kidney donor and Shelby County Commissioner Steve Mulroy (center) is flanked by two of his physicians James D. Eason, M.D., FACS, medical director of the with respect to process im- Methodist/University of Tennessee Transplant Institute and Luis Campos, M.D., provements that radically transplant surgeon. This photo was taken at a press conference held two days after Mulroy’s transplant to encourage others to donate a kidney altruistically. shorten setup times for large swaps, reducing the time patients wait for a kidney transplant. Whereas last year’s record-setting swap took six months to complete, chain 221 took only five weeks to finish. Large swaps also increase the ability to find matches for the most highly sensitized patients who have exceptionally high antibody levels that react to foreign tissue. Sensitized patients Chain 221 facilitated transplants for 10 patients who were extremely hard to match. memphismedicalnews

.com

GrandRounds CFI Prosthetics Orthotics Adds Practitioner Certified Prosthetist Orthotist Harold Calkins recently joined CFI Prosthetics Orthotics’ clinical staff.

Calkins has been a practitioner since 1972 and will bring his in-depth patient care experience and his skills in relationship building and community out- Harold Calkins reach to the company.

His philosophy of patient care is that the most effective outcomes are the result of treatment that includes teaming with the entire rehab team and the patient and patient’s family.

skills and making further contributions to his department in Osijek, plans to continue the pursuit of his PhD. In addition to publishing papers, perhaps one day Dr. Muzevic will be teaching and mentoring other neurosurgeons. This training for future generations in neurosurgery is something that would have received the highest approval of Dr. Raphael Eustace Semmes (1885-1982) founder of the Semmes-Murphey Clinic, over 100 years ago.

Neurosurgeon from Croatia trains for a month in Memphis Over 5,000 miles away, in Osijek, Croatia, the future practice of neurosurgery will be affected by training that happens here through a cooperative program of the Semmes-Murphey Clinic, the University of Tennessee Department of Neurosurgery and with the Dr. Dario Muzevic Osijek University Hospital Center, Department of Neurosurgery.

Dr. Dario Muzevic is the seventh neurosurgeon from overseas over the past five years that was involved in the Semmes-Murphey International Neurosurgical Fellowship Program, who has been given the opportunity to travel to the Memphis area and observe the techniques and technology used at the Semmes-Murphey Clinic as well as Le Bonheur Children’s Hospital and Baptist Memorial Hospital-Memphis. Under the watchful eye of Dr. Kenan Arnautovic, for his one month fellowship here, Dr. Muzevic has been able to observe procedures conducted by Dr. Frederick Boop, Dr. Clarence B. Watridge, Dr. Arnautovic and others.

Some of these more complex cranial and spinal surgical procedures are an addition to Dr. Muzevic’s training/experience, and not currently available in his country. New technologies, such Intraoperative Magnetic Resonance Imaging (MRI) were demonstrated. MRI is used to determine the success of a procedure before it is concluded, preserving optimum positioning for further work and avoiding the need to repeat the operation following a post-operative evaluation. Le Bonheur Children’s Hospital is one of just a few places in the USA where this technology currently exists.

Taking particular note of the Semmes-Murphey Clinic working schedule of 10-12 hours a day and the number of different and difficult surgeries performed there during a single day as well as the dedication to patient care, Dr. Muzevic was also impressed with the organization and leadership of the clinic.

With the impressive level of skill and technology he has seen during his time here, Dr. Muzevic, while honing his own

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GrandRounds Professor Robert W. Williams, PhD, at UTHSC Co-Authors Paper on Longevity Genetics Published in Nature Genetics research is offering a new clue to the mysteries of aging, thanks to a multidisciplinary team of scientists from Europe and the U.S.A. They have uncovered a new mechanism that contributes to aging and it’s located in the cell’s mitochondria. Mitochondria are the power generators of all cells in animals, converting glucose into a steady stream of ATP molecules – molecules that store and transport chemical energy within cells.

Robert W. Williams, PhD, is one of the co-authors of the recent manuscript titled, “Mitonuclear Protein Imbalance as a Conserved Longevity Mechanism.”

The paper appears in the May 23 edition of Nature, the international weekly journal of science. Dr. Williams is the UT-Oak

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Ridge National Laboratory Professor in the Department of Anatomy and Neurobiology at the University of Tennessee Health Science Center (UTHSC). To view the paper upon publication, visit: http:// www.nature.com/nature.

While differences in the environment are a crucial element in aging, genetics also plays a role. The international team of researchers uncovered a process in mitochondria that influences longevity using a combination of powerful methods. By knocking down specific genes, they stretched life span by up to 60 percent in a simple model organism — a worm called C. elegans. The work has not yet been linked directly to aging in humans, but the fundamental biology of mitochondria and their role in energy production are shared. More intense work is likely to highlight some of the key aging switches in cells.

Campbell Clinic Releases New Edition Of Textbook Used

By Orthopaedic Surgeons Worldwide Campbell Clinic recently released its internationally renowned, four-volume text entitled Campbell’s Operative Orthopaedics, 12th Edition, authored by Campbell Clinic physicians. The textbook has received rave reviews, including one from an independent audit conducted by Doody’s Review Service.

Reviewer Dr. Mark R. Hutchinson, an

orthopaedic surgeon from the University of Illinois at the Chicago College of Medicine, wrote that ultimately, comparing this new book to other books is not possible because Campbell’s truly stands alone in the market. The best exercise is not to compare it to other books, but rather to compare it to its previous editions.

This textbook, often referred to as “the Bible of orthopedic surgery,” is translated in seven languages and published by Elsevier.

Dr. Frederick Azar, chief of staff for Campbell Clinic said they are very proud of the 12th edition. He said the text is on nearly every orthopaedic physician’s bookshelf, further emphasizing the impact that Memphis medicine has on the nation and the world.

Those interested in purchasing a print copy of the book may do so through a variety of online retailers including Amazon.com, and the text is also available via a web version at ExpertConsult. The web version can be accessed using any device with internet capabilities including tablets and smart phones. In addition, Campbell Clinic has donated a copy for public use in the Memphis Public Library’s main branch.

Methodist South Hospital uses new system to treat PAD patients Methodist South Hospital is the first in Tennessee to use the recently FDA cleared Ocelot system by Avinger to help patients facing Peripheral Artery Disease (PAD), an unrecognized epidemic that affects between eight and 12 million adults in the U.S. and 30 million people globally. It is caused by a build-up of plaque in the arteries that blocks blood flow to the legs and feet.

The Ocelot catheter, supported by the Lightbox console, allows physicians to see from inside an artery during the actual procedure, using optical coherence tomography, or OCT. In the past, operators have had to rely solely on x-ray as well as touch and/or feel to guide catheters through complicated blockages. With Ocelot, physicians can more accurately navigate through CTOs thanks to the images from inside the artery.

Ocelot is the first-ever CTO crossing catheter that uses OCT technology to access exact regions of the peripheral vasculature where the blockages occur, while simultaneously providing physicians with visualization for real-time navigation during an intervention.

Because some blockages can become so severe and difficult to penetrate with traditional catheters, patients often resort to undergo extremely invasive bypass surgeries that result in even higher health risks and lengthy, painful recoveries.

This new System will help restore blood flow in completely blocked arteries in patients’ legs through a simple two-millimeter skin incision, helping to avoid amputation.

Additionally, it is a minimally invasive treatment designed to allow patients to leave the hospital within hours, and return to normal activities within a few days.

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When it comes to

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