FOCUS TOPICS SENIOR HEALTH RETIREMENT/SUCCESSION DERMATOLOGY
June 2013 December 2009 >> $5
PHYSICIAN SPOTLIGHT PAGE 3
Alan Levy, MD ON ROUNDS
MEMPHIS on the MEND BY PAMELA HARRIS
Creative Aging Midsouth Improving Quality of Life for Seniors with Music and the Arts Awakenings. It was a bestselling book. It was an Academy Award-nominated film ... 4
Patient Safety Takes Flight in Tennessee TCPS, LifeWings Partner to Implement TeamSTEPPS The Tennessee Center for Patient Safety (TCPS) recently announced a collaborative agreement with LifeWings Partners LLC ... 10
As Concerns Rise, Will More Doctors Retire Early? By JONATHAN DEVIN
Physicians are weighing their options for retirement in a pessimistic environment complicated by rising healthcare costs, legislation affecting Medicare, and overall healthcare reform. In Tennessee, not much is known yet about the possibility of changing trends in retirement. Nationally, however, medical media are reporting that cuts to Medicare reimbursement are having an effect on when doctors will plan to retire. Of course, this scenario has played out before. Gary M. Zelizer, director of government affairs for the Tennessee Medical Association, said that historically there is nothing new about doctors exploring retirement options when government-funded programs become uncertain. Zelizer said this has happened “about every time in the last 10 years that the SGR cuts hit the deadline. I imagine that some physicians threatened retirement in 1993 with the advent of (TennCare)
and the prospect of greatly reduced reimbursement.” As late as 2011, Tennessee physicians expressed concern over potential 8.5 percent cuts to TennCare reimbursements for mental health services, nursing homes, X-rays and dental services. Zelizer didn’t recall that a mass exodus of physicians ever occurred. While it is possible to find out how many physicians retired their licenses in any given year, the reasons for retirement are not recorded, Zelizer said, unless specific surveys are conducted. Zelizer did not know of any surveys regarding retirement in the wake of 2013 Medicare reimbursement cuts. In 2005, the Tennessee Medical Association gathered data on physicians’ feelings regarding reimbursement cuts and found that while 19 percent considered terminating participation in managed care organizations (MCOs), only 8 percent actually did, joined by .17 percent who terminated shortly before the survey.
HealthcareLeader
Bryan Ikerd Administrator, Trezevant Terrace De-Institutionalizing Assisted Living By JUDy OTTO
Notwithstanding the unpopular alternative, aging is a certainty we all face with varying degrees of trepidation; so it’s reassuring to find that administrator Bryan Ikerd is committed to delivering a warmer and more home-like level of efficient and secure care to residents at Trezevant Terrace, one of Memphis’ largest as-
ONLINE: M.MEMPHIS MEDICAL NEWS.COM
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sisted living facilities. And after the initial double take, it makes perfect sense that Ikerd’s background is in retail, where his customer service roots as assistant general manager for Macy’s prepared him to serve — not just by providing top-notch care, but by making customers and residents feel cared for. (CONTINUED ON PAGE 14)
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PhysicianSpotlight
Alan Levy, MD
Dermatologist’s career takes a U-turn at Silicon Valley By RON COBB
Many young people have set their sights on a career in medicine, only to change goals along the way because they didn’t have the right stuff, the costs were too high or the demands too severe. Dermatologist Alan Levy went the other way. He became a doctor after deciding his original career in high tech didn’t have the right stuff for him. Levy, whose Levy Dermatology opened in 2009 in Germantown, is a Memphis native who graduated from Duke University and took a job at Cisco Systems in San Jose, California. After three years in Silicon Valley, he decided a career change was in order. “The upside at the job was unlimited,” he said, “but I knew that the career before me was not a source of satisfaction. It took me 10 months to decide to leave Cisco. “I realized I wanted to have a direct impact on individuals’ lives. It hit me that medicine was what I wanted to do every day.” Levy had started some pre-med courses at Duke and now had to retake them as he prepared for the entrance exam at the University of Tennessee Health Science Center. “Several ulcers and one or two doubts later, I got my acceptance letter,” he said, “and I knew getting into medical school was my biggest accomplishment to that date.” He earned his degree in 2004, spent four years at UTHSC for dermatology residency and then a year at Vanderbilt University Medical Center, where he trained as a Fellow in Mohs Micrographic Surgery and Cutaneous Oncology. He now specializes in surgical, cosmetic and medical dermatology. Levy’s father is a physician (and his mother a retired teacher), but despite that ready-made counsel, it wasn’t until his third year of medical school that he decided on dermatology as a specialty. “I had great teachers,” he said. “I was like the grade schooler who looks up to the math teacher and therefore starts to get excited about math; I recognized the passion and intelligence of my mentors in dermatology and wanted to enjoy my work days as much as they seemed to enjoy theirs.” When asked how he liked Memphis while he was in med school, Levy said, “I couldn’t really say. I never saw the light of day!” But after the short stint at Vanderbilt, he was back in Memphis for good. memphismedicalnews
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“It’s a great medical community,” he said, “and a great place to practice. Also, my family and my wife’s family are here. We wanted to be close to home.” Levy and a fellow Duke grad, Goli Compoginis, are a two-doctor staff at Levy Dermatology, where treatments include Mohs micrographic surgery. As Levy explains, “Mohs surgery is a surgical procedure for skin cancer. It was developed by Frederick Mohs at the University of Wisconsin. It provides the most effective and advanced treatment for skin cancer and offers the highest success rate of all treatment modalities. “The Mohs surgeon can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed. The technique involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancerfree tissue is reached. “After fellowship training, the Mohs surgeon is specially equipped as a cancer surgeon, pathologist and reconstructive surgeon in one.”
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With a long career ahead, Levy, 39, hopes to “practice the best medicine I can, help people and learn something new every day.” That last part of that goal is hardly unattainable in a field as fluid as dermatology. “There is so much new research that is illuminating the vast influence on and integration of the skin with the rest of the body,” he said. “The skin is an amazing organ with regenerative, immunologic, neurologic and homeostatic properties. New information on the innate immunity of the skin reveals the incredible powers of the skin to heal. I see the outcomes of these properties daily with skin cancer and reconstructive surgery.” Whether the health of one’s skin is taken as seriously as it should is a matter for debate. But the fact that tanning salons remain popular suggests that part of the population at large is uninformed, in denial or willing to engage in risky behavior for the sake of appearance.
Levy says it is becoming clear that indoor tanning increases the risk of skin cancer. “There are national and international panels that have declared ultraviolet radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen,” he said. “I try to educate my patients on the dangers of indoor tanning and discuss the benefits of sun protective measures.” Levy’s hobbies include playing music, reading, fishing and spending time with his family. One of his shining moments in music occurred on Beale Street. “I played blues harmonica at B.B. King’s,” he said. “It was 11:30 on a Wednesday night, and five people were there, including my girlfriend – who is now my wife (Shira) – her friend, the bartender and two waitresses. But it still counts.” As for whether his four-year-old twin sons, Rex and Max, are going to continue the family tradition of practicing medicine, that remains to be seen. “At this time,” Levy said, “they are going to be a fireman and a garbage man.”
We can help guide your path. Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR. Through special funding, tnREC is offering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds. We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.
Apply online www.tnrec.org This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Office of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reflect ONC policy. 90RC0026/01 13.TREC.04.049
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Creative Aging Midsouth
Improving Quality of Life for Seniors with Music and the Arts MEMPHIS on the MEND
A participant at Page Robbins Adult Day Care Center enjoys a dance with a staff member.
BY PAMELA HARRIS
Awakenings. It was a best-selling book. It was an Academy Award-nominated film. It’s also a fairly common occurrence in many Memphis assisted-living centers. Of course, I’m not talking about druginduced awakenings portrayed in neurologist Oliver Sacks’ writings. I’m talking about the awakenings that are triggered when elderly nursing home or assisted living residents are exposed to music and the arts. Meryl Klein, the executive director of Creative Aging Midsouth (CAM), recently shared her eyewitness account of a female patient, who was brought into an on-site theater performance starring a local actor portraying Abraham Lincoln. The patient was wheeled in towards the back of the room in a reclining wheelchair and appeared to be lethargic. But when the actor began to recite the Gettysburg Address, it triggered an “awakening” in this elderly female patient, and she began to
recite the words out loud with him. Verbatim. Many in the room were moved to tears, including Klein. Klein also recalled another local resident – an elderly gentleman – in an assisted living center who lost his ability to speak after a stroke. The amazing thing? Although he couldn’t speak, he could sing – and music therapy brought that out in him. No doubt, some physicians and nurses now reading this may have witnessed instances such as this in their own practice. Or may know an activity director in a retirement community or assisted living facility, who has told stories of patients
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whose conditions improved because of music or art therapy. Dr. Concetta M. Tomaino, cofounder (with Dr. Sacks) of the Institute of Music and Neurologic Function, comments on the origin of music therapy in neurology patients: “The therapeutic aspects of music have been noted in societies for thousands of years; however, interest really grew around the time of World War II, in part because the Works Progress Administration (WPA) program started bringing musicians into veterans hospitals. Doctors and nurses observed that people who seemed to be totally unresponsive would come to life when music was played.” In his book, Musicophillia, Sacks notes the benefits of music therapy, “Music can move us to the heights or depths of emotion. It can persuade us to buy something, or remind us of our first date. It can lift us out of depression when nothing else can. It can get us dancing to its beat. But the power of music goes much, much further. Indeed, music occupies more areas of our brain than language does–humans are a musical species.” So what are the benefits of awakenings brought on with music and art therapy? Studies show that when the elderly are cognitively engaged, it can have numerous positive effects including decreased depression, better awareness and concentration, improved memory and recall, increased mobility and coordination (fewer falls), improved disposition and relaxation and decreased pain. In other words, music and art therapy can improve quality of life. CAM is a 501(c)(3) organization with the mission to improve the quality of life for Mid-South elders by providing them with access to music and art therapy. They bring high quality performances and workshops to older adults where they live and meet using local, professional artists. Some of the local artists include musicians La Don Jones, Ruby Wilson and Nancy Apple, harpist Barb Christensen, glass artist Teresa White, painters Judy Nocifora and Harriet Buckley and storyteller Elaine Blanchard. Klein, who has master’s degrees in both business administration and gerontology, founded CAM when she moved
to Memphis in 2004. She had previously been executive director of the same type of organization in Cincinnati and has fondly worked with elders throughout her career. Having worked with older adults with various stages of dementia or Alzheimer’s, Klein reminds us, “It’s important to remember that there’s still a person inside.” In its almost 10 years of existence, CAM has impacted more than 20,000 older adults. The only organization of its kind in the region, CAM has produced 3,000-plus performances and workshops at 56 facilities in the Mid-South. “Creative Aging is a strong partner with us in the exceptional care we provide to those with memory loss,” said Herbert Ann Krisle, executive director of Page Robbins Adult Day Care. “Just because an individual can’t quite remember their address or phone number does not mean that they can’t experience great joy and pleasure in music and art and the motion of dance. Our participants want to be productive and lead full, rich lives.” How Can You Help? DONATE Your donations can help bring more performances and workshops to more MidSouth facilities. You can sponsor a single performance for $250 or a workshop (painting, calligraphy, pottery, reading a novel) for $500. For $3,000, you can bring performances to any one facility for an entire year. Donate online at www. creativeagingmidsouth.org/contact, or call 901-272-3434, or mail your donation to 200 Jefferson Ave., Ste. 707 Memphis, Tennessee 38103. VOLUNTEER CAM seeks volunteer hostesses to introduce performers and help encourage audience participation. They also invite physicians – especially geriatricians – to speak at fundraisers about the benefits of music and arts on seniors. Midsouth senior facilities not yet partnering with CAM can bring music and art therapy to their residents by calling the program request line at 901-287-1831. To nominate a non-profit or charity to be highlighted in Memphis on the Mend, contact Pamela Harris at pharris@ medicalnewsinc.com. memphismedicalnews
.com
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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.” What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit. Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.
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Hey Doc, Your Website is Dead By TIM NICHOLSON
Source: Hospice Perception Study 2010
We want to change that statistic. This is just one of the surprising statistics revealed by a nation-wide survey of physicians. And that’s why Crossroads Hospice wants to help medical professionals understand more about hospice and how much patients and families can benefit. To do that, we’ve sponsored and published a variety of papers like the one written by Physicians Practice magazine: What Every Doctor Should Know About Hospice. 3 easy ways to get your free whitepaper. 1. Scan this QR code 2. Email info@CrossroadsHospice.com (subject line: Every Doctor) 3. Visit CrossroadsHospice.com/mn
Remember the Tamagotchi? It was popular with teens and preteens in the late 1990s. Owners of these pocketsized toys were told, “The Tamagotchi is a tiny pet from cyberspace that needs your love to survive and grow. If you take good care of your Tamagotchi pet, it will slowly grow bigger, healthier and more beautiful every day. If you neglect your little cyber creature, it may grow up to be mean or ugly.” The question or game of it all was to know, “How old will your Tamagotchi be when it returns to its home planet?” Or, as the kids knew, before it died. Its survival was up to the owner, or virtual caretaker as the toy manufacturer referred to them. But its death was inevitable. As with everything else that comes into the life of a child, it runs its course. The ecosystem for the pet would change considerably if the owner discovered the opposite sex, lost his backpack, was grounded, joined a cheer or sports team, or otherwise got busy with something more interesting than the digital pet in their pocket. It’s that way in the real world too. We live in an always tuned in, on-thego world where apps own every conversation and Facebook is the Internet. Yet, you have a website that like that forgotten Tamagotchi hasn’t adapted to the changes in the (web) ecosystem. And now? It’s dead. It’s dead to the referring physician upon whom you rely for business development. It’s dead to prospective patients who rely on it to determine the role you might play in their care beyond medical jargon and outdated resources. It’s dead to the caregiver, referring physician or healthcare partner who learns through images and video. And it’s dead to anyone who might dare expect to connect, gather or interact with you when they’re sitting with an ailing family member or on the bleachers at soccer practice. It’s dead because five changes occurred within the web ecosystem and you failed to adapt.
The web became about shared experiences.
People want to be where their friends are and where people with shared values or common interests and concerns can interact.
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The web became about personalization.
People want to know that you know who they are. You have to know what returning audiences find useful, recognize
what they need more of and allow them to share what they’ve found useful elsewhere.
The web became about engagement.
Users are no longer content to simply look at your info. They want to talk about it. Leave comments. Share ideas. See comments from others. See comments from you regarding their comments.
The web became mobile.
Smartphone ownership is a pandemic. Your website has to have meaningful functionality and legible text on the smartphone form factor. For many, it has become the preferred touch point. But at the very least it must be a capable companion to the desktop experience.
The web became more visual.
Pictures are still worth a thousand words. And they are among the most valuable assets your website can use to communicate your values, present your service, educate your audience and entice them to share what they learned on your site with others through a variety of sharing utilities. What happened to the web ecosystem? It became social. You know social, right? It’s that thing you do every time you share an article, click like, reply to a friend’s comment, upload a photo or subscribe to content from those who engage and inform you. And it’s not just for Facebook, Twitter and Pinterest. It should drive your website strategy. People on social websites feel like somebody. And while you might not have noticed, sites that use social plugins and methods have empowered your patients and their friends. They’ve set an expectation for something more than well, what you’re doing on your website. The Tamagotchi had a speaker. It was the cyber pet’s mouth, so to speak. Certain tones or beeps would convey the pet’s status – I need water. I need sleep. I need you to play with me – it’s a plea that you’d do something. So, consider this your website’s plea for you to do something. The savvy Tamagotchi pet owner knew how to reset the toy when he or she recognized it was near death. I bet I know a kid or two who might be able to reset your website. And now you know what must be done for it to “grow bigger, healthier and more beautiful every day.” 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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Hospitals Prepare For Costly Coding Changes By JONATHAN DEVIN
Coding for medical diagnoses will change dramatically on Oct. 1, 2014, when the ICD-9 codes are replaced by ICD-10, but Memphis-area hospitals say that despite the addition of thousands of codes, they are ready. “ICD-10 implementation is a huge change for the American healthcare system,” said Bill Griffin, vice president of corporate finance for Baptist Memorial Health Care. “In the U.S. we currently code using ICD-9 while the rest of the world has been on ICD-10 for years. Moving to ICD-10 is a positive thing, as it results in a more accurate and specific documentation of a patient’s diagnosis and the procedures applied in treatment.” In essence the change means that each diagnosis represented by an ICD-9 code will soon blossom into an entire range of extremely specific diagnoses, each with its own code. “The codes all drive the claims that a hospital or physician office generates and sends to the insurance company, Medicare or the patient,” Griffin said. “So not only does the coder have to be proficient at ICD-10, but so do the payers.” The new codes will come with a cost for hospitals, though, as they retrain coders and update systems. “ICD-10 will impact a large number
“
All this education and software preparation will cost our organization a significant amount — millions of dollars … — Bill Griffin, Baptist Memorial Health Care
of business and clinical documentation processes as well as the information systems that support those processes,” said Chuck Lane, CFO of Methodist University Hospital. “Methodist Le Bonheur Healthcare (MLH) is still in the process of providing staff training, ensuring information system readiness, and planning for a robust physician communication plan that will support the conversion. MLH is supportive of the conversion to ICD-10, and we believe that over the long term, improved documentation will help drive quality improvement nationally.” Still, neither hospital system is waiting for the deadline. The AMA said it should take three to six months to implement ICD-10, but many major hospital systems began planning for the change over the last two years. Or more.
“At Baptist, we started to address the change about three years ago,” Griffin said. “This included the development of an educational strategy for our hospital and physician coders and some support staff which we put in place about 18 months ago. We will complete our coder education in spring of 2014. We also have addressed the software transition that is necessary to provide the support for the coding initiative, too. The goal is to be ready to code proficiently when the mandatory adherence date of Oct. 1, 2014, arrives.” “While the three- to six-month time frame may be appropriate for small hospitals or physician practices,” Lane said, “large integrated healthcare organizations like MLH will take longer to implement. We began planning in 2011 for an implementation date that was originally set for 2013. We were pleased that the
implementation timeline was delayed to 2014, as it gave us more time to prepare our staff and upgrade our systems.” The cost of healthcare systems, namely for training, could reach into the millions depending on the size of the hospital. “All this education and software preparation will cost our organization a significant amount – millions of dollars – when completed in personnel training time, the training program and in IT products,” Griffin said. “There’s no question that conversions of this magnitude can be costly,” Lane said. “There is a great deal of staff education and training that must be done along with an assessment and often an upgrade to a variety of information systems. A wellexecuted plan can help to contain those costs and avoid any potential delays or losses in reimbursement.” But in terms of patient treatment, Griffin and Lane agreed that the cost is worth it. “There is clearly a new level of specificity required for medical coding,” Lane said. “Our physicians understand the care that we are providing; we just have to make sure that our documentation contains the required level of specificity.” “It’s a very complicated and challenging change to the healthcare industry, but it is a good change overall,” Griffin said.
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Doctors Need a Financial Plan, Much Sooner Rather Than Later By GINGER PORTER
The practice of medicine, once a sure return on investment, has in recent decades become more of a high-risk venture. Rising malpractice insurance, larger school loans, dwindling reimbursement, a forecasted shortage of physicians, lower physician salaries and a sluggish economy have made physician wealth management a minefield. A recent survey by Deloitte indicated 57 percent of doctors view changes in medicine under the Affordable Care Act as a threat, leading six in 10 physicians to report they might retire earlier than they had planned. Some will work for hospitals rather than deal with the load of new regulations, and more than half surveyed have already seen a 10 percent or less decrease in their paycheck (2011-2012). Financial planners specializing in physician accounts have a variety of approaches: put 30-40 percent of investment money in bonds and cash and the rest in stocks; save 20 percent of income across the board for retirement starting with the first real paycheck past residency; or, keep ample liquidity to capitalize on the purchasing opportunities of falling markets for greater return later. All advisors interviewed agreed, as one said, to “live by design and not default.” They say when it comes to getting a handle on physician finances, start early. Don’t procrastinate. And if you’ve made mistakes, get help or it will only get worse. “We advise doctors straight out of residency to think of the long-term goals first and look backward. Have a plan for that first paycheck where your income rises exponentially,” said Tom Martin, partner and regional director, Lawson Financial Group, the nation’s largest financial firm exclusively for doctors. Martin is the primary author of For Doctor’s Eyes Only, A Financial Guidebook for Doctors and Dentists (published in 2012).
“Where are you heading long term? Is it retirement, education planning, purchasing a dream home, taking care of your parents as they age?” Martin said. “We start by saving and investing for the longterm things and then take care of the short-term things. The leftover income is still gigantically larger than in residency.” William Martin said that due Howard to poor financial decisions it is common to see some practicing physicians in their 50s as financially strapped as they were in residency. The issue gets personal. He blames extravagance, poor planning and divorce. He cited the average age of divorce for doctors as 42. He sees the repeated example of physicians working long hours and “retail therapy” by spouses to compensate for the time away, then the doctor’s increased need to work to cover those bills, resulting in cycle perpetuation. Then there are great success stories. William Howard of the local firm William Howard and Company Financial Advisors, Inc., has been counseling doctors for 34 years. He told the story of a young physician starting out in the ‘80s. He had some really large income years and saved a lot of money. His portfolio now generates as much as he is earning from his practice. Some of this is because his income has been reduced from salary cuts and decreased reimbursements. But some is due to sound decisions and steady financial growth. “The best approach is a well-balanced, diversified portfolio,” Howard said. “If you are on the long-term horizon, the biggest risk is not the volatility of the investment, but it’s a loss of purchasing power from inflation. A diverse portfolio with at least 30 percent in bonds and cash is the way to go.” He added that four years ago, when the Dow was in the 6,500 range, was an
incredible buying opportunity that lots of physicians missed because they panicked and pulled out of stocks. “No one could have predicted that stocks would be where we are now – at 15,000. If you are not there participating, you miss out.” The biggest mistake he sees physicians making financially is using emotion to make investment decisions. This could be selling out of the stock market in a reactionary mode. It could be taking a financial course of action just because a colleague is doing it. It could be not getting financial help or putting off getting it. Echoed by both Martin and Philip Moser, a financial advisor with Dixon Hughes Goodman Wealth Advisors, LLC of Memphis, there is a need for a higher standard of wealth advisor for physicians. They encourage doctors to select advisors who owe a fiduciary standard of care, meaning they are legally obligated to do what is in their client’s best interest. Moser recommends a team of advisors covering risk management, asset protection, debt management, cash flow management, retirement, investment planning, contract negotiations, tax planning, education planning and estate planning. One advisor compares the financial path of the physician to charting a boat’s course. If someone is in the Atlantic with a destination of Miami and the boat is found to be on course for Boston, a small adjustment of the compass sets the boat back on course for Miami. But if the captain waits until the boat is almost all the way to Boston, it’s a huge problem and hard to correct. Diligence is key. “Today, it is not so much about how much you make as about how much you keep,” Martin said. “So doctors have to pay attention more to do everything right, because there is just not the extra fluff to cover it.”
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Concerns, continued from page 1 At that time, more rural physicians (93 percent) were participating with TennCare than doctors in metro areas (83 percent), but the rural physicians said they were more likely to leave the program. According to the study: The “business as usual” response reconfirms physicians’ willingness to continue to provide care to their patients as long as possible. However, closer analysis raises possible concerns for the Gary M. economic health of rural Zelizer medical practices, particularly specialists. While 81 percent of all metropolitan specialists said they would stay with TennCare, only 56 percent of rural specialists responded that way. Significantly, 38 percent of rural specialists said they would consider terminating participation in TennCare at the earliest possible date, compared to 10-12 percent of their rural primary care peers or all metropolitan physicians. More recently, a 2013 Deloitte “Survey of U.S. Physicians: Physician perspectives about healthcare reform and the future of the medical profession” found attitudes much the same on the national scale. Dealing with Medicare/Medicaid was the second most common reason that physicians were dissatisfied with practicing medicine (22 percent) after having less time with each patient (26 percent). In 2009, the Oregon Medical Association reported in a survey that 19.1 percent of Oregon doctors, mostly rural, had closed their practices to Medicare patients and that 28.1 percent had restricted the number of Medicare patients. Four in 10 physicians reported that their income decreased between 2011 and 2012, with decreases of 10 percent or less. Fifty-one percent said they believe physicians’ pay will fall in the next one to three years. Strikingly, 60 percent in the Deloitte survey reported considering an early retirement. The effect of large numbers of retiring physicians is unknown, and Zelizer noted that “true retirees are obviously getting older and their productivity may not be equitable to someone younger.” But the concern remains that rural patients would suffer the most from physicians’ early retirement because fewer physicians are available in rural areas as it is, and large numbers of retirees who depend on Medicare live in rural areas. Medicare pays less for reimbursements to rural doctors as well, because of lower costs. That compounds existing shortages, according to the American Association of Medical Colleges, which said that rural areas lack about 20,000 primary care doctors, while only about 16,500 medical doctors graduate annually. The Affordable Care Act represents one more possible shift in the market as potentially millions of new patients nationally, who did not have health insurance before, seek primary care in 2014. The question remaining is whether physicians will be able to afford their patients.
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Patient Safety Takes Flight in Tennessee TCPS, LifeWings Partner to Implement TeamSTEPPS By CINDY SANDERS
The Tennessee Center for Patient Safety (TCPS) recently announced a collaborative agreement with LifeWings Partners LLC, a West Tennessee company that has adapted the best practices of high reliability organizations to create safer patient environments for hospitals across the nation. Headquartered in Collierville, Tenn., LifeWings has brought together a team of physicians, nurses, and healthcare risk managers … along with former NASA astronauts, military flight surgeons, officers, pilots, and flight crew … to train healthcare professionals in the communications and teamwork skills used by pilots to ensure safety. TCPS and LifeWings are partnering on a program to enable Tennessee hospitals to adopt the healthcare version of crew resource management (CRM) training that is known as TeamSTEPPS. At the helm of LifeWings is Steve Harden, a former Navy pilot and TOPGUN instructor and current international pilot for FedEx. Harden, a Naval Academy graduate with more than 300 aircraft carrier landings, has been involved in safety training during the majority of his career and has personally trained more than 20,000 physicians, nurses, staff and administrators in TeamSTEPPS over the last decade.
After joining FedEx, he began training pilots in CRM, which was a relatively new discipline for commercial airlines at that time. CRM was born from work done out of NASA that found that 70-80 percent of airline accidents were the result of a breakdown in communication and teamwork. The specific course created for FedEx was so highly regarded that Harden began getting calls from outside organizations asking for similar training. With blessings from FedEx, Harden helped found Crew Training Inter-
national (CTI) in 1992. A few years later, CTI brought its expertise to the healthcare industry. “Quite honestly, it wasn’t our idea,” Harden noted with a laugh about what has become a major focus of their business. That first foray into patient safety came at the request of a hospital emergency department director who knew a CTI employee. Harden recalled, “He said, ‘I really think it could make a difference in my emergency department. Could you come in here and
see if my instincts are correct?’” After observing many similarities to the types of interactions and protocols used on flight decks during a site visit to the hospital, the CTI group came back with suggestions to improve safety and teamwork. “We said if we were kings for a day, here’s what we’d do. He said, ‘OK, do it,’” Harden said. From there, word-of-mouth spread quickly, and the group began sharing their expertise with other hospitals and departments. By 2005, the healthcare group had become so large that it was spun off into a separate entity … LifeWings. Following the landmark Institute of Medicine Report, “To Err is Human,” the Agency for Healthcare Research & Quality (AHRQ) created a CRM course specifically designed for healthcare and called it TeamSTEPPS. Harden noted TeamSTEPPS is really the generic term for crew resource management courses in the healthcare setting, and the term is often used interchangeably with CRM. Harden has been responsible for innovating a number of subsequent generations of CRM training program, and the LifeWings team uses a program they call TeamSTEPPS 2.0. When LifeWings trains healthcare staff, the focus is on one department or area. “We don’t train the entire hospital at once. It’s (CONTINUED ON PAGE 12)
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Accelerating Change in Population Health Management Sometimes the bigger the problem, the less expensive the solution. What’s expensive is trying to fix after-the-fact outcomes rather than creating strategies that get at the behaviors and cause. If these two sentences sound familiar, it’s the ending of my article last month, Accelerating Change in Education. I asked Jonna Elzen, CEO of MetroCare, to co-author this article because of her personal experiences. After Jonna wrote a portion of this article, there was a relevant article in the Commercial Appeal (originally written for the Los Angeles Times) by Beth Ann Swan, dean and a professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, Pennsylvania, titled, After Hospital Care, the Test Begins. I have known Jonna for a number of years, respect her tremendously and consider her a friend. Here is her contribution: “I am a conflicted healthcare executive. I have worked for and with physicians almost 30 years and know firsthand most of what is written that is wrong in our healthcare delivery system. I learned from the physician’s viewpoint, my own experience as a cardiac patient and, most recently, when my husband had a stroke. “After my second heart surgery, I developed a passion for change because 80 percent of heart disease is preventable. I contacted women’s groups, churches and the American Heart Association looking for audiences to educate women about their greatest health risk and understanding the very modifiable risk factors we face. I even made use of my work contracts and convinced one of the hospitals to allow me to work with their Coronary Intensive Care unit and Patient and Family Centered Care teams to develop a program so patients and their families who face open heart procedures didn’t have to be afraid, that they could see firsthand what equipment and units looked like and ask questions. This was important to me because I met a very engaged nurse who described in vivid detail what it would be like immediately following my bypass surgery. It was just as she said, and I was at peace, even though my family was a basket case. As patients and families, we only have fear of the unknown. “Even as I continue in my job and have the opportunity to hear and work with some of the leading reformists in healthcare, one fact continues to resonate with me: accountable care must start with engaged patients. Yet patient engagement is one of the biggest obstacles in executing the transformation change both for the individual and healthcare delivery. You are not cured of heart disease, but bypass surgery gives people another opportunity, and know ultimately, it’s up to the individual. “I have tried and am putting memphismedicalnews
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this belief system into a format plan. I investigated formal educational opportunities for patient navigators/ advocates. I have a passion and will continue to have a passion for reinvention, transformation, change or what ever you want to call it. I am one person, but I know there must be others who want to help me be an instrument for change. I know it can be done.” — Jonna Elzen. In the article I spoke of earlier, After Hospital Care, the Test Begins, Beth Anne Swan said, “In 2011, my husband was felled by a brain stem stroke. From the outset, we knew his recovery and rehabilitation would be long and difficult. We didn’t know his transition to posthospital medical care would be just as challenging. “I thought my training and access to resources would aid in managing my husband’s care. Instead, our experience showed me the many flaws in the world of medical ‘care coordination’ and ‘transition management.’ “We did not have an actual comprehensive care plan, and no contact within the system could help us coordinate my husband’s extremely complicated care once we got home. (He had his stroke while we were out of town.) “One in five elderly patients is readmitted to the hospital within 30 days of discharge. Data suggests that 76 percent of these readmissions are preventable, and poor care transition are most certainly to blame. According to a recent study, they are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions or get the necessary follow-up care. Some of the patients in the survey were not ready to change their behaviors, such as smoking cigarettes or clocking in long hours at the office. While the patient struggles to manage his own care, there is a distinct lack of communication between hospitals and the individual’s primary-care physician. We need change to reform the patient care and transition systems inside and outside the hospital. We need to change ‘patient centered care’ from a trendy phrase to true coordination that prepares a patient and his family for the outpatient care that keeps him at home instead of back in the hospital.” Jonna and Beth Ann have said it better than I could, especially since I have not experienced it. I hope Jonna will give Beth Ann a call and together they can help accelerate this needed change. 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. Jonna Elzen is CEO of MetroCare Physicians and can be reached at Jonna@metrocaredocs.com.
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Patient Safety Takes Flight in Tennessee, continued from page 10 just too big an elephant to eat at one setting,” Harden noted. Once a focus area has been determined, the hospital must decide who should attend. Harden said the standard answer is anyone responsible for good patient care, which very probably includes non-clinical staff in addition to physicians and nurses. It is, however, crucial for physicians to attend Steve Harden training. “We won’t work with a hospital unless they agree to interdisciplinary training that includes physicians,”
Harden stated. “It would be like a football team running plays without the quarterback.” While the checklists and processes vary by specialty, Harden said the common element in all programs is the ability to have effective assertion … what is commonly known as a ‘stop-the-line’ conversation. “All the research shows facilities that have a stopthe-line culture have the fewest number of patient-harming events,” he said. Harden continued, “Can your most junior and inexperienced nurse have a stopthe-line discussion with your most senior and experienced physician if they perceive
a problem with patient care? If the answer is ‘no,’ you’re going to have patient-harming events.” Those conversations are easier said than done considering the hierarchical nature of most healthcare facilities. “There’s such a great power distance,” Harden noted between a neurosurgeon who has spent years in medical school, residency and fellowships and a brand new scrub nurse who has been employed for six months. Still, that scrub nurse must feel confident in speaking up if a problem is perceived. “One of our mantras for the hospitals we work with is ‘It’s the right thing to do for
the patient, and the right thing for the hospital’s bottom line,’” Harden continued. He noted that safe care is also cost efficient care. With fewer mistakes come fewer penalties and lawsuits and greater market share. “As your quality goes up, your metrics and reputation improve,” he pointed out. Empowering the entire team also improves staff satisfaction and reduces turnover rates. “The average cost to turn over a nurse is $25,000,” Harden noted. In departments where they have implemented TeamSTEPPS, Harden said they’ve seen turnover rates drop from 10-15 percent to 2-3 percent, which is a huge savings to the bottom line. Between decreased malpractice costs and increased savings, Harden noted two hospitals systems that used LifeWings’s TeamSTEPPS program in Illinois increased profit margin to 16 percent … considerably higher than the national average of 3 percent. “Hospitals are not going to survive unless they do a program like this and do it well,” he stated. Harden noted best practices and evidence-based protocols aren’t kept secret so ostensibly everyone should know the right steps to take. Without a stop-the-line mentality, however, it’s almost impossible to achieve the desired outcomes. “If you have high infection rates, it’s typically not a process problem. It’s typically a culture problem,” he said. TeamSTEPPS training helps turn that culture around. “It’s the mutual support and crosscheck and holding one another accountable and communicating as you use the process … that is the secret sauce,” Harden concluded. For more information on the TeamSTEPPS training, go to the TCPS website at www. tnpatientsafety.com. A brochure and training schedule is available to download under the “What’s New” section of the TCPS homepage.
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Lending Voice and Vehicle AARP and RWJF collaborating with select states on national nurse education redesign program By LyNNE JETER
Twenty states, including five in Medical News markets, are working on a dynamic nurse initiative redesigning nurse education to bolster the advancement of nurses. The AARP and Robert Wood Johnson Foundation (RWJF), developers of the national program, Future of Nursing:Campaign for Action (Campaign), is working with Florida, Louisiana, Mississippi, Missouri, and Tennessee to implement the Institute of Medicine’s (IOM) evidence-based recommendations on the next chapter of nursing. (The IOM defines “evidence-based practice” as a combination of best research evidence, best clinical experience, and consistency with patient values.) Other states involved in the initiative are Colorado, Connecticut, Georgia, Iowa, Idaho, Kansas, Maryland, Michigan, Nebraska, New Jersey, Pennsylvania, Rhode Island, Utah, Wisconsin and Wyoming. The RWJF committed $3 million to help the states prepare the nursing profession to address the nation’s most pressing healthcare challenges. The Future of Nursing State Implementation Program will boost efforts already underway across the nation and the District of Columbia. The Campaign, the foundation explained, provides a voice and a vehicle for nurses at all levels to lead system change by collaborating with business, consumer, and other health professional organizations. “This program is designed to spur progress by supporting action coalitions, most of which are led by volunteers, that are doing promising work to implement the IOM recommendations,” said Susan B. Hassmiller, PhD, RN, RWJF senior adviser for nursing and director of the Campaign. “The foundation is committed to providing states with the support they need to build a more highly educated, diverse nursing workforce that will improve health outcomes for patients, families and communities.” The initiative provided two-year grants of up to $150,000 to state-based ac-
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tion coalitions that have made substantial progress toward implementing the IOM recommendations. The grants call for states to match funds. This pressing issue was addressed at the American Hospital Association’s annual meeting April 28-May 1 in Washington, DC, which focused advocacy efforts on transforming the healthcare delivery system, maintaining essential resources, and reducing the regulatory burden. The U.S. Department of Labor has identified nursing as the fastest-growing occupation through 2012. More than 1 million new and replacement nurses will be needed to fill the nation’s healthcare needs. “Current demand for quality nurses far outstrips the supply,” said Sheila Kelly, PhD, project director of the Mississippi Barriers to Nursing Education Survey. “Increased future needs will only exacerbate the crisis. In 2002, the Health Resources and Services Administration estimated that over 30 states were experiencing nursing shortages, and the shortfall would grow to over 44 states by the year 2020.” The Center to Champion Nursing in America (CCNA), an AARP initiative, AARP Foundation, and RWJF serve as the national program office for the Future of Nursing State Implementation Program. “This new program will help action coalitions get the strategic and technical support required to advance their goals,” said Susan Reinhard, PhD, RN, senior vice president of the AARP Public Policy Institute and CCNA chief strategist. The nonprofit, nonpartisan national organization with more than 37 million members is one of the nation’s most powerful lobbying groups. “Our hope is that states will get the boost they need to be effective in achieving the triple aim of addressing cost, quality and access.”
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Healthcare Leader: Bryan Ikerd, continued from page 1
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A business administration graduate of Mississippi State University, he relocated to Memphis in 2000. But when advancing his retail management career required another move, Ikerd balked. “I had really planted roots in Memphis,” he said. “I met my wife here; I love it here.” Fate led him to an executive directorship at a small assisted living community and ultimately to Trezevant, where for five years he has served both administrative and sales and marketing functions for Trezevant Terrace, the community’s assisted living facility — opened in November 2007. The Terrace is part of Trezevant Manor, which also includes independent living and nursing facilities. Retail’s loss is a significant gain to Terrace residents and their families, as Ikerd adds comfort, security and confidence to the lives of those who most need personal attention and care. Ikerd identifies the common thread in both careers: “It’s just taking care of people — keeping them happy.” His earlier customer service experience prepared him to deal easily with families and residents, listening and facilitating as he personally handles all tours, helps with move-ins, and guides and supports families through what can be a difficult decision and transition. His hands-on approach has earned laudable results: When Ikerd came on board in 2008, Trezevant Terrace’s 104 assisted living apartments were at only 47 percent occupancy; within two years they had reached 100 percent — with a waiting list — and have maintained at that level for the last three years. Dedicated to the memory of Suzanne Trezevant Little by her husband, Edward H. Little, the not-for-profit retirement Trezevant community was established in 1977 in the heart of Memphis. As a continuing care retirement community (CCRC), Trezevant provides all levels of care on one campus. It offers independent living apartments that are spacious, attractive and surrounded by amenities that include a chapel, a pool, and a performing arts center. A LifeCare plan begins with independent living and assures plan-holders a seamless transition to increased levels of care — from residential apartments and homes to assisted living, and then to nursing care, providing a complete continuum of care. The Terrace’s contribution to that continuum of care includes a memory support floor for residents with Alzheimer’s and other forms of dementia—an increasing cause of concern. “It’s well known that there’s a growing need for Alzheimer’s facilities,” Ikerd said. “The population is getting older, but at the same time we are also seeing
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an increase in early onset dementia. Our memory care floor is very well equipped with 27 apartments that have stayed full.” He describes a secure unit designed to comfort and protect those who need help, reminders and cueing with their activities of daily living — and a higher level of staffing that allows hourly checks throughout the day and night and provides a continuing series of activities designed to stimulate and engage residents. He points to a weekly clinic held on the premises by the medical director — a family practitioner and emergency medicine specialist — and the presence of a nurse practitioner two days a week and credits them with the facility’s exceptionally quick response to medical concerns. Ikerd takes special pride in the several awards that the Terrace, named for its beautiful garden terrace with gazebo, screened porches and walking gardens, has earned for healthcare construction and healthcare interiors. “We’re nationally recognized for our building — and very proud of it.” Each Terrace resident receives an initial assessment that guides the staff in developing his or her individual care plan — a plan that is readdressed and updated quarterly. “We know which residents need shower assistance, for example, and which need assistance with getting dressed in the morning and undressed at night,” Ikerd said. Ikerd also holds daily stand-up meetings with his core staff, addressing the current state of affairs within the building, and reminds everyone from staff to residents to families that he is on call 24-7 and expects to hear about needs, questions or problems — and to respond promptly. In addition, a transition team consisting of Trezevant’s CEO and leaders representing the full Trezevant community meets weekly to discuss what’s going on with all the residents in every level of care. “The transition team meetings are one of the best things we do at Trezevant,” Ikerd said. “It’s such a pivotal meeting for us. We talk about residents who have had a fall, who are moving in or struggling to adjust, residents who need assisted living or nursing home care. We cover all bases so the right hand knows what the left hand is doing.” He finds that people are coming to assisted living with greater healthcare needs. “The level of care they require is higher than in the past, and we have adapted to meet those needs. People are living longer, due to advances in medical technology, and often when they do need assisted living, they’re kind of in crisis mode.” Not surprising, perhaps, considering the average Terrace resident’s age is 87, with many residents in their 90s and two that are over 100. Ikerd credits a great management team and dedicated staff, who allow him to focus on providing the best care and service possible. His personal focus is on a family that includes a 7-year-old daughter and 5-yearold twins and plans for lots of shared vacation trips. memphismedicalnews
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CONNECTing Caregivers to Prevent Patient Falls By CINDY SANDERS
Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall prevention programs have only proven to be marginally successful over the long term. Cathleen S. Colón-Emeric, MD, MHS, and colleagues focused on the gap between quality improvement (QI) protocols and sustained bedside implementation in the nursing home setting. An associate professor of Medicine in the Division of Geriatrics at Duke University School of Medicine, ColónEmeric said previous Dr. Cathleen S. Colónstudies found the desired Emeric improvements occurred when outside trainers and researchers stepped in to create interventions. The external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. However, she continued, “When you try to train the existing nursing home staff to do those things, it doesn’t seem to work.” Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a direct link between the failure to successfully deploy fall interventions and the hierarchical culture present in most skilled nursing facilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Education & Clinical Center (GRECC), noted the vertical command structure doesn’t foster broad-based, interdisciplinary staff interaction. “They lack the connections with their coworkers that they need to share information and problem solve,” she said. “Nursing home staff tend to work in silos.” Colón-Emeric continued, “Coordination of a multi-factorial risk reduction program requires a great deal of communication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.” She added reasons for a fall might include any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pressure upon standing or suboptimal choice of an assistive device. “In order to improve fall rates,” Colón-Emeric said, “the team needs to know what the resident’s behavior is like.” However, the person with the most hands-on knowledge often isn’t the one memphismedicalnews
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creating that resident’s specific care plan. Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted. In an article published in Implementation Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educational intervention to foster improved connections within and between disciplines, heighten communication flow and encourage cognitive diversity in solving problems on behalf of residents. The next step was to see if the “all hands on deck” approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mastery of content and process change. Colón-Emeric said eight nursing homes in North Carolina and Virginia were selected with half randomized to receive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiving only the QI program training. The eight participants included a mix of community nursing homes and VA facilities. The CONNECT intervention included interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and relationships for problem-solving activities. “We designed the CONNECT intervention to show staff where their communications weren’t working … where gaps existed … and to teach them some practical tools to better communicate,” she explained. Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. ColónEmeric said to measure communication, the team used surveys before, during and after the intervention. The team also reviewed documentation of the types of prevention interventions in the medical record. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites. “What we found was that the staff communication levels improved a little bit
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NASHVILLE – In the wake of national health reform, the trust factor between hospitals and health insurance companies is perilously low. That’s the consensus of 373 hospital and health system administrators responsible for negotiating contracts with major health plans in the seventh annual National Payor Study. Conducted by Nashville-based ReviveHealth, the 2013 survey paints an interesting picture of administrators’ opinions about various private payor trends, including rates, payment of claims, denials and other actions. “The trust factor is huge when it comes to hospitals and health plans being able to play nice in the new world order of risk— sharing and improved health outcomes,” said ReviveHealth CEO Brandon Edwards. For the second consecutive year, hospital and health system leaders who negotiate managed care contracts with national health insurance companies pointed to WellPoint/ Anthem as the nation’s worst plan, with only a 16 percent favorability rating. WellPoint manages health plans in 14 states, including Anthem Blue Cross in California. “Even though WellPoint now has a CEO with a strong provider background, he’s got to turn around an aircraft carrier, and that takes time,” said Edwards, noting that business practices and corporate behavior have contributed to the company’s poor reputation. “Their major imperative has to be improving their reputation and rebuilding trust with providers.” For the third consecutive year, UnitedHealthcare exacerbates its perennial poor showing, ranked worst in all areas of contract negotiations except payment plans. The payor held firm as the health plan with the most consistently poor reputation among hospitals – and the slowest to pay. “Honesty and candor represent United’s biggest challenges,” noted Edwards. “Hospitals year in and year out cite UnitedHealthcare’s low rates, slow payments, bureaucracy, and honesty as reasons for their poor rankings.” Aetna was given high marks for the best rates, followed closely by Cigna. “Honesty and easy business dealings seem to matter more than rates,” said Edwards. “Otherwise, Aetna would be the best rated plan in every category.” This year, independent Blue Cross and Blue Shield (BCBS) plans and Cigna tied for the top favorability spot, with 49 percent. Last year, Cigna held the spot alone. In this year’s survey, Aetna’s approval rating was 46 percent, followed by Coventry and UnitedHealthcare at 30 percent each, and Humana at 25 percent. Despite having the lowest rates for three consecutive years, BCBS plans earned top ranking for best overall business practices. “Independent BCBS plans, however, ranked well ahead of Cigna (30 percent compared to 19 percent) in terms of overall best to deal with, despite having the lowest ranking in payment rates to hospitals,” said Edwards. “For several years in a row, the
survey revealed a complete lack of correlation between payment rates from any payor, and a hospital’s perception of that payor.” The survey, conducted in partnership with Catalyst Healthcare Research (CHR) and The Godbey Group, is the only one of its kind in the United States to target hospital leaders who negotiate managed care contracts with national health insurance companies. Respondents included CEOs, CFOs, and managed care/payor relations executives who negotiate on behalf of about one-third of the nation’s hospitals. “The goal of the study is to provide a national perspective of hospital leaders’ opinions of large health plans,” said Edwards, who initiated the survey after noticing a void in payor ratings. “Even though health plans rate hospitals and their physicians routinely, no one was rating the health plans.” On an optimistic note, nearly half of all participants believe their negotiated rates will improve this year. Providers have varying strategies for success, with wellness programs a top priority for their employees, and clinical integration a second focal point. “Hospitals are taking the lead on wellness and population health programs with their own employees,” said Edwards. “Now they need to take that experience and go out to local employers with solutions to keep those employees healthy and costs down.” Nearly 40 percent of respondents reported their hospital had been in at least one public contract dispute in the past five years that resulted in non-participation. Also, the gap between rates for the largest payor and rates for the second and third largest payors have widened considerably. “This ‘payor cost shift’ drives up profitability for the biggest plans at the expense of the smaller market share plans,” said Edwards. “That’s proven by the fact that more than one-third of hospitals would fail to meet profit margin goals if all private payor rates were the same as their largest payor.” Contracting priorities for the upcoming year – the top three are the same as 2012 – involve: 1. Increasing rates with the largest payor. 2. Producing better language protection against denials. 3. Increasing rates with the second and third largest payors. 4. Balancing the threat and opportunity of narrow networks within the hospital’s market. 5. Having better contracting language with the largest payor. 6. Procuring better reimbursement for high-cost drugs, implants and other carveouts. 7. Expediting claims processing and payments. 8. Improving rates for Medicare Advantage plans. 9. Shifting reliance away from the largest payor. 10. Bundling payments for medical home, ACO, or other population health strategies. SOURCE: ReviveHealth.
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Reflux KO
Torax Medical rolls out LINX procedure for GERD patients to select specialists By LYNNE JETER
A few dozen approved surgeons specializing in gastroenterology procedures across the nation are offering a revolutionary solution for patients with gastroesophageal reflux disease (GERD) that’s so new, many primary care physicians and some specialists aren’t aware of it as an option. “When the FDA ap- Reflux proved the LINX Reflux Management System, and the New England Journal of Medicine recently discussed the efficacy of the system, word began getting out,” said Sam Pace, MD, a board-certified gastroenterologist with Digestive Health Specialists in Tupelo, Miss., director of the Heartburn Center of North Mississippi, and a LINXapproved surgeon. Torax Medical Dr. Sam Pace opted to launch the procedure nationwide at approved centers, usually one or two per state. Torax
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LINX closed
Medical develops and markets products designed to restore human sphincter function via its technology platform, Magnetic Sphincter Augmentation (MSA), which uses attraction forces to augment weak or defective sphincter muscles to treat GERD that often irritates the esophagus, causes heartburn and other symptoms. Left untreated, reflux could lead to serious complications, such as esophagitis, stricture, Barrett’s esophagus and esophageal cancer. “I applaud the medical company for not doing a wholesale release,” said Pace. “Instead, the company is releasing it to
Swallowing
centers that do a lot of reflux work so the proper evaluation can be done.” The LINX System’s new device is a quarter-sized flexible band of magnets encased in tiny titanium beads. The magnetic attraction between the beads helps keep a weak esophageal sphincter closed to prevent reflux. Implanted around a weak sphincter just above the stomach, the minimally invasive procedure typically takes less than an hour to complete. “The force of swallowing breaks the magnetic bond to allow food and liquid to pass through, and then the magnetic attraction closes the lower esophageal sphinc-
ter back to form a barrier,” said David Gilliland, MD, FACS, a surgeon with Surgery Associates PA, in Tupelo, also an LINX-approved surgeon. Until now, physicians had only two options for treating reflux: medication or a surgical procedure called laparoscopic Nissen fundoplication, widely used since the early 1990s. In this procedure, the top part of the fundus is wrapped around the lower esophagus to improve the reflux barrier. Even though Nissen fundoplication may be effective, it has several draw-
backs. “After a patient has fundoplication, he can no longer belch or vomit,” said Gilliland. “Some patients report gas bloating because of this.” Three years after Dr. David sphincter augmentation Gilliland with the LINX System, the majority of treated patients were able to substantially reduce or resolve their reflux symptoms, while also eliminating their use of reflux-related medications, accord-
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CONNECTing Caregivers to Prevent Patient Falls, continued from page 15 in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communication was more pronounced in the community settings, as Colón-Emeric said the VA facilities already had high levels of communication. Charting turned out to be a non-factor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good mea-
sure of what is happening at the bedside … at the site of patient care.” As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said. Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites. However, she said the group is now in the second year of a larger trial of 24
nursing homes with 12 each in the CONNECT and control groups. “If we see the same magnitude of benefit, that would be statistically significant.” She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.” Colón-Emeric added that if the improved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing America’s growing senior population.
Falls Hurt Physically & Financially According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma. In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.
Reflux KO, continued from page 17
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ing to the New England Journal of Medicine summary. In 100 percent of patients, severe regurgitation was eliminated, and nearly all patients (93 percent) reported a significant decrease in the need for medication. Ninety-four percent reported satisfaction with their overall condition after having the LINX System procedure, compared to 13 percent before treatment while taking medication. “For years, surgery for reflux patients would best be described as a static deal, where you sew everything down,” said Pace. “The LINX procedure is dynamic because opening and closing simulates the normal sphincter, except you’re keeping it closed so you don’t have reflux. Now we have a choice for patients that we can tailor-make the surgical approach to this problem.” Like Nissen fundoplication, the procedure is done laparoscopically through five small punctures in the abdomen. “Once we’re in the OR, we can decide which procedure the patient is better suited for, depending on anatomy,” Gilliland said. For example, the LINX procedure cannot be done if the patient has a hiatal hernia larger than three centimeters. Another benefit is a quicker return to solid food. “We try to get LINX patients to eat regular food right away to train the device,” Gilliland said. “With the Nissen procedure, they’re on a prescribed diet for at least two weeks.” Because the procedure is new, insurance coverage varies by provider and is usually approved on a case-by-case basis.
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Letters Ms. Harris, Thank you for sending a copy of the recent Memphis Medical News that included the kind piece you wrote about our work. I’ve received several positive comments from others who read it; maybe some of those readers will heed your call to make a donation:) Rick Donlon, A founding physician of Christ Community Health Services Memphis Medical News welcomes letters from its readers. The newspaper reserves the right to edit for length. Each letter must include the writer’s contact information. Please email letters to pharris@medicalnewsinc.com.
GrandRounds New Directors at Regional Medical Center The Regional Medical Center is pleased to announce the following new Jana Jones additions to their staff: Jana Jones, Administrator, Ambulatory Surgery…Jones is the administrator for Ambulatory Surgery now under construction at Regional Medical Center. Jana most re- Stacie Winkler cently served as the COO and Administrator at the Eye Specialty Group and Ridge Lake Ambulatory Surgery Center. Jana has also worked with the Corrections Corporation Kathy Beydler of America and currently serves on the Concorde Career College advisory board. Stacie Winkler, Associate General Counsel….Winkler has joined the Regional Medical Center as Associate General Counsel. She will continue to practice in the areas of healthcare law and medical malpractice. Prior to joining the Regional Medical Center she was a shareholder in the Memphis office of Baker, Donelson, Bearman, Caldwell & Berkowitz. She is also a graduate of the University of Memphis Law School magna cum laude. Kathy Beydler, Director of Surgi-
cal Services….Beydler has more than 20 years experience in surgery administration including serving as the Director of Surgery at Methodist University Hospital and serving as the administrator at the Baptist DeSoto Surgery Center. Kathy’s educational background includes degrees in nursing, education and an MBA.
Saint Francis HospitalMemphis Receives Prestigious Award Saint Francis Hospital-Memphis is proud to announce that it has received Tenet’s 2013 Circle of Excellence Award. Saint Francis is one of nine Tenet hospitals recognized for superior achievement in the areas of quality care, service excellence and operational performance. The staff and physicians at Saint Francis Hospital-Memphis are being honored with a Circle of Excellence Award for demonstrating an outstanding commitment to their patients, community and hospital during 2012, according to Britt T. Reynolds, Tenet’s president of hospital operations. Saint Francis has an impressive history of serving the citizens of the greater Memphis community, according to CEO Dave Archer. This year, the hospital has received recognition from The Joint Commission, the American Heart Association, Memphis Business Group on Health and managed care organizations for quality, patient safety and clinical excellence.
Memphis Orthopaedic Group has opened a new office in East Memphis. The new office, located at 4515 Poplar Avenue, Suite 206, will serve as the group’s fifth Memphis area location. All of the board certified physicians at Memphis Orthopaedic Group practice at each location, allowing patients to see their preferred physician, regard- Memphis Orthopedic Group physicians gather to welcome guests at the new East Memphis location. less of which office they visit. Patients can now choose from the practice’s East, North, Central, Germantown and Riverdale locations. The new East office is located in the center of the other four practices, creating a nearby access point for patients who are not particularly close to one of the other offices. .com
Operating in a Media Firestorm
By Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding
Memphis Orthopaedic Group Opens a New Location in East Memphis
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Your Practice – Your Brand
April 15 was likely to be a busy day at Boston area hospitals. With some 27,000 runners in the Boston Marathon and a half million spectators, the treatment for falls, exhaustion, dehydration and other injuries was expected. Nothing could have prepared the hospitals for the tragedy that happened that day. While treating an unexpected number of people isn’t necessarily that out of the ordinary, treating them under the glare and aggressiveness of the international media is. According to news reports, the 170-plus victims of the bombing at the finish line of the marathon were split between 10 area hospitals. That means none of them were likely completely overtaxed from a medical perspective. But, in the face of a crisis situation, medical process is quickly overrun by so many other demands. It is those other demands that hospitals and medical practices can learn a lot from. These kinds of crisis place the hospital or practice in the media limelight as the expert, the healer, face of the local medical community to the world. And, this kind of attention doesn’t have to be as a result of a tragedy like the Boston bombing. Perhaps your hospital has been selected for a high profile treatment for a high profile client – an entertainment celebrity, a business leader of a political leader. In any of these cases there is a delicate balancing act between personal privacy, hierarchy of information (family first) and public expectations. There are some cases where total secrecy is demanded, like a major surgery for a business icon who came to Memphis for treatment a few years ago. In most cases, some degree of media access is allowed. When operating under the bright lights of the media, a medical practice or facility can do its part to keep things under control by following a few steps. 1) Establish physical media parameters. If the media knows where to go and that a single location will be the only source of information, they will follow the rules. Establish a media briefing room. Staff the room with someone who knows what is going on. Make drinks and snacks available. Make sure there is power and internet access. In other words, make it a comfortable area from which to do business. And, establish it in an easy-to-find location, but out of the regular flow of operations. 2) Set a schedule for briefings and updates, and a process for breaking news. That may be as simple as a briefing schedule board hanging in the room. For breaking news, gather every covering reporter email and cell phone, and then send group texts to alert them to the timing of the pending announcements. 3) Establish a hierarchy for information. Make the person delivering the information as high ranking as possible, but someone who is completely in the know. Battling reports on half information is more work than taking the time to get it right. Back to Boston. One hospital, Beth Israel Deaconess Medical Center, faced a greater challenge than the others. They had victims like the other nine facilities, but they also treated the accused bomber. For them, the three steps were even more important, and a fourth involving security was required. They knew a strict protocol had to be set and NO exceptions of any kind made. I can only hope that no one reading this ever has to face a media crisis brought on by a terrorist. But some of you will most certainly face a major highway accident, a fire, a natural weather disaster. When you do, take control, be firm, fulfill promises of information, and always be honest. The media is not there to make life difficult. They are just there to do their job. To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com
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GrandRounds BMG partners with River City Pediatrics Baptist Medical Group, Baptist Memorial Health Care’s multispecialty physician group, announced the acquisition of River City Pediatrics. River City Pediatrics will bring more than 50 combined years of experience in pediatrics to the group, said Jim Boswell, Baptist Medical Group chief executive officer and vice president of physician services for Baptist Memorial Health Care. This will be the first BMG pediatric group partnership in Memphis. Janet D. Geiger, M.D., Ellen J. Stecker, M.D., and Seema Abbasi, M.D. established their practice in November 2006. They see patients from newborn through age18.
Baptist Cancer Center taps new director Baptist Memorial Health Care announced today Dr. Stephen B. Edge will be the director of the Baptist Cancer Center. He will assume his new position in July 2013, and his duties will include oversight of the construction of the new Cancer Dr. Stephen B. Edge Center building, slated to open in 2014 near the Baptist Memorial Hospital-Memphis campus.
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Most recently, Edge served as the Alfiero Foundation Endowed Chair in Breast Oncology in the department of surgical oncology at Roswell Park Cancer Institute in Buffalo, N.Y. He is a graduate of Tufts University in Medford, Mass., earned his medical degree from Case Western Reserve University in Cleveland and completed his internship and residency at University Hospitals of Cleveland. Edge completed his fellowship at the National Cancer Institute in Bethesda, Md. While at Roswell Park Cancer Institute, Edge served in several different roles, including chair of the department of health services and chief of the breast division in the department of surgical oncology. In addition to his clinical role, Edge has been active in cancer care research and national policy development. His primary research focus has been in defining quality assessment tools for cancer care and systems to improve community-wide cancer care. Nationally recognized for his clinical and research work, Edge has published more than 170 peer-reviewed papers in oncology medical literature. He has received numerous awards, including the Statesman Award from the American Society of Clinical Oncology, and a New York Gubernatorial Award for his work in cancer survivorship.
Community Health Alliance and Baptist Memorial Health Care Enter Collaborative Agreement Community Health Alliance (CHA), Tennessee’s health insurance CO-OP, and Baptist Memorial Health Care have entered into a collaborative partnership to provide consumers with comprehensive patient-centered care. This is one of many managed care agreements Community Health Alliance is developing across the state as it assembles its network of preferred providers. One of the largest not-for-profit health care systems in the United States, Baptist Memorial Health Care offers a full continuum of care to communities throughout the Mid-South. The Baptist system, which consistently ranks among the top integrated health care networks in the nation, comprises 14 affiliate hospitals in West Tennessee, North Mississippi and East Arkansas; more than 4,000 affiliated physicians; Baptist Medical Group, a multispecialty physician group with more than 450 physicians; home, hospice and psychiatric care; minor medical centers and clinics; a network of surgery, rehabilitation and other outpatient centers; and an education system highlighted by the Baptist College of Health Sciences. Community Health Alliance (CHA) is Tennessee’s health insurance CO-OP,
created as part of the Affordable Care Act. A few things that make the company unique: Just like any insurance company, Community Health Alliance will be an approved carrier, regulated by the Tennessee Department of Commerce and Insurance, and is a member of the State Guaranty Fund. Enrollment opportunities begin on Oct.1, with policies effective Jan. 1, 2014. For more information, visit www.chatn.org
Bobby Meadows Hired As Executive Director Of MJHR Memphis Jewish Home & Rehab (MJHR), a not-for-profit organization providing rehabilitation services and long-term care for people of all faiths, announced that Bobby Meadows has been hired as the new executive director. Bobby Meadows Mr. Meadows is a licensed nursing home administrator who attended Marshall University and then the University of Alabama where he earned a business degree in healthcare management. He began his work in nursing homes as a CNA, later was state precepted, and then became licensed. He has a total of thirteen years of nursing home experience, eleven years as an executive director, the last six at Allenbrooke Nursing and Rehabilitation Center.
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GrandRounds “As physicians, we have so many unknowns coming our way...
One thing I am certain about is my malpractice protection.”
Dr. Aric Giddens Receives Physician Leadership Award Dr. Aric Giddens, a partner with the medical practice, Memphis Obstetrics and Gynecological Association, PC (MOGA) has been presented with the 2012 Physician Leadership Award from Saint Francis Hospital - Bartlett. Dr. Giddens was joined for the surprise presentation by several fellow physicians and members of the administrative staff at Saint Francis Hospital – Bartlett. Dr. Aric Giddens received both his undergraduate and medical degrees from Emory University in Atlanta. He completed his OB/GYN residency at UT Memphis and has been affiliated with MOGA since 1995. He is married to Dr. Andrea Giddens, who is also a MOGA physician.
VA Medical Center Holds Grand Opening of a new $3.66M OEF/OIF/OND Center In April, the VA Medical Center in Memphis, Tennessee, held an open house and ribbon-cutting ceremony to announce the grand opening of a new $3.66 million Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) building addition. The new 13,500 square foot center will offer many services for the increasing number of men and women who have returned from these wars. Post deployment screening and continuous care needs for multiple conditions including those related to polytrauma, traumatic brain injuries (TBI), Post Traumatic Stress Disorder (PTSD) and other specialty care needs are the focus for this new center. The open house ceremony marked the completion of work that began on this center in January 2011. Centers such as this assist soldiers in getting the VA health care and benefits to which they are entitled as they transition from the military.
Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer. Please submit press releases to pharris@ medicalnewsinc.com. memphismedicalnews
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Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control. What we do control as physicians: our choice of a liability partner. I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard. I believe in fair treatment—and I get it.
Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A (Excellent) by A.M. Best. ProAssurance.com • 800.492.7212
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GrandRounds Kathryn Schwarzenberger Appointed Chair of UTHSC Department of Dermatology
BOARD CERTIFIED PSYCHIATRIST NEEDED to serve as Clinical Director for 75-bed adult TJC accredited acute psychiatric facility. Potential faculty affiliation with UT Department of Psychiatry. Benefits include 37.5 hour work week (M -F, 8-4:30), retirement, 401K, health insurance, malpractice coverage, competitive salary, opportunity for additional income through night coverage.
The University of Tennessee Health Science Center (UTHSC) has announced the creation of a new Department of Dermatology in the College of Medicine. Launched in November, the department is chaired by Kathryn Schwarzenberger, MD. She assumed Dr. Kathryn her new responsibilities on Schwarzenberger May 1. Before joining UTHSC, Dr. Schwarzenberger was professor of medicine in the Division of Dermatology at the University of Vermont College of Medicine. After receiving her medical degree from the University of Texas Medical Branch in Galveston, she completed residencies in both internal medicine and dermatology at Duke University. A fellowship in immunodermatology research followed at the National Cancer Institute Dermatology Branch. Dr. Schwarzenberger has received numerous honors and awards, and has been published in multiple journals and dermatological textbooks. She currently serves on the board of directors of the American Academy of Dermatology -- the largest, most influential and most representative dermatology group in the United States. With a membership of more than 17,000, the academy represents virtually every practicing dermatologist in the country. All of the members of the new department are very active in the local dermatology and medical community. The faculty participates in the Memphis Dermatology Society, the Tennessee Dermatology Society and the American Academy of Dermatology. Members also serve many hospitals in the area, including the Regional Medical Center, the VA Medical Center, Methodist University Hospital and Le Bonheur Children’s Hospital, interacting with local colleagues on a daily basis.
Submit curriculum vita to Ms. Claudette Seymour, Director of Human Resources, 951 Court Ave., Memphis, TN 38103; or Claudette.Seymour@ tn.gov; or call Ms. Seymour at 901-577-1836 for more information. Facility operated by State of Tennessee Department of Mental Health & Substance Abuse Services
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CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com MARKET PUBLISHER Pamela Harris pamela@memphismedicalnews.com Ad Sales: 501.247.9189 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR editor@memphismedicalnews.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Heather Hauser Christie Passarello CONTRIBUTING WRITERS Ron Cobb, Jonathan Devin, Lynne Jeter Judy Otto, Ginger Porter, Cindy Sanders ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78
Physicians, Nurse Practitioners Join Midsouth Family Medicine The following providers have joined MidSouth Family Medicine: Tina Burns, M.D., Aparna Murti, M.D., Preston Givens, M.D., Barry Avent, FNP, Martha Evans, FNP, Suzanne Grooms, FNP and Debra Abston, FNP. All these providers are board-certified by the American Board of Family Practice. The providers listed above join Mike Nollner, M.D., Lee McCallum, M.D. and Jeff Mullins, M.D. in the practice.
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SOUTHCOMM Dr. Tina Burns
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Memphis Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
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GrandRounds Methodist Le Bonheur Healthcare Names Vice President, Chief Technology Officer Methodist Le Bonheur Healthcare (MLH) has named Eugenio “Gene” Fernandez, FACHE, vice president and chief technology officer (CTO). As CTO, Fernandez will develop information technology infrastructure strategy, including smart devices, Gene Fernandez mobility, wireless and security, and grow and support MLH information technology teams. Prior to joining MLH, Fernandez served as chief information officer at L.A. Care Health Plan in Los Angeles. With more than 20 years of experience as a healthcare information management bilingual executive, Fernandez has extensive knowledge of healthcare information technology systems, implementation, business process reengineering, IT strategic planning, IT outsourcing and project management. Fernandez is board certified in health care management as a fellow in the American College of Healthcare Executives. He is a member of the College of Healthcare Information Management Executives and serves on the board of advisors for the National Latino Alliance on Health Information Technology.
It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.
MGMA’s Mission: To improve the effectiveness of medical group practices and the knowledge and skills of the individuals who manage/ lead them.
UPCOMING LUNCHEONS AND SPEAKERS: JUNE 20TH Denise Burke with Butler Snow will be speaking on Preparing for Mandatory Compliance Programs & Increasing Personal Liability JULY 18TH
Tim Finnell of CB Group Benefits will be speaking on Healthcare Reform
Our Medical Specialty Group provides a dedicated team with tailored solutions to meet the unique financial needs of physicians and their practices. Visit suntrust.com/medicine to find an advisor near you. Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured • Are not Bank Guaranteed • May Lose Value. SunTrust Private Wealth Management Medical Specialty Group is a marketing name used by SunTrust Banks, Inc., and the following affiliates: Banking and trust products and services, including investment advisory products and services, are provided by SunTrust Bank. Securities, insurance (including annuities) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC registered investment adviser and broker-dealer, member FINRA, SIPC, and a licensed insurance agency. SunTrust Bank, Member FDIC. © 2013 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. How Can We Help You Shine Today? is a service mark of SunTrust Banks, Inc.
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ON THE
FRONT LINE OF LIFE.
Regional Medical Center has an unmatched record of saving lives. And we take that experience into every aspect of the healthcare we provide. We are on the front line of life.
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Client: The Med Job No: MED-41120 Title: Front Line Of Life Ad