Memphis Medical News May 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 3

David Wright, MD

ON ROUNDS

MEMPHIS on the MEND BY PAMELA HARRIS

Christ Community Health Services: A Vision Turned into Fruition In the beginning . . . there were four medical students: Rick Donlan, Steve Besh, Karen Miller and David Pepperman. ... 4

Medicare Reimbursement Cuts Create Long-Term Concern By JONATHAN DEVIN

Memphis-area physicians say they will not change how they do business because government-funded programs have suffered budget cuts. But the tension is increasing for a long-term resolution. The cuts, caused by Congress’ failure to avert sequestration, included a 2 percent cut in Medicare reimbursements that began April 1. Most physicians were disappointed, but not surprised “If (physicians) are members of the Tennessee Medical Association, they weren’t surprised,” said Wiley Robinson, MD, immediate past president of the Tennessee Medical Association. He also runs Inpatient Physicians of the MidSouth, a group of 22 hospitalists. “We’ve been keeping physicians well informed over the last several years and we’ve been working hard to lobby Congress to either withhold or reduce any cuts in reimbursements in order to preserve care for Medicare recipients.” The fear is that at some point physicians may begin to retire early, stop accepting new Medicare patients into their practices, or stop seeing (CONTINUED ON PAGE 16)

Mayo Clinic Fellow Trains at Mroz Baier The Mayo Clinic is world renowned for excellence, but isn’t above turning to a Memphis medical leader for occasional help ... 8

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Lisa Klesges New U of M dean aims at making public health a local priority By JUDy OTTO

Part visionary, part probing researcher, part diplomat, Lisa Klesges is 100 percent creative strategist when it comes to the University of Memphis’ fledgling School of Public Health – just 3 years old, but growing fast and moving confidently toward accreditation under her guidance as dean. Although the university had an established Masters of Health Administration program and

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added an interdisciplinary Masters of Public Health program four years ago, Klesges was offered the challenge of building a School of Public Health around this promising nucleus — and she accepted promptly. The resulting internal moves of faculty as well as hiring new talent have been exciting for the university and the community, says Klesges, who foresees a long-term and significant impact on the Memphis area’s overall attitude toward health, ultimately motivating (CONTINUED ON PAGE 14)

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PhysicianSpotlight

David Wright, MD

Founder of the Wright Clinic focuses on prevention By RON COBB

It was David Wright’s first day of medical school at the University of South Florida in Tampa, on the state’s west coast. Back home on Florida’s east coast, Wright’s wife, Cindy, was delivering their first child. Bad timing all around. Cindy was two weeks beyond her due date. David was in Tampa getting the house ready where they would live while he went to med school. “My biggest challenge was becoming a father and starting medical school all at the same time,” he said. “It taught me how to budget my time, I can tell you that.” More than 30 years later, Wright runs The Wright Clinic in Cordova, where, coincidentally, the message to his patients is that timing is everything. The clinic is all about prevention of heart attacks, strokes and diabetes. It’s about identifying at-risk patients and helping them make lifestyle changes before they become ill. Wright did his internal medicine residency at Baptist Memorial Hospital. He had financed medical school with an Air Force scholarship, so he also served for three years in Blytheville, Arkansas, as an internal medicine physician. When his tour of duty was up, he contacted some former classmates who had opened a practice in Memphis, and they accepted him as a partner in 1985. While he was at Baptist, Wright learned all he could about heart disease, and “once I got out in practice, I slowly realized that just taking care of someone after they had a heart attack or stroke is not what we need to be about,” he said. “We need to get ahead of that curve. We need to find those folks who are at risk as early as possible and teach them how to take care of their bodies, teach them proper nutrition, teach them the importance of exercise, teach them what they need to pay attention to so they never have to deal with heart attack and a stroke.” He had become interested in medicine at an early age. His father was an electrical engineer who worked on the Apollo moon program and the space shuttle; his mother was a nurse. At age 3, he had his tonsils taken out, “and my mom tells me I was very fascinated by all the doctors and nurses,” he said. “I knew she’d been a nurse, and shows like ‘Ben Casey’ and ‘Marcus Welby, MD’ were pretty popular in my childhood. Truthfully, I think Marcus Welby was one of the role models that sounded like a neat thing to do. At the time I was in high school, I was really good in science, and it seemed like a good fit.” The Wright Clinic (thewrightclinic. com) opened two years ago, but the doctor’s interest in prevention had been evolving over a number of years as he read the newest research and attended national seminars. He learned more from Berkeley memphismedicalnews

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HeartLab and its cutting-edge approach to cardiovascular testing, which included “a lot of factors beyond conventional cholesterol levels, including some genetic testing,” he said. Wright maintains his regular internal medicine practice, but the focus has shifted to prevention. “We try to keep it in the forefront that no one has to suffer the scourges of heart attack, stroke and diabetes, and even if you have a family history of those diseases, it doesn’t have to be that way for you.” Typically, patients go the clinic and begin with a 60-minute interview, with subsequent visits of 30 to 45 minutes. The goal is educating patients and providing a prescription for them to follow. The word “exercise” is avoided in favor of “movement medicine.” The outline for each patient is very specific. “We’ve had to do that because there’s so much noise in the world in terms of TV, infomercials or Internet on ‘eat this’ or ‘don’t eat that,’ ‘here’s the miracle food or miracle supplement.’ People don’t know what to listen to,” Wright said. “They kind of throw up their hands and eat what they enjoy. What we try to do is educate them on the specifics of their condition and what specific thing they ought to pay attention to in their diet. “People know they should exercise but don’t know how to do it, how much or how often, so education is a lot of what we do. “Most people think they’re bulletproof. Deep down they think ‘it’s not

going to happen to me.’ Or ‘it might happen to me, but I don’t want to think about it so I’m just going to pretend I’m bulletproof.’ Part of what we do is helping them understand what’s really going on inside their body, what their blood chemistry is telling us.”

After providing a specific plan, he said, “it comes down to reinforcing the message, because most of us can’t hear something once and act on it. We really become cheerleaders for these folks as they make baby steps toward progress.” Patients, he said, routinely lose 25 to 30 pounds over three to six months. “We haven’t added a drug to them, and it’s not a crazy diet,” he said. “They’ll come in and brag about how many dress sizes or how many belt loops smaller they are, how much better they feel.” Patients will be shown the change in their blood chemistry, and that “we know you have changed the course of your life, and we know you’ve either greatly delayed something that was going to happen to you, or hopefully totally prevented it from happening.” Away from the clinic, Wright can often be found with a trumpet in his hands. He’s a member of The Sunday Traffic Brass Quintet, playing at weddings, shopping malls, churches and nursing homes. He and Cindy also enjoy ballroom dancing, a result of starting dancing lessons 10 years ago as preparation for their daughter’s wedding.

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MAY 2013

Christ Community Health Services: A Vision Turned into Fruition MEMPHIS on the MEND BY PAMELA HARRIS

In the beginning . . . there were four medical students: Rick Donlan, Steve Besh, Karen Miller and David Pepperman. They became friends while studying at Louisiana State University School of Medicine and discovered that in addition to sharing the call to practice medicine, they also shared a strong Christian faith and a desire to bring that into their medical practice. All four belonged to an organization called the Christian Medical and Dental Association whose mission is to encourage medical students, and ultimately doctors, to serve with “professional excellence as witnesses of Christ’s love and compassion and to advance biblical principles of healthcare within the Church and to our culture.” And that’s exactly what this medical foursome did. With their entire careers in front of them, they investigated southern cities to find the place that needed them the most. Fortunately for us, they chose

Memphis because it was the city in Tennessee with the largest concentration of medically underserved and because it had the most severe shortage of primary care physicians.

Fasting, Praying and Waiting for Miracles

In the beginning . . . it was not easy. It took two full years to get the first funding and aid that came from Baptist Memorial Healthcare Foundation. It enabled them to open their first clinic in 1995. Still, it was a lot to handle. Over the years, they have literally existed with a lot of fasting, praying and waiting for God to bring them what they needed. In 1998, one big blessing arrived: Burt Waller, then CEO of The MED, met the four doctors in a meeting, loved their mission and vision and knew he could help. He agreed to come on parttime temporarily to offer his administrative expertise. Now, 15 years later, Waller is still there. In spite of all their good intentions,

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The CCHS founders in a photo taken around 1995, just after the first clinic opened. From left, Drs. David Pepperman, Rick Donlan, Karen Miller and Steve Besh.

What You Can Do to Help

hard work, good recruiting decisions and the family atmosphere they created, they were always “on the verge of financial collapse,” says Waller, who recalls the early days. “We couldn’t get paid from TennCare and we owed a lot of money. We would frequently come to the end of our rope and would fast and pray for answers.” Then one day the phone rang. It was a local attorney who needed to know if they had a brokerage firm in town because he had securities to transfer to Christ Community Health Services (CCHS). It was an anonymous gift from a woman whose father had passed away and left her an inheritance above and beyond what she needed. So she gave it to several Christian organizations in Memphis, including CCHS, which received $200,000 in stocks and securities. “That answered our prayers,” said Waller. To this day, they don’t know who that donor was. But Waller wants her to know the impact her gift made. “I hope she is aware of our progress and knows that her gift really preserved us.” Today, CCHS is the largest primary care provider for the poor in Memphis, serving 50,000 patients in 140,000 visits each year. About 90 percent of their patients are under the Federal Poverty Line. CCHS provided 800 women pre-natal care last year and delivered 600 babies. They are the second largest faith-based, federally qualified health center in the United States. They now have six health centers, three dental clinics, three full-service pharmacies and a mobile health van that serves homeless Memphians. They employ a staff of 300, including 30 physicians, 16 mid-levels and six dentists. While this paints a picture of amazing success, one of the founders, David Pepperman, MD, confirmed they still have their share of struggles which he believes will never go completely away. “If we got to be too successful, we might not keep doing the things that God wants us to do and that got us here. Struggles keep us dependent and praying.” So every morning before clinic they pray.

DONATE In spite of all the hard work, dedication, long hours and six health centers, CCHS ends up turning away 100 or so patients a day at some of their clinics. But they keep trying to lower that number. In the works is the expansion of their Frazier clinic, currently 3,400 square feet. When the addition is completed there will be 19,000 square feet of clinic space. They were able to secure a $5 million grant to help with the expansion, but still need help with the land and equipment when completed by the spring, 2014. In addition, CCHS has a new Women’s Health Initiative in all their clinics to offer better OB/GYN care and help lower the infant mortality rate in Memphis. Part of that initiative involves building a new Women’s Health Center in the Binghampton area of Midtown which is expected to open this summer. If you would like to donate to CCHS, visit their webpage www.christcommunityhealth.org and click on the DONATE tab, or call their administrative office at 901-260-8500. VOLUNTEER Among the needs of the CCHS are specialists willing to volunteer time and resources to see CCHS patients who are unable to pay. Specifically, they occasionally need radiologists, although both Methodist LeBonheur and Baptist Memorial Healthcare Corporation provide the majority of these services for them. More often they need orthopedic physicians and rheumatologists who are willing to partner and be a part of the CCHS mission of “providing high quality healthcare to the underserved in the context of distinctly Christian service.”

And God saw that it was good

18 years after the first CCHS clinic opened, two of the CCHS founders, Karen Miller, MD, and Steve Besh, MD, (West Clinic) have moved on and found other ways to serve. Rick Donlan, MD, and Pepperman are still in active roles at CCHS. Burt Waller is still looking to retire into a more part-time role.

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MAY 2013

Hey Doc, Will You Play Ball? By TIM NICHOLSON

Sharing information has to start with this – know to whom the information belongs. Hint: it’s not you, Doc, even if you’re the one holding it. It’s like it was yesterday. It was the first day of school in the second grade. I’d carried my baseball glove and ball for a game of catch during recess. Ricky had done the same. We chose to use his ball. He’d painted it green and yellow to honor his beloved Oakland Athletics. Mine just had a big “T” on it. I left it on my desk. On the way to recess the new kid asked if he could use my ball. He didn’t have one but he looked like he knew how to play. And since Mom had taught me to share, using mine was fine. When recess ended I went to retrieve my ball. The new kid threw the ball back to me. But it got by me and the teacher politely picked it up. She and I talked baseball on the way back to class. We were settling back in our seats before I realized that she still had the ball. I watched her put it in her desk drawer. Cool. It would be safe there until I needed it. After class I went to her desk to ask for the ball. I waited as she talked to another kid. Meanwhile, Mom was waiting in the carpool line. Knowing that, I reached for the handle on her desk drawer to retrieve my ball. The teacher slapped my hand with a ruler and said, “You can’t look in there.” “Yes, ma’am. But I’m just getting my ball while you’re busy with another patient (oops, I mean student).” My ball. Someone else used it with my permission. She now stored it. I wanted to use it. She suddenly acted like it was her ball. Okay, maybe I needed some sort of permission to access it. Maybe she had stuff in there from other kids. But at some level it should have been reasonable to let me get my ball – even a second grader knew that. So is the way it goes with patient data. The ball Ricky and I used was green and yellow. Maybe you’ve heard of the “blue button”. The Department of Veteran Affairs initially implemented it. Other public and commercial health plans have since adopted it. More than a million patients currently have access to their health data with the tool as found on health plan websites. And here’s what we learned about its use and patient views on personal health information at last summer’s Consumer Health IT Summit:

Who owns it

“It’s my right to have it,” said one veteran who suffers from a heart condition and Type 2 diabetes. “They’re my medical records and, with the Blue Button, I’ve got control of them.” Not only does he own it, he knows that it can be easy to access.

Who stores it

“There’s a wide perception out there that HIPAA is a barrier,” said Department of Health and Human Services Director of the Office for Civil Rights Leon Rodriguez, JD. “HIPAA is a valve, not a blockage. HIPAA is meant to regulate health information so that it is used to benefit the patient and for no other purpose.” So maybe the IT guy should stop offering, “We can’t do that. It’s a security issue,” in response to how it’s stored and accessed and admit that it’s really just an attitude issue. Most of your patients are accessing confidential information from other sources (i.e. the bank). They don’t see their health record as any more valuable than their banking information or any more difficult to access or secure.

Who uses it

Allowing access “moves us from personal health records tethered to particular providers to the concept of a personally controlled health record,” National Coordinator for Health IT Farzad Mostashari, MD, ScM, said. Rather than just viewing the record, users are encouraged to take ownership of their data. Patients can add information, point out errors in their records and share their health information with whomever they like. Heck, they could even put a big “T” on it if it’s theirs. Individually owned health information is expected to produce better health outcomes in the patient-centered future of healthcare. So let’s agree that the patient owns the data. Let’s let them share it as they like. And let’s accept the notion that whether on the clinic’s system or in the teacher’s desk drawer – we’re going to have to allow the owner to access it when they like even if it’s just for another game of catch. 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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MAY 2013

Mayo Clinic Fellow Trains at Mroz Baier By JUDY OTTO

The Mayo Clinic is world renowned for excellence, but isn’t above turning to a Memphis medical leader for occasional help. Tiffany Torstenson, DO, a Mayo Clinic fellow, recently took advantage of an opportunity to spend six weeks under the tutelage of Christine T. Mroz, MD, who serves as fellowship director of the Mayo Clinic Imaging Studies at the Mroz Baier Breast Care Clinic in Memphis. Torstenson, a graduate of Des Moines University Medical School in Iowa , initially completed her residency at Mercy Medical Hospital in Des Moines and went on to do her fellowship at Mayo Clinic. She completed her course of study at the Mroz Baier Clinic in March and is enthusiastic about her experience there. “My program director, Dr. Bowie, has been sending fellows down to Memphis to get more experience with Dr. Mroz,” Torstenson said. “At Mayo we don’t get a lot of hands-on with the ultrasound and reading mammograms, so I was really excited to have this opportunity for six weeks to come and meet her.” Because radiology departments have their own residents and fellows, she noted, “it’s very common in breast fellowships at big academic centers that the fellows don’t get a lot of experience doing biopsies or ultrasounds. Getting that kind of experience is difficult.” The Mroz Baier Breast Care Clinic was a natural choice to fill this need, Torstenson feels. “It was the best place I could go to get a good sense of the diagnostic part of breast oncology, since Dr. Mroz is one of the few breast specialists and surgeons in the world who reads her own mammograms. I have learned tons about mammography and ultrasounds; as much as you go to school, nothing trumps this kind of experience in the medical field.”

Tiffany Torstenson, right, with Dr Christine Mroz.

Mroz, also a Mayo alumnae, was the fourth female to complete a surgical residency at the Mayo Graduate School of Medicine at Rochester, Minn. She later became the first female president of the 17,000-member Mayo Clinic Alumni Association. One of the first female surgeons in Memphis, she has received numerous awards for her work as a breast surgeon; the Mroz Baier Clinic is nationally accredited and internationally recognized and attracts patients who travel great distances to receive care. Torstenson marveled at Mroz’s surgical skills, as well: “Dr. Mroz is the only doctor I’ve seen who doesn’t need a seed or a needle to locate and extract a fivemillimeter cancer.” Mammograms display two views — a

cranio-caudal (CC) view taken from above and a mediolateral-oblique (MLO) view taken from the side, at an angle. Mroz displays amazing skill at visualizing precisely in three dimensions what those twodimensional views present, Torstenson explained. “She knows where to make her incision, exactly where to dissect down. Most of us need more guidance. “Because a lot of the cancers or lesions we see are not palpable, obviously when you go to surgery you need something to help you locate a lesion that you cannot feel. Most surgeons use a wire localization; a wire is placed, usually by the radiologist, into the lesion or the cancer, and then the surgeon can dissect around that area to remove it. Or they can put a radiolabeled seed that looks almost like

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a rice pellet into the lesion and, using a gamma probe, can help localize lesions that way. “What Dr. Mroz does is unique. She is such a good clinician and such a good mammographer that she can just look at her film and know where that lesion is and exactly where to make her incision, without having anything to localize it. This is probably one of the most amazing things I have ever seen any surgeon, let alone a breast surgeon, do,” Torstenson said. As a result of her experience studying with Mroz, Torstenson said she now feels much more comfortable reading mammograms and can more easily identify abnormalities as either malignant or benign. The multiple opportunities she has enjoyed to perform ultrasounds during her visit have expanded her comfort level in that area, as well. “I’m going back to Mayo to finish my fellowship, and my goal is to be more vigilant, especially in the O.R., about getting the ultrasound machine out and just keeping up my skills.” Torstenson looks forward to completing her fellowship this summer and reported that she is still weighing her options relative to establishing a practice closer to home or in the Memphis area. “I have to say,” she laughed, “that my husband came to Memphis last weekend, and he went home 10 pounds heavier from eating so much barbecue!” Whatever her decision, she expects to stay in touch with Mroz in the future. “Dr. Mroz is truly one of the most amazing surgeons I have ever encountered,” Tortenson said. “She’s not only a great physician, she’s an amazing person. I’m just really glad I had this opportunity — many of the fellows don’t get to do this, and I think it’s really going to benefit me in my future.” The Mroz Baier Breast Care Clinic was founded in 1995, inspired by the breast cancer experience and death of Julie Bourgeois Baier — first wife of founder and CEO Joseph Baier, who says the clinic has served more than 45,000 patients to date and has been called the best breast center in the world. The Molly Meisenheimer Training Facility expands the clinic’s commitment to education and clinical study. Developed to be a teaching site for breast physicians in the use of modern technology, including digital stereotactic needle core breast biopsy and the use of ultrasound as a diagnostic test, the facility also provides space and audiovisual equipment for frequent physician conferences.

For more information, visit their website at www. breastcareclinic.com.

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Memphis Healthcare Real Estate Defies Trend

Investors grab what’s available after doctors align with hospitals By JONATHAN DEVIN

Doctors may feel a little uncertain about the healthcare market these days, but real estate experts have no doubts about medical offices. They are hot property. Even sequestration can’t slow a rush of investors hoping to cash in real estate made available by physicians’ groups aligning with hospitals. “Can anyone explain why the stock market’s gone up 10 percent in the last 90 days?” said Larry Jensen, president and COO of Commercial Advisors and an executive committee member of Cushman & Wakefield’s Healthcare Larry Jensen Practice Group. His point is that while it may seem counter-intuitive, the political risks associated with healthcare — namely cuts to Medicare reimbursements and uncertainty about components of the Affordable Care Act — are not stifling investments in healthcare real estate. “We’ve been taught that uncertainty translates into risk, and the more uncertain things are, the less inclined investors will be to invest,” Jensen said. “That’s just not the case in healthcare.” Cushman & Wakefield/Commercial Advisors developed its Healthcare Practice Group to keep up with a rise in that sector of commercial real estate. There are a number of reasons for the increase, beginning with the availability of space due to the trend of physicians aligning with hospitals. “On a local level, what seems to be fueling the real estate transactions is primary healthcare providers, namely Methodist, Baptist and, to a lesser extent, Saint Francis going out and purchasing practice groups,” said Jeb Field, vice president of Commercial AdJeb Field visors. “Some of those practice groups own their own buildings. There’s some redundancy built into their systems, so (the hospitals) are trying to reallocate those resources across the market for better coverage.” And who’s buying? “On the investor side, it’s been pretty robust,” said Scott Mason, exec managing director and leader of the Healthcare Practice Group for Cushman & Wakefield. “In the last 12 to 18 months, capitalization rates have come down a little bit, so the valuations are quite high. “Even some of the national REITS

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are carving out and selling their medical office building components because the prices are so good. Healthcare REITs’ stock values have gone up the most of any component in the REIT structure, probably 40 percent in the last 12 to 18 months in comparison to other stocks.” REITs, or Real Estate Investment Trusts, are required to distribute the lion’s share of their earnings as dividends, so they prefer a secure market, explained Rosemarie Fair, principal of One Source Commercial. As more medical office buildings come under the umbrella of major regional healthcare providers, the investments in those buildings become more secure. “REITs like the sale and lease back of medical office buildings because the hospital would have the master lease on it,” Fair said. “REITs are aggressively looking for medical office buildings. They have already picked the low-hanging fruit of medical offices on hospital campuses.” Fair added that markets in Tennessee, Arkansas and Mississippi are prime markets for REITs because the coastal markets have already been bought up. When a REIT buys and leases back a medical office building of a physician’s group in alignment with a hospital, it’s usually a win-win for the investors and the sellers, Jensen said, because hospitals want to get rid of redundant space so they can move services in high-traffic retail spaces. “Memphis Orthopedic Group just completed a lease on space that’s under construction at the 4515 Poplar Building,” Jensen said. “It’s an office building, but it’s located for retail. Baptist just bought the postal service building on Union Avenue. They haven’t announced what they’re going to do there, but it’s obvious that they want a location that’s high-traffic retail where they can do some kind of a physician office building.” Jensen also pointed out the success of Campbell Clinic in turning the Germantown Pkwy/Wolf River Blvd. corridor into prime space for medical offices even though there are no immediately adjacent hospitals. “(Medical patients) are becoming as much customers as patients,” Jensen said. “It’s all about the experience. The healthcare system is adapting to that slowly.” “That’s a microcosm of what’s unfolding nationally,” Mason said. “Real estate in healthcare has become strategic. Historically it’s been tactical. It’s been colocated with a hospital. Retail is the right word for it now. You’re looking for hightraffic, high-visibility locations.” That’s also true around the region. Gary Taylor, commercial developer for Gary A. Taylor Investment Company,

just completed the first LEED silver certified hospital administrative building for Community Health Services in Jackson, Tenn. The rural market continues to grow, Taylor said, not only because of the high valuation of property but because of growing patient needs. “When you look at the demographics in West Tennessee, we have one of the highest levels of adult onset diabetes in the nation,” Taylor said. “With that comes a tremendous amount of required care. “Our market (in Jackson) is a little more concentrated in some areas. Memphis is the healthcare mecca of four or five states in this region, and we are a small Memphis because we’re a healthcare mecca of a seven-county region.” But then there’s a common-sense side to investing in healthcare real estate right now, he said, while other investments are faltering. “CD rates and treasury rates are at an all-time low,” Taylor said. “If an older couple has $2 million in investments and it’s only drawing them 2 percent, it’s difficult to live off of. They don’t want a lot of risk, but they want some return.”

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MAY 2013

IT Acceleration

MedEvolve finds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide By LYNNE JETER

LITTLE ROCK – When Bill Hefley, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new information technology (IT) system to replace an antiquated one. After completing due diligence on various options, he played it safe and purchased a new system from the nation’s largest vendor. “It was a complete disaster,” recalled Hefley, noting the software was different than the demonstration version, the trainer was “preoccupied and disinterested,” and customer support was practically non-existent. “Our practice collections soon approached zero. I knew there had to be a better way.” A hobbyist computer programmer, Hefley devoted his energies to filling the void in the marketplace. From it, he established MedEvolve as a truly collaborative industry partner to solidify the IT backbone of medical practices. The success of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field

MAY 2013

of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing Board

In searching for a better solution in the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Horsham, Pa., and a pioneer in the emerging field of electronic medical records (EMR). “Intrigued, I became an early investor and a development partner focused on orthopedic clinical content,” he said, noting that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development partner with NextGen in 1994, working on the development of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing computerized billing and scheduling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering support and customer service. I frequently heard my physician friends and colleagues recount horror stories of flawed software systems with dismal support that were making it impossible to run their practices successfully. I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.” In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service. “My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We integrated our PM product with several specialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.” With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM.

“Physicians were struggling with increasingly complex third-party payor systems, growing documentation requirements, mounting government regulations, and threats of audits, fines and imprisonment,” said Hefley. “Practices were searching for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of the ever-changing rules and regulations. Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.” MedEvolve developed an RCM division, acquired three small RCM companies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists. “With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers immediately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”

Health Reform Impact

The 2009 American Recovery and Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system. “With the new criteria defined, MedEvolve saw a need for a modern EHR product designed from the ground up to meet Meaningful Use mandates and finally deliver on the industry’s promise of a cutting edge, customized solution that helps practices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.” Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excellent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature. As a result, employees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.” “In the software business, that means several operators are at the ready for periods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so (CONTINUED ON PAGE 15) memphismedicalnews

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May is Melanoma Awareness Month

UT Surgical Oncologist Offers Targeted Chemotherapy, Giving Hope to Patients With Melanomas and Other Cancers

Jeremiah Deneve, DO Surgical Oncology Doctors at UT Surgical Oncology are now using regional therapy to treat advanced skin and soft tissue cancers, including melanoma and extremity sarcomas. Isolated Limb Infusion (ILI) allows the delivery of regional chemotherapy, targeting cancer cells with much higher concentrations of cytotoxic chemotherapy than traditional systemic chemotherapy dosages. The innovative procedure has proven to be effective for highly selected patients with advanced skin and soft tissue extremity disease and offers an additional treatment option for patients when conventional chemotherapy, radiation, or surgery have limited impact.

Instead of circulating chemotherapy throughout the entire body, Isolated Limb Infusion limits the anti-cancer drugs to the affected limb. The minimally invasive technique provides an alternative to standard therapy, which often requires massive tissue removal or amputation of the limb. “Until recently, patients from this area had to travel to other parts of the country, such as Texas or North Carolina, to have this therapy,” says surgical oncologist Dr. Jeremiah Deneve Deneve, who was trained in the procedures at Moffitt Cancer Center at the University of South Florida. “Now, we are able to offer these techniques right here in Memphis at Methodist University Hospital.” ILI is performed in the operating room under general anesthesia and in a controlled environment. A vascular surgeon places catheters within the blood vessels of the affected extremity. The extremity is isolated and excluded from the systemic circulation using a tourniquet, which temporarily restricts blood flow. This allows the delivery of a much higher concentration of chemotherapy to the affected limb. The extremity is heated to increase the tumoricidal (cell death) activity of the chemotherapeutic agent. The cytotoxic agent is administered and circulated in the affected extremity for a set period of time and then cleared from the circulation. The procedure generally lasts two to three hours. Patients are closely monitored for side effects and generally discharged from the hospital within five days. “Patients require close surveillance after ILI treatment and often continue to receive additional therapy for distant or progressive disease,” says Dr. Deneve. “However, studies have demonstrated good outcomes for ILI when treating appropriately selected patients.” More importantly, highly specialized

procedures such as ILI for advanced extremity skin and soft tissue disease represent the culmination of a larger multidisciplinary effort that includes the surgical oncologist, medical oncologist, radiation oncologist, pathologist, dermatologist, and others who care for these unique patients. UT Surgical Oncology Team The physician team at UT Surgical Oncology is comprised of surgeons who are board certified in either surgery or surgical oncology. This multidisciplinary team provides compassionate patient care at convenient locations in both the Memphis Medical Center near Methodist University Hospital and in Germantown. They also serve on the faculty of the University of Tennessee Health Science Center College of Medicine, where they teach the doctors of tomorrow and participate in medical research. Dr. Martin Fleming Division Chief & Associate Professor – Surgical Oncology • Board certified, American Board of Surgery • Best Doctors • Specializes in cancers of the gastrointestinal system, breast, hepatobiliary and pancreas; melanoma and soft tissue sarcomas; thyroid and parathyroid disease.

Dr. Stephen Behrman Associate Professor – Surgical Oncology • Board certified, American Board of Surgery • Top Doctors • Specializes in cancers of the pancreas, esophagus, and stomach; biliary and pancreatic surgery; surgery for inflammatory bowel disease; and gastrointestinal surgery.

Dr. Gitonga Munene Assistant Professor – Surgical Oncology • Board certified, American Board of Surgery

• Specializes in cancers of the appendix, breast, pancreas, gastrointestinal system, skin (melanoma); and thyroid and parathyroid disease. Dr. Jeremiah Deneve Assistant Professor – Surgical Oncology • Board certified, American Board of Surgery • Specializes in cancers of the esophagus, pancreas, melanoma, sarcoma, and gastrointestinal tract. Dr. Paxton Dickson Assistant Professor – Surgical Oncology • Board certified, American Board of Surgery • Specializes in cancers of the liver, pancreas, esophagus, stomach, small intestine, colon, and rectum; melanoma, soft tissue sarcoma; benign and malignant diseases of the endocrine system. Dr. Elizabeth Pritchard Associate Professor – Surgery • Board certified, American Board of Surgery & American Board of Surgical Critical Care • Best Doctors • Specializes in benign and malignant breast problems and patients with high risk of breast cancer.

Dr. Alexander Mathew Assistant Professor - Colon/Rectal Surgery • Board certified, American Board of Surgery & American Board of Colon & Rectal Surgery • Specializes in cancers of the colon, anus and rectum; anal incontinence and fissure; bowel surgery; hemorrhoids; pelvic floor disorders; inflammatory bowel disease; stoma surgery; and rectal prolapse. More information Please call 901-866-8520 to make an appointment with UT Surgical Oncology in Germantown or 901-725-1921 for an appointment at the Memphis Medical Center office. Visit www.utmedicalgroup. com for more information.

Pictured from left to right: Stephen Behrman, MD, Paxton Dickson, MD, Elizabeth Pritchard, MD, Jeremiah Deneve, DO, Martin Fleming, MD, Alexander Mathew, MD, & Gitonga Munene, MD

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MAY 2013

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MAY 2013

Governor Selects “Third Choice” on Medicaid Expansion By CINDY SANDERS

When it came time to expand TennCare rolls to cover those up to 138 percent of the federal poverty level (FPL) or decline the offer that included a hefty federal match, Governor Bill Haslam opted for ‘none of the above.’ Instead, the state leader chose to put forth a third option he has dubbed the Tennessee Plan. Current estimates count a little more than 925,000 people in TennesGov. Bill see among the uninsured. Haslam Of that group, approximately 475,000 should qualify for subsidies available to those between 100-400 percent FPL in the new insurance marketplace. The balance of the uninsured either earn too much to receive subsidies (an estimated 50,000 Tennesseans), or are currently eligible but not enrolled in TennCare (estimates vary from 60,000-100,000), or have no viable coverage solution in the absence of Medicaid expansion or acceptance of the Tennessee Plan. The Kaiser Commission has placed that last group at 370,000 Tennesseans with the state estimating approximately 181,000 would have been expected to enroll in an expanded TennCare program over the next 5.5 years had the governor opted to go in that direction. How We Got to this Point As written, the Affordable Care Act (ACA) sought to significantly reduce the number of uninsured Americans through the individual mandate requiring coverage (with subsidies on a sliding scale to make such coverage more affordable) and by expanding Medicaid rolls. In 2012, the Supreme Court upheld the individual mandate but decided states could not be forced to accept a federal edict to expand Medicaid programs. Since the law was created with both parts of the equation in place, the Supreme Court’s decision to uphold one but strike down the other has left a gaping doughnut hole for citizens with the greatest need … non-pregnant, non-disabled adults under the age of 65 without minor children who are below 100 percent of FPL. “In the ACA provisions, anybody between 100 and 400 percent of poverty level could shop the exchange and get premium assistance,” explained Beth Uselton, program officer overseeing ACA outreach and planning for the Baptist Beth Uselton Healing Trust. “The law assumed anyone who was under the 100 percent FPL income threshold would get coverage through expanded state Medicaid.” The Supreme Court decision last summer left the lowest income

group without any guaranteed assistance to secure coverage, explained Uselton. For states that opted to expand Medicaid, the federal government will cover 100 percent of costs for the newly enrolled population from 2014-2016, phasing down to 90 percent by 2020 where the match rate is slated to remain. This rate is still significantly higher than what states receive for current Medicaid enrollees, which is 65 percent for TennCare participants. In the FY 2014 budget presentation prepared by Darin Gordon, Wendy Long, MD, and Casey Dugan of the Tennessee Health Care Finance Administration (HCFA) and released prior to the governor’s decision on expansion, the group estimated “the net cost of health reform to the state could be approximately $1.2 billion over the first five-and-a-half years (Jan. 1, 2014-June 30, 2019) depending on programmatic/policy decisions.” However, the report added, “The majority of that cost is unavoidable and will be incurred by the state regardless of its decision on Medicaid expansion.” The vast majority of that increased cost over 5.5 years comes from the “Eligible but not Enrolled” (EBNE) population … those who currently qualify for TennCare but who haven’t been on the rolls. This group will pull down the current 65 percent match rate. The mandate requiring most individuals to carry coverage … coupled with screening tools in the online insurance marketplace that alert individuals to Medicaid eligibility … is anticipated to drive between 60,000-100,000 EBNE individuals to TennCare. The other significant cost to the state is a new excise tax on health plans that includes Medicaid managed care plans. Had the state opted to expand TennCare to the 138 percent FPL threshold, the HCFA budget report estimated an additional $200 million in costs to the state over the next 5.5 years (state portion of coverage after 2016) and potentially an additional $100 million annually thereafter presuming the 90 percent match rate for the expanded population stayed in place … and perhaps significantly more if the federal government reduced their payment portion in the face of budget pressures down the line. On the flip side, saying ‘no’ to the expansion means Tennessee turns down billions of dollars in federal funds over the next few years. The Tennessee Plan In announcing his decision on March 27 to say ‘no’ to TennCare expansion, Gov. Haslam unveiled his ideas of how to insure those who would otherwise be left out of coverage assistance. He said expanding a broken Medicaid system doesn’t make sense for Tennessee. “That’s why I’ve been working toward a third option: to leverage the federal dollars (CONTINUED ON PAGE 18)

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Unconventional Wisdom Rethinking the approach to some autoimmune disorders By CINDY SANDERS

What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research findings. Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treating a range of inflammatory and autoimmune disorders. The rheumatologist, who is also a professor of Medicine and Rheumatic Disease at the Weill Medical College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease. Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is due to the body’s subsequent response. “What you were left with was an inflammatory problem that was no longer tied to the previous organism,” Paget explained.

A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder. In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological Association, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order to rein in the overactive immune system we believe to be causing the disease, we employ immu-

nosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.” A small but intriguing study out of the Division of Rheumatology at the University of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combination antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospective, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in any variable. At month six, the authors found significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The primary end point was achieved in 63 percent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into complete remission. No patient in the placebo group achieved remission. Pointing to this study, Paget noted that one of the failures of antibiotic regimens in the past in treating autoimmune disorders might be the duration of the therapy. “If

you give long courses of antibodies, you may very well calm the problem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosuppressive drugs to ameliorate the ongoing inflammatory issue after treating the triggering microorganism with antibiotics or antivirals for a relatively short course, “It may very well be we have to improve the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system. While much more research must be done, Paget said mounting evidence of the important connection between microorganisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ultimately portend a paradigm shift in the delivery of care. “In some of these, the organism is slow, smoldering … but still there in a low-grade way that is triggering the inflammatory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded.

(CONTINUED ON PAGE 15)

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MAY 2013

Healthcare Leader: Lisa Klesges, continued from page 1 and facilitating choices that promote better health. “I think there’s a resurgence of thinking about population sciences, which is just another way to talk about the methods and philosophy around public health,” Klesges said. “Public health has a really old history, dating back to the London cholera epidemic (1849) and John Snow’s studies of life, mortality tables and death within a population. The Affordable Care Act and healthcare reform encourage this much different take from the healthcare industry — not just caring for sick people but learning how to manage health in a population to keep them healthy — because reimbursements are shifting more toward that focus.” While the medical community focuses on the sick and outcomes related to the progression of poor health, public health focuses much more on primary prevention, “Even primordial prevention!” Klesges jokes. “That involves seeing the links between physical environment and healthy eating, opportunities to be active, clean air and water, that go even beyond primary prevention. The context of where and how we live and our environmental health are a big part of public health schools and the science we produce.” Klesges describes herself as “not afraid of leadership; when there aren’t other people available, I’m willing to step up and do the job.” As dean, her leadership role is all

MAY 2013

about partnerships and problem-solving, and Klesges has always enjoyed problemsolving. That’s what initially led her into the field of psychology, especially the experimental and developmental areas that rely heavily on effective research methods. Her talent for asking the right questions has led her through a unique and varied career, from a PhD in epidemiology at the University of Minnesota School of Public Health to service at St. Jude Children’s Research Hospital, associate professorships at Mayo Clinic College of Medicine and the University of Tennessee Health Sciences Center, and the role of principal investigator or co-investigator on more than 40 research projects supported by the National Institutes of Health and national philanthropic and local agencies. In this case, Memphis’ need for a school of public health appealed to Klesges’ love of problem solving. The greater need is also clear: Aging of the workforce within public health (leading to a projected future workforce shortage), coupled with the new demand related to the prevention focus of healthcare reform, led to a mandate to train more public health professionals and researchers, Klesges believes. The school’s mission, she feels, is help provide a further foundation for a city full of great efforts and ideas that are “maybe a little more separate than we want them to be,” Klesges said. “I joke that I want to be Switzerland — a common ground where different entities can come together

and trust us as partners to keep building, through projects and initiatives that nonprofits and health systems have brought to us. The idea is that we help train a future generation of leaders in this new health system which stresses blending of medical care more with the traditional public health provisional role — literally to move the dial on the health outcomes in the community.” Families can’t make smart choices to address issues like childhood obesity if there aren’t healthy opportunities around them; creating healthier environments and supporting health behavior information is essential. Klesges points to initiatives like the bike path coming in, a whole foods store with available and affordable fresh fruits and vegetables, community gardening efforts, and the Green Machine — a converted MATA bus that serves as a mobile fruit and vegetable bodega, bringing fresh produce to individual neighborhoods. The school’s immediate focus is on completing accreditation, however — usually a two-year-process. To finish out its candidacy this year, a third doctoral program is needed. “We have added two new doctoral programs in the last three years — a quick pace for us in the academic world,” Klesges said. Inevitably, her greatest challenge has been a resource shortage. “Four years ago was when the economy took a downturn; there was no longer even a neutral budget at the university. Over the last three years, our budget has been cut over 30 percent.

We were building a school at a time when resources were diminishing within the university budget. We reallocated as much as we could internally and brought in new faculty to create a great ‘Dream Team,’ and we did it all without any new state allocation.” Additionally, the school has acquired almost $10 million in external research funding. A South Dakota native whose original college major was in music, Klesges still occasionally plays the flute in church and has sung in the choir. She has two grown sons, one a process engineer, the other majoring in economics, mathematics and philosophy at Baylor University. She encourages readers to become more aware of the pressing issue of population health in our Memphis community and opportunities to become part of the solution. To learn more about participating, visit www.memphis.edu/sph.

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by Bill Appling

Accelerating Change in Education In my April column, we discussed a world led by economic force – a force that is primarily driven by job creation and quality GDP growth. Students don’t want to merely graduate; they want an education that results in a good job without taking on overwhelming debt. Earlier this year the University of Tennessee Health Science Center participated in a focus group initiative, “Accelerating Change in Medical Education.” The event announced a new competitive grant to change the way future physicians are trained. As part of this new initiative, the AMA will provide $10 million over the next five years to fund 8 to10 projects that support a significant redesign of undergraduate medical education. As discussed in the previous month’s column, at the Fogelman College of Business and Economics, Dean Grover reflected that the evolving model of higher education needs to address the 21st-century needs with 21st-century methods. “Before, there was this mindset that every student who wanted to get a business degree had to take a lot of prerequisite courses and follow a path that was largely academic training when in fact very few students were preparing for academic careers,” said Dean Grover. “We had all these requirements in areas such as economics, say, that would have been appropriate for a student who wanted to earn a Ph.D. in economics, but had little relevance for someone who wanted to earn an MBA, and go to work in a corporate setting,” Grover continued. “We’re changing all that.” Grover has worked to boost community and corporate support and build the school’s reputation. One way

he’s done that is by eliminating some barriers such as those pesky course requirements for students interested in MBA programs. “We embrace diversity. If you’re an English major or studied math or medicine you can earn a business degree without wasting time on some courses that, in all honesty, you probably will not put to use. Our degrees are functional. Jim Clifton, author of The Coming Jobs War, said, “If you were to ask me, from all of Gallup’s data and research on entreprenerushi0p, what will most likely tell you if you are winning or losing your city, my answer would be, fifth to twelfth graders’ image of and relationship to free enterprise and entrepreneurship. The better the image, the more likely your city will win. If your city doesn’t have a growing economic energy in your fifth through twelfth graders, you will experience neither job creation nor city GDP growth.” Some American might believe that government has to spend more on education. Many leaders agree that this is the silver bullet. But Gallup continues to find, as for more than 75 years, that lots of money is rarely the solution to the big problems. Sometimes, in fact, the bigger the problem the less expensive the solution. What’s expensive is trying to fix afterthe-fact outcomes rather than creating strategies that get at the behaviors and cause. But one thing seems clear and that is: education needs changing. 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.

IT Acceleration, continued from page 10 that less support is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some detached, impersonal entity; we partner with the practice in achieving their goals.” Today, MedEvolve offers PM and EMR software and RCM services to physician partners, and also electronic prescribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitioners to practices with more than 50 physicians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small memphismedicalnews

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physician IT companies nationwide. By year’s end, MedEvolve will outgrow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion. “We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”

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Cuts in Medicare Reimbursements, continued from page 1 Medicare patients altogether, lowering the availability of quality healthcare for aging baby boomers and people with disabilities. The percentage of Medicare patients in an individual practice varies from specialty to specialty, but Robinson said Medicare recipients represent 35 to 50 percent of practices in most specialties. There are still some questions about how the 2 percent cut will directly affect physicians, particularly if some are not already seeing large amounts of Medicare patients. “We’re not completely sure how the 2 percent cut is going to affect individual

“

I think the bigger problem is that the government has always found a way to try to protect physicians, and now with the way the changes are occurring, that could be going away completely. — Chuck Woeppel, COO, UT Medical Group

physicians, whether it’s a 2 percent across the board cut, which I don’t believe it is,” Robinson said. “I think it’s a 2 percent cut to CMS. Some physicians might see a small increase, but others might see a larger decrease.”

Some are staunch in their resolve to continue offering quality healthcare services. “Although the dollars we’re paid are important to us, it’s not something that we would immediately change the way we

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practice relative to Medicare patients,” said Chuck Woeppel, COO of UT Medical Group. “Our goal is to make sure that we stay focused on those people seeking our help and provide continuity of care. Within the group we’re probably going to feel some strain, but that’s not going to change the way we’re practicing at this point in time.” But down the road, the path is not so clear. Robinson said the real fear behind the recent Medicare cuts is that Congress may change the way it does business altogether. “If the law continues which is requiring reduction in Medicare cuts as part of what is called the Sustainable Growth Rate package that Congress passed a few years ago, we’re facing significant reduction of up to 25 or 30 percent,” Robinson said. “That is huge. If your practice is 50 percent Medicare, you can’t make that up. You can’t reduce your overhead to make that up. No one we’ve talked to in Congress believes that’s going to go through. They believe that new legislation will go through between now and this time next year to change that cut.” But then, until earlier this year, no one imagined that sequestration might take place either. “I think the bigger problem is that the government has always found a way to try to protect physicians, and now with the way the changes are occurring, that could be going away completely,” Woeppel said. “Ultimately that means a very big cut in Medicare. The long-term effects of it could be very substantial. That’s what we have to take a look at. We think there’s going to be some changes in the strategy of how we’re paid. Right now we’re aligning ourselves with the hospitals as best we can so that these large changes can be protected.” Robinson noted that some practices turned to the hospital systems because they were dealing with large amounts of debt or unsustainable overhead, which could potentially weaken them in the face of major Medicare cuts. Robinson said physicians will not all move to salaried positions. Some will continue on a fee-per-service basis and receive bonuses from CMS for improvements in quality of service. The current economic climate might actually be the unraveling of a system that began long ago. “If you’ve been in practice for 30 years or more, you could say it’s not been like this before,” Robinson said. “I personally saw a huge shift occur when managed care came to town. That really has driven the change.” UT Medical Group has a joint venture with Le Bonheur and is developing alignment programs with Methodist Healthcare and The MED. Woeppel said now is a good time for asking questions. “Are we doing things that we could be doing differently, that will cost less for the patients and us as we move forward?” Woeppel said. “Maybe there will be significant improvements in reimbursement because we’re lowering the cost of the insurance carriers including Medicare over time.” memphismedicalnews

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The Move from Social Media Marketing to Social Business Strategies By CINDY SANDERS

Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … pa- Andrew Dixon tients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular tool being used today to do that is email, but email was never intended to be a collaborative tool.”

In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but

Three Trends Driving Change Three trends are driving change in the workplace – social, mobile and cloud. People want to be connected; they want to be able to access their information on the move; and they want access on a variety of devices so information can no longer be stored in one physical space. “It’s incredible how powerful each of these trends are alone, and they are all converging,” said Andrew Dixon of Igloo Software. “By the end of 2013, 20 percent of all U.S. businesses will possess no IT assets whatsoever,” he said, quoting recent statistics. “All of their IT requirements will be outsourced and provided to them by the cloud.” Citing recent research from business and technology research firms McKinsey & Company and Gartner Inc., Dixon underscored just how pervasive these three trends are. “Seventy-two percent of all organizations have already adopted at least one social tool,” he said, adding, “Your phone will outpace your PC as the most popular device to access the Internet this year.” Although healthcare is sometimes criticized for being slow to adopt business technology, Manhattan Research’s annual Taking the Pulse® study of U.S. physicians’ digital use revealed 85 percent of physicians in 2012 own or use a smartphone professionally (up from 30 percent in 2001). Between 2011 and 2012 the number of physicians who own a tablet nearly doubled from 35 percent to 62 percent. Furthermore, half of the tablet-owning doctors have used their device at the point of care.

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they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.

Creating Engaged Communities

Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate mes-

sages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas. (CONTINUED ON PAGE 18)

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None of the Above, continued from page 12 available to our state to transform healthcare in Tennessee without expanding our TennCare rolls,” he stated. “I’d like to put in place a program to buy private health insurance for Tennesseans that have no other way to get it by using the federal money. I fundamentally believe that people having healthcare coverage is better for our citizens and state than people not having coverage.” The plan, which he said could cover up to 175,000 Tennesseans, calls for “copays for those that can afford to pay something so,” as the governor put it, “the user has some skin in the game when it comes to healthcare incentives.” He added the state would work with providers to lower the cost of care and move toward a pay-for-performance model. He also said the plan would have a definitive sunset that could only be renewed with the blessings of the General Assembly when the federal funding decreased. During the period of 100 percent federal coverage, Gov. Haslam said there was a window of opportunity to implement true payment reform and reduce costs by working with the healthcare industry. “We’d have a one-time opportunity to encourage their cooperation because healthcare providers will know that for the next three years, a portion of the population which had previously been receiving services with no reimbursement to the hospitals or doctors will now have insurance. But those same providers would clearly know that coverage for that population will

go away unless they can prove to us that at the end of three years, when we start paying a percentage of the costs of the new population, our total costs would stay flat,” he said. The Reaction When the ‘no expansion’ decision was announced, Craig Becker, president of the Tennessee Hospital Association, released a statement noting his organization’s disappointment that the governor didn’t feel like he was able to get the information and assurance necessary from the Centers for Medicare Craig Becker & Medicaid to move forward but supportive of the Tennessee Plan. The need to get more people covered, however, is of critical importance to state hospitals. In negotiating ACA, hospitals gave up a significant chunk of funding with the expectation that most Americans would have insurance coverage. Without the expanded Medicaid rolls, however, a large portion of the population will remain uncovered and unable to pay for services. “We’re giving away about $1.4 billion a year in cost to care for indigent people who are uninsured,” said Becker, stressing that figure was in hard costs rather than billable fees. “That’s our Achilles’ heel … the uncompensated care is the key to this whole thing.” Although hopeful Gov. Haslam and

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CMS will come up with a consensus that the General Assembly will then approve, Becker said the alternative holds grim prospects for not only the hospital industry but also the state’s economy. “We’ve already seen one hospital close, and that’s Scott County,” noted Becker. “That’s a small rural hospital, and there are some who say it should close; but I don’t think the people of Scott County would agree.” He added that like most hospitals, the northeastern Tennessee facility was a major employer for the county. “Healthcare provides a lot of jobs and good paying jobs. If you had any other industry with job losses like this, there would be a huge hue and cry,” Becker noted. Without expanding coverage, he said the THA anticipates additional contraction within the state’s healthcare field. The economic factor, however, is only a part of the bigger picture, Becker said. Those with insurance, he noted, tend to be healthier because they receive primary care services and help managing chronic conditions. One of the biggest frustrations, however, would be losing access to federal funds if a deal isn’t struck soon. “We’re already paying for this,” Becker said of the dollars the state would pass up if CMS doesn’t approve the Tennessee Plan. “It’s a redistribution of taxes. We’re getting cut $5.6 billion over 10 years,” he continued of money being diverted from the state’s hospitals under ACA. “So those dollars are going to D.C. Then, they distribute them to those who participate (in Medicaid expansion). Why should we send our dollars to California and New York when they should stay here in Tennessee?” he questioned. Becker added the THA is very open to the governor’s option but nervous that the state could lose an entire year of funding that would provide a necessary cushion while healthcare professionals make the changes in payment models and cost-cutting requested by Gov. Haslam. “If we’ve got the coverage and we show uncompensated care going down, then reform becomes a whole lot more palatable and easier to implement for hospitals,” he said. Michele Johnson, managing attorney for the Tennessee Justice Center, worries about whether or not the Tenness Plan will gain approval. She said CMS has now posted ground rules, and Tennessee is asking for concessions that have already been deemed a non-starter by Michele the federal government. Johnson “If they are interested in succeeding in getting federal approval for the plan, they have to propose something that’s real, and they have to negotiate in good faith with the federal government,” Johnson said of Tennessee’s leadership. She said Gov. Haslam sought clarifications from the federal government. “CMS responded by issuing guidance — Frequently Asked Questions, Medicaid and the Affordable Care Act: Premium Assistance.” That information, Johnson continued, makes it clear that the governor can

do much of what he proposes … but not everything. Her concern is the state plan includes items like co-pays and an appeals process that differs from Medicaid, which CMS has clearly stated it wouldn’t allow in negotiating Medicaid expansion funds to be used for purchasing insurance in the marketplace. “You can’t expect people to pay a co-pay they can’t afford,” she said of those under 100 percent FPL. On the flip side, the governor has also indicated he didn’t want to give on these items. “With our administration, either they are really bad at negotiating, or they’re not serious about making this a reality for our state,” Johnson stated. She continued, “We pray the governor will do all in his power to make health coverage a reality for working Tennessee families. His ability to take advantage of this opportunity is vitally important for all Tennesseans — not just uninsured working citizens but also the rest of us who will benefit from $6.6 billion dollars pumped into our economy and our healthcare infrastructure.”

The Move, continued from page 17 Security

“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”

Avoiding Information Overload

Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said. However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.

The Bottom Line

With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.” memphismedicalnews

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GrandRounds Dr. Sillay joins SemmesMurphey Clinic Semmes-Murphey Clinic in Memphis has announced the addition of Dr. Karl A. Sillay to their clinic. Dr. Sillay brings to the Mid-South his experience in adult and pediatric deep brain stimulation, an area of treatment with very limited local accessibility. The procedure is used in Dr. Karl A. Sillay treatment for illnesses such as Parkinson’s disease, Tourette’s syndrome, chronic pain and depression. Dr. Sillay obtained his Bachelor of Electrical Engineering Degree from the Georgia Institute of Technology in 1995. He received his Medical Degree in 1999 from the Medical College of Georgia. He completed his Internship at Vanderbilt University, and also his Neurosurgical Residency, which he completed in 2006. In 2007 he completed a Fellowship in Epilepsy and Functional Neurosurgery at the University of California at San Fran-

cisco. He is certified by the American Board of Neurological Surgery. He is an Associate Professor of Neurosurgery at the University of Tennessee, and has published several articles in his fields of study.

Qsource Names New VP Operations Dawn FitzGerald, CEO of Qsource has announced the appointment of Cori Grant MS, MBA as Vice President, Operations effective May 1, 2013. She was previously Director of Marketing and Health Services Research - Methodist Le Bonheur Healthcare. Cori Grant She will assist in the development and implementation of strategic plans and new business initiatives, and is a part of the senior management team responsible for operational excellence, organizational leadership and contracts oversight and governance.

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Geri Lansky Elected For Second Term As MJHR President Memphis Jewish Home & Rehab (MJHR), a not-for-profit organization providing rehabilitation services and long-term care for people of all faiths, announced that Geri Lansky was elected for a second one year term as president at their annual meeting. Other officers elected for a second one year term were: Minton Mayer, vice president/ president elect; Gregg Landau, vice president; Barbara Ostrow, secretary. Scott Notowich was elected for a first one year term as treasurer. Mrs. Lansky, who was originally from Rock Island, Illinois, has been married to Hal Lansky for 37 years. She is a merchandise buyer for Lansky Lucky Duck. A member of both Temple Israel and Baron Hirsch Synagogue, she is also an active member of WRJ/Temple Israel Sisterhood and a Life Member of Hadassah. The Lansky’s daughter Lia Pulver, son-in-law Dave Pulver, and grandson Ethan Myer Pulver live in Phoenix. Daughters, Julie Lansky and Melisa Weisman, son-in-law Steve Weisman, and grandson Max Jacob Weisman live here in Memphis. In addition to the elected officers, Dr. Jay Cohen will continue on the executive committee as immediate past president, and past presidents Barbara Jacobs, Nat Landau, and Steve Wishnia will continue as presidential advisors. Several new board members were also elected that evening for two year terms: Judy Edelson, Jonathan (Yoni) Freiden, Howard Hayden, Debbie Lazarov, Jennifer Roberts, and Henry Rudner. Board members who are continuing to serve are: Maurice Buring, Eliot Cohen, Jonathan Epstein, Bernard Lipsey, Judy Royal, Andy Saslawsky, Scott Shanker, Dr. Lee Stein, and Herbert B. Wolf, Jr. In Geri Lansky’s remarks about the past year, she talked about the 85th Anniversary Celebration with Henry Winkler and the 20th Annual Golf Tournament, both successful fundraisers for the organization. She went on to describe the commitment of so many individuals to the success of MJHR including Mary Anna Kaplan, who recently stepped down as executive director after 12 years of service.

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MAY 2013

GrandRounds UNOS Ranks Mid-South Transplant Foundation No. 1 in Country for Organs Transplanted The United Network for Organ Sharing (UNOS) recognized Mid-South Transplant Foundation, the organ procurement organization (OPO) serving Western Tennessee, Eastern Arkansas and Northern Mississippi, in its most recent quarterly results report as the No. 1 OPO in the country for organs transplanted per standard criteria donor (typically healthy donors under the age of 60 without multiple health issues). This is the first time for Mid-South Transplant Foundation to achieve this honor. UNOS data also ranks Mid-South Transplant as the No.1 OPO in the continental United States for the percentage of African American donors in 2012. Mid-South Transplant Foundation

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is one of 58 OPOs across the country, which helps facilitate the procurement of organs from donors and the distribution of transplantable organs from donors to those who are the most suitable recipients and those in the greatest need. The Memphis-based organization is one of the top OPOs in the United States with a strong record of service to the local community. MSTF was founded in 1976 and is solely dedicated to ensuring the most deserving patients get transplant organs. For more information, visit www. midsouthtransplant.org.

The Sickle Cell Foundation of Tennessee announced plans to provide transitional housing, job training and other services to men suffering with the disease through a newly renovated residence on West Brooks Road. Trevor K. Thompson, chief executive officer of the Sickle Cell Foundation, characterized “The Carpenter House” as a first-of-its-kind undertaking aimed at helping men, especially those 18 to 25, transition from their family homes to homes of their own. This is a ground-breaking initiative they have taken to help gentlemen with Sickle Cell disease, especially

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MAY 2013

Kenneth, is an associate professor of natural science at Southwest Tennessee Community College and founder of the annual Sickle Cell 5K Run/Walk. While housing at the six-bedroom The Carpenter House is for men, the Foundation’s mentoring program with St. Jude serves both men and women. Sickle cell disease is a genetic disorder that affects the red blood cells and can cause debilitating pain over the course of a lifetime.

Sickle Cell Foundation Takes Initiative For Mid-South Sufferers

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young men, who have jobs or job skills, Thompson explained. He also said they are partnering in this effort with St. Jude Children’s Research Hospital, which has provided a transition grant to support efforts to serve as mentors for young people with sickle cell disease. The Carpenter House is named in honor of Kenneth and Terrell Carpenter, who donated at the residence at 35 W. Brooks Road. Mrs. Carpenter is a Family Nurse Practitioner at Memphis Internal Medicine and Pediatrics. Her husband,

Autism Research Journal Publishes Study Results of Associate Professor at UTHSC Identifying and understanding the combination of factors that leads to autism is an ongoing scientific challenge. This developmental disorder appears in the first three years of life, and affects the brain’s normal development of social and communication skills. Results from a study led by Larry T. Reiter, PhD, at the University of Tennessee Health Science Center (UTHSC) are providing significant insights into the disorder through the study of a specific form of autism caused by a duplication on chromosome 15. This month his work appears in Autism Research, the official journal of the International Society for Autism Research. Dr. Reiter, who is an associate professor in the UTHSC Department of Neurology, holds joint appointments in both Pediatrics as well as Anatomy and Neurobiology. His study, which began in 2006, is focused on a sub-group of 14 individuals who have a specific chromosome duplication, known as int dup(15) -- short for interstitial duplications of 15q11.2-q13. Recruitment efforts were spearheaded by a parent support group for 15q duplication known as the Duplication 15q Alliance. Participants underwent a series of tests in order to better understand what autism looks like for those with this chromosome 15q duplication versus those with autism of unknown origin. This is the largest study of this particular sub-group ever undertaken at a single location with the same set of investigators according to Dr. Reiter who said they found several interesting points in the course of the study. Consistent with other much smaller studies, they found that maternal duplications of int dup(15) were always associated with autism, while paternal duplications did not always result in an autism diagnosis. They identified a signal in the brain that suggests the individuals with 15q duplication may have elevated levels of a neurotransmitter called GABA in both maternal and paternal duplication subjects. In addition, they identified previously unknown sleep problems in maternal and paternal subjects, which are more severe in the paternal int dup(15) individuals. On the basic science side, Nora Urraca, MD, PhD, a UTHSC postdoctoral researcher, worked with Dr. Reiter. Their clinical team members at Le Bonheur were Kathryn McVicar, MD, a pediatric neurologist at Le Bonheur, who is also an assistant professor of Pediatrics at UTHSC, and Eniko Pivnick, MD, a pediatric geneticist at Le Bonheur, who also serves as a professor of Pediatrics in the UTHSC Department of Ophthalmology. The project was funded entirely by a grant to Dr. Reiter from the Le Bonheur Shainberg Neuroscience Fund. Dr. Reiter serves on the scientific advisory board for the Duplication 15q Alliance and Idic15 Canada, two non-profit organizations that provide collaboration, advocacy, and research to families living with both idic and int dup(15), otherwise known as Chromosome 15q11-q13 Duplication Syndrome. He is also a member of both the International Society for Autism Research and the American Society for Human Genetics. memphismedicalnews

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GrandRounds TCPS to Partner with LifeWings Partners The Tennessee Center for Patient Safety (TCPS) will be partnering with LifeWings Partners, LLC in 2013 in its ongoing effort to make patient safety a priority across the state of Tennessee. The aim of this partnership will be to advance the adoption of TeamSTEPPS, a patient safety program built on the best practices from aviation to improve the reliability, safety and quality of care received by patients in Tennessee hospitals. The objectives of TCPS are to accelerate the adoption of evidence-based strategies that improve the safety and quality of care received by patients, and provide training for hospital leaders to advance their organizations’ culture of safety. The TCPS and LifeWings share in their commitment to increase patient safety, eliminate medical errors, and save lives. In 1999, the Institute of Medicine (IOM), issued results of a study titled - To Err Is Human. This study stated the following: Preventable medical errors account for more deaths each year than breast cancer, automobile accidents or drownings. Poor communication among healthcare workers is the most common cause of these medical errors. Nearly 70 percent of sentinel events have communication cited as a root cause. Despite efforts to change these statistics, communication failure has been cited as the number one contributing factor in reported sentinel events, over the past decade. LifeWings is a respected innovator in aviation-based healthcare performance improvement and was the first patient safety consultant to use the principles of the TeamSTEPPS program. The first generation of TeamSTEPPS, called the Crew Resource Management (CRM) program, was developed by a former Top Gun Instructor and a group of commercial airline pilots, former astronauts, physicians, nurses and risk managers. The program has proven to significantly and measurably reduce errors, increase patient and employee satisfaction, and cut healthcare costs. For more information on TCPS: http://www.tnpatientsafety.com/

will oversee the new program modeled on the Patient-Centered Medical Home Recognition Program (PCHM), the most widely adopted medical home model in the United States. According to Lee S. Schwartzberg, Medical Director, The West Clinic, the new program allows specialists to extend the value of the Patient-Centered Medical Home process and concept which has been successfully employed in the primary care world. Oncology practice is particularly suitable for this model

since it provides vast longitudinal care to cancer patients both those with active disease and those post therapy with regard to some of their survivorship needs. The West Clinic has been monitoring the progress of the specialty medical home for over a year and participated in preliminary PCSP workshops. Under PCSP, specialty practices committed to improving access, communication and care coordination can be recognized as the “neighbors” that surround and inform the medical home and colleagues in pri-

mary care, according to NCQA. The Patient-Centered Medical Home Recognition (PCHM) program places focus on ‘whole person care.’ In oncology this relates to recognizing, coordinating, and making available all patient needs including active therapy and palliation, end of life needs, and supportive care. Sixty-four organizations have enrolled to be early adopters of the PCSP program. For additional information, visit www.ncqa.org.

West Clinic Participates in New NCQA Patient-Centered Specialty Practice Program The West Clinic is pleased to announce that it has been selected by the National Committee for Quality Assurance (NCQA) to participate in a new program, Patient-Centered Specialty Practice (PCSP), which will offer recognition to specialty practices nationwide that demonstrate a commitment to improving access to and coordination of patient care. The NCQA, a not-for-profit focused on improving healthcare quality,

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. memphismedicalnews

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MAY 2013

GrandRounds Roger McGee, MD, Moves Practice to Germantown General surgeon Roger McGee, M.D., has joined Germantown Surgical Associates, on Poplar Ave. Dr. McGee specializes in the surgical management of a number of conditions including appendectomy, colonoscopy, hernias, gallbladder Dr. Roger McGee and many others. Dr. McGee earned his Bachelor of Arts degree in physics and biological sciences from the University of Mississippi in Oxford, Miss. and his medical degree from the University of Tennessee Health Science Center College of Medicine. He has practiced at Methodist Fayette Hospital since 2008.

UTHSC Adds Pediatric Nurse Practitioner and Neonatal Nurse Practitioner Options to DNP Degree Program Recently, Laura Talbot, PhD, EdD, RN, dean of the College of Nursing at the University of Tennessee Health Science Center (UTHSC), announced the opening of a new advanced training option – the Pediatric Nurse Practitioner (PNP) -- in the Doctor of Nursing Practice (DNP) Program at the UTHSC College of Nursing. Educating doctorally prepared nurse practitioners who can deliver health care is one important avenue to pursue to meet the need for more primary care providers in Tennessee and the region. It can take 7 to 10 years of rigorous academic and clinical effort before physicians are ready to practice on their own. Educating and training nurses with doctoral degrees gives patients in need faster access to qualified health professionals on the front lines of care. In addition, the Neonatal Nurse Practitioner (NNP) option in the UTHSC College of Nursing is reopening admissions at the doctoral level this year. The urban areas of Tennessee that offer specialized care of critically ill newborns have ongoing shortages of experienced practitioners in the neonatal intensive care units. UTHSC is the only public university in Tennessee to offer the NNP program. Until June 1, the UTHSC College of Nursing will accept applications for its first-ever Pediatric Nurse Practitioner (PNP) option and its Neonatal Nurse Practitioner (NNP) option, which graduated its most recent class in 2011. Application packets are available from the college via email to Roylynn Germain (RGermain@uthsc.edu) or Jamie Overton (JOverton@uthsc.edu) and by phone at (901) 448-6125. Classes for the PNP and NNP options begin on August 1, 2013. The DNP program is primarily an online curriculum open to applicants with either baccalaureate [BSN] or master’s [MSN] degrees in nursing. Since the DNP candidates complete most of their academic work online, with only

MAY 2013

a limited, required on-campus component, they can choose to work part-time while they study for the DNP. The online classes offer students flexibility in determining their own living arrangements, schedule of study, and timing of engagement in coursework. Plus their clinical practicums are arranged within reasonable proximity of where students reside. The PNP option anticipates accepting up to eight students, while the NNP option expects to enroll about six the first year. The small class size will provide students with individualized instruction from expert clinicians in these areas. DNP students can graduate in four to six semesters, depending upon whether they pursue full-time or part-time study, and whether they are already certified as an advanced practice nurse. Thus, the UTHSC College of Nursing expects that students in the inaugural PNP class and the NNP class will begin to graduate in spring 2015. These programs of study also include pathways for nurses with current advanced practice credentials and for those wishing to obtain initial certification. Applicants are evaluated on their potential or ability for functioning in the advanced practice role. They must demonstrate strong clinical skills, critical thinking, independent decision making, collaborative abilities with other health professionals, and nursing leadership. Academic requirements include a BSN or MSN degree, and a minimum 3.0 GPA. The UTHSC DNP program is accredited by the Commission on Collegiate Nursing Education (CCNE). Upon completion of the program, graduates are eligible to take national certification exams in their specialty area. Susan Patton, DNSc, PNP-BC, FAANP, associate professor in the Department of Advanced Practice and Doctoral Studies, will be coordinating both the PNP and NNP options.

MAG Mutual Pays Record Dividends to Policyholders MAG Mutual Insurance Company, the Southeast’s foremost medical professional liability insurer, will distribute $15 million in dividends to its policyholders this year. In addition, its board of directors approved a potential further $40 million to be earmarked for its Owners’ Circle® loyalty program, which provides distributions to qualifying insured physicians when they cease practicing medicine. Since its founding, MAG Mutual has returned more than $120 million in dividend payouts to its policyholders. In the last five years, the organization has paid more dividends than any other medical professional liability carrier in the Southeast. This year, MAG Mutual has also declared approximately $40 million to the Owners’ Circle program. When combined with the 2012 allocation, the

cumulative declarations to the Owners’ Circle now top $102 million. Since its foundation, the program has seen great success with 147 policyholders having been recipients of distributions. All MAG Mutual policyholders are eligible for this program. Set to be paid on June 1, the $15 million dividend is one of the largest in MAG Mutual’s history and continues the organization’s storied reputation for rewarding policyholders.

SVMIC Declares $10.0 M Dividend In keeping with the tradition of a mutually owned company, the Board of Directors of SVMIC has declared a dividend of $10 million to be returned to all policyholders renewing in the twelvemonth period following May 15, 2013. This is the sixth consecutive year SVMIC has declared dividends for its physician policyholders. Policyholders will receive the dividend in the form of a credit on the renewal premium. Additionally, no adjustments were made for rates on policies renewing during this time. John Mize, Chief Executive Officer, said that this represented the benefit of a mutual insurance company. Since SVMIC’s inception, a total of $328 million has been returned to physician

St. Jude Scientist Named ASCR Fellow Charles Sherr, M.D., Ph.D., chair of the St. Jude Children’s Research Hospital Department of Tumor Cell Biology and a Howard Hughes Medical Institute Investigator, has been named a fellow of the American Association for Cancer Research (AACR) Academy. Sherr is scheduled to be inducted into the academy’s inaugural class of fellows on April 6 in Washington D.C. The induction coincides with the group’s annual meeting. The designation recognizes scientists for making an extraordinary contribution to cancer research. Fellows were selected through a rigorous peer review process that focused on scientific achievements and contributions to the fight against cancer. Sherr’s work has advanced scientific understanding of the mammalian cell cycle and tumor suppressor genes, which are both disrupted in cancer. He is a member of the National Academy of Sciences and the Institute of Medicine. He has received numerous other honors and holds the Herrick Foundation Endowed Chair. He is one of 106 fellows in the AACR Academy’s first class. Going forward, a maximum of 11 individuals will be elected annually to membership by the current fellows. The AACR was founded in 1907 and is the oldest and largest scientific organization in the world focused on cancer research.

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