Memphis Medical News May 2015

FOCUS TOPICS WOMEN’S HEALTH HIT NURSES

May 2009 2015 >> $5 December

NURSE SPOTLIGHT PAGE 3

Lauren Beavers, APRN-BC

ON ROUNDS

Memphis Bucks Trend in Pay Disparity for Nurses Study concludes males earn more than female counterparts in most other cities

BY JAMES DOWD

Memphis Physician Suggests Options To Lower Costs Related to Breast Cancer A new report has fueled the debate over rising medical costs linked to routine breast cancer screenings during the past five years. The latest report estimates those costs are much higher than previously documented ... 5

PHiiT: Statewide Initiative Addresses Pressing Pediatric Issues In the fall of 2013, the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) launched a bold new initiative to address pediatric quality issues in primary care through the formation of the Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT) ... 6

ONLINE: MEMPHIS MEDICAL NEWS.COM

The Memphis medical community mirrors the rest of the nation in its nursing population, with women holding 90 percent of nursing positions. But unlike most other cities, where female nurses earn less than their male counterparts, Memphis healthcare organizations apparently follow gender-neutral policies regarding nurses’ pay.

That bucks a national trend uncovered by a report published in March in the Journal of the American Medical Association, which focused on gender inequality in salaries for nurses.

The study, which accumulated data from nearly 300,000 registered nurses during a 25-year period, found that on average male nurses earn about $5,100 per year more than female nurses.

Research was conducted by a team that included professionals from Vanderbilt University Medical Center and the Yale School of Public Health. The findings were based on data from two surveys: the National Sample Survey of Registered Nurses, which was discontinued in 2008, and the American Community Survey.

(CONTINUED ON PAGE 8)

HealthcareLeader Lanetta Anderson, MD, FACOG President, Bluff City Medical Society

BY JUDY OTTO

Lanetta Anderson, MD, recently installed as president of the Bluff City Medical Society, suggests that her early interest in medicine may have been sparked by her grandmother, a lay midwife who delivered the first eight of Anderson’s 16 siblings.

With a schoolteacher mom as arbiter, such

a large family encouraged competitiveness — “in a positive way,” she stressed.

Additional incentive to enter the field of medicine came from her two brothers who were physicians. As a high school student, she worked in the North Memphis medical office of one of her brothers.

Anderson attended Johns Hopkins Univer(CONTINUED ON PAGE 10

To promote your business or practice in this high profile spot, contact Pamela Harris at Memphis Medical News. pamela@memphismedicalnews.com 501.247.9189 PRINTED ON RECYCLED PAPER

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

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NurseSpotlight

Lauren Beavers, APRN-BC

Nurse practitioner got hooked early on helping women become mothers

BY RON COBB

For Lauren Beavers, it was love at first sight. She remembers the day at the University of Tennessee, Knoxville, when, as a nursing student, her career choice became crystal clear.

“One day they let us go into the prenatal care clinic and I followed a nurse practitioner around all day doing prenatal care, and it was like, ‘This is what I want to do.’ I really fell in love with obstetrics and women’s health,” she said.

It was all she wanted to do, and virtually all she has done since then. After earning her undergraduate degree in 2001, Beavers started work as a nurse in a post-partum unit and newborn nursery in Chattanooga, an experience she recalls as “awesome.”

Since 2008, she has been a nurse practitioner at McDonald Murrmann Women’s Clinic.

A Memphis native and graduate of Germantown High School, Beavers said she “knew at a young age that a career in healthcare was my calling. But I wasn’t exactly sure which direction to go with that.”

But a seminar at UT during her freshman year got her interested in nursing, and then the trip later to the pre-natal care clinic narrowed her focus to women’s health.

She followed her husband-to-be, Brent, to Chattanooga, where he had found work as a pharmaceutical rep before he eventually switched careers to law enforcement.

Her job in Chattanooga was “a great first job,” she said, but after a couple of years she started commuting back to UT and earned her master’s in nursing in 2005.

“I knew in the long term as I started a family I wanted to be more clinic-based,” she said, “and I knew I wanted to get back and get my nurse practitioner certification.”

In 2008, Brent landed a job with the federal government in Memphis, and for Lauren that meant a move back home.

Within a few weeks, she was hired by McDonald Murrmann.

“I was blessed to get that position straight off,” she said. “I’m just fortunate to work with such a highly respected group of physicians. We’re pretty unique because it’s an all-women practice. We have seven physicians and three nurse practitioners, all female, serving the needs of women.”

Initially full-time, Beavers now works part-time, allowing her more time to spend raising their daughters, ages 3 and 5. When the girls are older, she plans to return to school and work toward a Doctor of Nursing Practice degree.

“The direction for nurse practitioners is changing,” she said. “In the not too distant future, the goal will be for all nurse memphismedicalnews

.com

practitioners to be educated on the doctorate level and have a DNP. But right now I’m in a phase of my life where balancing motherhood and work is the ultimate challenge.”

The issue of how much autonomy nurse practitioners are given is important to Beavers, but maybe not as important as it is for some other NPs. She said her position is different because she’s in women’s health.

“For example, I see pregnant patients, but I don’t deliver them,” she said. “So when a problem arises and delivery is necessary, I can’t accomplish that goal. As a women’s health nurse practitioner, would I ever have a need to have full-practice authority? Because I can’t do everything the physician can do.

“Now, someone in primary care who’s doing screening and wellness exams, treating high cholesterol and doing that sort of thing, I can see that for them. But perhaps that’s why I’m not too vocal one way or the other because it doesn’t affect my practice as much as it does others.”

In her field, there’s a certain comfort in having a physician around, almost as a safety net.

“I like being able to work in collaboration with a physician,” she said. “I think a lot of nurse practitioners are wanting to open their own clinic and run their own practice without having a physician involved. But I like the role that I serve where I’m an extension of the physician and the physician is always right there for situations that are a little bit outside my scope.

“The nurse practitioners’ association (American Association of Nurse Practitioners) is encouraging nurse practitioners to contact their legislators to push for full-practice authority. I’m not really one of those out-there vocal nurse prac-

titioners lobbying. Honestly, I’m just trying to make sure the kids get their lunches packed and get out the door on time.”

Although Beavers has never wavered in her love for nursing, her perspective changed after she had her own children.

“Becoming a mother has definitely impacted my practice because you just don’t fully understand the experience of becoming a mother until you have. It’s given me a lot of empathy with the patients.”

At McDonald Murrmann, her duties include pre-natal care, well-woman checkups, STD screening, breast exams, IUD insertions and certain biopsies. In that respect, she said, she functions quite the way a physician does.

“One of the great things about being a nurse practitioner is that my schedule tends to be more flexible,” she said. “I’m telling you, our practice is very busy. Our physicians are highly sought-after, and sometimes getting an appointment may take a day or two. Which is not really that long, but for women who have something going on, we tend to want to be seen right away.

“So the nurse practitioner tends to have the quickest appointments. It’s nice to be able to feel like you’re ‘coming to the rescue’ because women are usually very, very grateful that you’re there and able to see them so quickly.”

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MedicalEconomics

BY BILL APPLING

A couple of weeks ago I found myself talking with three school teachers. They were young – 22 and 23 years old. Two were finishing their first year of teaching and one was finishing her second year.

I enjoyed listening to their excitement and consistent theme of caring about their students and wanting them to succeed in life, whatever they decided to do.

But, there was another consistent theme in this conversation: Frustration.

They didn’t want their enthusiasm to slowly drift away. They felt that their ideas and ways of teaching were not getting attention, or worse, being ignored, and they were being excluded in the education process for current and future educational needs and development.

According to these young teachers, burnout among new young educators usually comes within their fifth year of teaching because of the reasons mentioned. Keep in mind, these are adults.

By 2020, they will represent more than one out of every three adults (36 percent).

They are ethnically diverse, socially tolerant, and technology savvy. This generation’s unique blend of civic idealism and astute pragmatism will hopefully enable them to overcome the internal culture wars and institutional malaise.

Executives, managers, teachers, healthcare providers sometimes experienced bad luck or poor timing, but a large body of research suggests

Zoo of Biases… that may be by cognitive and behavioral biases. While techniques to “debias” decision making do exist, it’s often difficult for these individuals, whose own biases may be part of the problem.

There are tools and techniques that can help flag times when the decision making process may have gone awry and interventions are necessary.

Early researches suggest this is the case roughly 75 percent of the time.

(McKensey Quarterly, April, 2015, Phillip Meissner, Oliver Sibony and Torsten Wulf.)

Sibony says, “We have looked at this zoo of biases and tried to sort out what really matters. When people ask me what will make a difference as they build decision processes, I emphasize three things: “First, recognize that very few decisions are one of a kind. Lots of projects happened before, and you can learn many things from these experiences.

“Second, recognize uncertaintyhave alternatives, prepare to be wrong, and have a range of outcomes where the worst case is real and not ‘best case minus 5 percent,’ which is very common.

Creating a setting where it’s ok to admit uncertainty is very difficult. But if you can achieve that, you can make headway.

“Third, create a debate where people speak up. It’s the most obvious but also the most difficult. If you’re the decision maker, when you get to the debate you’ve already got an idea of

where you want it to lead. And if you’re an experienced executive, you’ve already influenced your people, consciously or unconsciously. A good intervention point is to ask subordinates if anyone disagreed with you about a recommendation they bring to you. If everybody agreed, that’s a sign that many may have been ‘groupthink.’”

Soras Sarasvathy, a professor at the Darden School at the University of Virginia, has researched the difference between how entrepreneurs and very good senior managers at Fortune 500 firms think. She gives them a scenario about a new-product introduction. The typical Fortune 500 manager will run projections from the market data. But the entrepreneur’s reaction is, “I don’t trust the data. I’d find a customer and try to see the product.” The entrepreneur’s reaction is, “I’m gonna experiment. I’ll find my way into it.” The entrepreneurs’ impulse to experiment is right. We need to breed more of this type of thinking into decision making.

Two particular types of bias weigh heavily on the decisions-confirmation bias and overconfidence bias. The former describes unconscious tendency to attach more weight than we should to information that is consistent with our beliefs, hypotheses, and recent experiences and to discount information that contradicts them. Overconfidence or bias frequently makes executives

misjudge their own abilities, as well as the competencies of the organization. It leads them to take risks they should not take, in the mistaken belief they will be able to control outcomes.

The combination of misreading the environment and overestimating skill and control can lead to dire consequences.

Consider a decision made by Blockbuster, the video-rental giant, in the spring of 2000. A promising start-up approached Blockbuster’s management with an offer to sell itself for $50 million and join forces to create a “click-and-motor” video rental model. Its name? Netflix. As a former Netflix executive recalled, Blockbuster “just about laughed [us] out of their office.” Netflix is now worth over $25 billion. Blockbuster filed for bankruptcy in 2010 and has since been liquidated.

In retrospect, it is easy to ascribe this decision to a lack of vision by Blockbuster’s leadership. But at the time, things must have looked very differently.

Netflix was not the the video-on-demand business it has since become. There were practically no high-speed broadband connections of the kind we now take for granted, and widespread use of video streaming would have seemed like a futuristic idea. In Blockbuster’s eyes, Netflix, with its trademark red envelope, was merely one of several players occupying a small land thus far unprofitable mail-order niche in the video business. Kind of like the Sears, Roebuck & Company catalogue of the past vs. online ordering now.

In an environment of change and disruption, many leaders fear – correctly – that their organizations do not take enough risks or will fall prey to “analysis paralysis” and let opportunities slip away.

Hence the popularity of start-ups as role models of fast, iterative decision making.

As Reid Hoffmann’s often said, “If you are not embarrassed by the first version of your product, you’ve launched too late.”

While this “better safe than sorry” mindset characterizes many successful startups, it may not be the best inspiration for the strategic decisions of mature organizations. Some risks are worth taking, such as those taken knowingly, in pursuit of commensurate rewards. But some risks are taken recklessly because the risk takers are blind to their own overconfidence or have failed to consider alternative viewpoints.

As the founder and president of J William Appling LLC, healthcare and management and consulting firm, I have greatly tweaked my business model.

Have you?

Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at j.william.appling@ outlook.com.

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Memphis Physician Suggests Options To Lower Costs Related to Breast Cancer

BY BETH SIMKANIN

A new report has fueled the debate over rising medical costs linked to routine breast cancer screenings during the past five years. The latest report estimates those costs are much higher than previously documented.

A Memphis physician says the reasons for the high costs are readily apparent, as are the ways to reduce the costs.

The study published in Health Affairs, a national, peer-reviewed healthcare journal, reported last month that the U.S. spends $4 billion annually on tests that produce false-positive mammograms and the over-diagnosis of breast cancer.

The increased use of digital mammograms, insufficient professional experience and subjectivity are the potential causes, according to Memphis breastcare specialist Christine Mroz, MD. She says doctors and patients can do several things to lower Dr. Christine Mroz medical costs and the chances of receiving a false-positive reading from a mammogram.

The study, performed by a research fellow at Boston’s Children’s Hospital and a Harvard Medical School professor, concluded that among the surveyed women, 11 percent received a false-positive result from a mammogram. That means about 3.2 million women nationally would get a falsepositive result each year, resulting in $2.8 billion in spending, according to the study.

“There has been an increase in the number of false positives in the last five years or so because they are being viewed digitally,” Mroz said. “When the mammogram is magnified four times its actual size, something may look abnormal when it isn’t. If you don’t know what you are specifically looking for, it can result in a positive reading to be on the safe side.”

Mroz is a breast surgeon with over 45 years of experience in breast care. She is the founding physician of the MrozBaier Breast Care Clinic, which opened in Memphis in 1994. Since then the clinic has seen more than 45,000 patients. Mroz and another breast surgeon, Ron Mattison, MD, see 25 to 30 patients per day.

The clinic is one of the few that still performs film screen mammograms, which use X-ray film.

“Digital screenings, where the results are viewed on a computer, are now the preferred method because an office doesn’t have to store film, so the cost is lower,” Mroz said.

According to Mroz, there is a learning curve associated with reading digital mammograms. Doctors must relearn how to view them.

“Clinics have used film screening since the 1970s, so digital mammography is relatively new,” she said. “All systems memphismedicalnews

.com

will be digital in the future, and I think professionals will get up to speed in reading them. My advice for the people reading them is to view them at actual size instead of magnifying them.”

Another factor that can generate false-positive results is that the radiologist viewing the screen may not be specialized in reading mammograms.

“Some clinics have rotating radiologists who are reading the mammograms, and they aren’t as up to speed on knowing what abnormalities to look for,” Mroz said. “You want the same mammography radiologist looking at the patient’s mammograms and ultrasound if possible.”

According to Mroz, mammography radiologists receive additional training and must be board-certified according to the 1992 Mammography Standards Act. These radiologists must view a certain number of mammograms per year and take continuing education credits to stay certified.

“Experienced interpreting physicians are viewing mammograms at the larger breast clinics in the Memphis area,” Mroz said.

She takes this one step further at her clinic.

“Each physician personally views the patient’s mammogram, ultrasound and biopsy results,” she said. “We also exam the patient and perform the surgery. We are a part of the entire process from day one.”

Mroz recommends that patients seeking a mammogram can decrease the chance of receiving a false-positive result by going to a clinic that specializes in mammography and inquire if a mammography radiologist reads the results.

“Patients need to make sure they are going to a place where the physician is experienced in reading mammograms,” she said. “Also, it’s best if the patient goes to the same office each year to receive a mammogram. That office has the patient’s previous mammograms on file for comparison. If a patient switches doctors, she should pick up her previous X-rays and take them to her new doctor.

“False positives can generate additional tests and in some cases surgeries, which can be expensive. That is another reason you want someone experienced

viewing the results. An experienced Interpreting Physician would know by the shape and distribution of a calcification if it looks cancerous. The person would be able to determine whether to biopsy it immediately or wait six months to see if it changes.”

Mroz stresses that in many cases it is safe for doctors to monitor a calcification for six months before performing a biopsy.

“Eighty percent of calcifications are not cancerous,” she said. “Things do not progress that quickly, especially in micro calcifications. A patient does not go from stage zero to stage three in six months. Six months is a perfectly safe time period to wait, and a patient’s life is not in danger during that time frame. The treatment for the patient is exactly the same.”

The American Cancer Society recommends yearly mammograms for women beginning at age 40, while the U.S. Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, recommends a biennial screening to be done at age 50. The study found that women 40 to 49 were more likely to have a false-positive mammogram compared to women over 50.

“There is a trend in some states, such

as California, where professionals are reevaluating whether to recommend a yearly mammogram at age 40,” Mroz said. “My professional opinion is that women ages 40 to 70 should still get a mammogram screen annually, but also perform a selfexam in the shower once a month. Selfexam is still the best way for women under age 40 to know something is abnormal.”

A mammogram is the best method to catch cancer in its early stages, Mroz said.

More than 62 percent of women ages 40 to 49 get an annual mammogram, and more than 72 percent of women 50 to 59 get a regular screening, according to the National Center for Health Statistics.

“My hope is that in 10 years we won’t have to perform mammograms,” she said.

“There is work being done with genes that hopefully will be able to predict a patient’s risk, so that mammograms are done selectively for only high-risk patients.”

Mroz suspects something as simple as a saliva specimen or a blood test might be able to detect whether a patient is prone to having breast cancer.

“We could experience a new treatment in breast cancer in the next decade,” she said. “Pin-pointing cancer genes means more targeted medicines, less surgery and less scared patients.”

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PHiiT: Statewide Initiative Addresses Pressing Pediatric Issues

BY CINDY SANDERS

In the fall of 2013, the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) launched a bold new initiative to address pediatric quality issues in primary care through the formation of the Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT). Following a successful first pilot program in East Tennessee, PHiiT is now expanding its education and quality improvement efforts across the state.

The collaborative – which is inclusive of all Tennessee parties utilizing pediatric care, delivering pediatric care, measuring outcomes or structuring payment systems – came about as a result of conversations with key stakeholders over the course of several years. Allen Coffman, Jr., MD, FAAP, who serves Dr. Allen as medical director of Coffman, Jr. PHiiT, said many practices were struggling in the wake of the recession. At the same time, practices were being asked to revamp many of their pro-

cesses.

“All of this was coming at one time,” said Coffman, a practicing pediatrician with Highland Pediatrics in Chattanooga and past president of TNAPP. “Providers were overwhelmed with the financial changes, care delivery changes, and changes on how our board certification processes were happening … so we asked, ‘How can we do this better?’”

As discussions became more formalized, Coffman said TNAPP realized it would take a broad coalition to address the changes providers faced and drive quality to improve the health of the state’s youngest citizens. PHiiT’s main goals are: • to educate providers about high value process changes for practices to impact serious population health concerns, • to bring together stakeholders to

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organize and prioritize what those population health priorities are and develop measures to assess outcomes, and • to ensure providers and patients have the tools they need to be successful.

“We’re really focusing on that patient-provider space and making sure the patient and provider have the tools they need to make that a better working relationship,” Coffman said. After all, he continued, “The only ones who can really change healthcare delivery are providers in concert with patients.”

Working with the National Improvement Partnership Network out of the University of Vermont, PHiiT set about to develop and implement quality improvement projects around pediatric health concerns that are high cost, consistent with state and federal priorities, have poor outcomes, are difficult for patients, and/or cause frustration for practitioners.

Coffman said each quality improvement project also includes a Continuing Medical Education component and standardization of metrics and outcomes reporting so the collaborative could analyze data (CONTINUED ON PAGE 12)

TPCA, United Health Foundation Connect for Quality Last month United Health Foundation awarded $900,000 to the Tennessee Primary Care Association to help support “Tennessee Quality Connect,” a clinical initiative connecting healthcare professionals and patients through Community Health Centers (CHCs) in person or by utilizing telehealth technology.

CHCs, which are often located in communities where primary healthcare providers and hospitals are not easily accessible, serve as a primary source of care for one in 17 Tennesseans. However, when a patient’s condition requires the attention of a physician not on staff at a CHC, a range of barriers from a lack of transportation to not having adequate childcare to not being able to take time off work can stand in the way of seeing the specialist. The United Health Foundation grant is focused specifically on providing access to behavioral health and nutritional counseling services for individuals with hypertension, diabetes and depression to help combat these chronic issues.

The ability to leverage telehealth technology extends the reach of urban-based specialty care providers, improving access to critical health services in remote and underserved areas. More than 10 million people nationwide directly benefited from using telemedicine last year, according to the American Telemedicine Association.

“The Tennessee Primary Care Association’s work in the community has shown significant success in connecting people with quality healthcare services, and we are grateful for the opportunity to support its efforts to bring new, innovative approaches to healthcare,” said Rita Johnson-Mills, CEO of UnitedHealthcare Community Plan of Tennessee.

Announced at Neighborhood Health in Nashville, the grant is part of United Health Foundation’s “Helping Build Healthier Communities.” The funds will be awarded over three years and will support the Tennessee Quality Connect initiative at 17 CHCs, which collectively represent 104 health center sites serving more than 300,000 residents across 44 counties.

All three sessions will be held at the Dixon Hughes offices at 999 S. Shady Grove Rd., Ste #400 in Memphis from 7:30 – 9 am.

THURSDAY, JUNE 18TH: DHG Healthcare will be presenting,

“How Does My Practice Stack Up Against the Best?”

Including practical guidance for practices relative to measuring meaningful data and ultilizing this information to optimize practice performance.

THURSDAY, JULY 16TH:

Jason Little, President and CEO of Baptist Memorial Healthcare Corporation will present:

“Medicaid Reform and New Payment Models.”

THURSDAY, AUGUST 13TH: DHG Healthcare will be presenting:

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Space is limited so please RSVP ASAP to blee@mdmemphis.org.

For more information visit: midsouthmgma.org

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MAY 2015

Officials gathered to celebrate the United Health Foundation grant to the Tennessee Primary Care Association last month. Pictured (L-R): UnitedHealthcare Community Plan of Tennessee COO Richard Reeves, Tennessee Primary Care Association CEO Kathy Wood-Dobbins, State Rep. Harold Love, State Rep. John Ray Clemmons, Neighborhood Health CEO Mary Bufwack, and UnitedHealthcare Community Plan of Tennessee CEO Rita Johnson-Mills. memphismedicalnews

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Letter to the Editor

Telemedicine May Improve Healthcare Access in Tennessee As the U.S. healthcare industry strives toward the apex of delivering the highest quality care at the lowest possible cost, we are adopting new ways to do things better, faster and cheaper.

Developing technologies that support telemedicine (also known as telehealth) could be one example.

Telemedicine is delivered by physicians, nurses and other care providers using various forms of web-based technology to interact with patients on screen versus in person. It typically involves videoconferencing, photo transmissions, remote monitoring of vital signs and other clinical services.

Telemedicine is a relatively new mode of healthcare delivery in Tennessee and in the U.S., though the number of patients worldwide using telemedicine services is estimated to rise from less than 350,000 in 2013 to about seven million in 2018, according to a 2014 report published by IHS Technology.

Healthcare organizations are also getting on board. According to a survey released by Becker’s Hospital Review last November, 84 percent of hospitals and health systems believe the development of telemedicine services is important to their organizations.

There are obvious advantages to a telemedicine encounter. For patients, it eliminates the time spent traveling and waiting, especially for people in rural areas where access to brick-and-mortar healthcare services may be scarce. More frequent physician-patient interaction and in-home monitoring solutions have the potential to speed up the delivery of care, help make sure patients adhere to treatment plans, better manage chronic diseases, and ultimately improve patient outcomes.

It also gives physicians who practice in rural parts of our state the ability to consult with specialists when patients are unable to travel to a referral appointment.

Critics raise valid questions about the quality, safety and effectiveness of a telemedicine encounter, including liability factors and appropriate access to and use of patients’ protected health information.

Some physicians buy in to the concept.

Others do not. Rules and regulations vary from state to state, with no federal legislation addressing the practice.

The Tennessee General Assembly in 1998 created a telemedicine license for physicians located outside of the state who used information transmitted electronically to diagnose or treat patients located within Tennessee. The “telemedicine license” is an alternative to a full Tennessee physician’s license. Last year, the Board of Medical Examiners proposed to eliminate the telemedicine license and require a “full” Tennessee license to practice telememphismedicalnews

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medicine. It also seeks to define telemedicine, and place parameters and restrictions on its practice. The Tennessee Medical Association and others are actively participating in these ongoing discussions, advocating for rules that promote safety and accountability for each patient encounter,

without being so restrictive that they stifle the technology’s potential.

To be clear, a telemedicine encounter is not the same as a face-to-face encounter with a doctor. Technology cannot replace that.

We should be open, however, to new technologies that can improve access to

quality healthcare in Tennessee and, if used and regulated appropriately, contribute to better patient health and help reduce overall healthcare costs.

John W. Hale, Jr., MD President, Tennessee Medical Association

MAY 2015

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Memphis Bucks Trend, continued from page 1

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MAY 2015

The disparity looms even larger in specialties such as cardiology, where male nurses earn about $6,000 more per year on average than female nurses. And in anesthesiology, where about 40 percent of nurse anesthetists are men, males earn an average of $17,290 more each year than female anesthetists.

The study, which covered 1988-2013, reveals that little has changed in gender pay gaps during the last quarter century.

According to the report, “Fifty years after the Equal Pay Act, the male-female salary has narrowed in many occupations. Yet pay inequality persists for certain occupations, including medicine and nursing. Studies have documented salary differences across clinical settings for diverse cohorts of physicians and higher salaries for male registered nurses.”

Even in areas such as chronic care that typically do not offer the higher pay scales found in anesthesiology and cardiology, pay inequality persists.

According to the study, male nurses managing conditions such as asthma or diabetes are paid on average nearly $4,000 more per year than females.

But while pay disparity between female and male nurses exists nationwide, that isn’t the case in Memphis.

In fact, a survey of the area’s leading healthcare institutions offers a decidedly different view.

At Regional One Health, which employs a total of 582 staff RNs, 514 (88 percent) are female, whereas 68 (12 percent) are male. Pay rates there are based on experience levels and job performance, and while salary figures were not released, a hospital spokesperson said that the average pay for female nurses is “slightly higher” than for male nurses.

However, the earnings difference is not related to gender. The female nurses earn more than their male counterparts because of higher levels of experience, which results in higher average pay.

At Methodist Le Bonheur Healthcare, which employs 3,686 registered nurses, 92 percent are female. Gender is not a factor in pay, a hospital spokesperson said.

“At Methodist Le Bonheur Healthcare, we’re committed to fair pay for all of our associates. That’s why we have a standardized approach for system-wide compensation for nurses based on years of experience and performance,” said Carol Ross-Spang, senior vice president of human resources at Methodist Le Bonheur Healthcare. “We regularly review pay patterns to ensure we’re honoring our commitment to fairness. Taking care of our patients and their families is of the utmost importance to us, and our nurses are crucial to our organization’s success.”

Similarly, at Baptist Memorial Health Care, female and male nurses are paid on standardized scale based on experience.

The organization employs 3,604 nurses, about 10 percent of them male. And while male nurses are in the minority, they are making gains in supervisory positions.

At Baptist, there are 16 males in nursing management positions, including two chief nursing officers, three directors of

nursing and 11 nurse managers.

“I’m encouraged that we’re seeing more male nurses in our facilities, and we’re proud that more men are becoming involved in nursing leadership positions,” said Susan Ferguson, interim vice president and chief nursing officer for Baptist Memorial Health Care. “Our pay is competitive and based on experience, with the same criteria for everyone regardless of gender.”

That’s important news for students in Baptist College’s nursing program, which has an enrollment of 526 nursing students, 486 of them female.

In an interview published by The New York Times, American Nurses Association spokesman Peter McMenamin said the study was valuable, but he emphasized that more information is needed to determine why the pay disparity exists.

“The folks who did the study are well qualified and they have lots of data. But my main hesitance in terms of statistics is they have fewer men,” McMenamin said. “You can’t say this is all a statistical fluke. It’s not.

But there are different things that could explain some of this challenge.”

Regardless of the factors contributing to the study, some believe that the profession offers dividends unavailable in any other industry. And in the Memphis area, that means equal pay for equal work.

“I love it because it allows me to do something different every day and I know that I’m making a difference in peoples’ lives,” said Margaret Sandidge, a registered nurse who works in the Emergency Room at Baptist Memorial Hospital-Collierville.

“I’ve been a nurse for 50 years. I’ve always been paid on my experience and how I do my job. Now that more men are entering the field, I think that’s great. There’s room for everyone.”

At the Loewenberg School of Nursing at the University of Memphis, firstyear student Timothy Robison said male students make up about 20 percent of his class. And he’s glad to see more males entering a profession that he believes offers unlimited possibilities.

“Because I already have an undergraduate degree, by the time I finish my studies I’ll have a BSN and I’ll probably go ahead and get my master’s degree,” Robison said. “There are so many avenues you can pursue in nursing, from clinical work to teaching, and there are all kinds of specialties. Nursing offers a career where I can help people, be well compensated for it, and work in any setting I choose. It’s full of opportunities.”

Scott Baker, who retired from the U.S. Air Force after 20 years and then went to school to become a registered nurse, agreed.

“I wanted a career where I could help people, and I knew about the nursing shortage, so I decided to go back to school and become an RN,” said Baker, who works on the Medical Surgical floor at Baptist Memorial Hospital-Collierville. “So far it’s been an amazing experience. I’m fortunate because I work with a great team, and even though men are in the minority, I’ve never experienced any gender discrimination.

This is a fantastic career choice.” memphismedicalnews

.com

Population Health Advances Physicians are buzzing about the new healthcare paradigm

BY JULIE PARKER

America’s independent physicians met mid-March in San Antonio, Texas, for the 20th annual national meeting of TIPAAA – The IPA Association of America, the largest trade association serving independent and integrated physicians in the United States.

The focal point: population health, a relatively new front burner issue unfamiliar to many practitioners. Congress included the model as a component of mandates in the Patient Protection and Affordable Care Act (ACA) (See box on page 12).

“We covered a lot of ground at our annual meeting to educate independent physicians about population health,” said Al Holloway, founder and president of TIPAAA. “Once we fully understand what it is, then we’ll find tools, products and services that can assist independent physicians in their daily practice.”

One question that repeatedly popped up: What’s the difference between population health and public health?

“Some view population health as a more modern version of public health, which itself – improving the health of the public – may be a goal, a measurement system, and a conceptual framework that undergirds a profession and a scientific field,” wrote Michael A. Stoto, PhD, in “Population Health in the Affordable Care Act Era,” published by Academy Health (Feb. 21, 2013).

“Population health differs from public health, at least perceptually, in at least two respects,” Stoto explained. “First, it’s less directly tied to governmental health departments. Second, it explicitly includes the healthcare delivery system, which is sometimes seen as separate from or even in opposition to governmental public health.”

David B. Nash, MD, MBA, founding dean of the Thomas Jefferson University School of Population Health, pointed out that population health “builds on public health foundations.”

Among the build- David Nash ing blocks, according to Nash: • Connecting prevention, wellness and behavioral health science with healthcare delivery, quality and safety, disease prevention/management and economic issues of value and risk – all in the service of a specific population. Examples: a city, provider’s practice, employee group, hospital’s primary service area or pre-school children.

• Identifying socioeconomic and cultural factors that determine the health of populations, and developing policies that address the impact of these determinants.

• Applying epidemiology and biostatistics in new ways to model disease memphismedicalnews

.com

states, map their incidence and predict their impact.

• Using data analysis to design social and community interventions and new models of healthcare delivery that emphasize care coordination and ease of accessibility.

“When applied to healthcare delivery, population health differs from conventional healthcare by emphasizing value rather than volume of services rendered,” said Nash.

How will population health affect phy-

sicians?

Monumentally, said Kathy Jordan, president of Jordan Search Consultants.

“The primary care practice of the future will look much different than it does today,” she said. “Instead of one-on-one encounters between the patient and their provider, the patient interaction process will include phone visits, email consultations, group visits, education programs and encounters with a variety of care team members. Out-of-office contact will

become the new norm as patient health improves. Additionally, primary care physicians of the future must exhibit leadership and interpersonal skills, as well as a passion for top-tier service delivery. How well they manage the team will directly translate to how well the health of their patient population is being managed, which will directly impact future compensation models.”

Important financially: To be eligible for incentivized government funding, orga(CONTINUED ON PAGE 14)

MAY 2015

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Healthcare Leader, continued from page 1

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sity School of Medicine, graduating in the top 20 percent of her class at a time when women were a 40 percent minority and African-American women were in a minority that was significantly less than that. Her internship and residency were completed at Northwestern University in Chicago, where despite being the only female in her eightresident group, she was voted chief resident.

“I didn’t really have a plan for OB/ GYN, but I did my rotations and loved them all – but in OB, the light went on,” she said.

Anderson attended Central and Northside High in Memphis, graduating in 1984, and is active today in Northside’s alumni association, where she recently helped her class raise nearly $4,000 for the school.

She left a position with Emory University in Atlanta to return to Memphis, where she found the medical community extremely welcoming to a newcomer with new ideas.

“It’s been one of the best decisions I’ve ever made,” she said.

Recently, she shared her views with Memphis Medical News: On women’s health needs: “The female patient is generally the center of healthcare not only for herself but for the family — children, spouse, boyfriend, co-workers — so the better served that female patient population is, the more the rest of the community will benefit.

“What’s really killing women is heart disease . . . and spousal abuse. When patients come into our office with their significant other, we always request a five-minute interview without the spouse, to share private information and make certain that this patient is not vulnerable to domestic abuse.”

Her practice at the Women’s Physician Group, which recently merged with Memphis Obstetrics and Gynecological Association, PC (MOGA), promotes natural labor and low intervention.

“I’m not necessarily critical of the induction planning,” she said. “I just think it’s overused; and with overuse, you’re going to have consequences. Not everyone is going to respond to the medication — their bodies are not ready — so you have a higher C-section rate. The most important thing we can do to change the climate of Cesarean section in Memphis is to minimize our induction. Sometimes being a good physician doesn’t always mean doing something to a patient.”

On underserved segments of society: “The average inner-city 13-year-old, 18-year-old or 25-year-old may not have health insurance or the guidance to get adequate care — and may be very vulnerable to peer sexuality starting to dominate their life, leading to unplanned pregnancy or STD. As a 30-year-old, they’re dealing with the consequences of behaviors that might have been impacted with guidance and care and counseling and appropriate birth control.”

Anderson takes pride in Memphis’ LARC (Long-Acting Reversible Contra-

ception) program, available through the A Step Ahead Foundation, courtesy of a privately funded grant that purchases IUDs or arm-implantable Nexplanon® capsules that provide protection from pregnancy for three years.

“We’re already seeing an impact,” she said.

On Bluff City Medical Society (BCMS): “In this era, it’s not really a black organization any longer, with black issues. I think it’s really a group that has broader issues that we’re addressing in a mainstream way. The value of Bluff City is that we can target the African-American community in some unique issues and serve as a resource to the community.”

She points to positive results of the society’s mentorship program for UT medical students, and its ability to address some of the stressors that African-American physicians may feel either in individual or in smaller group practices.

Among their efforts is the fourth annual Physician Business Symposium, scheduled for July 11 at the University of Memphis Holiday Inn. It shifts the emphasis from patient care and focuses on ways to structure practices in terms of their financial makeup.

“Affiliating with hospitals is the trend for medicine, but you’ll find many single physician practices in our organization,” Anderson said.

Bluff City Medical Society’s primary focus is on a healthy eating and living initiative that involves 10 predominantly African-American Memphis city churches.

“We’re trying to address the epidemic of obesity within our community, asking individuals to make a commitment for a minimum of one year,” she said. “Baptist does bloodwork, which screens for diabetes and cholesterol and anemia, and we are then on a program of monthly meetings and planned exercises.

“We’re trying to empower each church to be more than just a church in terms of ministry by also creating opportunities for the membership to ‘know better, and do better.’ The churches are working out. Several have been tested twice (the testing is quarterly), so hopefully by the end of the year we’ll have some data for an evidence-based approach next year of how to most effectively expand this program.”

Anderson regards her greatest accomplishment as being in a practice that she loves, and considers her most crucial issue to be time management. Adding the demanding job of presiding over BCMS to the daily workload of her practice is a challenge, she said. “I’ve never viewed myself as a leader, but I think I have ideas and I’m a fair person; and I think that people see that I like to empower other people — I’m more of a listener who comes up with creative solutions.”

She has a 22-year-old stepson majoring in physical therapy at Coastal Carolina University. Her leisure interests focus on mission trips to Africa (she’s made six) and travel to places to connect with different people, communities and foods. memphismedicalnews

.com

Stark Enforcement Settlement Shines a Light on Physician Compensation Practices

By Denise Burke

Late last year, a New York cardiology group agreed to pay $1.3 million to the U.S. government to settle charges that it compensated physicians based on how many patients they referred for medical CT scans and nuclear medicine procedures within their own group. This is one of the first Stark enforcement cases involving physician compensation inside a practice, and the case illustrates, once again, the increasingly aggressive enforcement environment in which healthcare providers operate. As has become commonplace, the allegation was originated by a whistleblower.

Cardiovascular Specialists, a ten physician group doing business as New York Heart Center, agreed to the payment to settle allegations that it violated the Stark law which prohibits physicians from referring patients for designated health services to entities in which they have a financial interest, absent an exception. The government also claimed that the practice violated the False Claims Act by filing claims in violation of the Stark Law. Most physician groups rely on the in-office ancillary exception to protect referrals of designated health services (such as lab, radiology and physical therapy, among others) to their own practices. The in-office ancillary services exception, however, is extraordinarily complex and what may seem like innocent tweaks to a physician group’s compensation formula may destroy the protection afforded by the exception.

This settlement should serve as an important reminder to all physician groups to assess compliance with the in-office ancillary services exception and to consult competent healthcare regulatory counsel before making changes to physician compensation formulas. The settlement came as a surprise to many physician groups that had become accustomed to payments within a physician group practice escaping the high level of scrutiny that arrangements with hospitals have historically received. This settlement underscores the Stark law’s prohibition against compensating physicians according to the volume or value of their referrals for services that are not personally performed or incident to services performed by the ordering physician. Unfortunately, this is just one more concern in the lengthening list of compliance issues that require healthcare providers to focus time and attention on regulatory matters rather than the primary goal of patient care.

As Former U.S. Deputy Attorney General Paul McNulty recently stated, “If you think compliance is expensive, try noncompliance.”

Denise Burke is a partner at Waller Lansden in Memphis.

Nationally, she is recognized in Chambers USA and Best Lawyers for her healthcare law experience. In West Tennessee, she was voted 2012’s “Lawyer of the Year” in healthcare law by Best Lawyers and was listed in the Memphis Medical News’ 2015 InCharge list of key healthcare decision makers. Ranked among the nation’s largest healthcare law firms, Waller’s nearly 100 healthcare lawyers and 40 years’ experience makes the firm the go-to counsel for healthcare organizations. The firm represents tax-exempt and publicly-owned hospitals and health systems and some of the largest publicly traded and privately-owned healthcare companies that operate more than 450 acute and behavioral hospitals and 500 ambulatory surgery centers.

www.wallerlaw.com

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.com

MAY 2015

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PHiiT Statewide Initiative Addresses Pressing Pediatric Issues, continued from page 6 and broadly share information and best practices.

The first initiative – Breastfeeding Sustainment and Smoking Cessation Project – was piloted through practices in Chattanooga, Knoxville and Oak Ridge with funding from the Tennessee Department of Health and data support from the Tennessee Initiative for Perinatal Quality Care (TIPQC). Coffman said the project kicked off in the summer of 2014 and winds up this month. An educational program was hosted over two weekends to get providers – which included physicians, nurses, nurse practitioners, and medical students – up to speed on ways to extend breastfeeding and discourage tobacco use around infants, and preliminary data has been very encouraging.

“When you look at breastfeeding, one-third will breastfeed no matter what you do, one-third won’t no matter what, and one-third in the middle are undecided, ambivalent,” Coffman said.

“There is a high value window during the newborn period. We know the sooner

you get them (mothers) in and the better you engage them that first two weeks, you maximize the chance they will continue to breastfeed,” he explained, adding this newborn period is also the most motivated time for caregivers to quit smoking.

“We have been able to improve the frequency of patients seen within 72 hours of hospital discharge from 76 percent at baseline to 85 percent at our first followup,” Coffman said. “Our two-month breastfeeding rate has increased from 56 percent at baseline, which was better than anyone expected, to 62 percent at our first follow-up,” he continued. Coffman did note the higher-than-normal baseline breastfeeding rate could be attributed to the type of practices that participated in in the pilot, which were already working to engage parents around the importance of breastfeeding.

As for the second part of the project, Coffman noted, “Only 60 percent of newborns were being screened for tobacco exposure at baseline. We were able to increase that to three-quarters, 76 percent,

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at our first follow-up.” He added that instead of just asking if the child was exposed to tobacco, which Coffman said could feel judgmental and garner a biased response, PHiiT trained providers to reframe the conversation. “What we tried to teach was to positively engage the family around their care network and then go back and ask if each of those persons used tobacco.”

Ultimately, Coffman noted, providers need effective tools they can use to engage with patients. “We know there is a finite amount of time that the provider and patient have so we look for the high value propositions … what really works.”

He continued, “We really push our education faculty to choose what are high value changes and then communicate that to providers and patients in a way that is useful.”

Coffman said an important part of the equation that has been missing is feedback as to what is sustainable and then using that feedback to help develop payment structures that incentivize continued process improvement. While the information is critical to inform practice and impact outcomes, Coffman was quick to say that PHiiT provides tools and data but allows providers the freedom to be innovative in how they address issues with patients.

With the first pilot successfully drawing to a close, PHiiT is looking to expand that project and others across the state.

The collaborative recently announced an award of a $1.49 million, three-year con-

tract with the Bureau of TennCare to take PHiiT’s efforts statewide.

The next project is to develop a pediatric metric dashboard with the assistance of all four pediatric residency programs in Tennessee. PHiiT’s quality coach will assist participating practices in gathering data pertaining to the measurement of the metrics. “That will give practices ongoing feedback as to what their practice is doing compared to the state aggregate,” Coffman said of the dashboard, known as the Provider Best Practice Resource.

From there, specific quality improvement projects will be added. Coffman said asthma would be among the first initiatives with obesity, behavioral health and developmental screening modules as other likely candidates to roll out in the near future.

“What we’re hoping is to give practices real data to make business decisions around investing in quality improvement,” he said. “I think providers are going to learn a lot about the way they deliver care.”

PHiiT has begun enrolling additional practices to participate in the expanded programming. Coffman said pediatric, family and general practices that see children are all welcome to participate. In addition, school-based clinics, health department clinics and federally qualified health centers are also encouraged to enroll. For more information, contact Becky Brumley via email at becky.brumley@ tnaap.org.

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HIT: Optimization Through Integration

BY CINDY SANDERS

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes on both a clinical and operational level.

Therefore, you might as well learn to optimize it.

That was a key part of the message Chris Miller, principal with Nashvillebased Cumberland Consulting Group, and Deb Dulac, director of PRISM and business systems for the University of Vermont Medical Center, shared with audiences at the recent HIMSS15 Annual Conference & Exhibition. More than 38,000 professionals flocked to Chicago last month to attend the premier health information technology conference, which included more than 300 peer-reviewed education sessions, vendor exhibits touting the latest technology options, updates on government regulations impacting the industry and keynote speakers ranging from Bruce Broussard, president and CEO of Humana, to George W. Bush, 43rd president of the United States of America.

“Over the past five years, there has been a huge shift towards technology largely because of the HITECH Act of 2009 and government programs like Meaningful Use that have helped drive the technology in healthcare,” Miller said.

Although slower to adopt technology into daily operations – particularly in a clinical setting – than many other industries, healthcare has increasingly been pressed to take an ‘all in’ stance.

Miller noted that over the last few years, technology has fundamentally changed the way providers … both large and small … operate. He added the challenge is balancing the adoption of technology with everything that brings.

“Today anything a healthcare organization wants to change in a business or clinical process requires a change in their technology, and likewise, any change in their technology has an impact on the care they provide or their revenue,” he said.

“I think healthcare entities were used to thinking of technology as a separate en-

tity, but now it’s so intertwined,” added the Atlanta-based HIT expert.

In their HIMSS presentation, Miller said he and Dulac focused on how to manage and optimize technology now that it has become so pervasive, while at the same time accounting for all the other changes happening in healthcare including a switchover to ICD-10, meeting ongoing and new Meaningful Use requirements, actively engaging patients, supporting accountable care models, and the myriad other programs that require attention.

The bottom line is that thinking of each of these mandates or initiatives as individual tasks to conquer leads to madness … or at least extreme frustration. Instead, Miller said the question should be, “How can organizations effectively manage all of those together with a higher degree of efficiency and lower overall cost?”

He continued, “When I think implementation, somewhere between 25-30 percent of the time spent on these changes is spent on testing so if you can group – effectively overlap testing on these programs – you can significantly save time.”

More than just testing, though, Miller said very deliberately grouping initiatives under a single governance project structure helps with a range of other issues from interoperability to simplification for

end users. “Being able to group things together almost makes it irrelevant as to what changes were made,” he said of the finished product in the minds of those actually using the technology.

The ‘ripping off the bandage’ approach means one educational update for those end users as opposed to having to create an educational module for each individual initiative. Not only does a rolling schedule of changes often feel more overwhelming, but also the time away from desks learning the new processes would typically be less under a grouping struc-

ture than to have 10 separate trainings for 10 separate initiatives.

Miller was quick to admit that creating overarching technology structures could be difficult without staff or contracted expertise, which makes it more problematic for small practices.

“Whether you see it as a good or bad thing, there’s certainly a lot of consolidation in the market. Small private practices are becoming more and more rare,’ he said. “I think one of the reasons is it’s becoming increasingly difficult for groups like that to manage all these changes.”

Miller added larger practices or health systems enjoy the economies of scale that make it easier to incorporate the rapid number of changes taking place.

However, he added that in addition to HIT consultants, software vendors typically also offer at least some assistance in helping clients assimilate new processes into their workflow.

“Managing technology is only getting more complex,” he concluded. “Organizations need to be intentional and strategic in how they do that … whether that’s implementing analytics platforms, system upgrades, system optimization, Meaningful Use programs, or ICD-10. They need to be looking at ways they can consolidate those initiatives to be more effective with their resources and increase the return on their technology investment.”

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GrandRounds CN Donates $100,000 for FedExFamilyHouse at Le Bonheur Children’s Hospital CN, North America’s Railroad, has donated a $100,000 gift to support FedExFamilyHouse, a home-away-fromhome for families traveling to Le Bonheur Children’s Hospital for treatment.

The announcement was made during CN’s annual shareholders meeting at The Peabody Hotel. In 2014, CN partnered with Le Bonheur for their CN Miracle Match program, which matched donations up to a total of $300,000 to Le Bonheur’s public giving campaign, Everyday Heroes. The campaign, along with CN’s matching gift, raised more than $780,000 in donations.

The CN gift to FedExFamilyHouse is one of the largest single donations in house’s history. FedExFamilyHouse’s dining hall will be named in honor of CN’s contribution. The house is Le Bonheur’s first housing facility for out-of-town families. Since opening in 2010, the 24-suite facility has served nearly 40,000 people from 40 states and nine countries.

The Jones Clinic Selected to Participate in National Oncology Program The Jones Clinic in Germantown is one of 12 clinics from across the nation selected to participate in the American

Society for Clinical Oncology’s (ASCO) training program.

The ASCO’s program is part of a nationwide effort to improve oncology care by working with oncology providers to find innovative ways to enhance processes of care and implement successful and meaningful quality-focused activities in their practices. This is the second year for the program which began in April and end in October.

As part of the training, the clinic will be implementing a survivorship program to extend treatment beyond remission and help patients deal with the myriad of issues they might encounter, both physical and emotional.

Education and Policies Focus on Public Health, End of Life Care, Payment Reforms at TMA Event Approximately 300 of the state’s physicians, and other healthcare professionals met in Nashville in April for MedTenn15, a medical convention sponsored by the Tennessee Medical Association.

Highlights included: • Tennessee Department of Health Commissioner John Dreyzehner, MD, delivered an address on what he considered Tennessee’s biggest public health challenges.

Population Health, continued from page 9 nizations must prove their commitment to, and implementation of, population health, said Jordan.

“They’ll be required to improve the patient care experience, the overall health of populations, and lower per capita costs of case,” she said. “As a more comprehensively integrated system focused on population health begins to dominate, the healthcare industry, healthcare experience and provider recruitment initiatives must also evolve.”

Enter population health management.

Regina Levison, vice president of client development for Jordan Search Consultants, said that “while population health is defined as the health outcomes of a group of individuals comprising a specific demographic population, population health management is a business model centered on the delivery of comprehensive care and management of total risk.”

The foundational shift in the healthcare experience will morph from an industry driven by reactivity to an industry driven by proactive measures, said Levison.

“The goal of population health is to keep a patient population as healthy as possible and minimize the need for costly interventions, procedures, emergency room visits, and hospitalizations,” she said.

As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will be reconstructed, said Jordan.

“Within this transformation, we’ll see an altered patient and physician experience,” 14

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she said. “With an emphasis on proactive preventative care, evidence-based protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume of patients seen.

“Although the results of these initiatives won’t manifest for a decade or more, population health management will almost certainly improve the quality of lives for millions of individuals throughout the country.”

The ACA and Population Health The Patient Protection and Affordable Care Act (ACA) addresses population health in four significant ways: • Provisions to expand insurance coverage target the advancement of population health by improving access to the healthcare delivery system.

• Other provisions seek to enhance the quality of care delivered.

• Lesser known provisions aim to improve prevention and health promotion measures within the healthcare delivery system.

• The final set promotes community- and population-health based activities, including the establishment of the National Prevention, Health Promotion and Public Health Council, which has already produced the mandated National Prevention Strategy and Prevention and Public Health Fund for monetizing Community Transformation Grants.

• A panel of physician experts discussed end of life care, including how healthcare providers can help patients and families engage in difficult conversations and make important choices about advance care directives.

• TMA’s in-house experts delivered two separate presentations about the Tennessee Healthcare Innovation Initiative, the state’s effort to move from a fee-for-service to a value-based payment model, and the current state and federal healthcare reform landscape.

• Dr. Roland Gray of the Tennessee Medical Foundation delivered a two-hour session focusing on the state’s growing prescription drug abuse epidemic.

For more detailed information about the convention, visit tnmed.org.

UTHSC Professor Awarded $2.6 Million to Study Toxicity of the Paraquat on the Brain Byron Jones, PhD, and his research team at UTHSC, are using newly awarded funds to investigate individual toxicity of the herbicide Paraquat on certain areas of the brain.

Paraquat, a weed killer used extensively in agriculture in much of the world, is suspected to increase risk for developing Parkinson’s disease.

Dr. Jones, a professor in the Department of Genetics, Genomics and Informatics in the College of Medicine at the University of Tennessee Health Science Center, has received a grant totaling $2.6 million from the National Institute of Environmental Health Sciences, a subsidiary of the National Institutes of Health. The award will be used to support a project titled, “Neural Toxicity of Paraquat Is Related to Iron Regulation in the Midbrain,” and will be distributed over five years.

Caliber Patient Transport Opens in Memphis; Will Offer Non-Emergency Transportation Services Caliber, a non-emergent medical transportation company, has opened in Memphis. The firm provides ambulatory, wheelchair, and stretcher services and will be an all-inclusive resource for patient care coordinators, social workers, DONs, insurance adjusters, discharge planners, and case managers.

Memphian Ty Jones is the local owner and plans to offer non-emergency transportation services for assisted/senior living and nursing homes, memory care centers, rehab and PT facilities, hospitals, and individuals. Jones says his new vans will be driven by specially trained and certified drivers offering “bedsideto-doctorside” service.

Caliber also will provide service for those undergoing routine treatment such as dialysis, chemo, methadone, as well as for those with workmen’s comp claims.

The company will offer 24/7 service, GPS and custom software. Those wanting more information may visit www.CaliberPatientCare.com.

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GrandRounds Janet Hunt Named Chief Nursing Officer at Methodist Extended Care Hospital

Memphis Transplant Surgeon Honored by the Tennessee Medical Association

Janet Hunt, RN, BSN, MBA, has been selected Chief Nursing Officer (CNO) for Methodist Extended Care Hospital.

Hunt had served as CNO at Methodist Fayette Hospital.

James Eason, MD, Medical Director of the Methodist University Hospital Transplant Institute and Professor and Division Chief of the Transplant Division for the University of Tennessee Health Science Center, has been awarded an Outstanding Physician Award. Eason was presented the award during last month’s Tennessee Medical Association’s annual convention last month.

Select Specialty HospitalMemphis Earns Quality Respiratory Care Recognition

The Outstanding Physician Award is given annually by the TMA House of Delegates to member physicians who through their illustrious medical career make an impression among their colleagues, peers and on the profession of medicine. After hurricane Katrina in 2005, Dr. Eason left New Orleans to become Medical Director of the Methodist University Hospital’s Transplant Institution in Memphis. His leadership has been instrumental in transforming the Institute into one of the best programs

in the county for liver and kidney transplants.

In 2011, Dr. Eason was appointed by the U.S. Secretary of Health and Human Services to a four-year term to the advisory committee on organ transplantation to assist in enhancing organ donation across the nation.

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.

Select Specialty Hospital-Memphis has been awarded the Quality Respiratory Care Recognition (QRCR) from American Association for Respiratory Care.

The QRCR program was started by the AARC in 2003 to help consumers identify those hospitals using qualified respiratory therapists to provide respiratory care.

The hospital also announced that Tammy Ellard, its director of business development, has moved her office from the Loewenberg Building, to the 11th floor of the hospital at 5959 Park Avenue.

Dr. John W. Hale, Jr. to Lead the Tennessee Medical Association John W. Hale, Jr., MD, a family physician in Union City, has been installed as 2015-2016 president of the Tennessee Medical Associatioin (TMA) the state’s largest professional organization for physicians. Hale’s term officially began in April.

As President, Hale Dr. John will serve on the TMA Hale, Jr. Board of Trustees, which is responsible for the direction and implementation of Association activities between sessions of the House of Delegates, the Association’s governing body. He will also serve as the public spokesman and official representative for TMA’s more than 8,000 members.

Hale is the 161st President of the TMA and succeeds Douglas J. Springer, MD, a gastroenterologist in Kingsport.

Hale is originally from Halls, Tennessee. He graduated from the Quillen College of Medicine at East Tennessee State University and has practiced family medicine at the Doctor’s Clinic in Union City for 24 years. He is board certified in family medicine and has been an active TMA member, serving on the TMA House of Delegates for 23 consecutive years. He has also been a TMA Judicial Councilor and served on the Board of Trustees and as Speaker and Vice Speaker of the House, a past Young Physicians Chair, and as a delegate to the American Medical Association House of Delegates.

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