Memphis Medical News November 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 3

An artist’s rending of Baptist’s new facility that will include a pediatric emergency department.

Samuel Dagogo-Jack MD

ON ROUNDS

MEMPHIS on the MEND BY PAMELA HARRIS

MIFA: Celebrating 45 Precious Years in Memphis, And Doing Much More Than You Probably Realize I have to admit it. I’ve never been hungry. There’s always been food on the table and a roof over my head. And I’m grateful .... 4

TMA Chief Looks at Healthcare’s Changing Landscape

Opening Date Moved Up For Baptist Pediatric ER By AMy FRENCH

Greater Memphis’ second dedicated pediatric emergency department is now scheduled to open sooner than expected – in November 2014 instead of spring 2015. That means families who want emergency care from pediatric specialists in a kid-friendly environment will have a full-service alternative to Le Bonheur Children’s Hospital in downtown Memphis. Other area hospitals care for children in emergency rooms built and staffed primarily for adult patients. “We think it will be a great Christmas present for this community,” said Anita Vaughn, CEO and administrator at Baptist Memo-

An advocate for doctors in a climate of uncertainty

rial Hospital for Women in east Memphis, where the new pediatric ER is under construction and ahead of schedule. The new facility will span 17,000 square feet and contain eight treatment rooms. The staff will include physicians and nurses who specialize in pediatric care, as well as child-life specialists trained to help parents and children cope with the stress of being in the hospital. Leaders in the Baptist Memorial Healthcare system see the expansion as a natural extension of services available at the Women’s Hospital, not a kickoff to competition with Le Bonheur, Vaughn said. She noted that LeBonheur’s emergency medical director was

HealthcareLeader

The Memphis Medical News recently had the opportunity to interview Russ Miller, CEO of the Tennessee Medical Association ... 11

Kim Avery, BBA, MBA, JD Administrator, Mid-South Pulmonary Specialists By JUDy OTTO

Battling the most feared and lethal diseases in the United States is not a job for sissies. Leading the charge in the battle against killer pulmonary diseases — by developing strategies, maintaining a high-tech arsenal and overseeing operations for Mid-South Pulmonary Specialists — Kim Avery is certainly no sissy. Ably flanked by practice manager Teresa

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Golden, Avery routinely engages in skirmishes on behalf of the practice’s 21 physicians and the pulmonary patients they serve; and she usually carries the day. Although the native West Memphian’s early intentions were to pursue a career in international business and she earned her undergraduate degree from the University of Memphis in that area, her employment experi(CONTINUED ON PAGE 12)

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PhysicianSpotlight

Samuel Dagogo-Jack, MD

Professor of medicine’s ‘restlessness’ leads to honors and grant By RON COBB

Samuel Dagogo-Jack is on a hot streak. The Nigerianborn doctor is a professor of medicine and director of the Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee Health Science Center. Last year, he was elected vice president of the American Diabetes Association. He will move up to president-elect in January and then president in 2015. In July, he went to Toronto to receive an award from the National Medical Association as Internal Medicine Section Physician of the Year. In mid-September came notification from the National Institutes of Health that his application for grant funding for a research project had been approved. “It is the best piece of news any researcher wants to hear,” he said. “It is the most exciting development of my career.” Dagogo-Jack estimates the grant will total more than $3 million over five years for a project titled “Pathobiology of Prediabetes in a Bi-Racial Cohort,” or POPABC for short. “It is to support a research idea that I’ve pursued for the last five years,” he said, “which is to ask the question, ‘Given that blacks in America have been reported to have relatively more diabetes compared to whites, if you found blacks and whites living in Memphis, all of whom have parents with diabetes, and you found them when their blood sugars are perfectly normal, and follow them closely with repeated measurements of blood sugars for many years, can you detect racial differences in early glucose abnormalities?’ “In other words, if the playing field is normal in terms of family history of diabetes, does race still matter? I’m most passionate about the POP-ABC study and its potential to lead to a greater understanding of why people’s blood sugar drift higher from normal, and what role race plays in that.” Dagogo-Jack grew up the son of a homemaker mother and a father who trained in the law and worked as a businessman in the oil industry. He had a sister who went into medicine, but his first inclination was to go into engineering, “partly influenced by what I heard my father discussing with his friends,” he said. “My father was in the early generation of Nigerians who were poised to take over from the British colonial people following independence of the colonies in the ‘50s and ‘60s. His friends talked about memphismedicalnews

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the need for newly independent countries to have a lot of scientists and engineers to build a country, so I kind of eavesdropped on those adult conversations. And when I went to school and had good grades in math and science, I was leaning toward engineering. I later course-corrected, and

medicine is a form of engineering of the human body.” Dagogo-Jack went from medical school in Nigeria to residency training in England, where he was certified by the Royal College of Physicians as an internist. He then returned to Nigeria to work and teach at the local university. “I did have my own stint of running clinics with a hundred or more patients daily,” he said, “no appointment needed, clinics open at sunrise and closed at sunset, where you’re not done until your last patient is gone.” But along the way, DagogoJack had passed an exam that qualified him to work anywhere in the world, and the thought of coming to America was always in the back of his mind. “My mentors and professors in England seemed to extol the virtues of an American experience,” he said. “The others joked that medical training was incomplete until the BA degree had been added. And I used to laugh and ask what is the BA, and it’s not Bachelor of Arts, it’s ‘Been to America.’ “I had a restlessness in me that I needed to head out and do more re-

search.” He came to Washington University in St. Louis in 1990, “not planning to stay more than two years, which was the mandatory required period to become an American board-certified endocrinologist, but I ended up staying 10 years at that great institution.” He trained there under two leading diabetes researchers, Dr. William H. Daughaday and Dr. Philip E. Cryer, mentors to whom Dagogo-Jack remains grateful. By 2001, Dagogo-Jack was ready to move on, and his next stop was Memphis and UTHSC. “There was opportunity for growth and leadership positions in my specialty field of endocrinology,” he said. “It was both an opportunity and a challenge because in the highly resourced and wellendowed private institutions like Harvard and Washington University, there’s a tremendous amount of support structure which is not often the case for state institutions. “I wasn’t quite sure what I was getting into. What I did know was that the University of Tennessee had strengths, and they included the opportunity to come and make one’s mark and contribute meaningfully to a population that needed specialists and endocrinologists in (CONTINUED ON PAGE 14)

NOVEMBER 2013

MIFA: Celebrating 45 Precious Years In Memphis, And Doing Much More Than You Probably Realize MEMPHIS on the MEND BY PAMELA HARRIS

I have to admit it. I’ve never been hungry. There’s always been food on the table and a roof over my head. And I’m grateful. While this is the time of the year when we all pause to give thanks for the bounty we enjoy, it seems kind of trite when you consider that for many, hunger is something that is experienced every day. Most of us can’t even comprehend what that would be like. In his book, The Road Less Traveled, M. Scott Peck begins with the sentence, “Life is difficult.” Even for those of us who have never known hunger, life is full of problems –sometimes overwhelming problems that can range from broken hearts and broken bones to financial distress, illness, disease and unbearable loss. Imagine the person who’s dealing with those things, but who also has to worry

about where the family will sleep tonight and how they’re going to be fed. In 2011, Memphis was declared the hunger capital of the United States. Since 2009, unemployment in the city has been at 10 percent. In spite of all the wonderful organizations in our city that are trying to change these facts, we still have a lot of hungry and homeless neighbors, which is why MIFA is so critical to Memphis. Founded in 1968 by area churches and later fully launched by two philanthropists, Gid Smith and Bob Dempsey, MIFA currently serves about 55,000 Memphians a year. Perhaps like me, you were not fully aware of all that MIFA does. I think you will be equally impressed with these 10 areas of service: COOL or College Offers Opportunities for Life: A readiness and life/ academic preparedness program for students from G. W. Carver and Booker T. Washington high schools. Community Legal Center: This

is an independent organization housed at MIFA that offers legal services to low income individuals. Emergency Services: Assists the working poor and seniors on fixed incomes with rent or mortgage payments, utilities, food, etc., while they deal with temporary crises. Emergency Shelter Placement: Helps families secure temporary shelter if homelessness cannot be avoided through mediation. Hands on Homes: Assists low income seniors with home improvement projects.

Homelessness Prevention: Helps eligible families quickly obtain permanent stable housing. Long Term Care Ombudsman: Advocates for residents in long-term care facilities, including nursing homes, assisted living facilities, and residential care homes. This program monitors resident care and quality of life, investigates and mediates complaints, and provides public education for clients and families. Meals on Wheels: MIFA delivers almost 448,000 meals a year to those in need. Senior Companions: Pairs low income seniors with the homebound, disabled or critically ill creating a mutually beneficial arrangement. Transportation: Helps seniors get to doctors’ appointments, pharmacies, banks, government agencies and congregate meal sites. It’s stunning how much impact the combination of all this work has on Mem(CONTINUED ON PAGE 14)

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Nobel Work

Hey Doc, I Hope You’ll Try This By TIM NICHOLSON

The most important part of your social media presence is not what your hospital or practice has to say, but what your patients have to say – especially to one another. Peer-to-peer interaction is the heart of social media. Likewise, it’s an important variable in healthcare. According to a study conducted by the Pew Research Center, more than 7 out of 10 Internet users living with a chronic illness have gone online to find other people with similar health issues. As a trusted source for healthcare information, you can use social media to reinforce that role by creating a channel for their connectivity. Your effort provides value and supports patients during their journey to wellness. Unfortunately, too much of what happens in a healthcare brand’s social media strategy is marketing and public relations centric. “We’re sponsoring a 5K.” “We have the best doctors.” And so on. What if, instead of posting content that merely announces information, you published open-ended content that creates engagement and starts conversation? Treating your social media as a sort of water cooler for conversations allows you to move in and out of it as teacher and learner. It enables conversations wherein your patients and their friends as fans and followers learn from one another. Did I just make this up? Nope. “These (social media) tools help us reach so many more people; we can bring shared interactions into our practice and that is powerful. This isn’t in addition to your job. This is part of your job. This is a conversation, and that is what we are trained to do. We can engage learners, patients and peers,” said Farris Timimi, MD, medical director for the Mayo Clinic Center. And, social media allows patients to have the conversation that you’re often reluctant to have – the one that says, “it’s going to be alright.” It starts with “I’m newly diagnosed” or “My loved one is going through a difficult treatment,” and all they’re really lookmemphismedicalnews

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ing for is somebody who’s been there and can tell them what to expect. Patients and their friends are hoping to find answers, information, advice and perhaps empathy. They are hoping to find someone who truly “gets it” or who shares their experience and has made it through. They’re even hoping for an opportunity to share hope with another. You’re not a cynic. You’ve just been conditioned to focus on the serious business of medicine. But that sometimes gets in the way of the hope and promise of medicine - which is what most patients see as medicine’s role. This notion of hope and connectivity was recently affirmed by a little social experiment. My teammates built a wall, placed it on a street corner in Memphis for one day and invited people to leave a thought related to health. We called it the “I wish you well” wall. There were over 1000 post-it-notes left on the wall and dozens taken by those who happened by. We learned that patients, family members, friends and passers-by generally want the best for others. Their notes were hopeful, often funny, sometimes poignant and full of promise. The notes were personal yet widely applicable. We know that patients want to connect with you, but they also want to connect with one another. You don’t have time to build a wall for post-it-notes. So, use your social media presence to make it happen. Post a subject header like “What’s the most meaningful thing a friend has done for you during your treatment?” Your efforts will lead to connections, enable shared experiences and fuel a little hope for better health outcomes. Come on. Try it. I wish you well. 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

The Nobel Prize is one of the oldest and most prestigious awards in the world. It is given for physics, chemistry, physiology, or medicine, as well as for literature and peace and is the best known. However, many consider it to be political. An associated award is the prize in economic sciences. The prize is worth $1.2 million, and is given annually to up to three (living) individuals (shared). The awards for medicine are selected for truly important advances and during the early years was given as recognition for a lifetime of work in the development of diphtheria and tetanus vaccines, malaria, lupus, insulin, and memory. With the award for the discovery of DNA, the prize began to focus on what goes on inside the cell. For example, the 2002 award went to Robert Horvitz for his work on programmed cell death, or apoptosis. This phenomena is seen in the thymus gland where Donald S. Gravenor, MD 95 percent of all cells die off and disappear (also seen in many other organs) with the metabolic pathways identified being common to all organisms from flatworms to humans. This understanding and knowledge has encouraged the development of cellular and other agents focused on killing cancers (encouraging apoptosis) and preventing degenerative diseases (anti-apoptosis). Another award was for the discovery of the bacteria Pylori as the cause of peptic ulcer disease. The 2006 award was for the discovery and description of microRNA as genomic material (which is not expressed) important in the regulation of gene expression as well as binding to pathogenic viruses.. The 2007 award recognized the discovery of principles of the introduction of gene modifications in mouse pluripotent embryonic stem cells, work that spawned treatment of cancers, bone marrow transplantation, blindness, spinal cord injuries, Parkinson’s disease and more. The 2008 prize was divided between the discoverer of the essential role of human papilloma virus in the development of over 90 percent of cervical cancer, leading to a highly effective vaccine prevention and possible ultimate eradication of this disease, as well as the discoveries of the human immunodeficiency retrovirus responsible for AIDS. The 2009 award was given for the discovery of how chromosomes are protected by telomeres, structures at the end of each chromosome protecting them from degradation, and how with each replication telomeres become shorter ultimately resulting in cell death. The 2010 prize was for the development of in vitro fertilization, with Louise Brown being the first human born by this technique (in 1978). The 2011 prize was recognition of discoveries of the innate immune and dendritic cell in adaptive immunity; these discoveries have led to active and highly effective treatments for cancer. The year 2012 was for research addressing the question that given that embryonic stem cells and specialized cells have exactly the same genes, what makes them different? As an example, if you take the nucleus out of a specialized cell from an adult frog and insert it into an embryonic (nucleus removed) cell, it turns into an exact genetic replica of the mature nucleus donor cell/adult frog, just a new version. This coaxing of adult cells to become unspecialized, primitive cells which can grow into adult fully specialized cells could have practical uses in treatment of myocardial infarction and neurodegenerative diseases, avoiding immune rejection and being a virtually unlimited source of tissues. The 2013 Medicine Nobel was recognition of how cells transport proteins. Given that vesicle transport systems have evolved over a billion years, any slight malfunctions may cause serious illness or death; this understanding gives insight into diabetes and other metabolic illnesses. These Nobel Prizes in Medicine demonstrate that people with curiosity and the courage to ask questions (with societal support) can change our world for the better, with this understanding of how we work being the foundation of future medical therapy. Thank you, Alfred Nobel.

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Asthma, the most common medical condition that affects Americans of all ages – about 40 million people – can usually be well controlled with drugs and patient education. The Centers for Disease Control and Prevention puts the annual cost of asthma in the United States at more than $56 billion, including millions of potentially avoidable hospital visits and more than 3,300 deaths, many involving patients who skimped on medications or did without. “The thing is that asthma is so fixable,”said Elaine Davenport, MD, of the Oakland, California, Asthma Initiative. “All people need is the medicine and patient education. While I was standing in line to pick up a prescription, I had the opportunity to talk with some people also waiting for their prescription. The first one was a 73 year-old retired teacher. She said that she used her inhaler sparingly, adding, “I minimize puffs to minimize cost.” Two 13-year-old sisters significantly decreased their amount of asthma attacks, while on medications and education, and neither has been hospitalized in the past year. Many siblings from the same household suffer from asthma. However, the mother of the two sisters said, “One of the drugs that really blew my mind was the nasal spray,” referring to her $80 co-pay for Rhincort Aqua, a prescription drug that was selling for more than $250 a month, but costs less than $7 in Europe, where it is available over the counter. As I wrote in the July issue of Memphis Medical News in a column titled, “PIPA and the Secured, Encrypted, HIPAA Compliant Physician Portal,” there are three reasons patients aren’t adherent to medications: They don’t understand the importance They are afraid of the side effects They can’t afford it Last year, $250 million was spent on lobbying for pharmaceutical and other health products. (Do the arithmetic: divide $250 million by the number of lawmakers in Washington.) Lawmakers in Washington have forbidden Medicare, the largest government healthcare purchaser, to negotiate drug prices. Gerald Anderson, who studies medical pricing at the Bloomberg School of Public Health at Johns Hopkins University said, “Americans use more generic medications than patients in any other developed countries. Prescription prices represent 10 percent of the country’s $2.7 trillion annual health bill, even though the average American takes fewer prescription

medicines than people in France and Canada.” Pharmaceutical companies also buttress high prices by choosing to sell a medicine by prescription, rather than cover a price tag that would be unacceptable to consumers paying full freight. They even pay generic drug makers not to produce cut-rate competitors in a controversial scheme called, “pay for delay.” The United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s healthcare arena – a surprising number of lifesaving drugs are made by only one manufacturer – and businesses often successfully blunt market forces. Asthma inhalers, for example, are protected by strings of patents – for pumps, delivery systems and production processes. It is hard to make generic alternatives, even when the medicines they contain are old, as most all are. The Global Economy and Competition. (Source: Health Care Cost Institute) This comparison is based on what $250 of the following two prescription drugs look like. Rhinocort Aqua (allergy spray) – two bottles in the United States, costs the same as 51 bottles in Romania. Advair (asthma inhaler) – one inhaler in the United States equals seven inhalers in France. There are no generic asthma medications available in the United States. But there are in Europe, where health regulators have been more flexible about mixing drugs and devices and where courts have been quicker to overturn drug patent protection. While, lawmakers in Washington play their fiddles, Americans are burned and burdened with the callous and uneducated policy makers who would rather act like “boy-dogs” fighting, and closing down the government for 16 days at a cost of $24 billion dollars. When lawmakers return to Washington, and come up with their farming bill, perhaps they can also look into and tell us why a net wt 7 ounce cup of a citrus salad of grapefruit and oranges costs so much. (I poured the cup in a bowl and hand counted 12 pieces of actual fruit; the rest being syrup). The average price in grocery stores that I visited: $1.29. 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.

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Tennessee Hospital Association Reinventing Tomorrow’s Healthcare Every Day for 75 Years structive deconstruction.’ Going into 2014, he continued, “Our Established in 1938, the Tennessee number one issue is the Affordable Care Act Hospital Association has adopted the taand trying to get people enrolled … not only gline “reinventing tomorrow’s healthcare the ones that are eligible through the federal every day for 75 years” as an exchange but to try to convince ongoing theme for 2013. the governor and Legislature to Over the years, the staff expand TennCare to include of the THA might have had the poorest of the poor.” many days … often stretchBecker added there are ing into many months … to approximately 500,000 Tenhelp members prepare for and nesseans who should be eligible implement change. However, for enrollment through the fedin the face of industry-wide eral exchange. However, there transformation, being nimble are another 400,000 currently enough to reinvent the hospileft out of coverage opportunital’s role in healthcare delivery ties unless Gov. Haslam and Craig Becker on a daily … if not hourly … the Centers for Medicare and basis has become the norm. Helping its Medicaid Services can come to an agreemembership navigate the challenges that ment about expanding TennCare rolls, come with sweeping reform is a central and the Tennessee Legislature approves theme of the programming at the THA the plan. Annual Meeting, held Oct. 31-Nov. 1 at “We’re having a hard time getting the Gaylord Opryland Resort and Convention Legislature to separate this from ObamCenter. acare,” Becker said. However, he noted ne“I’ve always said healthcare moves gotiations with CMS are ongoing, which he glacially, but we’re getting up to lightening said was an encouraging sign. speed now,” THA President Craig Becker “We’ve got $5.4 billion worth of cuts said with a rueful laugh. “It has been a over 10 years under the Affordable Care tough road to hoe right now for our memAct,” Becker pointed out. Those cuts were bers.” Yet, Becker continued, he ultimately more palatable when hospitals thought views the transformation process as ‘conMedicaid rolls would be expanded. When By CINDY SANDERS

the individual mandate was upheld but not the Medicaid expansion, anticipated coverage for large chunks of the population evaporated. “I’m really concerned about my rural hospitals. They don’t have the reserves some of the bigger hospitals do,” Becker said. However, he added no facility is immune to the looming financial stressors. Addressing the key point of coverage for the 400,000 left out, Becker stated, “If we don’t get it, some of our hospitals cannot make it. I guarantee that.” Three hospitals have recently shut down operations in Tennessee. While two in West Tennessee probably had more to do with the number of facilities in comparison to the population, one in East Tennessee simply couldn’t make it in healthcare’s new financial reality. Scott County residents now have to go elsewhere for care. “The hospital was struggling. When the (ACA) cuts came, it was the death nail for them,” Becker said. The Tennessee Hospital Association is also focused on the Tennessee Payment Reform Initiative, which is initially slated to be rolled out for the TennCare and state employee populations. Tennessee has received a CMS grant to transform the state’s healthcare payment system. While details are still being ironed out, the governor’s vision is to incentivize ‘quarterbacks’ (typically physi-

cians) to provide the highest quality, least costly care. As part of that plan, the quarterbacks would receive a bonus for sending patients to facilities with the best quality and lowest prices. However, Becker said there are concerns arising from geographic location and from skewed price comparisons. He pointed out large academic medical centers with high-cost service lines including trauma centers and burn units and other unusual expenses such as graduate medical education cannot fairly be compared to community hospitals without those same factors. In areas with only one nearby hospital, referring patients to a facility farther away that has a better cost structure might not be feasible … or desirable … depending on the urgency of the situation. Becker noted, “Seventy-five percent of physicians admit to one hospital only so I’m not sure it makes a lot of sense. I’m not sure that this will change physician admitting patterns.” However, he continued, the general consensus is that the plan will move forward so THA staff is preparing for implementation while addressing their issues with government and provider stakeholders in an effort to design a workable plan. Despite any reservations about the plan’s mechanics, Becker applauded the (CONTINUED ON PAGE 8)

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NOVEMBER 2013

Opening Date Moved Up, continued from page 1 among the experts consulted in planning for the new facility, which will cost an estimated $15 million. “Le Bonheur is a tremendous asset to this community,” Vaughn said. “They’re the high end. They do the hard, hard surgeries and have the super-super-subspecialists. You don’t want to duplicate that.” What Baptist does want is to enable continuity of care in emergency situations for the children born in its system. The state commission that awards certificates of need for new healthcare facilities unanimously approved Baptist’s application. “I think it’s long overdue, to be honest with you,” said Marixa Ervin, who gave birth to daughter Arianna at 23 weeks. She is among the parents on an advisory committee helping Baptist plan the services the new emergency department will provide. Arianna is now a healthy sixth-grader at Houston Middle School. But as a newborn, she spent 111 days in Baptist Memorial Hospital and underwent 21 blood transfusions, Ervin said. The experience left Baptist caregivers familiar with Arianna’s needs, and left Ervin more at ease seeking ongoing care at Baptist than elsewhere. “Emergencies are already so scary,” Ervin explained. “If you can, you want to go someplace familiar.”

Planners are consulting pediatricians and other experts regularly in search of ways to make the new emergency department a place where kids and parents will be as comfortable as possible. Some of their efforts will be visible in the facility’s play area and overall décor, which will have a nature theme. Pillars will look like trees, and thanks to a recent anonymous donation, there will be a large aquarium. Deeper insights from pediatricians, nurses and other experts on children have guided choices on equipment and procedures, said Missy Nelson, assistant administrator at Baptist Women’s Hospital. Nelson serves on the Pediatric Steering Committee. For example, Nelson said, children who must go through the often-scary, tunnel-like magnetic resonance imaging (MRI) machine will be able to watch DVDs through special glasses during the procedure. And the MRI table will be large enough to allow a parent to lie beside his or her child. The next steps for Baptist leaders will include contracting for ambulance services, establishing relationships with insurers, and a marketing campaign to make sure the public knows about the new option on the way.

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general concept of shared information. “I think the more transparent and the more information you get in the hands of our physicians and hospitals, the better off we are,” he said. While the immediate future brings many challenges, Becker said the message of the annual meeting is a hopeful one. “This is the constructive destruction of the health system as we knew it. It will be very different going forward.” As for the THA’s role in helping hospitals shift to population management models, Becker succinctly noted, “It’s coming, and we’re here to help you do it.” He continued, “We’ve really put an increased emphasis on quality. We’ve put an increased emphasis on education and on sharing best practices and process improvement data. Our data is all geared toward giving transparent information to our members so they understand how they stack up against others.” He added the THA has also been

hands-on in helping hospitals help their patients. In a move unique among hospital associations, Becker said, “We actually took $3 million out of reserves and put it aside for grants for hospitals to enroll people in the exchange.” He continued, “We touch 350,000 uninsured people every year in our emergency rooms.” Becker noted identifying those who qualify for the federal exchanges and getting them covered is a win/win for families and facilities. Hospitals have until the end of November to apply for the grants. “We’re excited to have a good opportunity to give back to our members and hopefully help our hospitals get ahead of the curve in signing people up,” he said. Despite the obvious pain points that come with transformational change, Becker and his staff are keeping an eye on the prize. “We’ll have a far better healthcare system once we get to the other side,” he concluded.

THA’s New Board Chair Before the final bell sounds on the Tennessee Hospital Association’s 2013 annual meeting, an important transition of power will take place. Joe Landsman, president and CEO of the University of Tennessee Medical Center in Knoxville, will pass the gavel to new board chair Reginald Coopwood, MD, president and Dr. Reginald CEO of Regional Medical Center at Memphis. Coopwood A graduate of Meharry Medical College, Coopwood practiced in Nashville as a general surgeon and served as chief medical officer for Nashville General Hospital. In 2005, he was named CEO of the Metropolitan Nashville Hospital Authority. In March 2010, he made the move to Memphis to take the top position at The Med. In addition to his role with THA, Coopwood also serves on the boards of several nonprofit organizations including March of Dimes, Leadership Academy, QSource and MidSouth eHealth Alliance.

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NOVEMBER 2013

National ‘Choosing Wisely Campaign’ Begins Hoping to decrease “overuse” in medicine From the Society of General Internal Medicine • Don’t perform routine general health checks for asymptomatic adults.

By ED DISMUKE, MD

The Memphis Medical Society (MMS) in partnership with the Tennessee Medical Association (TMA) has received a grant to better educate physicians and their patients about the problem of “overuse” of diagnostic tests, procedures and treatments in medicine. The American Board of Internal Medicine Foundation (ABIMF) has funded 21 projects conducted by state medical societies, specialty societies and regional health collaborates to educate doctors and their patients about the national “Choosing Wisely Campaign.” Research suggests that one-third of healthcare costs ($750 B/year) are wasted and do not benefit patients. Almost all national physician organizations (56 of them) have created a “Top Five List” of tests, procedures or treatments that are frequently overused and therefore do not help patients. That would make 280 recommendations from these 56 organizations. In fact, in multiple cases, the various organizations recommended similar approaches. In order to provide an indication of these national recommendations, let me list several that seem common to many patients seeing a primary care doctor. From the American Academy of Family Physicians: • Don’t do imaging (x-rays) for lower back pain within the first six weeks, unless red flags are present. • Don’t routinely prescribe antibiotics

for acute mild to moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement. • Don’t order annual electrocardiograms (EKG’s) or any other cardiac screening for low risk patients without symptoms. • Don’t prescribe antibiotics for otitis media in children aged 2-12 years with nonsevere symptoms where the observation option is reasonable. • Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. From the American College of Physicians (internal medicine) • Don’t obtain screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. • In the evaluation of simple syncope (fainting), and a normal neurological examination, don’t obtain brain imaging studies (CT or MRI).

From the American College of Radiology • Don’t do imaging for uncomplicated headache. From the American Academy of Pediatrics • Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is inducted. From the American College of Emergency Physicians (ACEP) • Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules. From the patient perspective, there are 5 questions to ask your doctor before you get any test, treatment or procedure. • Do I really need this test or procedure? • What are the risks? • Are there simpler, safer options? • What happens if I don’t do anything? • How much does it cost? The most important issue is for the doctor and patient to discuss these questions and

Are You Ready for a New Challenge? Parkwood BHS of Olive Branch, MS is expanding! We are devoted to providing award winning care and treatment of children, adolescents, and adults with psychiatric and substance abuse issues. We are located 30 minutes from downtown Memphis and 20 minutes from East Memphis. We are recruiting great leaders in the following areas: Director of Risk Management and Quality Improvement - plans, organizes and directs all risk and quality improvement activities in accordance with local, state and federal and other regulatory agency requirements To perform this job successfully, an individual must be a graduate of an accredited nursing or clinical services program preferred. Have five years clinical experience in mental health setting and three years experience in a clinical supervisory role preferred. RN, LCSW, LPC or LMFT preferred. Must possess knowledge of general and psychiatric clinical programming, working concepts and theory, leadership skills, age specific growth and development, therapeutic relationships and processes, limit setting, and crisis and behavior management. Current knowledge of regulatory agency guidelines to include Joint Commission Accreditation processes. Acute Services Program Manager and Residential Program Manager - 2 positions available. The Program Manager maintains the quality of social services to various patient populations provided through the supervision of licensed and non-licensed clinical and graduate student therapists. Serves as clinical liaison with inpatients and with continuum of care services. In conjunction with community resources, contributes to the maintenance of relationships with outside agencies, private practitioners, insurers and family members. To perform this job successfully, the candidate must have Master’s Degree in Social Science and a minimum of 5 years clinical experience in group leadership skills, age specific growth and development, crisis and behavior management, family therapy theory and practice. and 2 years of management experience with case management, discharge planning, utilization review including concurrent reviews. Previous supervisory experience with clinical therapists preferred. LCSW, LPC, LMFT preferred. House Supervisor/Registered Nurse – MS/TN licensed nurse experienced with children and adolescents required; adult experience also helpful. Full-time and PRN positions available:

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NOVEMBER 2013

together, decide what is best for each individual patient. To help patients better communicate with their doctors, Consumer Reports Health now has many patient education materials to help the patient better understand and better communicate with the doctor. To find these go to www.consumerhealthchoices.org. The Memphis Business Group on Health (MBGH) has the Consumer Report’s “Choosing Wisely Toolkit” to help educate employers and employees about the campaign and how to make the best medical choices for good health. Contact Cristie Travis about the toolkit at ctravis@memphisbusinessgroup.org for more information. The MMS and TMA are trying to better educate physicians in Shelby County and the state about the Choosing Wisely Campaign. The Society can arrange lectures and discussions on the topic and can help doctor’s offices find useful educational material for patients. Those wanting more information should visit www.tnmed.org or go directly to the Choosing Wisely website: www.choosingwisely.org. Ed Dismuke, MD, MSPH, is with the University of Memphis School of Public Health.

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TMA Chief Looks at Healthcare’s Changing Landscape An advocate for doctors in a climate of uncertainty By GINGER PORTER

The Memphis Medical News recently had the opportunity to interview Russ Miller, CEO of the Tennessee Medical Association. The following gives insight into what the TMA is championing in its role as a physician advocate in this challenging time to practice medicine.

Welcoming Your Patients to a New and Better Tomorrow

What is the Tennessee Medical Association’s role?

The TMA focuses on the big issues – those issues a big practice can’t handle or a hospital alone or a specialty of doctors alone can’t handle. These are things like medical liability reform, TennCare, health insurance exchanges, the Affordable Care Act and implementation, regulatory issues – things that hit every segment of the population in Tennessee. What is today’s community? Ten years ago, docs were not employed. Almost 40 percent of doctors are now employed by hospitals and physician-owned practices. It’s a different mentality. We have 8,000 doctors and students in training. In physicians, we have about 6,600 docs. Our market is probably about 12,000 practicing MDs in the state of Tennessee. The advocacy work, the education work and the products and services we develop are meant for docs in private practice. I like to say we have a 90 percent saturation rate in the practices. With the financial demands on practices, we may have close to one from each group.

When it comes down to the physician in his office, what is the big concern?

Government intrusion into the practice of medicine. It’s all cost-driven. I think patient care is at the forefront of every mind and “what do I have to do to get through the day?” What’s on their mind at night? “What’s tomorrow look like? Am I going to be told we’ve been bought? Am I going to be told we’ve been kicked off the network? Can I still do what I do every day?” Just across the board and it’s out of their hands. Why does healthcare cost what it costs? Why does a seat on an airplane cost what it costs? I can sit next to you and you don’t pay what I pay. I can sit next to you and you don’t pay what I pay. It’s not the same — you have to start with the basis point, and the government has decided what that is with Medicare weights, Resource-Based Relative Value Scales. It’s a place to start, and you work countless calculations off that. You factor in everything that goes on – the quality, the standards, the reportability, the measures, the testing that covers a liability. And now memphismedicalnews

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T H E G E T W E L L P L A C E F O R A D D I C T I O N R E C O V E RY O F F E R I N G H O P E F O R A F U T U R E O F R E C O V E RY Program Director: Phillip Bendall, LPC A new addition to the continuum of substance abuse services at Delta Medical Center, this program offers intensive out-patient care for those struggling with

Russ Miller

a substance abuse disorder. This safe and effective alternative to inpatient treatment allows the patient to return to their normal living schedule in the

government intrusion is not only in the payment but also in the portability, and they are telling you what electronic systems you have to have. It is too much for small medical practices. A mom and pop operation or a small solo practice almost can’t exist with the demands put on it by the payors, by the government. The complexities, the reimbursement levels, the margin is so small that you have to be either very specialized and have a unique niche, or you have to be part of a larger system where the margins work better.

evening and welcomes them to a new and better tomorrow.

You said primary care is in trouble. Please tell us what the TMA is doing.

• Patient, along with staff will create a plan for long term abstinence.

Yes, that bodes to lots of problems down the road. We need more providers, because we have an aging population needing more services – and we just have a growing population. Manpower issues are a big concern for us. Tennessee has to do a better job of keeping physicians. We have five medical schools. We are turning out 500 physicians a year and then you go to residency, and there are no residencies because they are Medicare funded — graduate medical funding comes back down to the states and that needs to be opened up. It is imperative Tennessee attract more doctors, because where you train you usually practice within 150 miles. The capacity is there and the willingness is there. Every hospital could use more residents. There is a great generational gap. They started the residency 80-hour-a-week cap. If you haven’t added anyone and you’ve capped how much they can work, then what do you do? The other docs have to start filling in on call more. We talk with the government about it. It is a great concern.

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ADMISSION CRITERIA • Diagnosis of abuse of any mood altering drug such as Alcohol, Narcotics • Cognitively competent to participate in the program • Willingness to make a commitment to participate fully in every aspect of the program For information regarding admission to any of our Behavioral Health In-Patient or Out-Patient Programs please call our 24 hour line at 901-369-6021. Most major commercial insurance accepted including Medicare

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(CONTINUED ON PAGE 20)

NOVEMBER 2013

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ences with Complete Health (now United HealthCare) inspired her to focus on healthcare economics (her area of MBA study), and ultimately led her to return to law school for a JD degree, also from the University of Memphis. Mid-South Pulmonary Specialists was recovering from an embezzlement situation, Avery remembers, and was focused on growth when she began serving as its administrator in 1998 while completing law school. Together, she and Golden spent her first year and a half tackling the challenge of restoring order: “We had to find out whether we had filed claims or billed for claims, whether we would have to write off any money, what kind of contracts we had, did we have any protocols for our medical staff?” Avery said. “Everything was up in the air, so we had to create an infrastructure for the practice.” Avery launched a comprehensive marketing study to determine the practice’s strengths and weaknesses and identify local competitors and means of differentiating the practice before developing a plan and moving forward. Apparently it worked. Since 1998 the practice has grown from six to 21 physicians and is now one of the largest single pulmonary critical care practices in the Southeast. How useful is your law degree? “I use a lot of employment law, contract law and healthcare law. I use it writing policies and procedures, handling HR situations, disaster plan compliance, a lot of HIPAA. I still have my bar number, and I do work with malpractice attorneys; if a suit is filed and we have to go through mediation, I’ll stand in place of the physician.” What are the most prevalent conditions you see? COPD — chronic obstructive pulmonary disorder — is the third-leading cause of death in the United States, and Mid-South Pulmonary Specialists see a lot of it, Avery said. “There are about 25 million people in the country with COPD. The good news is that it’s preventable and treatable. When you see a chronic cough or bronchitis, you need to be tested for COPD, because this area of the country, particularly, has a large population with respiratory issues.” Lung cancer is the leading cancer killer in both men and women in the United States; it affects more than 370,000 Americans each year. Avery reports that their second-largest patient group is those with lung cancer. “We’re the only pulmonary group in town that has a 16-slice low-dose CT scanner that we use to screen patients for lung cancer. Low-dose CT is a lot more accurate and beneficial than a chest X-ray. You can find cancers faster, earlier, and you can get into your treatment a lot earlier and hopefully improve outcomes and longevity.” Recent research from the National Cancer Institute National Lung Cancer Screening Trial found that low-dose CT

NOVEMBER 2013

screening has shown a 20 percent reduction in lung cancer death compared to chest x-ray. The American Lung Association recommends low-dose CT screening for current or former smokers ages 55 to 74, with a smoking history of at least 30 pack-years, and with no history of lung cancer. (A “30 pack-year” means one pack a day for 30 years.) “The good thing about a physician’s office like ours having a CT in our office, is that you pay the co-pay, there’s no facility fee, we can get our results back within 24 hours (and) it will take you 15 minutes to come in here and do it. It’s not a burdensome process — it’s very easy,” Avery said. Their third-most sizable patient population is those suffering from sleep disorders, which are much more common than people realize and often go undiagnosed or misdiagnosed, Avery said. “Sleep apnea can create severe heart problems. In children it contributes to insomnia, ADD and poor grades. We treat thousands of patients every year at the sleep disorder center. If you snore, that’s a huge sign — you need to be diagnosed, because over time it can contribute to an early demise.” Proudest accomplishments? Avery takes pride in having recruited some top-notch physicians to this area and in having successfully converted the practice to electronic medical records in 2006 — long enough ago that an upgrade to the system is now high on her priority list. Along the way she has also consolidated three offices into their strategic location at 5050 Poplar Avenue. Other goals include helping local hospitals improve rankings in their intensive care units, and establishing a COPD population management program that will prevent hospital readmissions of discharged patients by closely supervising patient compliance. Avery envisions that someday MidSouth Pulmonary Specialists will be the single largest pulmonary critical care practice in the country, with 35 to 40 physicians, dominating the Southeast and becoming a nationally branded corporation. Her fascination with growth and change, her dauntless “bring it on” attitude and confidence that “everything is negotiable” make Avery a force to be reckoned with; if anyone can make it happen, she can. Avery’s advice for a growing practice? “(1) Know your market, know exactly who your patients are, know how to service patients to the best of your ability. (2) If you don’t know, ask — there’s never going to be a day where you know everything. (3) If you make a mistake, acknowledge and rectify it.” In her free time, Avery enjoys working out, running in races, and having fun with her three children, ages 12, 14, and 16.

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Hot topics in HealtH law by John Arnold

Representing Physicians, Hospitals and Healthcare Providers since 1975

Unbundling Bundled Payment Contracts As the fee-for-service model faces continued scrutiny, payors continue to explore new payment models designed to improve quality and efficiency while reducing costs. Many payors are increasingly advancing bundled payments as an alternative to fee-for-service. A bundled payment involves a single payment covering services delivered by two or more providers during a single episode of care or period of time. These new bundled payment models attempt to allocate financial risks among providers and payors more equitably while rewarding quality and outcomes. In order to achieve these lofty goals, however, bundled payments are becoming increasingly complex. Consequently, a well-drafted contract is critical to safeguarding the rights of physicians. While no two arrangements will be the same, the following offers a good starting point for physicians who are considering entering into a bundled payment contract. Defining the Bundle As payors expand bundled payment models, it should come as no surprise that new arrangements are challenging existing boundaries by making bundled payments for even more complex conditions in both inpatient and outpatient settings. Some ambitious models, for example, are making bundled payments for certain types of cancer and management of chronic conditions like asthma and diabetes. So while the specifics of the bundle will always vary, all bundled payment contracts should address the same fundamental questions:

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What events trigger the bundle? When does the bundle end? What events break the bundle? What providers and services should be part of the bundle? Defining the Bundled Payment At the core of bundled payments is a pre-determined budget. At least one progressive model has elected to base budgets primarily on clinical practice guidelines, but most models continue to rely on historical data for establishing budgets. This means the contract should limit the data used to account for statistical outliers and physicians should advocate for a refined risk adjustment process that accurately mitigates health disparities in different patient populations. Also, physicians may want to consider additional contractual safeguards to protect against volatility, such as mechanisms to prevent “cherry picking” healthier patients and “lemon dropping” sicker patients or setting patient eligibility criteria as part of the standard for what triggers the bundle. Allocating the Dollars and Allocating the Risk While payments can be made prospectively (i.e., a single payment on the front end), most arrangements make payments retrospectively by paying physicians in the normal course of business (e.g., fee-for-service) and then reconciling the amount paid against the pre-determined budget at the end of the episode. Under both methods, the party bearing the risk suffers a loss when claims exceed the pre-determined budget for the bundle. This means contracts must specifically address risk allocation in addition to the method for making payments and the reconciliation process. Currently, most arrangements begin with a shared savings model to incentive physician participation and transition to a shared risk model and/or full risk model over time. In this scenario, the contract should provide adequate time for physicians to adapt before exposing physicians to financial risk. Contracts 101 Bundled payment contracts should address the same issues fundamental to most contracts. In collaborative arrangements with other providers, the contract’s governance provisions should guarantee equitable representation among the parties and define the method for approving material decisions. Such decisions include adding new providers or classes of providers, modifying compensation, establishing quality standards, and implementing and paying for new technology. Physicians should also contract for reasonable termination rights and advocate for a comprehensive dispute resolution process. Decision-making safeguards, reasonable termination rights, and comprehensive dispute resolution procedures are fundamental to most contracts and particularly important to protecting the rights of physicians in complex bundled payment agreements.

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Healthcare Law • Contracts Among Healthcare Providers • Acquisitions, Joint Ventures, and Mergers • New Practice Formations • Stark Law, Anti-Kickback Law, and False Claims Act • HIPAA and Patient Privacy Issues • RAC, ZPIC, and MAC Audits and Appeals • Billing, Coding, and Compliance • Responding to Governmental Investigations • Provider Non-Competes

www.RaineyKizer.com Memphis Jackson 1.800.677.2414 NOVEMBER 2013

Physician Spotlight: Samuel Dagogo-Jack, MD, continued from page 3 diabetes research. “You could be a specialist and endocrinologist and focus on making sick people feel better and treat difficult disorders. But the endocrinology research component brings along the treatments of tomorrow and discovers the new twists to how diseases occur and therefore how to prevent them. It was that area of discovery that I was attracted to – in addition to, of course, the therapeutic area of treating sick folks and making them feel better.” Near the top of Dagogo-Jack’s list of accomplishments is his extensive volunteerism, for which he has been well-honored. “I go to Nigeria every year,” he said. “I have a foundation that I helped start, the Diabetes Association of Nigeria. I’ve supported them intellectually and given

MIFA: Celebrating, continued from page 4

lectures each time I went. I’ve carried insulin vials and medication. I’ve run free clinics. Some years I do more than one visit depending on the need or the resources available. “I intend to build upon my experiences, and incorporate many friends who have expressed great interest in becoming involved in global health and philanthropy and volunteering. The University of Tennessee has a track record of having faculty members who have generously given their time to go to South America, Haiti and other faraway places to alleviate human suffering. “It’s something I hold dear in the grand scheme of things, and near the top of my bucket list is a mission to scale up global philanthropic work for addressing healthcare needs in Africa.”

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phis. Economically, just the Meals on Wheels and the Family Crisis programs make an almost $11.8 million difference to our local economy. And the long–term economic impact of the Teen Program? More than $94.7 million. Obviously, MIFA’s main focus is on seniors and families. And Memphis has a growing senior population. It’s predicted that by 2015, our senior population will rise another 18 percent. And coincidentally, almost 18 percent of our seniors are at risk for hunger.

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VOLUNTEER Volunteers mean everything to MIFA. They need volunteers in most all of the 10 service areas listed in this article. For every hour that you volunteer, you save MIFA over $22. Got extra time? Delivering Meals on Wheels is about a two-hour project. You can do it once a week, once a month or once a year. Got an interest in mentoring teens? Mentor a high school student in the COOL program. Got fundraising skills? Help with MIFAs fundraising events. Got handyman skills? Help with senior home improvement projects. Got an interest in advocating for seniors in long-term care facilities? Become an Ombudsman volunteer. Like many of you, I’m starting to anticipate the holidays. I’ll be planning new, hopefully healthier feasts for my family and pondering what cakes and pies I will bake. Allow me to take this opportunity to wish all of you a happy and safe holiday season. Let’s try to keep those less fortunate in mind and do what we can to help out. Organizations such as MIFA make it easy for us. Write a check and mail it to MIFA, PO Box 3130, Memphis, TN 38173-0130. Or to volunteer a couple of hours of your time, visit mifa.org for more information or call 901-527-0208. I’ll be taking a break from Memphis on the Mend in December so we can publish our annual InCharge Directory of healthcare executives. However, if you know a worthy Memphis non-profit or charity, please send me a nomination, and I will consider spotlighting them in 2014. I look forward to hearing from you at pamela@memphismedicalnews.com.

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Early Warning System: Researchers Identify Diabetes Risk Biomarker By CINDY SANDERS

What if a simple blood test could provide information that your patient had a significantly elevated risk of developing diabetes within the next decade? What might that mean from the standpoint of early intervention and prevention? While it’s much too soon for this type of clinical application, researchers at the Vanderbilt Heart and Vascular Institute (VHVI) and Massachusetts General Hospital have identified a novel biomarker that lends itself to such intriguing questions. Led by Thomas J. Wang, MD, director of the Division of Cardiovascular Medicine at Vanderbilt and physician-in-chief for VHVI, the team recently published results of their discovery of elevated 2-aminoadipic acid (2- Dr. Thomas J. Wang AAA) as a precursor to diabetes in The Journal of Clinical Investigation. Tapping into the rich data source of the Framingham Heart Study, which is now following its third generation of participants, the Wang research team studied blood samples gathered more than a decade ago from 188 individuals who ultimately developed type 2 diabetes and 188 who did not develop diabetes. Using these blood samples, the investigators were able to compare levels of metabolites to see if there were any differences between the group that went on to develop diabetes and the group who did not. Wang noted newer technology now makes it possible to profile hundreds of metabolites at one time. “One of the things that really lit up when we looked at the people who developed diabetes was 2-aminoadipic acid,” he said. “Having elevated levels of 2-AAA predicted risk above and beyond their blood sugar at baseline, their body weight, or other characteristics that put them at risk.” Wang added there doesn’t appear to be a specific threshold of risk at this point … the higher the levels of 2-AAA, the higher the risk of developing diabetes. In fact, those in the top quartile of 2-AAA concentrations had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared to those in the lowest quartile. Interestingly, the researchers found 2-AAA might not be just a passive marker. As part of the same study, the team conducted mouse model testing and discovered giving 2-AAA to the mice actually altered the way the animals metabolized glucose. “It suggests the molecules might be memphismedicalnews

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playing a direct role in how the body processes glucose rather than being an innocent bystander in the process,” Wang said. He added that elevated levels of 2-AAA don’t necessarily mean the molecule is bad for the body. Instead, it could be a defense mechanism where the body is producing higher levels to fight risk from another, as yet unknown, source. Figuring out the metabolite’s exact role in the functioning of pancreatic cells is one area for future research. If, indeed, 2-AAA turns out to be a defense mechanism to stave off diabetes, the good news is that the metabolite could be given to humans in the form of nutritional supplements. On the other hand, if 2-AAA turns out to be harmful to the body’s glucose regulation system, further research could reveal methods to lower the metabolite’s presence. Wang was quick to say the next step is to conduct additional research to measure 2-AAA in other human populations outside of the Framingham study through both retrospective and prospective studies. More in depth animal model studies are also in the pipeline. “A lot of the effort will be focused on trying to understand the biologic effect of 2-AAA in developing diabetes,” he said of the work going forward. However, Wang said the current research results at least raise the possibility that somewhere in the future knowing how high a person’s circulating 2-AAA levels are could impact clinical practice by allowing providers to adopt a more aggressive intervention posture among those at highest risk, whether that be through exercise, weight loss or pharmacologic measures. It is conceivable that 2-AAA might be the type of red flag for diabetes that high cholesterol is for heart disease. “Understanding why diabetes occurs and how it might be prevented is a very intense area of investigation because of the serious consequences of having the disease,” Wang said. “Down the road, this might be one part of the armamentarium of tests that could be considered. If this were proven useful in further studies and could be used clinically, it would be an easy test to administer.” As for the impact of the findings right now, Wang added, “In 2013, it highlights a specific pathway that might be related to diabetes risk that we previously didn’t know about.” Considering the prevalence of type 2 diabetes and growing obesity epidemic in the United States, that is an important lead for researchers working to develop strategies to interrupt the disease progression and stop risk from becoming a reality.

Alternative Dynamic Bracing for Pediatric Neurological Based Muscle Imbalances Parents of children with lower extremity hypertonic muscle imbalance face treatment of Crouch gait and long term bony deformities of the knee, ankle and foot. Traditional bracing has focused on immobilization which does not prevent the deformities in adolescent children. Ambulation for children becomes very difficult when the knee and ankle are locked. Their energy expenditure is increased and the child experiences decreased step length, Proprioception and balance. The lack of motivation to walk, run or play leads to more weakness and dysfunction along with possible deformity from absence of muscle use. More parents of physically challenged kids are embracing the concept of using night time dynamic bracing and less rigid functional daytime bracing to enhance their child’s life and activity level. Advanced technology in components of limb braces using concentric torsion adjustable tension allows us to block unwanted movement in one direction and stretch the shortened muscle in the other direction. Protocol for parents or caregivers is focusing at night long term prolonged stretch therapy for 8-10 hours. Human Technology, Inc. recently opened a pediatric specialty clinic in Germantown, Tennessee working closely with orthopedics, physical therapy and neurological clinics focusing on improving functional outcomes for better ambulation and development of physically challenged kids in the area. Pediatric patients are evaluated in a team approach including the parent, physician, Physical/Occupational Therapist and Orthotist to determine an optimal bracing plan for achieving goals. Patients with crouch gait are managed with concentric knee extension night time bracing to improve length, muscle strength and function, while at the same time using more dynamic bracing on the foot and ankle with a controlled motion system that focuses on improving balance, Proprioception and muscle function. Advocating for children to obtain the best technology for overall improvement should be high on the list for parents, caregivers and medical professionals. Advancements made in orthotics and prosthetics over the years can change the development, growth and life of physical disabilities and deformities. By Frank Caruso, CO/LO – Director of Orthotics - Human Technology, Inc. Prosthetics & Orthotics

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Integrative Medicine Goes Mainstream ABOIM ﬁnalizes board certiﬁcation exam for emerging specialty By LyNNE JETER

TAMPA, FLA. – Mimi Guarneri, MD, FACC, and fellow founding members of the American Board of Integrative Medicine (ABOIM) spent the lingering days of summer putting the final touches on a new board certification examination for a specialty that’s garnering national attention. “Creation of integrative medicine as a specialty by the American Board of Physician Specialties (ABPS) guarantees excellence in the field and assures consumers of healthcare the practitioner they’re seeing has reached a high standard of practice,” said Guarneri, board-certified in cardiology, internal medicine, nuclear medicine and holistic medicine. Tampa, Fla.-based Dr. Mimi ABPS, the first multiGuarneri specialty certifying body to offer physician certification in integrative medicine, is the official certifying body of the American Association of Physician Specialists (AAPS) and one of three national certifying organizations of MDs and DOs. The ABPS has led industry response to trends in urgent care, disaster

medicine, hospital medicine and family medicine obstetrics. Andrew Weil, MD, said the formation of ABOIM – one of 18 ABPS boards – marks an important milestone in the development in the field of integrative medicine. “Finally, there’s a way for qualified physicians to present themselves as experts in offering competent integrative care to patients,” said Weil, who helped establish integrative medicine as a specialty. Of the other two national certifying organizations, the American Board of Medical Specialties (ABMS) represents the largest national organization certifying MDs and DOs. The American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) certifies DOs only. “Integrative medicine focuses on getting to the underlying cause of disease and implementing personalized programs that help people achieve optimal health,” said Guarneri. “In conventional medicine, we’re taught to make a diagnosis and prescribe a treatment. In integrative medicine, we look for the underlying cause of the problem or health challenge. For example, in conventional medicine, we may diagnose diabetes and prescribe a medication. In integrative medicine, we look at what a person is eating (to determine if)

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Integrative Medicine Board Certification 4-1-1 ABOIM certification is available to both allopathic and osteopathic physicians in the United States and Canada who are practicing integrative medicine and have completed a residency training program approved by the Accreditation Council of Graduate Medical Education (ACGME), American Osteopathic Association (AOA), Royal College of Physicians and Surgeons of Canada (RCPSC), or College of Family Physicians of Canada (CFPC). Complete eligibility requirements are available online. Qualified physicians interested in becoming board certified in integrative medicine may submit an application by Dec. 1; the initial exam will take place next May. Applications are available online at www.aapsus.org and may be obtained by contacting the ABPS Certification Department at (813) 433-2277.

they’re deficient in micronutrients linked to diabetes. If they’re physically fit, are they exposed to toxins? Are they under stress? All of these can cause diabetes. We may prescribe medicine, but we also look to correct the underlying cause. We treat the whole person – body, mind and spirit – and we look at an individual’s relationships to family, community and planet.” ABOIM and the Consortium of Academic Health Centers for Integrative Medicine define integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses

on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” Guarneri, founder of the Scripps Center for Integrative Medicine in La Jolla, Calif., and president of the American Board of Integrative Holistic Medicine (ABIHM), pointed out that as a cardiologist, her goal is to also reverse the patient’s health challenges. “Integrative medicine provides me the tools that weren’t available in my conventional medical training,” she said. “As a cardiologist, I’m well versed in the role of medication, surgery and stenting for treatment of cardiovascular disease. But, it’s my training in integrative medicine that’s taught me the principles of nutrition, the evidenced-based use of natural supplements, and the role of the mindbody connection. Integrative medicine allows me to complete the circle of care.” Eudene Harry, MD, medical director of Oasis Wellness & Rejuvenation Center in Orlando, Fla., was thrilled to learn about the new board certification in integrative medicine. “It’s very good that integrative medicine is being acknowledged as a specialty,” said Harry. “The message is: let’s not be exclusive. Let’s be inclusive. Let’s look at all evidence-based material and treat it equally.” Harry, who specializes in both holistic and emergency medicine, said integrative medicine allows “more focus on information-gathering.” “That’s going to be helpful,” she said. “Medications don’t address the issue that’s driving the patient to the doctor’s office.”

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PROMPT AND PERSONAL – IT’S HOW REGIONS KEEPS THE WHEELS OF PROGRESS TURNING FOR SMALL BUSINESS. Dr. Susana Leal-Khouri began her relationship with Regions in 1996 at the suggestion of her personal accountant. She was just starting her private practice, the Miami Dermatology Center, and needed to furnish the offices. “Regions has been very helpful in allowing us to be able to start and grow the practice. They’ve also helped make it possible for us to hire the right people,” says Dr. Leal-Khouri.

“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.” What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit. Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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NOVEMBER 2013

Gaining Perspective on the Reimbursement Landscape: Glass Half Empty … or Half Full By CINDY SANDERS

To see something in a different light often requires a shift in perspective. David A. Williams, CPA, MPH, FHFMA, leader of healthcare reimbursement and advisory services for HORNE LLP, believes this certainly holds true for practices and facilities facing everincreasing budget pressures.

Glass Half Empty

David A. Williams

Williams, a partner in HORNE’s Ridgeland, Miss. office, noted for many healthcare providers, any incremental increase in revenue is eaten up by rising costs — from increased wages to higher prices for supplies to hikes in rent and utilities. He pointed out that for hospitals, the largest revenue stream is for inpatient stays, and the largest single payer is Medicare, which can represent from the low 40s to the high 60s in terms of percentage of patients. “There has been a market basket update, but for the last couple of years,

it’s been less than 2 percent,” he said. Williams noted the government puts in the full market basket update but then begins reducing the rate by looking at adjustments tied to value-based purchasing, readmission rates and acquired conditions, in addition to other factors. “Normally you’re seeing very minimal increases. It’s caused a flattening of revenue per patient,” he said. Then, Williams continued, after payment increases are netted out, “Medicare is subject to a 2 percent reduction to fulfill the sequestration order.” He added that Medicaid, which typically covers anywhere from 5-15 percent of patients … or higher depending on location and a hospital’s safety net status, is not currently subjected to sequestration. Yet, he said, hospitals are faced with mounting concerns about Medicaid expansion, uncompensated care, and cuts to disproportionate share hospital payments. For hospitals in states that didn’t opt to expand Medicaid rolls, administrators are worried about rising levels of uncompensated care for those that fall into the gap in the Affordable Care Act between traditional Medicaid eligibility and quali-

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fying for federal subsidies on the healthcare exchange. Even for providers who are in states that did expand Medicaid, Williams said uncertainty still exists about how reimbursement will actually net out. Traditionally, Medicaid has reimbursed providers at a set match rate for direct patient services and a 50 percent rate for the administrative portion of the episode of care. Although the ACA Medicaid expansion plan covers 100 percent of patient services for three years and then rolls down incrementally to 90 percent over subsequent years, the administrative match remains at 50 percent so the state does incur additional cost by expanding rolls. Additionally, Williams said certain provisions of the ACA require mandatory changes for states regardless of expansion, including: welcome mat population or those who were eligible for Medicaid but had not enrolled previously, foster children expansion to age 26, expanded eligibility for children, primary care physician fee increase, and health insurer fee. In Mississippi, a non-expansion state, the estimated amount of the mandatory changes is between a $272 - $436 million increase in spending. With this amount of growth, the state is not expected to increase the reimbursement rate for a full episode of care. Medicare DSH payments also are causing administrators to lose sleep at night. Initially, the ACA plan called for a 75 percent reduction in Medicare DSH payments. However, Williams said part of the final regulation that went into effect Oct. 1 of this year moderated that number a bit by moving to an empirical DSH payment for uncompensated costs … a complex, calculated cut that softens the blow some by looking at a hospital’s relative share of Medicaid inpatient utilization as a proxy for uncompensated patients. Williams said that for one hospital in the Mississippi Delta, the original Medicare DSH reduction would have meant a loss of $5.6 million. “But,” he continued, “because of the additional payment to fund the uncompensated cost, it was actually a reduction of $2 million.” While that is still a significant loss, “It could have been worse,” Williams noted. Still, he continued, “You’re faced with the fact your revenue isn’t growing as fast as your expenses. It’s very concerning to most every healthcare organization around.”

Glass Half Full

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NOVEMBER 2013

So if revenue isn’t going up, the logical place to increase margins is to decrease costs. Yet, healthcare providers want to make sure they provide the best care possible without sacrificing a patient’s well being simply to save a few dollars.

“A lot of people equate higher quality with higher cost, but that’s not necessarily true,” Williams pointed out. In fact, he said, doing the right thing in the right way is often significantly more cost efficient. “A major cost in providing care to patients is variation in the clinical process of care,” Williams said. He added it is easy to find real world examples of this type of variation where one hospital’s cost for an average hip replacement is $45,000, yet another one might have an average cost of $22,000. “What’s the disconnect?” he asked of the two cost scenarios. “A lack of standardization of using evidence-based protocols,” he answered. By using data available through electronic health records coupled with a partnership with technology company Health Catalyst, Williams said HORNE is able to mine the available information to look at clinical pathways and search out deviation from standard protocols that adds to the cost of care. He was quick to add that the technology doesn’t seek to stop physicians from exercising their medical judgment but does highlight where there are outliers when it comes to following clinical protocols. “Best practices and evidence-based medicine say that these are the best protocols out there,” he pointed out. Following those protocols not only saves money, but also should optimize quality. With increased transparency, payers and patients will have access to information regarding those positive outcomes and lower costs, which could ultimately drive volume.

A Foot in Both Boats

Administrators and chief financial officers are caught between the fee-forservice and value-based payment worlds right now. Williams said they are trying to keep their heads above water in the current payment system … and now reimbursement experts want them to shift their focus to population management. Although making the move is understandably frustrating, Williams believes it is also the best option to ultimately improve the bottom line. “There has to be a change in culture from what it’s been in the past,” he noted. “We tell them, ‘Let’s prepare for it by being the most efficient, effective deliverer of care and eliminating patient waste.’ That puts you in a competitive advantage over those providers that have a higher cost structure.” It is a different mindset, Williams continued, to stop attacking reimbursement from the top and instead improve revenue by cutting costs. “If you deliver high quality at a lower cost, then your margins are going to be greater. We see opportunities,” he concluded. memphismedicalnews

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Doubling Residency Slots USF Health Morsani COM hosts one of the nation’s largest distributive residency programs; maintains high retention rate of new doctors By LYNNE JETER

Editor’s note: The Solutions series is a new feature of Medical News, focusing on innovative answers to the growing chasm between the number of medical graduates and residency slots. TAMPA, FLA. – While the gap between medical graduates and the number of residency slots nationwide continues to challenge industry leaders, the University of South Florida (USF) Health Morsani College of Medicine (COM) is bucking the trend. Within the next couple of years, the number of residency slots will nearly double to 1,400. “We have one of the nation’s largest distributive residency programs, with 730 USF residents at seven sites, and a proposal to add another 700 residents,” former USF Health CEO Stephen Klasko, MD, also former dean of the Morsani COM, said before he left the school in August to become the first executive selected to head both Thomas Jefferson University and the TJUH System in his home state of Pennsylvania. Klasko significantly contributed to the medical school infrastructure expansion, allowing meaningful strategic growth of the residency program. The ambitious plan fits the distributive model, allowing USF Health Morsani COM the ability to sponsor or participate in residency programs as “civilians,” explained Charles Paidas, MD, vice dean for clinical affairs and GME for the USF Health Morsani COM. “We’re offering a shopping list of educational and research initiatives that are required for GME certification,” said Paidas, noting that Naples Community Hospital in Naples, located more than 150 miles away, represents the school’s most recent affiliate addition, and that a pact for other affiliations is in the works. When Paidas, the plan’s architect, became associate dean for GME in 2009 after five years with the school, the residency program faced governance and operation issues that required improved oversight. He assembled a strategic committee that allowed the school to garner impeccable institutional review commendations from the Accreditation Council for Graduate Medical Education (ACGME). In 2011, he was promoted to his current post. At the suggestion of USF medical students, Paidas also brought together Association of American Medical Colleges (AAMC) executives, GME leaders and medical school deans to the USF Health GME Summit last year. The well attended event “begs the issue of a replay this year,” he said. “Our goal was to characterize the state of GME memphismedicalnews

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in Florida. For example, the average number of residents per 100,000 population in the U.S. is 35.9. Florida’s at 17.5. That’s a raw data point that tells you we need to double the workforce. That translates to 2,900 residency slots in the state.” Boosting the number of residency slots also improves the chances of keeping new doctors in Florida. “Florida had nearly a 59.6 percent retention rate of residents who complete their training and stay here,” noted Paidas. “The mantra around the country is: wherever you do your residency – not where you attended medical school – is likely where you’ll practice. USF pushes that to 68 percent.” Of 128 total first-year resident slots, USF Health Morsani College of Medicine placed medical graduates in the following specialties, according to the National Resident Match Program:

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Dermatology: 4 Emergency Medicine: 10 Family Medicine: 8 Internal Medicine: 29 Medical-Preliminary/Ophthalmology: 1 Neurological Surgery: 2 Neurology: 5 Obstetrics-Gynecology: 5 Orthopedic Surgery: 4 Otolaryngology: 3 Pathology: 4 Pediatrics: 15 Physical Medicine & Rehabilitation: 2 Plastic Surgery (integrated) 3 Psychiatry: 8 Radiology-Diagnostic: 8 Radiation Oncology: 1 General Surgery: 6 Surgery-Preliminary: 2 Surgery-Preliminary/Urology: 3 Vascular Surgery: 2

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Medicine-Pediatrics: 3 “This past year, we matched all 128 firstyear slots in the first round of Match,” said Paidas. “We haven’t done that in 20 years!”

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GrandRounds Funds Established for Three Victims of Helicopter Crash

Injuries don't always happen during the day. Have a break or sprain in the evening? MOG's board certified physicians can see you at our Germantown walk-in clinic after work or school and get you back to life.

Funds have been established for each of the families of the three team members from Le Bonheur Children’s Hospital and Hospital Wing who were killed when their craft crashed in a woods near Somerville, Tennessee, on October 22. Those wishing to contribute may either make a donation by check or online. If paying by check, it should be made payable to the Le Bonheur Foundation and mailed to: Le Bonheur Foundation, PO Box 41817, Memphis, TN 38174. Contributors are asked to designate to

Denise Adams

Carrie Barlow

Charles Smith

whom the funds should go. Those wanting to make a donation online should go to https://events.lebonheur.org/helpfund. Donations may also be made in their honor to the Pedi-Flite team at http://www.lebonheur.org/donatenow. The helicopter crashed while en route from Memphis to pick up a child and take him to Le Bonheur. The three victims are Denise Adams, a respiratory therapist; Carrie Barlow, a flight nurse; and Charles Smith, a Hospital Wing pilot.

The Family Cancer Center Foundation receives ASCO’s Quality Oncology Practice Initiative (QOPI) Recognition The Family Cancer Center Foundation has been awarded the prestigious QOPI Certification for providing the highest quality cancer care. The QOPI Certification Program provides a three-year (continued on page 21)

TMA Chief, continued from page 11 When it comes to attracting doctors, why is Tennessee a good place to practice medicine?

Liability limits, which reduce cost of being a doctor. Your medical malpractice premiums are lower here. That’s something we did through our advocacy – dropped it 35 percent in Tennessee since 2009. That is purely a market result to fewer claims and less damages. Now, when there are legitimate cases, when they are getting to court, they are being settled faster. It has reduced cases by 50 percent, and it helps the legitimate ones get through.

What is the TMA’s position on the Affordable Care Act?

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MOG EVENINGORTHO is at our Germantown location only. 20

NOVEMBER 2013

Again, it comes down to government intrusion in healthcare. There is a lot of good in the ACA, but the bad is so bad, it neutralizes it. One of our concerns is the dictatorial nature of how they are handling it. Our greatest gripe with the ACA is it did nothing to reduce our administrative hassles. It increased them twofold. It is taking even more time away from patients in the office. It is shifting an incredible financial burden to states. The market is already fragile. The unsustainability of the program — to go through all this is I think the fear that it all comes crashing down. There’s been very little physician input into the what — what are we providing? How do we pay for it? I call it the three-legged stool. You want low cost, high quality, access. That’s everyone’s goal. It’s a delicate balance. Just because you pass it doesn’t mean it’s going to happen. We are big advocates of the doctorpatient relationship. That relationship is sacred and crucial. Then with exchanges, they are going to tell you where to go and that endangers that relationship. You have three months now to shop, see where you are going to qualify, see if you understand it. If you have a preferred physician, start with them. Ask if they are participating. If not, you are going to be totally swayed by cost

alone. It will be a very interesting year to say the least in 2014.

How have patients changed the healthcare marketplace?

Age. Demand. Complexity of illness. The Internet has made the delivery of care more complex. WebMD is great. But when a patient comes in with printouts from three websites, saying “this is what I have,” and the doctor has to read through 45 minutes of materials to tell the patient “that has nothing to do with you,” then assess the patient — it can stall the process.

How effective have TMA’s advocacy efforts been?

I think very effective in light of the size and complexity of what we have. We have open-door relationships with all the insurers. We will work on protocols and their regulatory structures and getting them right. Obviously the best advocacy is something that does go to the legislature. Where we might be criticized is not stopping change – like not stopping managed care in the ‘80s. There are some things you can’t stop. The market changes due to consumers. You can stick your head in the sand, or you can work on those things you can influence. That’s what we have chosen to do.

What can you say that is encouraging to physicians?

We can’t get along without you, and patients really respect you. The profession as a whole has a revered spot. Our organization exists to maintain that high level of professionalism. At the heart of physicians is their patients, and as long as they don’t forget that, they’ll be OK. The uncertainty of your business is heavy on your mind, but at the end of the day, there are patients that need their physicians. And that’s not changing here. At the end, there’s patients that need surgery, kids need checkups, the healthcare service industry remains. It’s just how we pay for it. memphismedicalnews

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GrandRounds The Family Cancer Center, continued from page 20

certification for outpatient hematologyoncology practices that demonstrate compliance with a rigorous set of standards for quality cancer care. Pressure to demonstrate high-quality care and a commitment to continuous quality improvement has become increasingly important for healthcare providers. For a time, quality efforts focused on areas outside of cancer care, most notably primary care, cardiology, and diabetes care. This is likely due to the complexity of cancer care, the limitations of claims data in providing meaningful quality analyses, and the emotional context of cancer rather than to the confidence that all cancer care is appropriate and safe. QOPI provides a system for practices to measure processes of oncology care semiannually, using retrospective medical record abstraction methodology. It was initially conceived as a tool to allow practices to assess the quality of care provided to their patients by measuring concordance with a limited set of process measures. However, as the number of participating practices has increased and experience with the measures has grown, QOPI has become the benchmark for practices, allowing comparisons amongst peers and possibly improving performance. More recently, collaborative networks have been created to enable sharing of best practices using QOPI to track performance. The QOPI Certification Program is the next step in a continuum of changes intended to improve patient care and respond to the rapidly changing oncology landscape.

its Germantown campus since its initial development in 2002. The newly-owned Midtown facility will operate as Campbell Clinic Surgery Center – Midtown, with the former becoming Campbell Clinic Surgery Center – Germantown. With the addition of Midtown Surgery Center to the Campbell footprint, they’ll not only be able to double the size of their orthopaedic surgery space, they’ll also enhance the clinic’s geographic reach near the Downtown-Midtown corridor according to Campbell Clinic Chief of Staff Frederick M. Azar.

Hope House annual luncheon The annual Hopes and Dreams Luncheon hosted by the Hope House was held on October 16, 2013. The purpose of the luncheon was to raise funds for scholarships for Hope House children. Hope House children are affected by HIV and poverty. All Hope House children are on scholarship. This nationally accredited preschool has children who range in age from six weeks to five years. Frank Davis is the current Hope House Board President, and J. William Appling is one of Hope House’s newest Board Members. For more information about Hope House, contact Betty DuPont at 901-219-3333.

Attending the Hope House annual luncheon: County commissioner Chris Thomas, Betty DuPont,PhD, executive director of Hope House , county commissioner Heidi Shafer

I don’t just have insurance. I own the company.

Lisa Young, M.D. Sutherland Cardiology Clinic Germantown, TN Invasive Cardiology

Trumbull Laboratories Receives Accreditation From College Of American Pathologists

Trumbull Laboratories, LLC has been awarded accreditation by the Accreditation Committee of the College of American Pathologists (CAP), based on the results of a recent onsite inspection. The laboratory’s director, Thomas M. Chesney, MD, was advised of this national recognition and congratulated for the excellence of the services being provided. Trumbull Labs is one of more than 7,000 CAP-accredited laboratories worldwide. The CAP Laboratory Accreditation Program, begun in the early 1960s, is recognized by the federal government as being equal to or more stringent than the government’s own inspection program.

Campbell Clinic Acquires Midtown Surgery Center

Campbell Clinic Orthopaedics has purchased Midtown Surgery Center, an ambulatory surgery center. The 18,000-square-foot facility will allow Campbell Clinic, the largest provider of orthopaedic and sports medicine services in the region, to add four new operating rooms under its management and improve convenience for the clinic’s patients. The clinic has owned and operated Campbell Clinic Surgery Center on memphismedicalnews

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Medical Professional Liability Insurance “These are uncertain economic times. So the way I see it, this is the time to be more diligent than ever when choosing a professional liability insurance carrier. I need a company with the proven ability to protect my livelihood for the long haul. That’s the reason I chose SVMIC. Their long commitment to physicians in our state, through their extensive physician governance system and consistently high ratings from A.M. Best, is unmatched. Only SVMIC has the track record and financial stability my career deserves. And, my career is much too important to settle for anything less.”

Mutual Interests. Mutually Insured. Contact David Willman or Susan Decareaux at mkt@svmic.com or 1-800-342-2239. SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies. Follow us on Twitter @SVMIC

www.svmic.com

NOVEMBER 2013

GrandRounds New surgeon at the Church Health Center

Nia Noelle Millan Zalamea, M.D.was inspired to come to the Church Health Center by both her upbringing and her past experience as a pre-medical student. Her father, a nurse anesthetist, and her mother, an RN, began doing medical mission work in Dr. Nia Noelle the Philippines when she Millan Zalamea was 17. After graduating from college, Nia chose to pursue medicine in order to be able to participate and contribute to their mission projects. It was truly an experience for her to witness how much of a difference they made as individuals by sharing resources and skills in underserved communities. Her experience at the Church Health Center as a Clinic Assistant opened her eyes to the work of Dr. Scott Morris here in Memphis. This community is so blessed to have a place where a complete/whole health model of health is available to the working uninsured and underserved.

McDonald Murrman Women’s Clinic Hires Steven Coplon

McDonald Murrmann Women’s Clinic is pleased to announce Mr. Steven Coplon, MHA, FACHE, FACMPE as their new Chief Administrator Officer. Mr. Coplon comes from a strong background in healthcare management, representation, and Steven Coplon future strategic planning. As former CEO of The West Clinic for eight years, Mr. Coplon helped put that clinic on the map locally and internationally which enabled him to be involved with the “game changers of healthcare,” as we know it today. McDonald Murrmann Women’s Clinic was founded in 1996 by Drs. Mary McDonald and Susan Murrmann, who left another OB/GYN clinic to form their own. Since then, the clinic has grown to seven full-time female physicians and two nurse practitioners.

VA Grant Will Enable Memphis Non-Proﬁt To Expand Services Catholic Charities of West Tennessee (CCWTN) has received from the Department of Veterans Affairs (VA) a $900,000 grant that will be used to help fund a new program to provide vital assistance to veterans and their families. Called “St. Sebastian Veteran Services,” the program will focus on making a variety of important services available to the growing number of homeless veterans and their families in Shelby County, as well as those at imminent risk of homelessness. The grant from the VA’s Supportive Services for Veteran Families will help CCWTN assist as many as 160 veterans and their families during the program’s first year. The services will include: • Assistance in obtaining short-term housing • Assistance in obtaining earned

NOVEMBER 2013

benefits • Employment counseling • Family ﬁnancial counseling • Referrals to other CCWTN programs • Referrals to other community based programs The work of St. Sebastian Veteran Services will focus on case management activities designed to help find permanent independent living residences for homeless veterans and their families as well as assisting those facing imminent eviction or foreclosure.

Remembering Dr. Robert “Alex” Sanford It is always sad to lose a leader in our field of neurosurgery, but the recent passing of Dr. Robert A. “Alex” Sanford has truly impacted the Memphis medical community. He loved his work and loved the children he was so dedicated to saving. His commitment made him beloved and respected by those he worked with, as well as his Dr. Robert patients. Sanford A native of Southeast Arkansas, Dr. Sanford originally came to Memphis and joined the Semmes-Murphey Clinic in 1984. For over 30 years, Sanford worked diligently to save the lives of many children with brain tumors and other neurologic problems. With the support of his partners at Semmes-Murphey, he founded Le Bonheur’s surgical brain tumor program – in collaboration with St. Jude Children’s Research Hospital and the University of Tennessee Health Science Center. The brain tumor program has grown to be the largest program of its kind in the country. Sanford was honored in 2010 by the American Association of Neurological Surgeons/ Congress of Neurological Surgeons Section on Pediatric Neurological Surgery as recipient of the Franc Ingraham Award for distinguished service. He was one of fewer than 10 neurosurgeons ever bestowed this high honor. In 2012, he was honored by the Memphis Business Journal with the Health Care Heroes Lifetime Achievement Award. In 2007, Dr. Sanford was honored as a Health Care Heroes finalist in the physician category along with his Semmes-Murphey colleague, neurosurgeon Dr. Frederick Boop. He will be missed by those who knew and respected him.

West Cancer Center Opens New Clinical Trial The West Cancer Center has announced the opening of a prostate cancer clinical trial, which may be a potential treatment option for men with metastatic castration resistant prostate cancer (mCRPC) in patients with pain. This trial is a randomized, multicenter, double blind, placebo controlled phase 3 study of XL184 (cabozantinib) in patients with advanced symptomatic mCRPC that has progressed on multiple prior treatments.

This agent will be compared with standard chemotherapy option of mitoxantrone and prednisone. Dr. Brad Somer is the principal investigator for this study. Cabozantinib is a combined VEGFR/ MET inhibitor. Early small-scale studies evaluating cabozantinib activity in various tumor types, including metastatic prostate cancer, showed resolution of bone scan abnormalities observed in some patients. Some patients also experienced improved pain control, regression of soft tissue disease, decreased circulating tumor cells and bone markers as well as PFS improvements. The main goal of this trial is to evaluate if there is pain reduction with the drug in a larger patient mCRPC population. The COMET-2 trial is a parallel ongoing trial with the COMET-1 trial. Exelixis, Inc. has an on-going trial COMET-1, which is a phase 3 randomized double blind controlled study of XL184 (Cabozantinib) vs prednisone in mCRPC, in patients who have received prior docetaxel and abiraterone or enzalutamide. The aim of the COMET-1 trial is to evaluate for a survival advantage with cabozantinib. For additional information contact Cindy Inman at cinman@westclinic.com

Methodist Le Bonheur Healthcare Introduces New Program to Develop Future Physician Leaders In response to the transforming landscape of health care, Methodist Le Bonheur Healthcare is implementing an innovative program to create physician leaders of tomorrow today. Michael Ugwueke, COO for Methodist Le Bonheur Healthcare worked with the UT Center for Executive Education in Knoxville and the American College of Physician Executives in Tampa Florida to develop a 12-month program that focuses on building and strengthening leadership skills within physicians. Some of the topics covered include Building a High Performance Culture, Facilitating Change as a Physician Leader and Effective Physician Leadership. The classes are held monthly. Ugwueke says his drive to create the Physician Leadership Academy comes from the desire to build the next generation of physicians who excel both as leaders and healers. When hospitals team up with physicians he believes great things in health care can be accomplished. The first class of physicians will graduate in August 2014.

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GrandRounds New, Expanded Location for Endocrine & Diabetes Clinic The physicians and staff members of the Endocrine & Diabetes Clinic, LLC moved to their new office in Cordova located at 290 South Walnut Bend, Suite 1, off Germantown Parkway. Additionally Dr. Rabia A. Rehman will join the clinic in December. The new and expanded office will provide the additional space needed to accommodate Dr. Rehman’s joining the group, which includes Dr. M. Nauman Qureshi, Dr. Salma Khan, and Dr. Javeria Ahmed, and will provide patients with greater access to their services, including comprehensive diabetes care and thyroid disease management along with ultrasound, ultrasound-guided biopsy, and osteoporosis treatment. The new office also provides convenient patient parking and same-day appointments. The practice is also developing a new website for its patients which will soon be available and can be found at www.myendoweb.com.

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

Select Health Alliance Names New CMO Baptist Memorial Health Care has named Dr. Henry Sullivant, president and managing partner at the Ruch Clinic, as the first chief medical officer for Select Health Alliance. Sullivant will lead the physician-led clinical integration project, with the mission to deliver a better care delivery model that will then go to the marketplace as a collaborative effort between a physician group and a hospital. Sullivant has practiced as an obstetrician and gynecologist since 1983. The ultimate goal is to improve the quality of care, minimize redundancies of care, eliminate waste in health care delivery and reduce health care costs according to Sullivant. Select Health Alliance is a partnership between Baptist Memorial Health Care and more than 800 physicians in the Mid-South, including both independent community physicians and the Baptist Medical Group. The group began two and a half years ago in an effort to share data to coordinate and produce betterquality care for patients in the future from the 900,000+ physicians already enrolled in the data program. The initiative is also going to provide a health care delivery model for looking at future payment models like pay-forperformance and bundle payments said Sullivant, who believes the end result will be care that is streamlined, cost-effective and timely and that delivers a high patient-satisfaction rate. Sullivant’s list of qualifications include his work as a former president of the medical staff for Baptist Memorial Hospital for Woman, chairman of Baptist’s OB/GYN department, head of the hospital’s metro medical executive committee and chair of quality improvement.

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HEALTH CARE REFORM DECLINING TOP LINE REVENUE

DELIVERY MODEL CHANGES PHYSICIAN COMPENSATION RISKS EVERY DAY IS A CHALLENGE

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