Memphis Medical News October 2014

FOCUS TOPICS SENIOR HEALTH REIMBURSEMENT GASTROENTEROLOGY

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PHYSICIAN SPOTLIGHT PAGE 3

Edward L. Cattau Jr., MD

ON ROUNDS

Impact of Crittenden’s Closure Felt in Memphis As Well as Arkansas

BY GINGER PORTER

Medicare Math

Or How a 2.3 Percent Raise Became a 3 Percent Reduction At first glance, the FY-2015 revision of the Medicare hospital inpatient prospective payment systems by the Centers for Medicare & Medicaid Services appears to offer acute care hospitals a 2.3 percent rate increase beginning this month ... 6

Surgeons to Patients: Is This Really Necessary?

Doctors say sometimes waiting is the best option Before deciding on whether a surgical procedure is necessary, the patient and surgeon should be discussing a pile of questions that could end up being thick enough to cut with a scalpel ... 8

The closing last month of Crittenden Regional Hospital (CRH) in West Memphis and the bankruptcy filing that followed not only have been devastating to the community, but also had an immediate impact on Memphis. And the effects are still emerging.

One West Memphis official has called the closure “the biggest nightmare for our county.”

Arkansas attorney Denny Sumpter has filed a lawsuit alleging that insurance premiums withheld from employees’ checks were not applied to their healthcare claims. CRH was self-insured, with a third-party administrator. Sumpter has a personal stake, as his mother was a CRH employee for more than 35 years and between her and her husband have about $100,000 in medical bills left unpaid.

“The employees knew the hospital was in financial trouble. They were being turned over to (CONTINUED ON PAGE 18)

HealthcareLeader Bobby Meadows, Executive Director, Memphis Jewish Home & Rehab From West Virginia to Memphis’ ‘Hidden Treasure’

BY JUDY OTTO

When Bobby Meadows describes the Memphis Jewish Home and Rehab Center as a great place he is proud to serve, he’s sharing the insight of a man who has seen life from several distinct perspectives: as a child whose father and grandfather worked in West Virginia

coal mines, as a student who worked his way through college as a black-hat (underground) coal miner himself, as a certified nursing assistant with a genuine passion to care for seniors such as those he had been raised to love and respect, and as a leader with more than 12 years of experience as executive director of successful (CONTINUED ON PAGE 10)

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PhysicianSpotlight

Edward L. Cattau Jr., MD

Happy in Memphis, doctor need not fret now over president’s health

BY RON COBB

Being a doctor and dealing with stress go hand in hand, but it’s safe to say that as director of endoscopy at Gastro One, Edward L. Cattau Jr., MD, does not have the health of the president of the United States weighing heavily on his mind, as it did 30 years ago.

At the time, Cattau was a Naval officer and chief of gastroenterology at the National Naval Medical Center in Bethesda, Maryland. Among other duties, he was consultant to the attending physician to Congress, the vice president and the president.

“In 1984, President Reagan had a routine physical which revealed a positive fecal occult blood test,” Cattau said. “I was consulted and recommended a colonoscopy.

My recommendation was not acted upon by those in authority at that time.

“I was told he could not fit it in his schedule while campaigning for his second term. After the election, I continued to write letters to his new physician, stressing the need for the president to have his colonoscopy. After some delay, I performed the procedure in July 1985 and found a cancer in the cecum. The president had a curative operation the following day.”

Cattau later received a Navy commendation medal for his care of the president, but not before he navigated some rough seas, including “professional abuse to which I was subjected by the lay press and their medical consultants.”

“There were a few nationally prominent gastroenterologists who went on television news shows and criticized aspects of the president’s care – particularly the delay between the abnormal stool test result and the colonoscopy – although they were not privy to details which made their comments invalid.

“As an active duty naval officer, I did not have the prerogative of defending myself publically. When Sam Donaldson asked me during a press briefing if I thought the president should have received better care, my response was, ‘The standard of care is the same for you, for me and the president of the United States.’ While the press took this as some type of egalitarian statement, the hidden meaning was the standard of care prompted the recommendation for the president to have a colonoscopy a year earlier, the same as for any patient. In reality, the president’s delay had nothing to do with the standard of care, but rather to a decision by someone to not comply with my recommendation.”

After leaving the Navy in 1986, Cattau joined the faculty at Georgetown University, and four years later decided “my strengths and long-term goals were better suited to private practice.”

He was recruited to Memphis by Lawrence Wruble, MD, founder of Memphis memphismedicalnews

.com

Gastroenterology, and was convinced of “a nearly unique opportunity here.” The office then was downtown, and “we were teaching basic second-year medical school GI physiology classes, not something I’m sure any other private practice group was doing. Plus, Memphis seemed like a good place to raise a family – and it has been.”

The son of a nurse and Navy enlisted man, Cattau was raised in Niagara Falls, New York; Virginia Beach, Virginia; and Worcester, Massachusetts.

“I spent most of my time studying and working,” he said.

He performed in school plays and was class orator, as well as working at a Howard Johnson’s as dishwasher and then night manager. He started at the University of North Carolina on a Navy ROTC scholarship “with the intent of being either a pilot or a JAG officer. It was after my sophomore year that I realized I had a calling for medicine.”

But the next two years he struggled with finances and grades, resigned his ROTC scholarship and had to greatly step up the pace to become a chemistry major and meet the pre-med requirements.

“That was the beginning of a lifetime of sacrifice and support by my dear wife, Sue,” he said. They had dated in high school, and she followed him to UNC. They married at the end of his junior year.

“She quit school and worked clerical jobs to support us,” he said. “She encouraged me to get the grades I needed to get my GPA up.” Sue eventually went on to earn a nursing degree.

They have two grown children – Chris, who is finishing a PhD in wildlife conservation at the University of Florida, and Megan, who just returned from 14 months performing research in Borneo and is on track to earn a PhD in ecology from Columbia University.

Closer to home, Cattau is enthused about the July merger of Memphis Gastroenterology Group and Gastro One. He

credits managing partners Drs. Michael Dragutsky and Richard Aycock with steering Gastro One into a leadership role on the state and national level.

Cattau’s free time finds him as an elder at his church, working with the local chapter of the Christian Medical and Dental Associations and doing mission work.

“When I do get to the gym -- not nearly enough, so don’t tell my primary physician – I enjoy listening to faith-based programs.

“My Christian faith is the most important thing that defines me as a person and as a doctor. I don’t talk about it much, quite frankly because on any given day I am such a bad witness as I too often let events inappropriately affect me.

“But I must say I came to Memphis as a self-content, happy moralist thinking I was knowledgeable, humble and openminded, only to find I was ignorant, arrogant and close-minded. When asked why I came to Memphis, I used to say, ‘It was because of my smooth-talking Jewish senior partner.’ Now I know better and the answer is ‘to receive grace from my merciful, loving Jewish Master. The job was just a sweet perk!’”

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MedicalEconomics

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OCTOBER 2014

Everything involving the Centers for Medicare and Medicaid Services (CMS) is a moving target. But there’s no denying that ICD-10 is coming. It’s just a question of when.

Keep in mind that I am writing this article September 17, 2014. And I would not have been able to write it without the help of my friends at the MGMA Corporate office in Englewood, Colorado, including Robert Tennant, senior policy advisor, and Jeb Shepherd, senior government affairs representative with the MGMA Government Affairs division.

The ICD-10 delay gives us an opportunity to take low-cost, highimpact steps to prepare for the new code set. In spite of this time we’ve been given, (October 1, 2015 is the new compliance date) the Medical Group Management Association research suggests that overall industry readiness for implementation continues to lag.

The results, compiled through the Association’s Legislative and Executive Advocacy Response Network, indicate that less than 10 percent of practices report making significant progress when rating their overall readiness.

As part of the MGMA ICD-10 advocacy efforts, MGMA strongly asserted that comprehensive end-toend testing is a prerequisite to ICD-10 implementation. Through the hard work and advocacy of the MGMA, CMS has announced three separate testing weeks for conducting “acknowledgement” testing for claims using ICD-10 codes.

In my April, 2014 article in Memphis Medical News, “CMS Hasn’t Got a Clue,” I pointed out that challenges remain; a back-end link providing payments and automated account records to insurance companies have yet to be built and might not be completed before summer.

I quoted from Time, March 10, 2014; “CMS said this is mostly a headache for the insurance companies and providers.”

(Thus passing the buck away from CMS.) The wire services, on September 17 reported lax security: “HealthCare. gov, the health insurance website serving more than five million Americans, has significant security flaws that put users’ personal information at risk,” said the Government Accountability Office. It cited more than 20 specific security issues related to who can get into the system, who can make changes in it and

what to do in case the complex network fails. (Remember growing up and being told, “Do as I say, not as I do.”?)

The CMS’ new deadline (extension) for implementing ICD-10 for physician practice adoption of the diagnosis component known as the “Clinical Modification (CM)” is October 1, 2015.

After that date outpatient claims will need to be coded with one of approximately 69,000 codes, an increase from 13,000 codes in ICD-9-CM. CMS also indicated that all HIPAA-covered entities (providers, health plans and clearing houses) would be required to continue to using ICD-9-CM through September 30, 2015, even if they were already prepared to move to ICD-10.

CMS has agreed to comprehensive end-to-end testing that includes returning a remittance advice. The testing weeks will be November 17-21, 2014; March 2-6, 2015; and June 1-5, 2015.

CMS says, “We specifically hope designating these three weeks will help to generate an increased interest,” but reiterates that acknowledgement testing is permitted at any point prior to October 1, 2015.

Some of you may remember the Comedy Series, “Sanford and Son,” staring Redd Foxx, which ran from 1972 to 1977. In the TV series his wife, Elizabeth, was deceased. During the show if some event occurred that had an impact on him, Fred would hold his chest as if he’s having a heart attack, look up toward heaven and say, “Ut oh, this is the big one, hold on Elizabeth honey, I’m coming to join you.”

I hardly missed an episode of “Sanford and Son.” You might want to hold your chest.

In 2008, MGMA worked with Nachimson Advisors, LLC, on a study, to try and come up with the ICD-10 cost impact on individual provider practices.

In 2014, after a six-year period with a group of consultants, they noted a substantial change in those cost estimates.

To determine the practice variable, they estimated costs for small, medium and large practices. Individual practice size was based on variable factors such (CONTINUED ON PAGE 12)

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Medicare Math

Or How a 2.3 Percent Raise Became a 3 Percent Reduction

BY CINDY SANDERS

At first glance, the FY-2015 revision of the Medicare hospital inpatient prospective payment systems (IPPS) by the Centers for Medicare & Medicaid Services (CMS) appears to offer acute care hospitals a 2.3 percent rate increase beginning this month.

Dig deeper, however, and it looks more likely that Tennessee hospitals will actually realize less than last fiscal year for providing the same services.

“It’s death by a thousand cuts,” explained David McClure, senior vice president for Finance & Medicare at the Tennessee Hospital Association. “What CMS gives you, they find a way to take back.”

McClure, who has been with THA for nearly two decades, recently spent several weeks deciphering the 500-plus pages of the IPPS final rule, which was published in the Federal Register in August in advance of going into effect Oct. 1. “The inpatient rule controls the payment to hospitals for about $2.5 billion in the state of Tennessee,” he said. “This inpatient rule continues on with the implementation of provisions in the Affordable Care Act and the American Taxpayer Relief Act of 2012.”

On the plus side of the payment equa-

tion for Tennessee hospitals, he noted, “The market basket update this year was 2.3 percent. That’s about $60 million.”

However, McClure continued, those ‘new’ dollars are quickly offset when looking at reductions and penalties spread out through a number of provisions in the two acts. Two automatic cuts tied to ACA re-

duce the market basket index by 0.5 percent and 0.2 percent respectively. The first is a reduction to offset productivity improvements assumed to have been gained through increased efficiency. The second, McClure said, is a general reduction to help pay for the Affordable Care Act that is in place through 2021. “Those two reductions account for about $16 million in cuts,” he noted.

“Then in the Taxpayer Relief Act, they have what’s considered a coding reduction. That’s worth about $17.5 million,” he continued.

McClure said the rationale behind the 0.8 percent cut is that hospital personnel are becoming better coders.

He added that’s probably true considering the number of audits and increased emphasis on coding education. However, McClure continued, the basic premise behind the rationale is flawed since billing is for services rendered … being ‘better’ at coding has no impact on the actual cost of the service provided.

With these three cuts in place, more than half of the $60 million increase has already been erased. And, McClure noted, that’s just the beginning.

“Probably the biggest change that will happen for hospitals in 2015 comes

from the Medicare Disproportionate Share payments,” he continued.

McClure explained CMS began implementing a strategy in 2014 to reduce Medicare DSH payments because enrollment in health plans and expansion of Medicaid was anticipated to increase the number of people with coverage. CMS also reworked the formula for offsetting care delivered to the uninsured. The Medicare DSH funding was split into two pools with 25 percent remaining traditional DSH and 75 percent moving to a new uncompensated care pool.

“We’re becoming part of the minority now in states that haven’t expanded Medicaid,” McClure noted. “CMS looked at uncompensated coverage rates nationwide and made a decision about how much to cut and how to divide it nationally.”

With 27 states opting to expand Medicaid, the uncompensated care pool has been significantly impacted. The net result, McClure said, is that Tennessee is really hit twice … both by not expanding coverage to a large population segment and then by receiving reduced rates for delivering care to that patient sector.

“Tennessee will receive 23.8 percent less in DSH and uncompensated care pool payments,” he said. “Under all that redis(CONTINUED ON PAGE 14)

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The Modern Practice: Controlling A Better Experience

by Brad Parsley

Over the last 16 years our company, Audio Video Artistry, has installed a lot of magnificent entertainment systems in doctor’s homes all over the midsouth. But it’s our work in their clinics and offices that have been the biggest growth area for us over the past few years. Control and automation technology is being used in new and exciting ways to improve the experience for doctors, practice personnel, and patients.

Conferencing, surveillance, music, and video are all being used in medical practices to improve security, communications, and the patient experience. At Memphis Radiological PC, located at The Brownstone in Germantown, these technologies converge to offer multiple benefits in their beautiful new space. Office manager Kim Ashur sat down with us recently to discuss those benefits and how the iPad has found its way into their daily routine.

Getting the most use is the conference room according to Ashur. “We host our board meetings, employee meetings, and vendor presentations, as well as occasional relaxation time watching TV during lunch.” She also says access and control are simple. “I use the iPad. I can control the entire room from right here. As a matter of fact, I can control all of our systems from the same iPad.” Reliable devices that are personally familiar to doctors and employees, such as the iPhone and iPad, make the system far more inviting and user friendly.

Multiple zones of music include exam rooms, waiting rooms, and offices.

Users in each of the areas can choose to listen to their own preferences such as iPod, Pandora, AM/FM, and Sirius/XM. The result is a more relaxed atmosphere that puts the patient more at ease. A television at the reception area also helps to pass the time for waiting patients. The future connectivity of digital signage to this TV also allows the practice to display important information on the screen alongside television content. Some practices even use this medium for advertising additional services and products they offer while patients entertain themselves.

Ashur also points out that surveillance cameras have proven to be one of the most valuable systems they have included in their office. They use them for safety and security for their employees. “Before we leave the building when working late, we will check the cameras for any potential safety concerns” says Ashur. She also has used the recorded content to capture and document an employee policy violation.

Of course, reliability and expandability are critical considerations when including technology in your office. For critical operations, more entities choose Crestron than any other brand in America. Government, corporate, hospitality, and healthcare have chosen Crestron overwhelmingly for 40 years. At Audio Video Artistry, we exclusively recommend Crestron to our clients and it was the best choice for Memphis Radiological as well.

The process starts with an integrator like Audio Video Artistry. A free, no obligation site survey determines how we can best suit your needs and which options make the most sense. For the modern medical practice, enhanced security, communications, and entertainment is a healthy choice.

If you have not implemented control and automation technology in your practice, it is a valuable addition to consider.

Brad Parsley is co-owner of Audio Video Artistry located in Memphis, Tennessee. You can contact Brad by phone at (901) 601-6254 or via email at brad@avartistry.com

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OCTOBER 2014

Surgeons to Patients: Is This Really Necessary?

Doctors say waiting sometimes is the best option

BY LAWRENCE BUSER

Before deciding on whether a surgical procedure is necessary, the patient and surgeon should be discussing a pile of questions that could end up being thick enough to cut with a scalpel.

Is this the right time? What are the alternatives? What if you don’t get the surgery? Do the benefits outweigh the risks?

How long will the recovery be? What is the long-term prognosis? How important is my age?

And that’s just for starters. Some doctors say a patient should do thorough research on the Internet and make lists of questions before deciding on non-emergency surgery.

“I run into this issue a lot, and what I can tell you is patients need to speak up and not be afraid to talk to their doctor and bring up questions,” says William Mihalko, MD, professor and J.R. Hyde Chair of the Joint Graduate Program of Biomedical Engineering at the University of Tennessee Health Science Center. “In our elderly population when they get into their 70s a lot of times William they’re not always proac- Dr. Mihalko tive in asking the questions they may have.”

Mihalko, who also is in the Campbell Clinic Department of Orthopedic Surgery and Biomedical Engineering, adds, “My advice is that if something doesn’t seem right or they don’t understand something they need to speak up and ask their doctor. There are no stupid questions from a patient. Sometimes there’s that white-coat syndrome or patients get the deer in the headlights feeling or they just forget the questions. I tell patients one of the best things to do is make a list of questions.”

Surgery for an older patient carries some special considerations, but doctors say every case is different and decisions must be tailored to the individual.

“It’s not so much the chronologic age as it is the physiologic age,” says Timothy Fabian, MD, the Harwell Wilson Alumni Professor and chair of the Department of Surgery at UTHSC. “You can have some 50- or 60-year-olds who are going to do worse than some 90-year-olds because they haven’t taken care of themselves. They Dr. Timothy Fabian might have heart disease or they’ve smoked all their lives.

“Is anyone ever too old for surgery?

Not really, but it would depend on what the surgery is. If it’s someone 90 years old with the same inguinal hernia he had for 50 years, that would be someone you wouldn’t want to operate on. But if they’ve got an abdomi-

nal aortic aneurysm that’s getting bigger in size that’s documented and they’re in reasonably good health regardless of their age, then you operate on them.”

Mihalko’s specialty is hip and knee replacement surgery, an elective procedure that he says calls for some practical as well as medical decisions. Some patients start thinking about surgery before they actually need it.

He once did a hip replacement for an otherwise healthy 92-year-old man whose alternative was moving to a nursing home because of his arthritic hip. The surgery allowed the patient to live independently for several more years.

But the surgeon emphasizes to patients that surgery is not always the answer.

“Just because their X-rays say they have bad arthritis doesn’t mean they have to undergo hip or knee replacement,” Mihalko explains. “It all depends on how it’s affecting their life and everyday activities. If they’re still able to take a walk and get in enough exercise to keep their heart and their lungs fit, then it’s probably not time to be thinking about that hip or knee replacement.”

Another reason a patient might want to at least delay such surgery is that the advancements in surgery over the past 15 or 20 years have been unprecedented. There may be a better procedure just ahead.

“Surgery is radically different over the last 15 years in almost all areas, and the technological advances have been incredible,” Fabian says. “Almost every area now has some element of minimal invasive approaches to surgery, be it heart surgery, neuro surgery, orthopedics or general surgery. That’s completely revolutionized all of surgery.

“It’s happened at some expense,” he continues, “but in most circumstances through studies of procedures it’s found to be as effective and safer. In follow-up surveys, in the overwhelming majority, there’s better patient satisfaction with these minimally invasive approaches.”

Mihalko adds that the best is yet to come.

“Progress in medicine is moving much faster, so if you wait three or four years until it is bad enough to be impacting your life there may be a new procedure out or a new treatment that’s going to significantly benefit you,” the doctor says. “We may have a new treatment we didn’t have when all this started, and once you do a hip or knee replacement you burn the bridge. You can’t go back.

“I think too many times a lot of patients get into the mindset that, ‘Well, if I’m going to need it eventually I should just do it now.’

That’s not necessarily the right mindset.

There are many 65-year-olds who are not as fit as some 75-year-olds. There are some 75-year-olds who are out there running halfmarathons. It really comes down to the individual patient, and we need to treat them that way.” memphismedicalnews

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Bobby Meadows, continued from page 1

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nursing homes and rehab centers.

“I was born near the coal fields, where we didn’t have access to a lot of healthcare facilities — particularly nursing homes,” he said. “People took care of each other at home. My mother was always a provider for others, and she instilled in us a love for our elders and seniors — and a desire to care for them that guided me into the industry. I started my career as a certified nursing assistant at a nursing home, and being involved in patient care is still one of the most important parts of my job.”

Meadows personally meets with all new hires who join MJH’s 300-member staff and shares with them his firm conviction: “If you don’t love seniors, then please consider this your last day!”

He credits his father and grandfather for the work ethic that drives him and helped forge a management style that stresses leading by example. “I would never ask a staff member to do anything I wouldn’t do,” he said. “I still enjoy getting out on the floor and taking care of patients.”

After attending Marshall University, Meadows earned a business degree in healthcare management from the University of Alabama before achieving a chain of successes managing several sizable nursing home facilities, maintaining each with 98-99 percent occupancy and 95 percent patient-family satisfaction ratings.

Proud of where he comes from, and proud of where he is, Meadows was drawn by the deep roots and history of faith, plus the integrity and quality of care associated with the Memphis Jewish Home for nearly 90 years.

“To be associated with the Memphis Jewish Home is an honor for me — the greatest accomplishment of my career,” he said.

One unusual challenge he faces, however, is the cost of kosher food. MJH has one of only two kosher restaurants in the Memphis area and serves close to 200 visitors each day from the second-largest kitchen in West Tennessee, Meadows says.

Because kosher-certified chefs are rare, the kitchen also provides catered meals for hotels and other places that are not kosher.

“So we have a little hidden treasure here,” Meadows states. “One that even a lot of the Jewish community aren’t aware of.”

The Home, which accepts all faiths, has a patient population that is 30 percent Jewish. It brings religious services to those unable to attend them because of their health and in reconnecting to their faith, many patients find their identity . . . and inner peace.

Even given its traditional excellence,

the facility offered Meadows initial challenges: inefficient admissions systems and a consequentially reduced census, declining business performance and low staff morale.

Thanks in part to recent renovations and “a huge operational turnaround” during his nearly two-year tenure, the Home has increased its current patient census and gained recognition, awards and titles for both the nursing home and therapy aspects of the facility.

Meadows says the current population today is 157. (Capacity is 160.)

It is now one of Memphis’ “Top 50 Workplaces” (per The Commercial Appeal), “Memphis’ Best Nursing Home” (per Memphis Business Journal), one of the country’s best nursing homes (according to U.S. News &World Report), and ranks in the top five of Memphis Business Journal’s physical rehabilitation units. It has also earned a coveted across-the-board 5-star rating from Centers for Medicare and Medicaid Services.

What’s his secret?

“I’ve always felt that some of the secret to success is making yourself available,” Meadows said. “The patients we serve didn’t get to choose me; I chose to do this.

So I make myself available to them 24-7.

I talk to every patient here and give them and their families my personal cell phone number.”

Not content to be one of the top five therapy providers, Meadows is firmly focused on becoming number one. MJH has one of the largest therapy gyms in the city and one of the highest staff-to-patient ratios; he plans to build upon that by growing the therapy programs, focusing on more patient-centered care and restoring each patient to enjoyment of the activities he or she loves most.

“We want to be the innovative leader of both short-term and long-term care,” he declared. “I want us to be the first choice for everyone’s therapy or nursing home care because we’re the best.”

In today’s healthcare environment, that’s admittedly a tall order. “As a skilled nursing facility, we’re one of the most regulated industries in the country — far more so than hospitals,” he said. “This is a very difficult time, with continued cuts in reimbursement from both Medicare and Medicaid for our senior care. I recently saw a report that claimed that by 2025, nursing homes may be nonexistent. Whether it’s true or not, you have to be concerned.”

In his leisure hours, Meadows enjoys family time with his wife and three daughters ages 5, 9 and 11 — who bike and run together, support Alabama football and bring joy to patients by involving themselves in MJH activities.

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MEMPHIS MEDICAL NEWS MSK Group, P.C., is an integrated orthopaedic group of approximately 36 well-regarded physicians dedicated to comprehensive orthopaedic care. With multiple locations, you are sure to find a convenient location to take care of all your orthopaedic needs.

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Conducting Innovative Public Health Prevention Research

BY LYNNE JETER

TAMPA – Lexington Market-East End, a mini-market located in a historically black “food desert” neighborhood in Kentucky, was once considered an eyesore and unsafe place to shop. Now, it’s the centerpiece of a community driven by new and updated businesses and a stellar example of effective community-based prevention marketing (CBPM) for policy development.

The successful overhaul, resulting from The Good Neighbor Store initiative, exemplifies only one project from an impressive track record that helped the Florida Prevention Research Center (FPRC) at the University of South Florida’s (USF) College of Public Health garner $4.35 million in federal funding over a five-year cycle from the Centers for Disease Control and Prevention (CDC) to conduct innovative public health prevention research among population health disparities.

“We’re thrilled to receive funding for this particular grant, especially this go-round, because the field was highly competitive,” said Carol Bryant, PhD, distinguished USF Health professor and director of the FPRC. “Congress cut the funding level significantly for this cycle,

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dropping the number of recipients from 37 to 25. When we saw the recipient list, there were quite a few surprises. Harvard didn’t make it. Neither did the University of Michigan, which has a very strong program. The University of Texas, an

original recipient with a terrific program, didn’t make it. This time, we competed against the University of Florida for the first time… such a stellar university.”

The list of 24 academic institutions in 25 states became 26 schools when, at the

last minute, the CDC added a second Pennsylvania system, making a second exception not to award two prevention research centers (PRCs) in the same state. (Two New York PRCs received CDC grants.) These PRCs will partner with communities to translate research results into effective public health practices and policies that avoid or counter the risks for chronic illnesses, including heart disease, obesity and cancer.

(See the companion article listing the funded PRCs and their projects on page 13.)

“We worked tirelessly to have a very good proposal,” said Bryant, noting team members skipped vacations last summer and worked nights and weekends to finetune it.

USF, whose FPRC program has been continuously funded since 1998, was the only Florida academic institution to make the final list. The USF center’s specialty niche: social marketing.

The award “helps USF reinforce its brand equity as a leader in communitybased social marketing and gives us the credibility that allows us to be more effective,” said Bryant.

Specifically, the FPRC’s award – $750,000 for the first year – will support research to promote colorectal cancer (CONTINUED ON PAGE 12)

OCTOBER 2014

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ICD-10 Delay, continued from page 4

Academic Internal Medicine Opportunities Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE

Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.

Apply at: https://jobs.etsu.edu Inquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622, Johnson City, TN 37614. Phone (423)439-6367; email: heatonka@etsu.edu.

ATTENTION MEDICAL PRACTICE MANAGERS:

Join Us For Upcoming Educational Luncheons

October 16:

Mitch Graves, President & CEO Healthchoice

November 20: Ed Rafalski, PhD, MPH, FACHE SVP Planning & Marketing Methodist LeBonheur Healthcare

as specialty, vendor and software. To be consistent, this is how the size of the practice was defined.

A small practice is comprised of three providers and two administrative staff.

A medium practice is comprised of 10 providers, one full-time coder and six administrative staff.

A large practice is comprised of 100 providers, 64 coding staff comprised of 10-full time coders and 54 medical records staff.

The estimated costs for medical practices to convert to ICD-10 were released in 2008 and then again in 2014 as follows: • 2008 Study Small practice - $83,290 Medium practice - $285,195 Large practice - $2.7 million • 2014 Study Small practice - $56,639 - $226,105 Medium practice - $213,364 $824,735

Large practice - $2,017,151 $8,018,364 Based on a few budgets of some of the practices I work with, using seven variables, the most outstanding cost was payment disruption. For each size practice, almost 50 percent of the costs in the budget were payment disruption.

About two years ago, in an article I wrote for Memphis Medical News, based on my understanding and after talking with some of my colleagues in different parts of the country, I said, “Set up a budget and I suggest you meet with your banker, because with all the pieces involved you absolutely have a cash flow issue with your practice that could be substantial.”

In light of this, the old cliché holds true for CMS, “Do as I say not as I do.”

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

Conducting, continued from page 11 screenings among underserved populations initially in Hillsborough, Pasco and Pinellas counties, with plans to later expand to other regions of Florida.

The project to promote colorectal cancer screenings among the underserved, selected by the Florida Department of Health, begins in October, Bryant explained.

“This will be our first time for the center to work very closely with research colleagues at Moffitt Cancer Center, and state, regional and local partners, including the state health department, American Cancer Society, and many other community-based organizations in Tampa Bay’s tri-county region,” said Bryant. “Those partnerships will give us a fabulous interdisciplinary team. We’ll learn together how to think about applying social marketing to colorectal cancer screening by looking at the entire system.”

The USF center will identify groups at high-risk for the disease that are most

likely to respond to prevention marketing strategies with changes in behavior and therefore benefit from the tests that can find colorectal polyps or cancer.

Colorectal cancer screening is the second leading cause of cancer deaths among men and women in the United States, pointed out Julie Baldwin, PhD, professor of community and family health, who will become the FPRC co-director with Bryant this month as Bryant transitions to retirement in 2016.

“Building upon established partnerships, we plan to identify, tailor, implement, and evaluate a multilevel intervention to increase colorectal cancer screening using community-based prevention marketing for systems change,” Baldwin said. “We’re very fortunate to draw upon our team’s expertise in social marketing and community-based participatory research, and our experience in developing and evaluating effective colorectal cancer interventions.”

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Funding America’s Prevention Research Centers

BY LYNNE JETER

ALABAMA: University of Alabama at Birmingham: Prevent HIV/AIDS among at-risk young black men living in disadvantaged Birmingham neighborhoods, using a social network intervention and modern communication channels.

ARKANSAS: University of Arkansas for Medical Sciences: Improve hypertension control among Arkansas’s racial and ethnic minorities by identifying cost-effective, selfmanagement strategies using community health workers.

ARIZONA: University of Arizona: Reduce health disparities of Latinos living in Arizona border communities by strengthening nutrition, physical activity and mental health programs, and linkages between primary care settings and county health departments via community health workers.

CALIFORNIA: University of California, San Francisco: Improve care of young black men who have sex with men living with HIV through community-clinical linkages.

CONNECTICUT: Yale University: Improve nutrition and increase physical activity among students and adults in schools and communities in Connecticut by comparing interventions.

FLORIDA: University of South Florida: Increase colorectal cancer screening among adults in partnership with Florida Department of Health.

GEORGIA: Morehouse School of Medicine: Prevent sexually transmitted disease and HIV/ AIDS among black teenagers in Atlanta community organizations by comparing evidence-based interventions.

ILLINOIS: University of Illinois at Chicago: Increase physical activity among the general population through improved access to and use of parks and recreational facilities in lowincome, urban Chicago communities IOWA: University of Iowa: Increase physical activity through use of parks and recreational facilities among adults in Ottumwa, using lay health advisors/community health workers.

KENTUCKY: University of Kentucky: Increase colorectal cancer screening among adults 50 years and older in a medically underserved, rural Appalachian service area, using lay health workers.

LOUISIANA: Tulane University: Increase physical activity and access to healthy foods through sustainable environmental and social immemphismedicalnews

.com

provements in the black neighborhoods of the renowned 9th Ward in New Orleans.

MARYLAND: Johns Hopkins University: Prevent mental health difficulties, substance use (tobacco, alcohol and drug use), risky sexual behaviors (teen pregnancy, age of sexual initiation, HIV transmission), violence, and academic failure among adolescents in Baltimore City Public Schools by providing life skills training.

MASSACHUSETTS: University of Massachusetts Medical School: Increase healthy eating and healthy activities among children in Worcester through a built environment intervention, using family-focused community health workers.

MINNESOTA: University of Minnesota: Increase academic performance and reduce violence, bullying, age of sexual initiation, and substance use among middle school students in the Minneapolis-St. Paul metro area with a teacher-student team social, emotional learning program.

NEW HAMPSHIRE: Dartmouth College: Reduce smoking, cardiovascular disease and obesity among persons with serious mental illness through community-clinical linkages and health systems interventions.

NEW MEXICO: University of New Mexico Health Sciences Center: Promote healthy eating, active living, and tobacco-free living in rural Hispanic, American Indian and Anglo communities in Cuba and surrounding communities.

NEW YORK: New York University School of Medicine: Improve hypertension control and prevent cardiovascular disease among Asian and Hispanic American adults in New York City by implementing the Million Hearts Initiative, using a combination of community health workers and clinical interventions.

University of Rochester: Increase healthy eating and physical activity by adapting an evidenced-based healthy lifestyle intervention for use with deaf adult American Sign Language (ASL) users in Rochester.

NORTH CAROLINA: University of North Carolina at Chapel Hill: Increase physical activity and healthy eating, and prevent cardiovascular disease among adults through clinical-community linkages in Hertford and surrounding communities using technology-assisted community health workers.

OHIO: Case Western Reserve University: Improve nutritious food access in low-income, lowaccess Cleveland neighborhoods through farmer’s markets and nutrition education.

OREGON: Oregon Health & Science University: Pre-

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Medicare Math, continued from page 6 tribution and computations, we will receive $36 million less in Tennessee than we would have under the traditional formula of DSH payments.” He added large, urban hospitals would feel the brunt of those cuts, absorbing approximately $32.5 million of the anticipated $36 million in lost reimbursement.

David For those keeping up McClure with the math, the reimbursement picture now looks like this — $60 million on the plus side for FY-2015 and approximately $69.5 million in new cuts. “Then on top of that, you take away another 2 percent for sequestration,” McClure continued, noting the automatic spending cuts are currently scheduled through 2024.

Monetary Penalties After all the automatic cuts, hospitals must also factor in monetary penalties associated with quality metrics.

“From the quality side, there are really three metrics being considered this year — value-based purchasing, readmissions and hospital-acquired conditions,” McClure said. He added the 19 different measures being considered under value-based purchasing are anticipated to be an economic wash for hospitals in Tennessee.

As for the readmissions penalty, McClure noted CMS has increased the area

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of focus from three in 2014 to five in 2015 with the addition of COPD and elective hip and knee implants. “The cap in the penalty also moves from 2 percent to 3 percent in 2015,” he said. The estimate is that Tennessee hospitals will probably see close to $10 million in penalties this coming year.

Similarly, CMS is looking at eight different measures under hospital-acquired conditions and comparing and ranking hospitals nationally. Those in the worst quartile for HACs will see Medicare payments reduced by 1 percent. “We estimate there will probably be 17 or 18 hospitals in Tennessee (that fall in that quartile), and estimate it will reduce those hospitals’ payments by $7 million total,” he said.

McClure noted that at the time he spoke to Medical News CMS had yet to publish the final data on hospitals regarding both the readmissions and HAC program but that information was anticipated to be available by Oct. 1.

The Bottom Line “When you get to the bottom, bottom line, we would get $25 million less than we did last year,” McClure said of expectations for FY-2015 in Tennessee. That reduction, which equals close to a 1 percent cut from FY-2014, coupled with wiping out the entire 2.3 percent increase touted for FY-2015 means area hospitals will receive about 3 percent less than anticipated this coming year. “Right now we’re in the neighborhood of receiving 92-93 percent

of cost … so we’re getting paid less than cost,” McClure pointed out of net Medicare IPPS payments.

So how do hospitals keep the doors open? “Hopefully CMS is correct and some of these (newly) insured will come into the hospital and help provide some cash flow and help the hospitals survive,” he said of those joining commercial plans through the

federal healthcare marketplace.

However, he noted, many of the newly insured are opting for high deductible plans that have a lower monthly costs. “They get federal subsidies for their premiums but not for their deductibles,” McClure continued.

“Some folks are having a hard enough time paying premiums. I don’t know how they’ll pay a $5,000 or $10,000 deductible.”

AHA Reacts to Final Rule Linda Fishman, senior vice president for the American Hospital Association, released the following statement regarding the IPPS final rule: “Today’s rule will make it more difficult for hospitals to maintain their commitment to their communities. We are very disappointed that the ACAmandated Medicare Disproportionate Share Hospital (DSH) cut is significantly higher than originally proposed. While we understand some of the reductions are due to increased coverage, it is unclear how CMS arrived at the remaining reductions. These payments provide vital support to hospitals that serve the most vulnerable patients. That’s why we continue to urge Congress to help hospitals and patients by delaying the Medicare DSH cuts for two years.

While we appreciate CMS making refinements to its scoring methodology for the hospital-acquired conditions penalty program, one-fourth of hospitals will continue to be penalized regardless of their improvement in quality. Additionally, the program negatively affects those hospitals caring for older, sicker patients. We will continue to urge Congress to develop an alternative proposal that would more effectively promote hospital quality improvement.

We appreciate CMS’ willingness to involve stakeholders on developing a methodology that will more accurately pay for short inpatient stays, and we will work with CMS on this important issue.”

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Doctor’s Orders

BY TIM NICHOLSON

I sat in the parking garage, phone to my ear, breaking bad news to the doctor/ client on the other end of the line. He, most likely standing just outside a patient exam room, showed me what might be a healer’s most valuable trait.

The business I’ve run for the past 10 plus years is winding down. Like a patient with a chronic condition that doomed it to a half-life, it would never be its former self or a better self. I’d made the decision to close it.

The past couple of years had been an experiment to see if there was a cure for what ailed the business. There were efforts at giving away the day-to-day to those closer to the client and presumably the culture. There were also the sometimes successful but short-lived efforts to build another business from within it. And of course, the ill-fated attempt to become better at managing the business and less of being the business. None of these in-house remedies would do more than treat the symptoms or frankly simply mask the condition.

So, I started a series of letters and phone calls to those who’d become part of my family. Most humored my description of what was going on for a moment before quickly asking, “what’s this mean to my whatever it is/was we’re doing together?” I get that. It’s always been about the customer.

But this one was different. “So, how are you doing?” he replied. “You know you’ve helped to bring my practice into the 21st century.”

I thanked him for that and began to apologize for the inconvenience my closing would create for his business. He interrupted, “This is business. You have great ideas. First, you have to take care of yourself. I want you to trust your instincts and ignore what other people say.”

A lump formed in my throat.

I’d imagined how many times he’d offered similar advice to a young mother.

That’s part of what pediatricians do, right? And considering that he sees 30 plus moms and their children each day and has for twenty-plus years, he probably knows what works and what doesn’t.

He’s treating the child and in some measure the mom. She second-guesses herself in response to a mother-in-law’s comment, something a teacher has said, or some child-expert on television.

“You’re not doing this right” or “that’s not how we did it in my day.” And she starts to doubt herself. He turns the doubt around.

So Dr. Bubba Edwards, thanks for your bedside manner – empathetic and hopeful – and for extending your wisdom to me. You captured in a moment what I’d sought to find for the past couple of years. While the things we tried were sincere and genuine efforts they ran counter to what my intuition was telling me – it said, “It’s okay to be the brand and to let talented others lift it. They’ll rise, too.”

I didn’t listen then but I’ll have to now, doctor’s orders.

So Doc, thanks for indulging me these past two years as Memphis Medical News has allowed me to share thoughts regarding the medical community’s use of social media. What men and women like you and Dr. Edwards do each day is invaluable. And while they say that Dr. Google is the most popular “physician” on the Internet, it’s still you the patient most trusts. Hey, you don’t have to practice medicine alongside “him” but you can use Facebook, Twitter, Pinterest or Instagram to remind them of something he can’t do, care.

Tim C. Nicholson is the President of Bigfish, LLC. Find him on twitter @ timbigfish or email tim@gobigfishgo.com

Funding America’s, continued from page 13 vent sexually transmitted infections, HIV, substance use, tobacco use, and teen pregnancies among American Indian/Alaska Native teens in underserved communities in Portland and surrounding areas by implementing a culturally appropriate, evidence-based intervention delivered by tribal health educators.

PENNSYLVANIA: University of Pennsylvania: Promote healthy weight among obese adults through a workplace weight loss program in three Philadelphia businesses, using environmental change strategies.

University of Pittsburgh: Improve physical functioning and reduce obesity and subsequent chronic disease among older adults in Allegheny County through a weight management lifestyle intervention.

SOUTH CAROLINA: University of South Carolina at Columbia: memphismedicalnews

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Increase healthy eating and leisure-time physical activity among blacks through an evidence-based program in rural South Carolina churches, using lay health workers.

WASHINGTON: University of Washington: Decrease pain and increase mobility of adults with arthritis by implementing a community exercise program (Enhanced Fitness) through community-clinical linkages with healthcare providers and the YMCA. WEST VIRGINIA: West Virginia University: Improve physical activity behaviors among middle school children in West Virginia by comparing school- and family-based interventions.

For more information on Prevention Research Centers nationwide, visit http://www.cdc.gov/prc.

Your Practice – Your Brand

Valuing a Bucket of Ice Water on Your Head

Yes, I am one of the thousands or people who willingly let someone dump a bucket of ice chilled water over my head. I did it because I thought it was fun to be a part of something that big, that viral. I wanted to be able to challenge friends of mine to do the same. And, by the way, I also donated to the ALS Foundation (Amyotrophic Lateral Sclerosis, often referred to as “Lou Gehrig’s Disease”).

While donating on the website, I learned more about the disease, something I had never sought out before. Apparently many others have done the same, because as of my writing this in mid-September, Ice Bucket Challenge donations have surpassed the $112 million mark.

To me, the success of the Ice Bucket Challenge is amazing and unprecedented.

I don’t think anyone could have imagined something so individual becoming so international; something so simple and completely unrelated to the cause being such fundraising simple-genius. But it is, and it has become one of those once-in-alifetime “lightening in a bottle” examples.

So what does this online fundraising phenomenon have to do with the readers of Memphis Medical News? I would say lots. Like the ALS Foundation, many practices in the vast medical world go for years operating successfully, well out of the eyes of popular culture. You have your patients, your referring doctors, your associates in the profession and the organizations in which you are involved, and they all know you well enough to make your business a success.

The question is, what would your organization do with a sudden flash of attention, and as a result a strain and drain on the organization to keep up with all the new business, inquires and demands on its time. To me, just as impressive as the Ice Bucket Challenge’s success and the dollars flowing in is that the ALS Foundation has been able to take it all in stride. The website has been able to keep up without the glitches that so often paralyze an organization when traffic surges (healtcaremarketplace website anyone?). The few anti sentiments to ALS Research based on religious beliefs that tried to rise against the campaign never caught traction. And, most important, the ALS Foundation seems poised and prepared to take this surge of awareness and build upon it. Hard to remember, but there was once a time when the Susan G. Komen Race for The Cure was a new idea, and the St. Jude Children’s Research Hospital Thanks and Giving Campaign signed its first celebrity. Those organizations used the media platform for growth and for good.

Most of you are not charities, but most of your organizations do have very smart doctors practicing or doing research. If something you discovered or pioneered suddenly took off on a national basis, the organization needs to make sure that not only the science is at the top of its game, but the communication tools, channels and messages are as well. Policy and procedure and information flow must be flawless in execution for every patient and inquiry. Organizations that experience a rare 15 minutes of fame are often limited to just that 15 minutes, not because they don’t deserve more, but because they can’t handle more.

Every time you market in any way, make sure to step back and also ask, “If this is as successful as I hope it can be, am I ready?” If the answer is yes, then ask, “If this is successful beyond expectations, what do I need to do to quickly become ready?”

Perhaps the greatest benefit of the Ice Bucket Challenge to all of us beyond The ALS Foundation is that it is a cold splash of reality that marketing success demands preparation. If not prepared it might just be nothing more than a splash.

— Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding,rberry@sullivanbranding.com To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com

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Reimbursement Revisit A look at payment innovation

BY CINDY SANDERS

While physicians and facilities have long had to keep up with different negotiated contract rates among payers, the reimbursement landscape has become much more varied over the last few years as a push toward payment innovation has ushered in a host of reimbursement options ranging from shared savings programs to bundled payments to carrot-and-stick compensation as applied to quality and efficiency metrics.

Rob Lazerow, practice manager for Research & Insight at The Advisory Board Company, recently analyzed some of the payment changes providers are navigating as the healthcare system begins to shift away from a feefor-service model. While the traditional payment method based on volume still makes up the majority of healthcare reimburse- Rob Lazerow ments, Lazerow said it appears the shift toward accountability models is picking up steam … albeit slowly.

Lazerow, who is based in Washington, D.C., has created a ‘Field Guide to Medicare Payment Innovation’ (advisory. com). However, he was quick to note the transformation isn’t limited to the Centers

for Medicare & Medicaid Services. “There is a lot of payment innovation happening right now, and it’s happening in both the public and private sectors,” he said. Lazerow added CMS, commercial payers, state Medicaid programs and employers are all experimenting with new payment models in markets across the country.

While there is any number of subtle variations within the pilot projects, Lazerow said there are generally three big categories of payment innovation being rolled out at this time — pay-for-performance initiatives, bundled payments, and shared savings reimbursement models.

Pay-For-Performance “It’s still a fee-for-service payment, but a portion is withheld and linked to predefined metrics, including process, outcomes and patient satisfaction measures,” he said. “Medicare has a lot of experience here,” Lazerow added of the Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program and hospital-acquired conditions (HAC) penalties.

Lazerow said in some cases, it could mean hospitals must invest in performance software or additional manpower to provide the necessary outcomes data … effectively making it cost more to capture the same reimbursement rate compared to the pre-

pay-for-performance world. However, as Lazerow pointed out, this isn’t a ‘request’ from CMS. These are mandatory programs for all hospitals that accept Medicare prospective payments with two of the three already in place and the HAC penalties set to begin in fiscal year 2015.

“We’re seeing pay-for-performance in hospitals and physician practices,” Lazerow said, noting the reimbursement model has spread past the Medicare population. “The challenge then becomes having different payers with different metrics.”

Even when broad categories of data collection apply to multiple payers, it isn’t uncommon for each to ask providers to drill down to different outcomes measures within the umbrella category. “As you can imagine, the reporting and compliance burden continues to grow,” Lazerow noted.

Bundled Payments Lazerow said bundled payments offer a different take on volume-driven reimbursement by coordinating care among all providers responsible for a patient’s diagnosis, treatment and rehabilitation and inserting a level of accountability into the group dynamic.

“In a traditional fee-for-service world, all these providers are paid individually and have no aligned incentives or mutual

accountability,” he explained. Although bundled payments are still volume-based … the more you do, the more you are paid …

Lazerow said the concept focuses on costs and outcomes. “A bundled payment drives efficiency and quality within a discreet episode of care.”

For payers, Lazerow said the reimbursement model creates both savings and price predictability. The sum for the bundle of care is generally less than would have been paid individually to those involved.

On the provider side, the reimbursement option helps drive efficiency and care coordination with a goal of having the patient receive the right care in the right setting to maximize outcomes and minimize costs.

While Medicare has a big program around bundled payments, Lazerow said this model has been adopted by the spectrum of payers including private employers. Wal-Mart, he noted, has established a bundled payment program around certain cardiac care and orthopaedic procedures.

Although most current bundled payment programs are designed around specific procedures such as hip replacement or cardiac bypass surgery, Lazerow noted, “We’re starting to hear more interest around medical admissions, as well as the procedures.”

(CONTINUED ON PAGE 20)

It’s not what we treat, it’s who.

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Impact, continued from page 1 collection agencies and told ‘just pay $20 a month on it, we’ll get to it,’” said Sumpter, who said court evidence will show that since January nothing has been paid to the third-party administrator, Cigna.

“The proper thing to have done would have been for Cigna to cancel the plan and notify employees. Had they done that or had the hospital done that, these employees would have been able to get on the health care exchange. They would have at least had health insurance,” he said.

Cigna is named in the lawsuit as well as the Crittenden Hospital Association; Gene Cashman, the former CEO; and David Raines, the chairman of the board.

In a statement to Memphis Medical News, Cigna said it “does not comment on pending litigation, and any questions related to the hospital’s self-funded benefit plan should be directed to the hospital.”

The hospital closed on September 7 with an estimated debt of nearly $30 million ($23 million plus a $6 million lien on the property). It filed for Chapter 7 bankruptcy five days after closing.

A referendum on a one-cent sales tax increase had been passed in June to help the hospital, with county voters approving it by 86 percent. The tax would have generated $30 million for the hospital over five years to keep the facility from closing.

The tax was to start collection October 1.

Crittenden County Judge Woody Wheeless said officials are trying to get the tax stopped, but it would take another vote to discontinue it.

“The earliest we can get it on the ballot is December, so it is possible that two months’ worth of taxes could be collected. The only thing the money can be used for is maintenance and operations of the hospital,” he said. “I am going before a circuit judge to determine where we go from here. The State of Arkansas said it is the first time a tax has been asked to be repealed before it was collected.”

Regarding the allegations, he said a financial audit by an outside firm is warranted. He cited monthly financial statements required per a decades-old agreement with the hospital association.

He said he had requested them but hadn’t received them for 21 months. Wheeless also said employee pensions are underfunded by an estimated $9 million.

He recounted the job losses, lost benefits, debt, lack of emergency services for the citizens and said, “This is the biggest nightmare for our county.”

One of the hurdles in finding a buyer or tenant for the hospital is that the buildings are part of the bankruptcy. The property was used as collateral to back $8 million in revenue bonds taken out by the Crittenden Hospital Association in 2007.

Wheeless said $6 million is still owed, and an arrangement would have to be made with bondholders before the property could reopen. A team is being formed to actively recruit potential hospital users.

Interest has been expressed in the facilities before, he said, but renovation and modernization costs had been prohibitive.

Wheeless said a number of doctors

are owed money by the hospital. The ones with practices bought by the hospital were sent scrambling to set up elsewhere and get relicensed with insurance companies and the Affordable Care Act in order to continue in practice, he said. Those doctors are having to admit patients to other Arkansas hospitals or to Memphis.

Memphis hospitals most likely to now see Crittenden County patients are Methodist University Hospital, Regional One and Le Bonheur Children’s Hospital. Le Bonheur spokesperson Sara Burnett said there is really no change in service to Crittenden in pediatrics.

“We already had a very positive relationship with the regionals,” she said.

“With Pedi-Flite and our designation as a children’s trauma center on the state level in Tennessee, Arkansas and Mississippi, we would have gotten those children here anyway.”

Regional One said the same. “We already have the trauma business from Crittenden and the high risk OB,” said spokesperson Angie Golding. “We have seen an increase in our ED, but not a level of volume we can’t handle – more like an uptick in non-critical emergency. And we had experienced that increase before when they closed for six weeks after their fire (earlier this year).”

Ray Walther, MD, medical director of the Methodist University emergency department, said it initially had experienced about 20 to 30 visits a day above its usual volume. Those numbers are stabilizing, he said, and the recent move into a new, more spacious ED was helping. He also said major trauma would go to Regional One, but Methodist is seeing more people with chronic illnesses such as chronic heart failure, cardiac problems and diabetes and other medical problems.

Because CRH was part of a stroke network in Arkansas, he expects to see more of those primary neurologic and cardiac events as well.

Walther is a veteran director of emergency departments in rural hospitals in Somerville, Brownsville, Dyersburg, Osceola, Blytheville and Wynne, and expressed concern about the lack of emergency services in Crittenden County.

“It is difficult for me to believe a county that large would go without a hospital,” he said. “However, Brownsville has closed and there have been lots of closings of rural hospitals across the United States.

The number of ERs nationally is declining. You would think level one trauma would be brought to trauma centers here by helicopter. However, a lot of people walk in and drive themselves when it’s very serious trauma, so theoretically, there could be deaths.”

Cristie Hollis, a patient and former employee of CRH, said her family will have to go to Memphis to receive emergency care. “Unfortunately, the only two times my husband and I needed care, there really wasn’t time to get to Memphis,” she said. “My husband probably would have died if not for being stabilized at CRH before transport to Memphis.”

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Manners Matter

As the New Health Economy forces physicians to become patient-centric, customer service moves to the forefront

BY LYNNE JETER

For years, the primary care doctor was a trusted person considered almost family.

From house calls to meeting a patient late at night or on weekends, physicians were known for their manners, going the extra mile for patients, and their trustworthiness.

Media portrayed healers as wise professionals in movies and television shows.

Yet lately doctors aren’t quite viewed the same way, especially as medicine is becoming consumer-driven. Patients often grumble about long waits while visiting their doctor; physicians who seem disinterested, rude, or arrogant; or a staff that lacks empathy.

As a result, some folks say the family doctor doesn’t seem the same. What’s changed in healthcare? Have doctors become ruder or is it because of shortages in the medical profession that doctors no longer have as much time to provide individualized service? What should patients expect from doctors? What should doctors expect from patients?

“Dr. Silverman and I have been in practice since the late 1960s, and we’ve noticed that doctors’ manners have deteriorated over the last few decades. Now you can see it in the popular media,” said Atlanta pediatrician Saul Adler, MD, who co-wrote “Your Doctors’ Manners Matter: Better Health through Civility in the Doctor’s Office and in the Hospital,” (BookLogix, 2014) with Atlanta cardiologist Barry Silverman, MD. “A certain percentage of the population is always shopping for new doctors. Maybe they move to a new town, or change insurance plans, or as the economy improves, people are moving out of their parents’ home and establishing new households. The layperson can’t really evaluate his skills, but if the doctor treats you with respect, listens to you, addresses all your concerns, and you leave the office feeling this doctor is somebody who has your best interest at heart, then you’ve found a doctor you can work with and respect.”

Maintaining the Health of Your Practice Nick Hernandez, MBA, FACHE, CEO of ABISA LLC, a Florida-based healthcare consulting firm that specializes in solo and small group practice management, said perhaps more than ever, physicians need to be focused not just on attracting more patients, but also on not losing the patients they have.

Aside from physician-specific interaction, Hernandez emphasized three areas of attention for practices, to prevent losing current patients: A disrespectful staff. “The correlation between respect and patient safety has been well-documented, but a disrespectful staff can also impact the health of your memphismedicalnews

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practice,” said Hernandez. “Whether it’s absent-mindedness or plain unprofessional behavior on behalf of your staff, these poor attitudes will lead to lost patients. No matter how small the staff, most practices could use a primer or refresher on customer service. Using words please, thank you, and you’re welcome can go a long way.”

A dreary, dull office appearance.

“There are many things your practice can do to overcome this without spending a lot of money on remodeling,” said Hernandez. “Does your staff straighten magazines and tidy up throughout the day? How old is your reading material in the lobby and waiting areas? It’s a good rule to never have magazines that are a year old.” Hernandez noted other small changes to make a big difference.

“When’s the last time your lobby received a fresh coat of paint? If you have a small operation and don’t have janitorial service nightly, then on the days without service, have your receptionist run a vacuum through the lobby area at the end of the day.”

Elongated office delays. “Scores of data from patient satisfaction surveys show that patients are extremely frustrated when their appointment time is delayed significantly,” Hernandez pointed out. “While patient care is certainly not as programmed as an automated manufacturing line, many practices could run much more efficiently if they scrutinized the operational flow of the practice.”

Sometimes, common sense and good manners should prevail, said Hernandez.

“As time-impacting issues arise during the day, communicate that to your patients,” he encouraged. “They’ll be much more forgiving if they’re aware of the schedule. Remember, it’s highly unlikely this appointment to your office is the only thing they have on their agenda for the day.”

Especially in the age of social media, word about poor service travels at lightning speed.

“Patients still tend to assess provider quality in terms of service and access,” said Hernandez. “It’s the wait time, the rude staff, and the inability to stick to a schedule that anger patients. The key is to not have patients leave the practice because of poor office policies or simple misunderstandings.”

Best Practices: Social Media Marketing In a recent column, “Big Fish,” Tim Nicholson, CEO of Big Fish LLC, a Memphis-based healthcare marketing firm, discussed Best Practices for social media marketing that involve enabling more voices.

“It’s difficult to build community with-

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Reimbursement Revisit, continued from page 16 Shared Savings Models Although bundled payments might be highly effective for unavoidable care, the concept doesn’t address preventive care.

That’s where accountable care models … also known as shared savings … step in to apply population health metrics to mitigate potentially avoidable healthcare spending.

The intent with these reimbursement models is typically to spend some in order to save more.

“The big focus right now is on shared savings models,” Lazerow pointed out. He added providers work together against a pre-set annual spending target per patient.

Unlike past payment experiments based on monthly capitated payments, the shared savings model combines existing fee-for-service payments with a reconciliation process at the end of the year. Providers then share in a percentage of the savings they generate. Best practices and quality metrics are a foundational element to ensure patients aren’t denied necessary care simply to save money.

“The overall concept of the ACO is these providers are collectively accountable for the total cost and quality of care for populations of patients over time,” Lazerow stated.

From Medicare Advantage plans to self-funded employers, the focus on population health has taken root across the country. While providers also seem to embrace the evidence-based concepts and focus on chronic disease management integral to population health, the financial realities of such programs have proven problematic in some cases. Lazerow noted that of the 32 original participants in the CMS Pioneer ACO program, nearly one-third have left … with seven moving to Medicare shared savings programs, which have a lower risk profile for providers, and three dropping out altogether.

“One challenge providers are facing is that sharing 50 cents on the dollar of volumes they are destroying might end up creating a negative financial outcome for the health system,” said Lazerow. “They’re not capturing enough of the savings they are generating.”

The Bottom Line Lazerow noted he hears different sentiments from different providers as to which payment innovations they prefer. Some, he added, might like to stay in the traditional fee-for-service model, but that ultimately is unlikely given payer demands for more accountability, increased savings and improved efficiency.

“Some providers right now, given their market dynamics, are in a watch and wait mode, but each year we see more and more payers and providers experimenting with accountable payment models,” Lazerow concluded.

Impact, continued from page 18 She said she was unable to comment further on the closing of CRH due to the lawsuit.

Rural ambulance services have been stretched. Crittenden Ambulance Service Corporation has reported that calls that previously took 15 to 20 minutes sometimes were taking hours. Judy Thomas of CAS said that concerns not only included construction delays but also longer trips and bridge icing in winter.

“There are elderly residents that just refuse to cross that bridge,” she said. “And if we are in transport to Memphis from Earle or somewhere and then we have a wait time, it is taking critical care for other patients out of the county.”

The closure is also sending some jobs across the river. A job fair was held for CRH employees before the closing. Organized by Methodist Le Bonheur Healthcare, a management consultant to the hospital, the fair included Methodist Le Bonheur, Tenet/St. Francis, Office Team, Regional One Health, Baptist Memorial Health Care, Helena Regional Medicine, Christ Community Health Services and others for a total of 33 employers.

Methodist reported about six hires from the fair just a couple of weeks after it was held, said Tracy Moore of Methodist human resources. Regional One had two new hires at that time as well and also had received several applications, Angie Golding said. Bright Star Care, a nurse staffing agency, had a few applicants and expected more, said branch manager Kay Shultz.

The home health and hospice portion of CRH was bought before bankruptcy was filed, enabling patients to have no interruption in service and to see the same caregivers. It was acquired by Scott Ferguson, a West Memphis radiologist, and Rick Williams, an owner of hospice care facilities around Arkansas. The sale saved about 50 out of more than 400 jobs within the Crittenden regional system.

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GrandRounds LifeLinc Expands Services in Three States LifeLinc Anesthesia, a growing anesthesia management company based in Memphis, Tennessee, is proud to announce partnerships with four new medical facilities in the southeastern United States. Delta Gastroenterology in Southaven, Mississippi, Digestive Health Center in Ocean Springs, Mississippi, St. Anthony Healthcare in Englewood, Florida and Tri-State Gastroenterology in Crestview Hills, Kentucky will all utilize various aspects of LifeLinc’s management model for their anesthesia services. The addition of these four facilities will further bolster LifeLinc’s portfolio of both gastroenterology and pain management partners.

Since the company’s formation in 2003, LifeLinc has grown to provide services in ninestates for hospitals, ASCs and office-based practices. Deep management experience coupled with unmatched clinical expertise has driven LifeLinc’s leadership in reducing costs and increasing surgical facility efficiency and quality. Callan explains, “Our top priority is always patient safety. We pride ourselves in our anesthesia providers and the support we are able to give them. We also understand that with strong physician leadership and CRNAs working to their full scope and potential, we can continue to eliminate barriers to efficient care in surgical facilities across the country.”

In addition to now employing over 100 anesthesia providers, LifeLinc’s expanded administrative staff now includes an in-house legal counsel, a compliance officer and dataanalysts, joining the company’s billing, provider recruiting, credentialing and payor enrollment staff. LifeLinc continues to expand their internal, data-driven quality and performance measures with the goal of consistently exceeding national benchmarks.

Staff Additions at Semmes Murphey Foundation Semmes Murphey Foundation has added two Part-Time Research Project Assistants. In this Danielle Millay role Danielle Millay and Olivia Gibson will assist with The National Neurosurgical Quality Outcomes Registry (N2QOD) for measuring neurosurgery quality outcomes. Olivia Gibson For more information visit www.semmesmurphey-foundation.org.

Manners Matter, continued from page 19 out conversation,” Nicholson explained.

“Creating good content isn’t good enough.

Invite trusted sources to guest post on your page. Host a Facebook Q&A with a physician from your team. Get a conversation started. And don’t be afraid of what you hear. Helping people get it right makes you the most valuable voice in the community.”

“Avoid broadcasting” means not limiting a social media presence to announcements regarding office hours, new staff members, and new services. If doctors’ social media connection doesn’t compel interaction, Nicholson said, “You’re Charlie Brown’s schoolteacher. Sure, she had important information to share, but all the kids heard was, ‘Wah, wah, wah.’”

Patients also follow one of marketing’s golden rules: People are attracted to images of themselves.

“Potential new patients are smart and have learned to use your Facebook wall as a place to find out who makes up your community,” said Nicholson. “If they don’t see people like themselves, they’ll be less inclined to connect. We’re clearly not advocating excluding anyone. We’re encouraging you to be intentional in your marketing. A grandmother who likes a pediatrician’s page is not nearly as good a match to a potential new patient as a young woman who does.”

More than anything else, know what patients want, said Nicholson.

“You can be a leader in empowering a healthcare community, who in turn advocates for your brand and sees you as among the best practices,” he said. memphismedicalnews

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GrandRounds Mitchell Family Medicine Joins Methodist Primary Care Group Marion residents Aaron Mitchell, MD, and nurse practitioner Jama Davis, both with Mitchell Family Medicine have joined Methodist Primary Care Group.

Aligning with Methodist allows the practice to remain in its current Marion location and offer the Dr. Aaron Mitchell same operating hours.

Dr. Mitchell is the only physician in Marion who is board certified in family medicine. He sees patients ranging from newborns to senior citizens. Nurse practitioner Davis treats walk-in Jama Davis patients and also provides women’s health services.

Dr. Mitchell earned a Bachelor of Science degree in bio-medical chemistry with a minor in biology from Oral Roberts University in Tulsa, Okla. He continued his education at the University of Arkansas for Medical Sciences where he earned his doctor of medicine degree. He completed his residency at the University of Arkansas for Medical Science Area Health Education Center where he was chief resident. While in medical school, Dr. Mitchell completed his MBA with the University of Arkansas at Little Rock.

Davis earned a Bachelor of Science degree in nursing from Missouri Southern State College in Joplin, Mo. She received her Master of Science in nursing, family nurse practitioner degree from Arkansas State University in Jonesboro, Ark.

UT Medical Group Names CEO Andrew “Drew” Botschner has been appointed chief executive officer for UT Medical Group Inc. Botschner was previously an owner/ operator and general counsel for CarePoint Partners LLC, a Cincinnati-based provider of pharmacy and related services for patients who need home-based infusion services. He also served as general counsel for UC Physicians, the faculty practice group for the University of Cincinnati Medical School, and for Ohio’s Deaconess Health System.

Dr. David M. Stern, Drew Botschner who chairs UTMG’s board of directors and is executive dean at the University of Tennessee Health Science Center said that Botschner has experience in healthcare as an attorney, businessman and administrator will help take the organization to the next level. In his role as general counsel for UC Physicians, he was an integral part of re-engineering the practice plan to its currently very successful form. During the course of this

work, Botschner worked extensively with physicians and administrators in multiple health systems.

An Ohio native, Botschner earned a bachelor’s degree and a law degree from Wake Forest University and a master’s degree in business administration from Xavier University.

Baptist Memorial Rehabilitation Hospital Set for October Baptist Memorial Rehabilitation Hospital, in affiliation with Centre Healthcare Baptist Memorial Health Care and Centre Healthcare, a national provider of inpatient acute rehabilitation services, dedicated solely to partnering with medical centers to develop and operate acute rehab hospitals, have partnered to build the new inpatient rehabilitation facility, Baptist Memorial Rehabilitation, which is set to open this month.

The brand new 49-bed freestanding hospital will provide a wide range of clinical services for patients recovering from complex neurological conditions, strokes, brain and spinal cord injuries, complex orthopedic injuries, amputations and other conditions. To facilitate the treatment of these patients, the new hospital will have all private rooms and contain specialty features such as a dedicated stroke unit, an Activity of Daily Living space, a mobility courtyard and an expansive therapy gym.

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GrandRounds Baptist Memphis Wins Pharmacy Award The Department of Pharmacy at Baptist Memorial Hospital Memphis was recently presented with the Innovative Health-System Pharmacy Practice Award by the Tennessee Society of Health-System Pharmacists.

The award is given annually to a pharmacy department staff in a hospital with more than 100 beds in recognition of efforts which advanced the level of pharmacy services within the past two years.

By making this move pharmacists in the flagship hospital are more visible, more involved and are a more immediate service to nurses and ancillary staff. The inpatient staff assists with providing services to the ambulatory care center, stem cell center, cardiac services as well as offsite physician practices.

Regional One Health and UTHSC Launch New Faculty Practice Regional One Health and the University of Tennessee Health Science Center (UTHSC) have partnered to create a new academic physician group that will enhance the delivery of specialty care and hospital-based medical services in the Memphis area. The new group, called UT Regional One Physicians, launched October 1, and includes many UT Medical Group, Inc. (UTMG) physicians who have a strong history of affiliation with Regional One Health.

UT Regional One Physicians will provide services in several adult medical specialties including cardiology, obstetrics/gynecology, maternal fetal medicine, infectious disease, hematology, as well as several services provided in both the hospital and outpatient settings such as surgeons, radiologists and anesthesiologists.

The formation of UT Regional One Physicians provides the ideal physician and hospital model while maintaining a commitment to an academic mission and improving the health of the community.

UT Regional One Physicians is physician led, ensuring the providers have the support they need to provide the best patient care. The health system management by Regional One Health provides opportunities for synergies and best practice in administration and process improvement for positive patient experiences. Finally, UTHSC involvement as the academic partner provides research and innovation that can lead to better outcomes. All providers in UT Regional One Physicians will be UTHSC faculty members, and the group will be governed by an 8-member board of directors including practicing physicians. The practice group is the largest academic-affiliated physician organization in the mid-south.

Hospitals across the country are realizing that they can no longer settle for the status quo when it comes to anesthesia services. Those hospitals are turning to LifeLinc.

At LifeLinc, we specialize in identifying and fulfilling the clinical and financial goals that best fit your needs.

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Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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