Mississippi Medical News July 2013

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PHYSICIAN SPOTLIGHT PAGE 3

William A. Billups III, MD ON ROUNDS

North Mississippi Health Services had 31 leaders and Baldrige Committee members, along with 31 lottery winners in attendance at the Malcolm Baldrige National Quality Award Ceremony in Baltimore, Md. Employees submitted their name for a drawing, with winners (pictured here) selected to represent various work groups.

Garnering ‘The Baldrige’ Skin Cancer Treatment Advancement

Non-surgical alternative for treatment of NMSC eliminates scarring, better choice for older patients Terri Hayes Henson, MD, was aware of the underutilization of superficial radiation therapy (SRT), a non-invasive alternative treatment for non-melanoma skin cancer (NMSC) approved by the FDA in 2007. After thoroughly discussing the new modality with Mohs surgeons across the country ... 4 The Mississippi State Medical Association (MSMA) 145th Annual Session Business Meeting will take place Aug. 16-17 at the Norman C. Nelson Student Union on the campus of the University of Mississippi Medical Center in Jackson.

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NMHS one of four organizations nationwide to receive 2012 national quality award TUPELO—When North Mississippi Health Services (NMHS), the nation’s largest rural health system, received the coveted 2012 Malcolm Baldrige National Quality Award, more than 60 representatives from the Tupelo-based organization clapped and cheered as NMHS CEO John Heer and Bobby Martin, past chairman of the NMHS Board of Directors, accepted the nation’s highest presidential honor for performance excellence through innovation, improvement and visionary leadership.

Only four U.S. organizations received the award during an April 8 ceremony in Baltimore, Md., commemorating the 25th anniversary of “The Baldrige.”

“We’re honored to receive the Baldrige Award as it recognizes ‘role model’ performance and demonstrates a long-term commitment (CONTINUED ON PAGE 10)

Healthcare Delivery Institute HORNE graduates charter ATP class, enrolling for fall and winter terms

By LyNNE JETER

Just before Thomas Prewitt, MD, relocated to the magnolia state to join the University of Mississippi Medical Center (UMMC) as associate professor of surgery and director of health policy, a breast surgical oncologist, an educator, and a health policy advisor to the vice chancellor, he detoured to Salt Lake City, Utah, to complete Intermountain Healthcare (IHC)’s Institute for Health Care Research and Advanced Training Program (ATP), the international standard bearer for healthcare delivery improvement training programs.

“I was so very inspired by my time spent in that program, and Participant Dr. Peter Arnold is in focus.

Coming Soon!

(CONTINUED ON PAGE 12)

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PhysicianSpotlight

William A. Billups III, MD

By LUCY SCHULTZE

On its busiest night, an emergency room in Meridian doesn’t approach the ordinary intensity of trauma care in innercity Dallas.

But for William A. Billups III, MD, training as a surgeon in such a demanding setting meant being able to bring a higher level of care back to his hometown.

“It was one of the busiest trauma centers in the country,” said Billups, who completed his surgical training at Parkland Memorial Hospital in Dallas before joining Medical Arts Surgical Group in Meridian.

Both the surgical and organizational skills he gained during his training have translated into improved systems of care for Meridian’s trauma program.

“The time that I trained in Dallas was when violence and crime and trauma were at their peak, and at a time when we did much more operative therapy than we do now,” Billups said. “I was able to get a lot of experience in a short amount of time, which I have found rewarding and helpful.”

Billups returned to Meridian in 1996 to join the eight-member general-surgery practice which also includes his father, William A. Billups Jr., MD. “Working with my dad has been one of the greatest parts of coming back home,” Billups said. “I don’t know that I would have come back, if it weren’t for my father practicing here.

“He has been a great mentor, and there was a lot that I learned from him in the first few years that has certainly made me a better surgeon.”

The elder Billups had joined the Meridian practice in 1972 from service in the U.S. Air Force.

“I grew up always being able to get a

feel for the type of work that he did, which seemed exciting,” Billups said. “When I went to medical school, I tried to go with an open mind. But I enjoyed my surgical rotations, and that reaffirmed an original desire to go into surgery as a career. I’ve not regretted it.”

Billups completed his undergraduate degree in chemistry at Millsaps College and earned a medical degree from the University of Alabama at Birmingham. He spent the early 1990s in Dallas for his internship and residency at Parkland Memorial Hospital and the University of Texas Southwestern Medical Center.

“We had a very high volume of trauma, which allowed me to get a lot of operating experience and a lot of repetition in managing major trauma emergencies — often several at a time,” Billups said.

“The move back to Meridian actually meant much less volume. But when we’ve had some disaster-type scenarios, or had

several major trauma cases at once, the organization I learned during my residency has come in handy.”

Since that time, trauma surgery has taken on a more conservative treatment approach, relying more on observation and imaging than on exploratory surgery.

But for a surgeon-in-training, the latter approach was, in a sense, more valuable.

“I’ve seen tremendous strides in morespecific diagnostic techniques, which have allowed us to treat patients non-operatively and expose them to less morbidity from non-therapeutic surgery,” Billups said.

“In a way, though, I’m thankful that I trained in a time when we did so much surgery, because it gave me a lot of operative experience. It is more difficult to obtain now, in this era of non-operative management.”

For the Meridian medical community, a secondary skill set Billups honed in Dallas has proven just as important — methods of organizing and prioritizing care for multiple acute cases.

Billups returned to Meridian just as the state was beginning to organize the Mississippi Trauma Care System. He took on the challenge of providing leadership in coordinating trauma care among Meridian’s three competing hospitals: Riley Memorial Hospital, Jeff Anderson Regional Medical Center and Rush Foundation Hospital.

Since his practice covers all three hospitals, Billups had been able to observe the need for a systematic and standardized approach to dealing with multiple injured patients. But while his training experience made that need apparent, it also provided the solution.

“Many of the manuals and protocols we put in place were taken directly from Parkland,” Billups said. “We’ve actually

kept a relationship with Parkland, between our nurse coordinators and our trauma program, to see what changes they’ve made over time and keep ours up-to-date.

“We even sent some of our nurses and our current nurse coordinator out to Parkland for a period of time, to learn more systems for organization and performance improvement.”

For his part, Billups shares trauma call at two different hospitals with his partners, being on-call every fourth night and every fourth weekend. Still, the group makes a point of being flexible enough to trade call for special occasions.

“Everyone wants to help everyone else be with their families,” Billups said. “Our group is large, but we’ve always gotten along together and cooperated well.”

The Medical Arts Surgical Group as it exists today was formed when two practices merged about a decade ago, Billups said.

The group has since cooperated in building the outpatient Meridian Surgery Center Outside of work, Billups retreats to his family farm south of town, where he grew up hunting and built a weekend home about 10 years ago. His parents did likewise, and both ended up moving out to the farm full-time.

“It’s not what we originally planned, but it’s worked out great,” Billups said. “My kids have been able to grow up down on the farm with their grandparents nearby.”

In addition to hunting and fishing, Billups has developed a passion for training Labrador retrievers for hunting, competitions and field trials.

Billups and his wife, Mary, have two children: Sarah Catherine, 21, a junior at Vanderbilt University; and Robert, 18, who will be a freshman at Notre Dame University this fall.

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Skin Cancer Treatment Advancement

Non-surgical alternative for treatment of NMSC eliminates scarring, better choice for older patients

By LYNNE JETER

Terri Hayes Henson, MD, was aware of the underutilization of superficial radiation therapy (SRT), a non-invasive alternative treatment for non-melanoma skin cancer (NMSC) approved by the FDA in 2007. After thoroughly discussing the new modality with Mohs surgeons across the country, the dermatologist from Southaven, Miss., invested roughly $230,000 for the mobile device and room preparation expenses and began offering the modality on June 7.

“Lack of awareness is the only reason why it hasn’t been widely introduced,” said Henson, the first dermatologist to offer SRT in a tri-state area. “Dermatologists in general have a knee-jerk reaction to surgery. But SRT is making a resurgence because there’s a need for this optional treatment.”

Nationwide, targeted photon therapy is a favorable NMSC treatment option, thanks to improved technology and treatment protocols that allow treatment to be done on an outpatient basis for patients who are considered suboptimal candidates for surgical procedures.

“The improved therapeutic modality gives us a lot of flexibility and versatility in the treatment and management of non-melanoma skin cancers,” derma-

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tologist David Kent, MD, told members of the American Academy of Dermatology (AAD) at its recent annual meeting.

“Until recently, all the radiation therapy treatment was 30 to 40 years old, without the production of newer machines or any new research and development performed.

The quality of the older machines became somewhat dated and devices became temperamental, requiring effort to perform radiation treatments.”

Older SRT systems once used for

treating various types of cancer conditions require long set-up procedures and larger space, and are challenged with costly maintenance and lack of parts availability.

With the development of newer, safer and more efficient radiation machines that undergo rigorous annual inspections by state departments of health, along with dosimetry of the doses made much simpler with total fraction tables, targeted photon therapy is much easier to administer. An important note: The equipment emits less radiation than a dental x-ray.

“One of the benefits of radiation therapy is that we can concurrently treat multiple lesions in one sitting,” said Kent, an instructor in the Department of Internal Medicine at Mercer University School of Medicine in Macon, Ga. Henson, founder of The Dermatology Clinic of North Mississippi PLLC, said the investment represents “a good ROI” because “if I brought a Mohs surgeon into my practice, it would cost a lot more.” She refers patients requiring Mohs surgery to Mohs surgeons in Memphis.

The SRT process, a less expensive alternative to Mohs micrographic surgery, takes about two minutes per treatment in a series of 5-12 sessions on an outpatient basis in Henson’s office. It’s adaptable to non-ambulatory patients in wheelchairs; their head may be immobilized with foam blocks. It’s also a good option for patients

taking blood-thinning medication.

Henson was quick to caution that SRT, made by a Boca Raton, Fla.-based company that sold 60 units in 24 months worldwide, “isn’t for everybody.”

“The ideal patient is 65 or older,” she explained. “There’s a risk down the line – a delayed reaction 25 to 30 years later – of dyschromia, a disorder of pigmentation in the irradiated field.”

Every case must be individualized, said Henson.

“In certain situations, for example a 60-year-old who doesn’t want to face surgery, as long as they’re aware of the risks, I’d do it,” she said.

Most insurance providers – and Medicare – approve the procedure.

“Some insurers might require prior authorization,” she said. “But it’ll be less costly than the alternative, which is Mohs micrographic surgery. It’s simply another modality to treat these common malignancies.”

In cases where patients have tumors with aggressive histologic growth features, such as often seen in morpheaform basal cell carcinoma, Mohs surgery may be a better treatment option.

“For select patients and tumors, targeted photon therapy is an excellent option to consider,” said Kent. “In my experience, the new and improved radiation therapy technology offers us a viable, cost effective and cosmetically attractive treatment option for nonmelanoma skin cancers, and is a wonderful addition in our armamentarium.”

Henson’s interest in dermatology was sparked after 1995 AAD president Rex Amonette, MD, FAAD, founder of the Memphis Dermatology Clinic and the tri-state area’s inaugural Mohs surgeon, talked to pre-med honors students at the University of Memphis. By the time she completed a rotation in dermatology during her elective fourth year at the University of Tennessee Health Science Center (UTHSC) College of Medicine in 1993, Henson was hooked.

However, to get into the very competitive field, Henson worked hard to graduate third in her class. She completed her dermatology residency at UTHSC. “I liked the lifestyle opportunity that comes with dermatology, though I’m on call often since we’re the only dermatology clinic to do hospital consults with Baptist (Memorial Hospital) DeSoto,” said Henson, who has a nurse practitioner and physician assistant on staff.

With research showing one in five people will develop skin cancer, and the massive baby boomer generation morphing into senior status, Henson runs a very busy practice.

“I’m thrilled to offer SRT,” she said.

“It won’t replace surgery by any means, but it’s a good non-invasive option for my patients who don’t want surgery. It’s a painless, wonderful treatment with excellent cure rates (98 percent effective) and cosmetic outcomes.” mississippimedicalnews

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Protection from Harm

Baptist implements safe patient handling and lifting programs

By LYNNE JETER

Baptist Health System employees rallied around the hospital atrium on April 10, when Baptist Patient Care Services celebrated the launch of the Diligent Safe Patient Handling Program, the newest innovation in patient safety and fall prevention that nationally has reduced more than 80 percent of patient handling incidences.

“This program will greatly enhance the safety of our healthcare workers and patients, significantly reducing the number of employee injuries associated with the lifting and positioning of patients,” said Baptist Nurse Manager Cindy Davis of the “Spring into Safety” celebration, noting that a typical nurse lifts 3,600 pounds in an eight-hour shift. “So many times, the healthcare worker can’t get patients up and out of bed. These new devices will not only take the pressure off the staff, but it also helps get patients mobile, helping promote quicker recovery.”

Baptist Health System’s Surgical ICU Nurse Council brought the idea to

hospital administrators to create a safer lifting environment for staff and patients needing assistance moving from a bed to a wheelchair or from a sitting to standing position. They implemented the national safe patient handling program that’s also used for fall recovery.

The improvements will be accomplished with the use of various lifting and

positioning devices.

For example, some of the equipment includes: • Sara Stedy, a standing and raising facilitator that supports up to 400 pounds and fits around a toilet and bedside commode.

• Sara Plus, a standing and raising aid with a capacity of 420 pounds, which converts to a walking assist device.

• MaxiMove, a dependent lift that transfers patients up to 500 pounds into a hospital bed.

It also helps turn patients and transfer them to a chair or bedside commode and is used for fall recovery.

• Tenor-Bariatric Lift, a 700-pound capacity dependent lift that transfers patients to a chair or bedside commode, helps them shift upward in bed, and is also used for fall recovery.

• Dane Wheelchair Mover, a powerassist transport device that attaches to a wheelchair.

• Maxi Air- Lateral Transfer, a device for transferring patients in a supine bed to a bed, gurney or stretcher.

• Maxi Sky, a ceiling lift for patients up to 600 pounds, with an additional feature to bear 1,000 pounds. The dependent lift helps transfer patients from a bed to a chair, wheelchair or bedside commode, and also facilitates fall recovery.

ARJO is the equipment manufacturer providing the lifting equipment. Diligent, a sister company of ARJO, is providing clinical support to initiate the cultural changes needed for a successful program.

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The Move to DNP

Nurses embrace advanced degree program to address the increasingly complex healthcare practice environment

By CINDy SANDERS

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In October 2004, member schools of the American Association of Colleges of Nursing (AACN) voted to endorse the organization’s position statement calling for the transition of the level of preparation needed for advance practice nursing from the master’s degree to the doctorate level by 2015 through the addition of the DNP — Doctor of Nursing Practice.

“Will we have all of our APRN programs transition to DNP by the 2015 deadline? Probably not … but we will have a critical mass that are,” Dr. Jane said Jane Kirschling, Kirschling PhD, RN, FAAN, dean of the School of Nursing for the University of Maryland who serves as 2012-2014 board president for AACN. “I feel like we’ve reached the tipping point,” she added.

Indeed, the growth of DNP programs nationwide has been remarkable. By spring 2013, programs existed in 40 states and the District of Columbia. “We are extremely pleased that we currently have 217 Doctor of Nursing Practice programs

up and running in the United States. If you go back to 2004, we only had seven programs,” Kirschling noted. “In addition, we have 97 new programs under development.” She added enrollment has jumped from 170 DNP students in 2004 to 11,575 last year.

Rooted in the desire to deliver the highest quality of care in the practice setting, Kirschling said the addition of the DNP was consistent with what is happening in other healthcare disciplines including pharmacy, audiology and physical therapy. Grounded in evidence-based practice, she said the hope is that these doctoral-prepared nurses will take existing discoveries and more rapidly drive that knowledge to the bedside. Additionally, she said the degree is anticipated to prepare these nurses to provide leadership in an increasingly multifaceted healthcare environment.

“What I project we’ll see with time as we graduate more from the DNP program is they will actually partner with PhD nurses to create some really interesting synergy to solve really difficult clinical issues and to solve them in a quicker timeline that directly impacts patient care,” stated Kirschling.

The reason for the DNP movement is

multifactorial. In addition to aligning with other health profession disciplines that offer a clinical doctorate, Kirschling said the degree also recognizes the complexity of the nation’s evolving healthcare delivery system.

The number of hours and amount of academic work required to become an advanced practice registered nurse provided another impetus behind the DNP movement, Kirschling noted. Nursing had already moved to increase and expand practical knowledge in APRN master’s programming. Where many master’s degrees in other fields require 30-36 credit hours, the four recognized APRN master’s programs — Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Midwife — already required a minimum of 40-55 credit hours. With the newer doctoral degree, students need, on average, 80 credit hours in the baccalaureate to DNP program and an additional 39 credits in the master’s to DNP path.

“Healthcare in the county has changed dramatically,” Kirschling concluded. “The depths of knowledge and the skill set any provider needs have just increased over time. We, as a discipline, felt it was critical that our graduates be prepared to meet the demands of the future.”

PhD vs. DNP Jane Kirschling, PhD, RN, FAAN, president of the American Association of Colleges of Nursing, said the addition of the Doctor of Nursing Practice (DNP) degree was the clinical complement to the long-standing Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc) degrees, which prepare students for scientific research.

The PhD, she noted, “is really intended to prepare the next generation of scientists for new discovery so they are generating new knowledge for the discipline.” In addition to an interest in a nursing faculty career with a research component, Kirschling said it was fairly common for nurse executives to obtain a PhD as they sought to increase leadership roles. With the addition of the DNP, nurses now have two terminal degree tracks from which to choose — research and practice.

The newer DNP quickly overtook PhD and DNSc programs in terms of the number being offered across the country. Currently, there are 131 researchfocused programs in the U.S. The number of research doctoral programs grew from 103 to 131 between 2006 and 2012. During that same time period, DNP programs grew from 20 to 217.

As the field looks to increase the number of doctoral-prepared nurses, the good news is enrollment is up in both research-based and practice-based doctorate programs, although the newer DNP degree has seen much more rapid growth as more academic institutions have begun offering the option.

Between 2004 and 2012, the number of students enrolled in DNP programs increased from 170 to 11,575. The number of students seeking a PhD in nursing grew from 3,439 to 5,110 during the same timeframe.

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Tapping into Hospice and Palliative Medicine PCPs benefit from services of underutilized specialty

By LYNNE JETER

Not long ago, hospice referrals for end-of-life care were typically made only a few weeks before the patient’s death.

Now, good hospice referrals are made six months to a year in advance to allow time for patients and their families to transition to the final phase of life. Palliative care comes in sooner for patients suffering from serious illness, with specialists having the advantage of focusing on the patient, not the disease.

“Just about any patient with a serious, life-limiting illness can benefit from palliative care,” said Robert Lehmberg, MD, FACS, assistant professor of hospice and palliative medicine at the University of Arkansas for Medical Sciences (UAMS). “It improves the patient’s quality – and sometimes length – Dr. Robert of life.”

Lehmberg Hospice is definitely underutilized in the United States, said Derrick O’Connell, RN, MBA, chief quality officer for Esse Health, a St. Louis-

based practice group with nearly 100 physicians and specialists.

“There are barriers to hospice because of the inability to confront mortality as a psycho-soDerrick cial issue,” he said, “and O’Connell barriers within the medical community to refer patients to hospice because physicians and their teams may feel they’ve failed in the medical management of a patient.”

Miguel A. Paniagua, MD, FACP, concurs. Because so many great technological advances in medicine have been made, he said a patient’s treating physician may view their death as failure.

O’Connell, a former hospice manager, said the emerging Pa- Dr. Miguel A. Paniagua tient Centered Medical Home (PCMH) model has a mechanism in place to assist primary care providers (PCPs) with the transition of patients to hospice and palliative care.

“Primary care providers and their

teams can facilitate the documentation of advanced directives for each patient,” he explained. “Each patient is counseled on choices in the event of a life-ending medical condition or event. It’s important when provider teams recognize that the patient is nearing the end of their life cycle and can begin the patient-centered collaboration for appropriate end-of-life care with a statement like: ‘there’s nothing more medicine can do for you. We’d like to refer you to hospice care because they’re experts at keeping you comfortable at end-of-life care and can enable you to die with dignity.’”

Paniagua, associate professor and director of the Department of Internal Medicine Residency Program at Saint Louis University (SLU) School of Medicine in Missouri, said a smooth transition is easier when the primary care provider (PCP) team clearly communicates the end-of-life plan with patients.

“We similarly teach many high-tech and high-reimbursing procedures in medicine, but in my view, the most delicate and nuanced procedure we can teach and learn is the bedside conversation about

Palliative v.

Hospice Care Palliative care: • provides comfort and relief from pain and other distressing symptoms; • is meant to neither hasten nor postpone death; •integrates the psychological and spiritual aspects of patient care; • affirms life while regarding dying as a normal process; • assists patients in living as actively as possible until death; • helps the family cope during the patient’s illness; • uses a specialized team approach including physician, nursing, chaplaincy and social work; and • is provided in conjunction with therapeutic treatments such as chemotherapy and radiation.

Hospice: • focuses on caring, comfort and dignity at end of life; • provides relief from pain and other distressing symptoms; • is meant to neither hasten nor postpone death; • integrates the psychological and spiritual aspects of patient care; • helps the family cope with the patient’s end of life and their own bereavement • uses a specialized team approach including physician, nursing, chaplaincy and social work.

(CONTINUED ON PAGE 8)

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Tapping into Hospice and Palliative Medicine, continued from page 7 goals of care and treatment planning,” he said. “Like any procedure in medicine, there are effective and ineffective ways of doing it. Unfortunately, not enough emphasis is placed on teaching and learning this procedure, which leads to much variability in the way it’s delivered, as well as providers’ discomfort and unease with doing it.”

Paniagua also noted that mainstream media’s sensationalized coverage of euthanasia and physician-assisted suicide issues has hindered progress in the advancement of the specialty and public perception.

“In reality, (euthanasia and physi-

cian-assisted suicide) is such a miniscule practice, and in only three states,” he emphasized. “But my view is that too often patients feel they have no other way out of their suffering. More often than not, we providers don’t do an adequate job providing palliative care to most of the suffering.”

Lehmberg, who switched specialties to hospice and palliative medicine after a neck injury prevented him from continuing his nearly 30-year plastic surgery practice, said the most common misperceptions about the specialty are the differences between palliative care and hospice,

and getting the team involved early enough to “truly assist the patients, their families and the treating physicians.”

“Most people, physicians included, think of us only in terms of hospice and end of life,” said Lehmberg. “However, palliative care improves the quality of life of patients and their families with lifethreatening conditions through the prevention and relief of suffering, and also the treatment of pain and other problems – physical, psychosocial and spiritual.”

Palliative care may be extremely helpful to physicians and patients in conjunction with therapeutic treatments,

such as chemotherapy and radiation, said Lehmberg, noting that requests for hospice and palliative care consultations for the UAMS Department of Hematology and Oncology has increased significantly – from 400 in 2007 to more than 2,200 estimated this year.

“As evidenced by our program growth, an awareness of the role of palliative care is increasing,” he said. “Still, I’d like to continue to contribute to a better understanding of our subspecialty and how we can help. Once a patient has been diagnosed with a life-threatening illness, it’s really never too early to involve a multi-disciplinary palliative care team.”

Palliative care transitions to hospice care when the illness progresses to the point that therapeutic treatments are no longer applicable, explained Lehmberg.

“In palliative care, an experienced team is best at fitting in with the primary medical approach, not rivaling it,” said Lehmberg. “As consultants, the palliative care team … complements the treatment and care provided by the primary physicians.”

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When it was established 25 years ago, the American Academy of Hospice and Palliative Medicine (AAHPM) had 250 charter members. Now, the professional organization has 5,000 members.

Yet even though four of five larger U.S. hospitals now have palliative care programs, and consultations for the specialty have spiked, new growth isn’t keeping pace with the coming demand. New hurdles hinder progress – a rapidly aging baby boomer generation coupled with the existing senior population, continued segmentation of care, and limited funding for specialty training programs.

AAHPM leaders recently proposed a solution to the specialty shortage problem: Timothy E. Quill, MD, FACP, and Amy P. Abernethy, MD, FACP, president and president-elect of the AAHPM, respectively, suggested reserving palliative medicine physicians for more challenging cases, while also increasing the palliative skills of primary care providers (PCPs) and specialists who see patients daily.

Using their model, PCPs would receive appropriate education to address management of pain and other symptoms and other basic palliative care needs. Palliative medicine physicians would be called in to manage difficultto-treat pain, complicated depression, anxiety and grief and other more complex needs.

SOURCE: AAHPM.

5/22/13 1:29 PM

5/22/135/22/13 1:29 PM 1:29 PM

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MedicalEntrepreneurs

Selling for Success

By MARTIN WILLOUGHBY Southwestern Advantage (formerly known as Southwestern Company) is a Nashville-based publishing company that recruits about 2,500 to 3,000 college students each summer to sell its educational products door-to-door using direct selling methods. Their summer associates fan out around the country and work long grueling hours making cold calls each day. A significant percentage of the summer associates quit within the first few weeks, but those who persevere have the opportunity to make a significant income and learn invaluable skills.

For many people, just the thought of having to cold call can create a queasy feeling. Too often, the perception of “selling” is just this type of cold calling sales job. I also find there’s a misperception that selling requires a “good ole boy” back-slapping personality. However, in reality, almost all us of have some element of selling in our jobs regardless of our title, and it turns out the best sales people aren’t necessarily the over-the-top extraverts.

I’ve never held a formal sales job; however, I’ve spent most of life in positions where I had to “sell” to make a living. As a college student, I taught tennis lessons, which led to my first career managing tennis complexes.

I then went into the law and consulting business, where I had to grow my book of clients.

In each facet of my career, I’ve needed to be able to use the skills of persuasion to move people to action. Best-selling author Dan Pink in his newest book, To Sell Is Human, makes his case that, “Whether its selling’s traditional form or its non-sales variation, we’re all in sales now.” He also shares that studies show the best sales people are actually “ambiverts” who have a mix of introvert and extravert characteristics.

Even traditional professional careers have increased pressure to have practice development. I’ve found that many firms historically were able to stay busy simply because they had their doors open. However, today’s competition is fierce and global. Traditional professions in careers like medicine, law, accounting, and architecture have to hone their substantive professional skills and also their business development abilities. Regardless of your career path, undoubtedly, your job will include the need to move others to action, even if just a co-worker. Therefore, investing some and energy in learning how to motivate others to action is a worthwhile investment. I’ve summarized three key principles below that I teach in business development training for organizations.

1. Know yourself. It’s critical to have self-awareness when trying to mississippimedicalnews

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move others to action. I use the Birkman Method® assessment tool, but several other good tools exist to help you understand your own personality style. We tend to communicate in our own style instead of flexing to the style of the person needing motivation or direction. These tools allow us to become more in-tuned with our own style and more adept in speaking to people in their own “language.”

As Pink found in his research, ambiverts have the greatest results in moving others to action because they can adapt to both introverts and extraverts.

2. Know what you do. This task may seem simple enough. However, I find that too often people struggle to articulate what they do in a clear and compelling manner. Too often, we just share our functional job title or profession. Consider sharing what you do for a living in a way that invites further conversation and questions. One of the best ways to do this is to describe what you do in a way that brings value to clients, customers, patients, et cetera. For example, you could say, “I help clients ______.” Being able to follow up that with a description of how you bring that value is also important.

Bottom line: Make sure you have your “elevator speech” to share with people who are kind enough to ask about your occupation.

3. Know others. Dale Carnegie in his bestseller, How to Win Friends and Influence People, captured the key element to “selling,” which is to be genuinely and authentically interested in other people. The key is to ask great questions and listen to the response. Henry David Thoreau said, “The greatest compliment was paid to me today. Someone asked me what I thought and actually attended to my answer.” Thoreau spoke great truth with his comment. If you want to stand out from the crowd and really show people you care, ask them questions and be an attentive listener. When you start to learn more about others, you’ll be in a much better position to follow the Platinum Rule and “treat people as they deserve and want to be treated.”

By knowing yourself, understanding how to communicate effectively about your role, and learning to be a great questionasker, you’re in a great position to succeed in sales even if you don’t sell for a living.

For those who believe sales is a dirty word, I encourage you to rethink the importance of being able to influence and persuade people effectively. Your career might just depend on it!

Martin Willoughby is a serial entrepreneur, author of the book Zoom Entrepreneur, and a business consultant.

Direct questions to Martin at martin. willoughby@butlersnow.com

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Garnering ‘The Baldrige’ continued from page 1 to focusing on the right things,” said Heer, who initially reviewed the Baldrige criteria in 1997. “It became clear to me that using them as a guide was the best way to run a ‘world-class’ organization.”

In his remarks at the award ceremony, Heer said, “I’m honored and humbled to accept this award on behalf of the 6,200 employees, 500 physicians, 200 volunteers and our boards of directors. Their dedication to providing a culture of quality, focus on patient/customer satisfaction and commitment to the provisions of high clinical quality and safety are the reasons why I’m here before you today. Their compassion, care and yes, even love, for those we serve never cease to amaze me.”

North Mississippi Medical Center (NMMC) in Tupelo, NMHS’ flagship hospital, initially applied for the national award in 2003 and won it in 2006. NMMC and NMHS hold the distinction of being the only Baldrige recipients in Mississippi.

Heer, who joined NMHS in 2004, said the intention was always to apply for the Baldrige award as a healthcare system.

“We wanted to start with NMMC in Tupelo because of its geographic concentration,” he said. “After we became proficient in the criteria at NMMC, we expanded the concepts and approaches to the entire organization.”

After submitting its application last May, NMHS hosted a site visit by a team of Baldrige examiners in early October. The team visited multiple locations throughout

the healthcare system – Tupelo, Pontotoc, Baldwyn, Iuka, Columbus, Eupora, West Point, and Hamilton, Ala. – and interviewed approximately 600 people.

Each Baldrige application is reviewed by a team of examiners. Each examiner spends approximately 60 hours over the summer reviewing the application, including regular emails and phone calls, until the entire review is completed in August. If an application warrants a site visit, each team member spends about 25 hours preparing, and an additional 80 hours or more while on site.

Even though NMHS leaders are enthusiastic about receiving this award, the benefits of going through the process are much greater, emphasized Heer.

“The most valuable part of the Baldrige process is three-fold,” he explained. “It forces you to focus on the right things; it creates alignment and deployment throughout the system; and it creates a burning platform to help you get better, faster.”

NMHS Chief Strategy Officer Ormella Cummings, PhD, also played a vital role in the Baldrige application process. As part of NMHS’ strategic planning methods, Cummings and her staff routinely interview community members.

“We use the Baldrige criteria to refine how we listen to our community and how we trend our data so that we act on it and make sure that it’s part of our strategic plan,” she said. “Using the Baldrige criteria helps us speak with one voice. Our goals and objectives are clear, and all of our

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By the Numbers The Malcolm Baldrige National Quality Award application has seven sections: • Leadership • Strategic Planning • Customer Focus • Measurement, Analysis and Knowledge Management • Workforce Focus • Operations Focus • Results Since the award program’s debut 25 years ago, 93 organizations have received “The Baldrige,” the nation’s highest recognition for organizational performance excellence.

Last year, 39 companies and organizations across the United States submitted Baldrige applications. The breakdown: 25 healthcare organizations, one manufacturer, three service companies, two small businesses, three educational organizations and five nonprofits/governmental agencies.

Of the 39 applicants, a dozen U.S. organizations received site visits in 2012: five in healthcare, one in manufacturing, one in service, two in small business, one in education and two in nonprofit.

The number of hours spent reviewing a Baldrige application and an on-site visit by a team of examiners to clarify questions and verify information in the application: 1,000.

The 2012 Malcolm Baldrige National Quality Award was presented in four categories: North Mississippi Health Services in Tupelo, representing healthcare; Lockheed Martin Missiles and Fire Control in Grand Prairie, Texas, for manufacturing; MESA Products, Inc. in Tulsa, Okla., representing small business; and City of Irving, in Irving, Texas, for nonprofit.

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employees are clear on how they can contribute to that.”

Cummings believes the Baldrige process also helps organizations understand the true value of results.

“You can do a lot of great things, but if your results don’t show that, then you’re missing something,” she noted. “We look at results at every level – from system-wide down to work units and individuals. This really raises the bar on how we measure our success.”

She emphasized how the prestigious award gives NMHS employees and community members a deep sense of pride.

“We’ve had a vision in place for a long time to be the provider of the best patientcentered care and health services in America,” she said. “This puts us in a position to do that; it makes us better and pushes us every time. It’s a win-win for our organization, our employees, our community and our state.”

NMHS Chief Medical Officer Mark Williams pointed out that Baldrige examiners look for alignment.

“They want to know that everyone’s on the same page,” he said. “Thankfully, we have a unique relationship with our physicians – both employed and private practice. Many of them are very involved in the community, and they really have a sense of personal accountability in these efforts. They make a concerted effort in pursuing quality and safety for the pure sake of better patient care. They show a genuine commitment to achieving the mission, vision and values of NMHS, and that’s very impressive.”

Marsha Tapscott, marketing director for NMHS, has served on the Baldrige steering committee since 2005. In addition to being involved in writing and editing the application, she’s also the Baldrige public affairs contact for the healthcare system.

“Through that role, I interact with people all over the nation who call or email with questions about our Baldrige journey,” Tapscott said. “It’s really interesting to talk to people who know what this award means and hear why they’re using these criteria to improve quality and processes.”

After receiving the 2006 and 2012 awards, NMMC and NMHS hosted several sharing days, with participants from across the United States and also groups from Japan and New Zealand.

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Sports Medicine Community Weighs In

Zurich 2012 Concussion Consensus Statement clarifies issues, muddles others, exemplifies mystery of TBI

By LYNNE JETER

No RTP (return to play) on the same day, regardless of circumstances. An earlier return to light exercise, recommended.

And the differential between pediatric and adult patients, clarified.

Those are among the highlights of the 2012 Concussion Consensus Statement derived from the 4th International Consensus Conference on Concussion in Sport, held last November in Zurich.

Every four years, the International Ice Hockey Federation, International Olympic Committee, International Rugby Board, International Federation for Equestrian Sports, and FIFA (International Federation of Association Football) host the conference, which results in an updated concussion consensus statement.

“The new statement shows that we basically still don’t understand concussions, and there are many opinions on how to diagnose and treat them,” said William Feldner, DO, a sports medicine specialist at South County Family & Sports Medicine and St. Anthony’s Medical Dr. William Feldner Center in St. Louis, Mo., and team physician for Lindenwood University and USA Vol-

leyball. He’s also a board member of the Joint Commission for Sports Medicine and Science, an editorial board member of the Clinical Journal of Sports Medicine, and past president of the American Osteopathic Academy of Sports Medicine. “And, while it’s not in the (consensus) statement, there’s some interesting genetic research going on. We may eventually be able to Dr. Marc Hilgers predetermine if someone is more susceptible to concussion based on their genetic makeup.”

Marc Hilgers, MD, PhD, director for sports medicine fellowship, sports medicine research, and a sports medicine physician at Level One Orthopedics with Orlando Health in Central Florida, said he didn’t expect major changes in the 2012 consensus statement.

“I’ve been keeping my finger on the pulse of knowledge and I knew what was coming down the pike,” said Hilgers, also the team physician for Orlando City Soccer and the Minor League Umpire Association, medical advisor for the Florida Orthopaedic Institute, and assistant professor of family medicine at the University of South Florida. “That’s why I wasn’t surprised, especially with the broad spectrum of specialists from all over the world who

met to write the updated statement, that it was kept general and not too progressive.”

Bill Hefley, MD, an orthopedic surgeon and partner at OrthoSurgeons based in Little Rock, Ark., said the latest consensus statement showed “great development in the CRT (concussion recognition tool) for lay use.” The 2008 conference resulted in the development of the Sport Concussion Assessment Tool (SCAT2), a standardized method of eval- Dr. Bill Hefley uating athletes ages 10 years and older for concussions.

“This tool takes out the ‘guesswork’ and interpretation for laymen,” said Hefley. “The SCAT3 has a background section, which is a great addition to the SCAT2. Also, the SCAT3 is much more streamlined with clinician instructions on its own page, rather than after each section.

The Child-SCAT3 is a great new tool for younger athletes who may sustain concussions.”

Todd Ross, MS, ATC, an athletic trainer for Pulaski Academy with OrthoSurgeons, highlighted the 2012 consensus statement’s importance “because it continues the worldwide awareness of concussions (and) shows the dedication the medical society has for learning more

about concussions, how to recognize concussions, how to properly manage athletes with concussions, and how to properly and safely return an athlete to play after a concussion has subsided.”

The only major blip noted repeatedly: the altered position on CTE (chronic traumatic encephalopathy). Hilgers called it “an interesting update … on an issue that had ‘percolated up’ since 2008.”

• The 2008 section on chronic traumatic brain injury (TBI) notes: “Epidemiological studies have suggested an association between repeated sports concussions during a career and late life cognitive impairment. Similarly, case reports have noted anecdotal cases where neuropathological evidence of CTE was observed in retired football players. Panel discussion was held, and no consensus was reached on the significance of such observations at this stage.

Clinicians need to be mindful of the potential for long-term problems in the management of all athletes.”

• The 2012 TBI section notes that “clinicians need to be mindful of the potential for long-term problems in the management of all athletes. However, it was agreed that CTE represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that a cause and effect relationship has not as yet been (CONTINUED ON PAGE 13)

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Healthcare Delivery Institute, continued from page 1 I wanted to do that sort of work,” said Prewitt, who joined HORNE on Jan. 2, 2012, to launch the Healthcare Delivery Institute (HDI) in Ridgeland. Patterned after IHC, the HDI has two components:

the ATP focusing on healthcare delivery improvement training, and clinical improvement services with HORNE partner, Health Catalyst. “I’m still practicing medicine, but more from a macro than

The 4-1-1 on the HORNE Healthcare Delivery Institute ATP The Advanced Training Program (ATP) provides healthcare providers, administrators and executives the essential tools needed to prepare for post-health reform change.

Ideal participants include clinicians in physician practices, hospitals and health systems; C-suite administrators; elected officials responsible for health policy; government healthcare policymakers; healthcare attorneys, consultants and educators; health system data professionals; improvement team leaders; mid-level administrative managers; nursing home managers; and risk management professionals.

Under the tutelage of HDI staff, each participant conducts an improvement project at their home institution over the duration of the course.

The curriculum overview includes: • Managing Clinical Processes: An Introduction to Clinical Quality Improvement • Features of Effective Teams • Quality Controls Cost • Understanding Variation • Data Types: Which Statistical Process Control Chart Should I Use? • Deployment: Clinical Integration • Tracking Healthcare Costs • Understanding New Delivery Models: ACO, Bundles, Capitation • Data Driven Improvement with Key Process Analysis • Leadership and Diffusion of Change “The curriculum provides the participant a knowledge base and skill set to take a leadership role in quality and policy in virtually any healthcare environment with a focus on improvement theory, data and measurement, delivery model change, and leadership skills,” said Thomas Prewitt, MD, director of the HORNE Healthcare Delivery Institute.

micro level. It’s very rewarding.”

For the ATP, participants meet twoand-a-half-days a month for four months to complete the training program, of which a total of 80 CME hours are available.

“This is for people who are going to be true leaders in healthcare, and that was certainly the case for the people I trained with at Intermountain,” said Prewitt, noting that all learning takes place in a classroom. “Face-to-face relationship building of participants is very important. So much of learning occurs at the participant level, with the cross-talk about experiences taking up a large part of training.”

Cost of the ATP is $5,000, with incremental discounts for multiple participants from the same institution. It’s a bargain compared to $10,500 for a 20-day executive session at IHC, and a similar program at the Institute for Healthcare Improvement in Cambridge, Mass.

Local graduates of the inaugural ATP, also featuring participants from Tennessee, include Peter Arnold, MD, of UMMC; Neely Carlton of Jackson; Bill Grantham, MD, of MEA in Clinton; Barney Hebert of Hattiesburg; and Mark Hutson, Janna Stiles and Regina Givens of Greenwood Leflore Hospital in Greenwood.

“It’s encouraging to meet a group of medical leaders who see the innovation challenge as an opportunity rather than an unwanted burden,” said HDI instructor Andre Delbecq, DBA, the J. Thomas and Kathleen A. McCarthy University Professor at Santa Clara University.

HDI instructor Niall Brennan, director of the Office of Information Products and Data Analytics, Office of Enterprise Management for the Centers for Medicare and Medicaid Services (CMS), was inspired “seeing the energy in the room of frontline care providers as they realized the potential of data to improve care.”

HDI instructor Larry Grandia, a Health Catalyst board member, said techniques taught in the ATP have eliminated “spotty” results of applying classic performance improvement techniques to clinical care processes by offering a solution to data access and also focusing on quality.

“Clinicians welcome performance improvement when high quality is the desired outcome,” he said. “Experience … has proven that consistent higher quality actually reduces cost, not the reverse.”

(See sidebar for more detail.)

HDI is gearing up for the fall and winter sessions, which can accommodate up to 30 participants per term.

“No pre-requisites needed,” explained Prewitt. “Participants are those likely to be leading improvement teams while also reducing costs. They’re two

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sides of the same coin; it reduces variation at the level of the clinical enterprise. I just returned from a health data conference, and it’s amazing how some major players still don’t understand some of that messaging. It’s the overarching goal we’re striving to communicate.”

For more information, visit www. horne-llp.com.

True North When Healthcare Delivery Institute (HDI) instructor Larry Grandia served as Intermountain Healthcare’s director of information systems, he was intimately involved in ways to increase quality and reduce cost by collecting and analyzing operational data in search of ways to eliminate unnecessary or inefficient processes.

“The results were consistently astonishing,” he said. “Higher quality, lower cost, and more consistent and predictable care were always the outcome. It’s hard work, but with the right data, right tools and right people involved, improvement is assured.”

The good news: operational data in healthcare is abundant.

The bad news: typically data are isolated within discrete, operational systems.

“Extracting and linking these data to each other in a nimble enterprise data warehouse exposes the collective data to analytic tools like Key Performance Analysis, resulting in real insight into performance improvement opportunities,” he said.

The only question about inevitable industry change involves how much will come from externally-imposed change, compared to internally-driven performance improvement through systematic elimination of waste, Grandia said.

“Interestingly, the more internally-driven change that occurs, the less externally-driven change is required,” he said.

“Further, whichever healthcare provider seriously initiates the data-driven improvement journey, the better that organization will be prepared for future success, regardless of the transformation approach ultimately selected.

The ATP approach will never lose its value with the passage of time. Data-driven continuous process improvement will be a – if not the – sustainable winning strategy for all future healthcare organizations.”

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Sports Medicine, continued from page 11 demonstrated between CTE and concussions or exposure to contact sports. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was also recognized that it’s important to address the fears of parents and athletes from media pressure related to the possibility of CTE.” “It seems unclear what their true position is between the two consensus statements and needs to be better explained,” said Ross, particularly given the unfortunate trend of former and current professional athletes taking their own lives for their families “to donate their brain … to prove CTE is in fact an issue.”

Among high-profile, self-inflicted deaths in recent years are professional athletes Junior Seau, Derek Boogard, Dave Duerson, who may have been the only one to commit suicide and leave instructions donating his brain for the study of CTE. Former NFL Chicago Bears quarterback Jim McMahon has agreed to donate his brain to science after his death.

Another point of controversy: concussion determination. A neuropsychologist in the field of treating concussions pointed out the 2004 consensus statement was driven largely on a grading scale (1-3) for concussion with loss of consciousness serving as a means of grading the severity of concussion,

from which the 2008 consensus statement began to deviate.

“My take is that a concussion is more black and white,” he said. “Either you have a concussion or you don’t. When you get into grading scales and severity ratings, you oftentimes relay misinformation to patients and the other providers involved in the case.

Calling it a yes-or-no decision takes that away. Oftentimes, athletes get caught up in whether their concussion was mild or severe, which leads to poorly-based expectations about recovery. A concussion is a concussion and everybody recovers differently.”

In the clinical treatment and management of concussion, the clinician is the key, said the neuropsychologist.

“The consensus statements, the most recent one included, spend a lot of effort discussing sideline assessment tools, baseline testing, cognitive assessment tests, balance testing, RTP decisions, and preferred means of assessment or treatment,” he said.

“All these components are tools that, when used correctly by a well-trained clinician, can be extremely valuable. But the clinician remains the most important piece in terms of concussion treatment and management. The consensus statements do very little in terms of providing practical guidelines for the clinical care of concussion with respect to the individual clinician.”

Notable Highlights Todd Ross, MS, ATC, an athletic trainer for Pulaski Academy with OrthoSurgeons in Little Rock, Ark., emphasized other notable 2012 Concussion Consensus Statement highlights: • In the preamble, “ … therapists, certified athletic trainers … coaches and other people” were replaced with “primarily for use by physicians and healthcare professionals,” which better addresses who should be diagnosing concussions and handling RTP decisions concerning concussions.

• “Brain injury” was added to the first sentence to read: “Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain induced by biomechanical forces.” “One could argue the point of, by definition, a concussion isn’t an injury but a process,” he said. “Adding the language of brain injury nullifies this objection.”

• A timeline for concussion status was identified as “in some cases, symptoms and signs may evolve over a number of minutes to hours,” which could broaden the clinician’s interpretation of signs and symptoms.

• The “Classification of Concussion” subtitle was changed to “Recovery of Concussion.”

• In the neuropsychological assessment subtitle, the second and third paragraphs were rewritten and show less of an emphasis on the patient seeing a neuropsychologist. However, the emphasis changes to neuropsychological (NP) testing and a multidisciplinary approach to concussion management.

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GrandRounds Save the Date!

The Mississippi State Medical Association (MSMA) 145th Annual Session Business Meeting will take place Aug. 16-17 at the Norman C. Nelson Student Union on the campus of the University of Mississippi Medical Center in Jackson.

See agenda at www.msmaonline. com/Docs/Documents/AS%20info%20 -%20cropped.pdf.

Mississippi Sport Medicine Receives 2013 Jackson Award The US Commerce Association has chosen Mississippi Sport Medicine for the 2013 Jackson Awards in the Orthopedic Physician classification.

The USCA “Best of Local Business” Award Program recognizes outstanding local businesses throughout the country.

Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.

The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups.

Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.

Starkville Ophthalmologist Brings New Glaucoma Procedure to Mississippi Starkville ophthalmologist Dr. Jim Brown is the first in Mississippi to have performed an implant procedure that holds promise for some glaucoma patients. The iStent® Trabecular Micro-Bypass is for those with mild to moderate glaucoma and is performed concurrent with cataract surgery.

Patients who have the surgery are commonly able to have their medications reduced or even discontinued.

The FDA approved iStent in the summer of 2012. Brown performed the first iStent implant in Mississippi a few months later.

According to manufacturer Glaukos® Corporation, iStent is for patients with combined cataract and openangle glaucoma, and it reduces intraocular pressure by creating a permanent opening that improves the outflow of fluid.

The company notes that, at one millimeter in length, iStent is the smallest medical device ever approved by the Food & Drug Administration.

As with any medical treatment, each patient’s specific history and conditions

are taken into account in deciding whether to perform the procedure.

Brown’s practice is the Eye & Laser Center of Starkville. He is board certified by the American Board of Ophthalmology and is a Fellow of the American College of Surgeons.

St. Dominic’s Diane Mayo Awarded Fellow Status The American Society of Radiologic Technologists bestowed the status of Fellow on Diane Mayo, R.T.(R)(CT), during the ASRT Annual Governance and House of Delegates Meeting in Albuquerque, N.M., in June.

The ASRT established the honorary Fellow category in 1956 to recognize members like Mayo who have made outstanding contributions to the profession and to ASRT. Fellows have volunteered in leadership positions at the national and local levels, written articles for publication, presented at professional meetings and helped advance the radiologic science profession.

Mayo, a resident of Florence, Miss., has a long history of involvement with the ASRT. She joined the association in 1976 and has served in every nationally elected officer position on the ASRT Board of Directors. In addition, she has served in the House of Delegates as a Radiography Chapter delegate and CT Chapter delegate, and she has been involved in advocacy activities as a member of the Committee on R.T. Advocacy. Mayo also lectures at radiologic science conferences across the country. She is the quality assurance coordinator for diagnostic imaging at St. Dominic-Jackson Memorial Hospital in Jackson, Miss.

Methodist Rehab therapist named 2012 Health Professional of the Year

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JULY 2013

The National Multiple Sclerosis Society’s Alabama-Mississippi Chapter has selected Susan Geiger of Jackson as its 2012 Health Professional of the Year.

Geiger has served on the local community board of the National MS Society for almost five years and Susan Geiger serves on the National MS Society Clinical Advisory Committee. This past year, she began an 8-week “Free from Falls” program for persons living with MS. She also volunteers numerous hours for chapter fundraising events such as Walk MS. Geiger holds a Bachelor of Science in mathematics from Mississippi State University, a Bachelor of Science in physical therapy from The University of Mississippi School of Health-Related Professions and a Master of Business Administration from Millsaps College. At Methodist Rehab, Geiger serves as the manager of outpatient growth and development and maintains a clinical practice emphasizing balance and vestibular rehabilitation.

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Top honors for orthopedic surgery excellence for five consecutive years.

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River Oaks Hospital is proud to be one of America’s 100 Best Hospitals for Orthopedic Surgery and the only hospital in Mississippi ranked among the Top 5% in the Nation for Overall Orthopedic Services five years in a row. Leading-edge technology, the latest in medical advancements, and our genuine, compassionate care earned us national recognition. Visit our website to find one of our orthopedic surgeons. RiverOaksHosp.com

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Sometimes Your Team MVP wears a lab coat.

With fourteen board certified, fellowship trained specialists, it’s easier than ever to stay in the game.

Mississippi Sports Medicine and Orthopaedic is the state’s leading full-service orthopaedic speciality practice routinely performing countless shoulder, elbow, hand, hip, knee, ankle and foot procedures, guiding their patients through rehabilitation to complete recovery.

There is no longer a need to sit the bench.

MSMOC... because Life is a Sport.

Jeff D. Almand, M.D. Gene R. Barrett, M.D. Jamey W. Burrow, M.D. Jason A. Craft, M.D. Chris Ethridge, M.D.

1325 East Fortification Street Jackson, MS 39202

Mississippi’s Orthopaedic Specialists Since 1984

Larry D. Field, M.D. E. Rhett Hobgood, M.D. Brian P. Johnson, M.D. Penny J. Lawin, M.D. Robert K. Mehrle Jr., M.D.

James W. O’Mara, M.D. Trevor R. Pickering, M.D. James Randall Ramsey, M.D. Walter R. Shelton, M.D.

401 Baptist Drive, Suite 301 Madison, MS 39110

4309 Lakeland Drive Flowood, MS 39232

Toll Free (800) 624.9168 or (601) 354.4488 www.msmoc.com Scan the QR code to the right with your smartphone to get Mississippi Sports Medicine and Orthopaedic Center website information. While you are there be sure to click on our facebook link and Like Us.