West TN Medical News February 2016

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PHYSICIAN SPOTLIGHT PAGE 3

Fady Geha, MD

Priorities for the 109th General Assembly State Associations Outline Legislative Wish List

ON ROUNDS

BY CINDY SANDERS

The second legislative session of the 109th Tennessee General Assembly officially convened on Jan. 12, 2016. With lawmakers back in Nashville, the leadership teams representing the state’s physicians, nurses and hospitals are ready to share key priorities and make a case for a list of wants, needs and concerns impacting the delivery of care to Tennesseans.

TMA

More Liver Cancer Patients Receive Y-90 Treatment

The Tennessee Medical Association has outlined three key priorities for this legislative session: reimbursement stability, clarifying malpractice caps, and codifying the doctor as the team leader.

The Healthcare Provider Stability Act, sponsored by Sen. Bo Watson (R-Hixson) and Rep. Jon Lundberg (R-Bristol), would limit how often insurance companies could change fee schedules and payment policies and require adequate notice of those changes to make the process more transparent.

“It’s impossible for a physician to make sure the business side of a practice runs smoothly when health plans can cut reimbursement mid-contract

Therapy Isn’t a Cure But Slows Disease, Improves Quality of Life For the last couple decades, intra-arterial yttrium-90 radioembolization, or Y-90, treatment for liver cancer has been gaining ground in medical communities across the country ... 4

(CONTINUED ON PAGE 6)

HealthcareLeader

Jackson Native Comes Home to West Tennessee Healthcare Prevent, Protect, Improve Healthways Continues Expansion of Ornish Heart Disease Reversal Program When two wellness giants joined forces in 2013, the hope was that millions of people would benefit ... 7

Darrell King Relishes New Opportunity

BY SUZANNE BOYD

After being gone nearly twenty years, Darrell King has come home to Jackson. The former director of business operations at the Jackson Clinic has returned to the healthcare scene in West Tennessee, just this time he is across the street from the clinic. As vice president for West Tennessee Medical Group, King is bringing practice administration experience to the hospital side of operations.

An Old Hickory Academy alumnus, King earned his bach-

Darrell King’s family supporting son Will on the soccer field.

(CONTINUED ON PAGE 10)

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PhysicianSpotlight

Impacting Northwest Tennessee Hearts Dr. Fady Geha Works for Better Patient Access

In his practice, which includes a satellite While the thought clinic in Caruthersville, of life in a big city and Missouri, Geha sees the working in academia whole spectrum of carwas attractive to Fady diovascular issues from Geha, MD, practicing coronary artery disease in a small town won to cardiomyopathy out. As one of only two and valvular heart discardiologists at Heartease. “When you manworks Center for Cardiage any cardiovascular ology in the Northwest disorder, you have to Tennessee town of take all risk factors into Dyersburg, Geha finds consideration,” he said. himself in the midst of “While there is a higher an opportunity to imincidence of some health pact the lives of patients factors such as diabetes in a three state area. in this area, there is a Born and raised propensity for coronary in the Middle Eastern artery disease anywhere country of Lebanon, you go. Gibson County, Geha grew up in a for example which is not multicultural society far from Dyer County where studying and where I practice, has one Dr. Fady Geha meets with a staff member in his office at Heartworks Cardiology Center. living abroad were not of the highest prevalence uncommon. The son of coronary artery disof parents who were educators, he was alease in the state of Tennessee. ” diovascular disease, echocardiography ways encouraged to continually learn and With February being heart month, and nuclear cardiology and is a Fellow of pursuing higher education was an expecGeha emphasizes the importance of prethe American College of Cardiology. tation rather than a suggestion. “Since a When his training was complete, young age, I had a passion for chemistry, Geha initially thought academia would biology and physics so I always knew I be where he would land, but found pracwould do something in the medical field. tice work to be attractive as well. During Contributing to well-being of the general his nationwide search, an opportunity in population was one of the main reasons Dyersburg, Tennessee caught Geha’s eye.

I chose medical school,” said Geha, who “In 2011, as I was applying for positions, speaks three languages. “As there are very the one in Dyersburg seemed to provide few medical schools back home, getting one that would be challenging as well as accepted to one is very competitive and have lots of opportunity for growth,” he considered a huge accomplishment.” said. “There were very few full-time cardiGraduating in 2003 from the Lebaologists in the area. The hospital, adminnese University School of Medicine in Beiistration and the medical community are rut, Lebanon, Geha came to the United very supportive of having full-time cardiStates for his internal residency training. ologists as well as growing the specialty so He spent three years at North Shore Long it has been an easy matriculation for me.

Island Jewish Staten Island University HosThere is a great need here and we hope pital in training. He then served one year to add local interventional cardiology seras chief resident where he taught medical vices to the mix soon. A process that will students, supervised residents, conducted certainly take cardiology in Dyersburg to weekly grand rounds as well as activities the next level.” that were administrative in nature and related to quality improvement initiatives.

After his year as chief resident, Geha went to Tulane University in New Orleans, for post-residency clinical training before returning to New York after a year to complete his training in cardiology finishing in 2011. “New York was a very busy place for medical training and gave me the opportunity to be exposed to a great deal of pathology and disease array. I have always been fascinated by the neat and SUBSCRIBE TODAY complex cardiovascular physiology from a cellular to a clinical level. Heart disease to begin receiving West TN remains, unfortunately, one of the most Medical News in print or on common causes of death worldwide,” said your tablet or smartphone Geha. In addition to publishing several articles in peer review ed journals, he is www.WestTNMedicalNews.com board certified in internal medicine, carBY SUZANNE BOYD

vention. “While cardiology is a very broad specialty, our primary focus is on prevention. Working together with physicians and patients to prevent heart disease is more compelling than treating the disease,” he said. “We always advise patients to see their primary care doctors regularly, stay active, stay fit and stop risky behaviors such as smoking.”

His medical training and four years in practice have taken Geha from the big city to a small rural town. While he likes both, he finds each has its own characteristics and unique qualities that make them attractive. “Rural areas are much different now than they were in the past. Often, they are closer nowadays to large cities and many are expanding the healthcare options they have to offer so while moving from a large major metropolitan area like New York to Dyersburg was an adjustment, it was not a bad one,” said Geha. “I acclimate to new areas easily. Dyersburg is reasonably close to Memphis and Nashville so I take short weekend trips when I have the weekend off. While I do have a pretty hectic schedule, when I have some time off, I enjoy traveling to the beach or really anywhere.”

Keep your finger on the pulse of West Tennessee’s healthcare industry.

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More Liver Cancer Patients Receive Y-90 Treatment

Therapy Isn’t a Cure But Slows Disease, Improves Quality of Life

BY JAMES DOWD

For the last couple decades, intra-arterial yttrium-90 radioembolization, or Y-90, treatment for liver cancer has been gaining ground in medical communities across the country. In use across Europe for many years, the therapy was introduced in the United States in 2000 and has been available in the Mid-South for several years.

“There are more than 140,000 cases of metastatic colon cancer diagnosed in the United States every year, and many of the patients we see are those whose colon cancer has spread to the liver,” said Dr. Henry J. Dalsania, MD, an interventional radiologist at Memphis Interventional Radiology Clinic (MIRC).

“The Y-90 treatment is primarily for patients whose cancer can’t be treated through chemotherapy or surgery.”

The treatment option is becoming increas- Dr. Henry J. Dalsania ingly utilized because of educational efforts within the Baptist system, Dalsania explained. No longer

considered an unproven or experimental treatment, Y-90 is becoming a more mainstream therapy for patients whose conditions aren’t appropriate for other therapies.

“The growth in our Y-90 therapy is directly related to our multidisciplinary approach and our collaborative efforts,” Dalsania said. “We have a great deal of communication between physicians to discuss all possible treatments for patients, and our interventional oncologists are skilled in determining a variety of treatment options that benefit our patients.”

In addition to the MIRC, which is affiliated with Baptist, Dalsania said other

area medical facilities such as Methodist Le Bonheur Healthcare, St. Francis Hospital and West Clinic offer Y-90 treatments.

For many patients suffering from this type of liver cancer, surgery isn’t an option because tumors may be too large or numerous. The Y-90 treatment is less invasive, doesn’t generate many of the negative side effects often associated with chemotherapy, and typically is performed on an outpatient basis.

“This is a different kind of treatment because it isn’t curative, but instead it’s intended to slow the progression of the disease,” Dalsania said. “This treatment helps improve the quality of life.”

A 2011 report published by the Society of Interventional Radiology (SIR) deemed the treatment safe and effective.

“We knew that this unique interventional radiology treatment, done on an outpatient basis, which combines the radioactive isotope Y-90 into microspheres that deliver radiation directly to a tumor, was one of the best ways to give patients a treatment that doesn’t harm healthy cells,” Riad Salem, MD, said in the study.

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Salem is a professor at Northwestern University. “Now we know that patients can actually tolerate much higher doses of radiation than previously thought, which provides results in patients progressing on standard chemotherapy. While patients aren’t cured, their lives are being extended with less down time and their quality of life is improving.”

A 2014 SIR study found the treatment is similarly beneficial for breast cancer patients whose cancer has spread to the liver. The results were remarkably effective.

The study examined Y-90 treatment results of 75 women with breast cancer liver metastases. The study found the treatment “provided disease stabilization in 98.5 percent of the women’s treated liver tumors.”

Robert J. Lewandowski, MD, associate professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, explained the findings and promoted the therapy’s use.

“Although this is not a cure, Y-90 radioembolization can shrink liver tumors, relieve painful symptoms, improve the quality of life and potentially extend survival,” Lewandowski said in the report.

“While patient selection is important, the therapy is not limited by tumor size, shape, location or number, and it can ease the severity of disease in patients who cannot be treated effectively with other approaches.”

While radioembolization is palliative rather than curative, some doctors are using it as a second line treatment in conjunction with chemotherapy, Dalsania said. The procedure takes one to two hours in the medical facility, followed by a few hours of rest and recovery before the patient returns home.

During treatment, millions of microspheres of glass or resin beads filled with Y-90 are injected through a catheter from the groin into the liver artery leading to the tumor. The blood supply to cancer cells is blocked, and high doses of radiation target the tumor without damaging healthy tissue.

Common side effects include flu-like symptoms and body aches, spikes in temperature and fatigue.

Unlike chemotherapy, Y-90 does not typically cause nausea or hair loss.

Benefits of the treatment include the ability to direct higher doses of radiation at tumors and the nonsurgical, minimally invasive procedure. Risks include the chance of allergic reactions, infection and ulcers.

“We’re seeing some cases where Y-90 can shrink tumors to the point that surgery is an option,” Dalsania said. “This treatment is not a replacement for chemo or an alternative option, but it can sometimes assist with treatments to benefit patients without some adverse side effects.”

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Let’s Talk About Valvular Heart Disease

BY SANDRA V. DEE, MD, FACC

Valvular heart disease (VHD) is a type of heart disease that involves the heart valves. Degenerative valve disease is the most common form of VHD in the United States, while rheumatic heart disease accounts for the majority of valve pathology in developing countries. Diseases of the valve could be due to regurgitation, insufficiency or stenosis. VHD may be present at birth or acquired.

Causes of valvular heart disease

The presence of heart murmur does not always indicate heart disease. It may be detected as incidental findings on imaging or non-invasive testing. Before the advent of antibiotics, rheumatic heart disease was the most common cause of VHD. Valve disease may be congenital, like bicuspid aortic valve or pulmonic stenosis.

Acquired diseases could be from, myxomatous or calcific degeneration, infection, coronary artery disease, cardiomyopathy, radiation treatment, connective tissue disorders, tumors, and use of anti-obesity drugs like Fen-phen, which have been removed from the market after being linked to VHD.

Signs and symptoms of valvular heart disease

Symptoms depend on the type and severity of valve disease. If the onset of valve disease is acute, symptoms can occur quickly. If chronic, the heart has time to adjust until the valves deteriorate. Patients with diseased heart valves may present with symptoms of shortness of breath, fatigue, weakness, dizziness and loss of consciousness. Symptoms may be more pronounced with activities, although they could occur even at rest. Some patients complain of palpitations, chest pain, leg swelling and weight gain.

Diagnosis of valvular heart disease

Patients with known or suspected VHD should undergo a thorough history and physical as well as chest x-ray and electrocardiogram. Echocardiogram assesses structural abnormalities and ventricular function, severity of stenosis or regurgitation. Cardiac catheterization identifies the presence of coronary artery disease and severity of regurgitation. Cardiac CT or MRI may also detect abnormalities of the valves.

Treatment of valvular heart disease

The goals for treatment of VHD are to protect the valves from further damage, lessen symptoms, repair or replace the valves. Patients without symptoms or westtnmedicalnews

.com

have minimal symptoms may be observed for some time until there are indications to repair or replace the valves. Patients should maintain a healthy life style, avoid excessive salt intake, refrain from smoking and excessive alcohol intake, control risk factors for hypertension and heart disease.

Medications are given to improve symptoms, reduce the workload of the heart and regulate heart rhythms. Anti-platelet medications like aspirin or Plavix prevent clots and may be prescribed for patients with VHD who have experienced transient ischemic attacks.

Balloon valvuloplasty for stenosed valves uses a catheter inserted through the blood vessel into the narrowed valve which is then stretched. Surgical repair or replacement may be necessary depending on the patient’s age, medical condition and specific valve affected. Replacement valves may be bioprosthetic or mechanical. Patients with mechanical valves are maintained on life-long anticoagulation with Warfarin due to higher risk of blood clots. Surgery may be done as open heart or with minimally invasive techniques.

TAVR ( transcatheter aortic valve replacement), has been developed for patients who have severe aortic stenosis who are poor surgical candidates for traditional surgical aortic valve replacement. The procedure is performed in a hybrid suite with cardiac catheterization and surgical capabilities by a team comprised of interventional cardiologists, cardiothoracic surgeons, imaging specialists and anesthesiologists.

Recent advances in the treatment of VHD can save the lives of patients who are deemed ineligible to undergo the standard open heart approach.

Dr. Sandra Dee specializes in women’s heart health, clinical, vascular, noninvasive and interventional cardiology with the Jackson Clinic. She received her medical degree at the University of Santo Tomas, Manila, Philippines. She completed her Cardiology Fellowship at the University of Tennessee in Memphis and Interventional Cardiology Fellowship at the University of Virginia. Dr. Dee is board certified in Cardiology.

Don’t Miss the Big Event

Physician Compensation: Key Focus in False Claims Act Enforcement

By Denise Burke and J. D. Thomas

The Department of Justice announced yet another multi-billion dollar recovery year from False Claims Act enforcement – totaling over $3.5 billion for FY 2015. Although lower than last year, this is the fourth year in the row that the Department has recovered more than $3.5 billion. Of that total, the majority, or $1.9 billion, came from the healthcare industry for claims related to allegedly unnecessary or inadequate care, kickbacks to providers to induce referrals, or overbilling for goods and services paid for by Medicare, Medicaid, or another federal healthcare program.

While these settlements and recoveries ran the gamut of the healthcare industry, hospitals were hit unusually hard regarding compensation to physicians. The most prominent resolutions this year involved the Stark law, with major settlements against Adventist Health System ($115 million); North Broward Hospital District ($69.5 million); and Columbus Regional Healthcare System ($25 million plus contingent payments up to an additional $10 million). The Department also resolved the long running Tuomey case for $75 million after prevailing at the Fourth Circuit. A careful review of these recent cases provides some insight into About the Authors: “red flags” that may prompt governmental scrutiny. For example, all of these cases involved physician compensation in excess of the 90th percentile and involved compensation greater than revenue from personally performed services. Most also contained compensation based on services performed by others, inflated RVUs or other fees not directly generated. Notably, all of the recent cases had independent fair market value analysis opinions, although most also included some indication of “shopping” for favorable opinions or other Denise Burke is a partner with Waller and focuses evidence that the valuations raised issues regardexclusively on healthcare ing high compensation. These cases are concerning investigations, regulatory because clearly there are cases where it is appropriand operational issues. ate to pay physicians more than is collected for their Denise is the current professional services, such as areas with high indigent chairman of the Tencare rates or where recruiting efforts have been unsuc- nessee Bar Association cessful. These cases, however, contain much guidance Health Law Section, ranked by Best Lawyers for hospitals and physicians as well as their legal and and featured in Memphis valuation advisors.

By the Department’s own admission, much of its False Claims Act enforcement is driven by whistleblower, or qui tam, lawsuits filed under the False Claims Act - and this year’s results were no exception. Whistleblower’s counsel have certainly taken note of these settlements, particularly some of the eye-popping resolutions against hospitals charged with Stark violations. As such, additional qui tam actions in these areas are likely, as is a continued focus by the Department. With the recent issuance of the “Yates Memorandum” by Deputy Attorney General Sally Quillian Yates demanding that, absent extraordinary circumstances, all settlements against corporations should include actions against the individuals responsible for the conduct, we can expect future investigations and settlements to focus on individuals, including physicians and hospital executives.

As such, attention to these issues, and documentation to support decisions, is more important than ever.

Waller is ranked as one of the ten largest healthcare law firms by Modern Healthcare, representing scores of physician practices and companies that own or operate approximately 450 hospitals and 150 ambulatory service centers.

J.D. Thomas is a partner with Waller and a member of the Firm’s Healthcare Compliance and Government Enforcement Group. He represents and advises healthcare companies and providers with regard to myriad fraud and abuse issues including investigations and litigation involving the False Claims Act, Anti-Kick Statute and Stark law.

www.wallerlaw.com

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Priorities for the 109th General Assembly, continued from page 1 with no recourse for the physician,” said TMA President John W. Hale, Jr., MD. Hale said another priority for TMA in the upcoming session is to work toward a consti- Dr. John W. tutional amendment Hale clarifying the General Assembly has the authority to set the caps on noneconomic damages in cases including medical liability actions. Laws were passed in 2011 but are now being threatened by lawsuits. In order to make it to the ballot for a vote in 2018, the proposed amendment must pass two separate General Assemblies, which makes this session critical for TMA. “The General Assembly needs to act now to prevent us from going backwards on the issue of a noneconomic damages cap,” said Hale, adding he was “confident Tennessee voters will support it if given the chance to have their voices heard.”

One of the key pieces of legislation on TMA’s list of priorities is the Ten-

nessee Healthcare Improvement Act, which outlines a team-based healthcare delivery model with doctors as the team leader in patient care coordination. The TMA-backed bill is being offered as an alternative to the Nurse Independent Practice/Full Practice Authority Bill.

The Tennessee Nurses Association has long advocated for legislation to remove scope-of-practice barriers, which has put the two major provider organizations at odds on this issue.

“Having the proper collaboration from a physician in diagnosing and treating a patient ensures the highest quality of care and patient safety,” stated Hale. “We want to knock down silos among providers, increase care collaboration and create a model that supports the best possible patient outcomes. The Healthcare Improvement Act will allow advanced practice nurses to use the full extent of their training but make sure that a physician is involved in the care of every patient. It’s in the best interest of all Tennesseans.”

Getting Involved in the Process The Doctor’s Day on the Hill is slated for March 1. Approximately 300 physicians from across the state are expected to convene at Legislative Plaza in Nashville to share opinions and expertise with state lawmakers. To register or for more information, go online to tnmed.org/dayonthehill.

The TNA Legislative Summit is set for April 6. More than 1,000 student nurses, registered nurses and faculty are expected to attend the annual event, which includes presentations on hot topics and the opportunity to meet with legislators. Information is available at tnaonline.org under the Events section.

TNA

The Tennessee Nurses Association disagrees with that assessment. For TNA Executive Director Sharon Adkins, MSN, RN, it comes down to improving access to care while decreasing costs to the system and individual patients.

“We certainly understand there are major changes going on in Sharon healthcare; and in TenAdkins nessee, we are consistently at the bottom of healthcare rankings,” Adkins said. “In order to address that, we’re concerned about providing access to quality, affordable care. Advanced practice registered nurses are positioned to provide that care, and so we will oppose any efforts to restrict their ability to practice to the full extent of their education, training, experience and certification.”

She continued, “Though the Tennessee Medical Association has introduced legislation to ‘improve healthcare,’ it essentially will restrict the existing practice of advanced practice registered nurses.

Their bill would increase cost and decrease access.”

Adkins noted that while scope-ofpractice issues are a major focus, there are a number of other bills that have been filed that could potentially impact the state’s healthcare landscape. To that end, TNA leadership is reviewing proposed legislation and will weigh in as necessary.

“We will support any legislation that is beneficial to the healthcare of the citizens of our state,” Adkins concluded.

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THA

Although TMA and TNA might have to agree to disagree over practice authority, both organizations are united, along with the Tennessee Hospital Association, in supporting continued efforts to pass Insure Tennessee.

While hopeful the General Assembly once again will consider the proposal to extend healthcare coverage to more than 200,000 Tennesseans, THA Chief Executive Officer Craig Becker recognizes it will be difficult to gain traction on coverage expan- Craig Becker sion during a presidential election year.

Becker said there is work to be done even if legislators don’t formally take a look at Insure Tennessee this year. “We’re going to use this as an opportunity to provide more education to the Legislature and more public education, as well,” he said, adding there are lingering misconceptions about program.

Of key concern to THA is maintaining Tennessee’s Certificate of Need program. Becker said there have been discussions about eliminating the CON program with free market proponents opposed to government intervention in controlling healthcare supply.

“Those in favor of a free market say it controls costs, which would be true if there was a level playing field … but there’s not,” Becker stated. “We have to take all comers.”

Becker added the CON program helps control ‘cherry picking’ so that an ambulatory surgery center or imaging center doesn’t siphon off commercial pay patients without taking charity care patients.

Becker said not having a program in place “definitely poses a threat to hospitals in communities.” In addition to endangering access to care, Becker said eliminating the CON process would actually increase cost to the system.

Another area of emphasis this year is on telehealth reimbursement. “In 2014, we passed legislation that required insurers to pay for telehealth/telemedicine,” Becker said. However, he continued, the insurance industry “has come up with some loopholes so that they don’t have to pay in certain circumstances, which really guts the intent of the bill. In our opinion, it subverts the legislative intent.” Becker said THA is working with lawmakers to clarify the legislation with the strong support of hospitals and providers.

Also garnering broad support is the creation of a statewide stroke system.

THA is working with TMA and TNA to replicate the success of the trauma system to ensure stroke patients receive the right level of care at the right time in the right setting. Launching a coordinated statewide stroke response system might even be feasible without requiring formal legislation, Becker noted.

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Prevent, Protect, Improve

Healthways Continues Expansion of Ornish Heart Disease Reversal Program

By CINDY SANDERS

When two wellness giants joined forces in 2013, the hope was that millions of people would benefit. Nearly three years later, the partnership between Dean Ornish, MD, and global well-being improvement company Healthways continues to expand, bringing evidence-based lifestyle programming to ever-increasing numbers of individuals across the nation.

Based in Franklin, Tenn., Healthways is a provider of wellbeing and health improvement solutions to nearly 68 million people on four continents.

The company entered into an exclusive agreement with Ornish in July 2013 to operate and license his Lifestyle Management Programs, which included interventions addressing early-stage prostate cancer, type 2 diabetes, and heart disease.

A cornerstone of the partnership is Dr. Ornish’s Program for Reversing Heart Disease™ (Ornish Reversal Program), which is scientifically proven to not only treat … but also to reverse … the progression of heart disease through comprehensive lifestyle changes.

“What’s different about it is recognizing lifestyle is a viable treatment alternative for cardiac disease that can actually reverse the disease at its root cause,” said Robert Porter, managing director of the Ornish Reversal Program for Healthways.

He added integral parts of the program focus on diet and nutrition, exercise, stress management and group support.

“One of the unique things about the program is that it is offered to people in cohorts of eight to 15,” Porter said. “The reality is we are social animals. We’ve discovered the power of that group support and community in helping individuals make and sustain a behavior change.”

Each small group participates in 18 four-hour interactive sessions. In addition to learning new strategies and techniques from a staff leader, participants also use group time to share suggestions and practical solutions to incorporating new habits into daily ‘real’ life. During a session, the group might share a meal, practice yoga together, work on stress reduction exercises and learn how to choose wisely from restaurant menus. “They don’t just learn what they should do … they actually do it,” Porter said. “They’re actually living the program during those 18 sessions.”

He pointed out the support system functions in much the same way as having a workout buddy, mixing social interaction with a degree of accountability. “It’s a really powerful way to provide support, a bond and a covenant among the group that helps them build (program elements) into their new lifestyle,” he explained.

Porter added the bond is so strong that participants formed alumni groups to continue to foster encouragement and maintain interaction. The Ornish Rewesttnmedicalnews

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versal Program website (ornishspectrum. com) states 87.9 percent of participants continue to get together regularly after finishing the 72 hours of active programming. In fact, Porter noted, some of the participants from the early research studies, which go back decades, continue to keep in con- Robert Porter tact.

“Dr. Ornish, over 30 years, has done the most rigorous research you can imagine,” Porter said of the science behind the program. Starting with the notion that it’s easer to turn off the faucet than to mop up the floor, Ornish began formulating ideas about how to improve health while he was still in medical school. By 1978, Ornish and colleagues at the University of California, San Francisco showed heart disease could be reversed after only 30 days, as demonstrated by improved blood flow to the heart, in a pilot study that utilized the tenets of the Ornish program.

Based on nearly four decades of ongoing research, which has been widely published in peer-reviewed journals, the program was approved for Medicare reimbursement under the category of ‘Intensive Cardiac Rehabilitation’ beginning in 2011. In addition to nationwide reimbursement through Medicare, commercial payers in 17 states also cover the program for heart disease.

“As the evidence grows, as we gain experience, the science would seem to predict there is the possibility for this program to expand to a larger number of chronic diseases,” said Porter. He added a few payers have extended the criteria for coverage to include those with diabetes and early-stage prostate cancer.

The core program, however, is currently focused on heart disease. With the exception of congestive heart failure, which Porter said he hopes will be added in the near future, the program is approved under Medicare for the same diagnoses as traditional cardiac rehabilitation.

The six qualifying conditions are: • Acute myocardial infarction in the preceding 12 months, • Coronary Artery bypass surgery, • Current stable angina pectoris, • Heart valve repair or replacement,

• Percutaneous transluminal coronary angioplasty or coronary stenting, and • Heart or heart-lung transplant.

A focus on lifestyle modification and prevention has increasingly become more mainstream in healthcare, but transforming the delivery system remains an ongoing challenge.

Phil Newbold, CEO of Beacon Health System in Indiana, which launched the program in August 2015, noted, “If you look at the mission and vision statements of most hospitals and health systems, the word ‘health’ is all over them … but if you look at where we spend our resources, about 99 percent goes to the medical side of things and very little actually focuses on health. When we looked at the Ornish Reversal Program, we saw that it was the best way for us to really embrace health in a scientific way and better align ourselves with our mission of creating a healthier community.”

Echoing the sentiment, Porter said, “I think our whole healthcare system was built around passively waiting to treat people when they presented with a problem. We’ve found that is unsustain-

able. It’s unsustainable financially, and we’re not optimizing the health status and qualify of life for people.” He continued, “The best way for us to promote health is to adopt a healthy lifestyle that prevents the onset of chronic disease.”

The Ornish Reversal Program is rapidly gaining a foothold in the medical community since rolling out nationally about 18 months ago. At the end of 2015, four new partner sites were announced in Texas, Florida, North Carolina and Virginia. At press time, Healthways had implemented the program in 22 sites across 14 states with two more programs in the process of being launched and numerous others in the discussion phase.

While Porter said it was too early to have hard financial figures in terms of savings to the health system, he noted early indicators have been impressive. “We’re certainly seeing incredibly solid clinical results,” he said. “Based on those clinical results, the predictive variables would indicate we expect to see solid results in other outcomes like readmissions and costs.”

Physician groups and hospitals interested in learning more about the program and research behind it should go online to ornishspectrum.com or call Healthways at 877-888-3091.

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A COMMENTARY

Insure Tennessee Meeting Becomes One-Way Conversation

By PEGGY BURCH

Scott Morris, MD, thinks people’s ability to get healthcare shouldn’t have to depend on which side of the Mississippi River they live on.

“Why do people east of the Mississippi have less than those west of the Mississippi?” Morris, CEO of the Church Health Center, asked a group of about 75 people who had gathered at Baptist Memorial Hospital in January to talk about Insure Tennessee.

The answer depends on state lawmakers. On the west bank, the Arkansas legislature approved a plan to use funds provided under the Affordable Care Act to purchase health insurance for low-income residents on the government healthcare exchange.

More than 200,000 of those eligible signed up after the program began in 2014.

To the east, Tennessee lawmakers

last year voted against a plan to cover state residents in similar financial circumstances.

‘No’ votes by a bloc of Republicans on two Senate committees kept the Insure Tennessee proposal from getting to the Senate floor.

Whether the states decide to use it or not, federal money to expand Medicaid is available under the ACA. Insure Tennessee is Republican Gov. Bill Haslam’s proposed alternative to Medicaid expansion that would cover an estimated 280,000 uninsured residents who don’t qualify for TennCare, the state’s Medicaid program, and have incomes under 138 percent of the federal poverty level. About half of those uninsured residents work.

Morris is immersed in the “coverage gap.”

“Over 90 percent of the patients at Church Health Center are working and

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uninsured,” Morris said. “They’re in that position where they don’t qualify for anything.” And there are 900 people on the waiting list to become CHC patients.

The forum at Baptist Hospital regarding Insure Tennessee had nearly 30 supporting hosts, including Shelby County Mayor Mark Luttrell, newly elected Memphis Mayor Jim Strickland, former county Mayor Jim Rout and CEOs of Baptist Memorial Health Care, Methodist Le Bonheur Healthcare and Regional One Health.

The audience heard from Cyril Chang, PhD, economics professor and director of the Methodist and Le Bonheur Center for Healthcare Economics, who said many of the 280,000 “Swiss cheese people” who fall through the holes of insurance coverage in Tennessee work in food service, construction, maintenance and transportation.

A page in his PowerPoint presentation said “Medicaid expansion would have brought an estimated $352 million of federal dollars to Shelby County between 2014 and 2016 at no extra cost to the state.”

According to academic estimates, Insure Tennessee would have brought more than $1 billion to the state each year and created 15,000 jobs.

Greater Memphis Chamber CEO Phil Trenary said a unanimous 120 members of the Chamber’s Chairman’s Circle support it.

But the speakers were preaching to the converted. The forum was designed to win over Republican state legislators who must approve Insure Tennessee. They weren’t there.

Rout, the Republican former mayor who’s now president and CEO of BankTennessee, invited seven members of Shelby County’s Republican delegation to attend the forum. None did.

A Memphis Medical News reporter called the lawmakers to ask why they didn’t attend.

State Rep. Mark White said he supports Insure Tennessee but couldn’t get to the forum because he was having a tooth extracted at the time. Rep. Curry Todd didn’t return email or phone messages; an aide who answered the phone in his Nashville office said, “Not one of his constituents in Germantown and Collierville has called asking why he didn’t attend.”

Rep. Steve McManus didn’t reply to an email or phone calls. Rep. Jim Coley’s office aide said he didn’t go because of “health issues.” Rep. Ron Lollar wrote in an email that he had a previous appointment: “Sorry I couldn’t make it. Thanks for asking. Ron”.

Sen. Mark Norris said via email that he had been contacted by two hosts but regretted because of a “prior commitment out of state.”

Sen. Brian Kelsey, an outspoken opponent of Insure Tennessee, had intended to go but had to work in his law office until midnight Jan. 7, according to an aide in his office.

As the legislature convened for its 2016 session, Lt. Gov. Ron Ramsey, speaker of the Senate, told the Times-News in Kingsport that Insure Tennessee wouldn’t be reconsidered during this legislative session since a new U.S. President is going to be elected in November and a new administration might change the healthcare program: “The timing is bad now,” Ramsey said.

Morris told the audience at Baptist about a patient he had seen at Church Health Center that day – a construction worker who needs a knee replacement and had been using duct tape to stabilize his knee.

“We have the ability to get his knee replaced,” Morris said. “We have a thousand doctors who volunteer with us, and as long as doctors volunteer, the hospitals provide facilities. Smith & Nephew will give us a knee. It’s a wonder to behold how this all works. “But he (the patient) asked if he’d have to miss work if he had the surgery. He doesn’t get paid if he doesn’t work. What doesn’t exist is the means for him to pay his light bill in the winter if he doesn’t work.”

Morris, who’s also a minister, says Insure Tennessee makes sense financially “without question,” but he thinks it shouldn’t be an economic or political issue. “If we view this as a question of what is the morally right thing to do, it certainly changes the tenor of the conversation when that happens,” he said.

Based on attendance at the recent forum, it would have to be a one-sided conversation.

Peggy Burch has served as a former government and politics editor at The Commercial Appeal during a 35-year career as a reporter and editor at two major newspapers.

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Jackson Native Comes Home, continued from page 1 elor’s degree in finance from the University of Tennessee at Knoxville in 1988.

His first job out of college was with First American Bank, which is now Regions Bank, in Nashville. In 1989, he transferred to Jackson. “In the early 1990’s banking was sort of a hit or miss industry,” said King. “A friend of mine, who was with the Jackson Clinic, mentioned they had an opening in their business office and thought that with my background I would be a good fit for the position. It seemed like a good move so in 1990 I joined the clinic as their business office manager.”

By 1998, King was married with a daughter and was awaiting the arrival of his son. He was also the director of business operations for the clinic, was dealing with marketing, played a role in the constructions of the Jackson Clinic South as well as the Jackson Clinic North and earned his Master of Business Administration degree from Union University.

“Thanks to Carl Rudd giving me the opportunity to be involved in lots of different things at the clinic, my role had really expanded and I had learned so much,” said King. “But I also knew that I had probably gone as far as I could at the Clinic at the time so I started looking to see what other opportunities were out there.”

Ironically King found the right opportunity while waiting to welcome his second child into the world. “My wife Tracey, was in labor with our son,” he

said. “I was looking in a journal and saw an opportunity in Maryville, Tennessee. It was a chief executive office for a smaller group than the Jackson Clinic but it afforded me the opportunity to learn new things, so in the summer of 1997 we moved back to East Tennessee.”

Over the next ten years, King helped the clinic grow from 20 to 50 providers, acquired a practice and started a real estate partnership. King knew it was time to move on and his next opportunity came through a familiar hometown connection. “Carl Rudd had told me about an opportunity in Fort Smith, Arkansas.

He suggested that I talk to someone he knew in Jonesboro who had been in Fort Smith,” said King, who is a certified medical practice executive. “It was from that call that I learned of a chief operating officer position at Northeast Arkansas Clinic (NEC).”

In 2007, King took the reigns as COO for NEC. “It was a very progressive group of 80 physicians,” he said. “The group had a not for profit foundation and a real estate partnership. They also owned 40 percent of the local hospital, which was a different twist on things for me. In 2010, Baptist Memorial Healthcare out of Memphis bought the clinic and we became Northeast Arkansas Baptist Clinic. I took over as CEO, recruited 45 new doctors to the clinic and moved into a new building that was adjacent to the new hospital Baptist opened in 2014.

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The NEA Baptist facility was the largest construction project of its kind in Arkansas and one of the ten largest healthcare construction projects in the country at that time.”

While Jonesboro was closer to home than they had been in East Tennessee, King says the thought of returning to Jackson was something they had known they would do if the right opportunity arose. In the fall of 2015, West Tennessee Healthcare made him an offer too good to refuse. On December 1, King became the vice president of West Tennessee Medical Group where he is responsible for more than 80 hospital-employed physicians including the hospitalist program, a gastroenterology group, neurosciences and cardiovascular surgery.

“What I found so interesting about this opportunity was that not only would I get to work for my hometown health system, I would be moving from the private side to the health system side of healthcare,” said King. “While I still do a lot of the same things that I did with the clinic, I now have exposure to other things going on inside the health system.”

Although he has only been in the position a few months, King has jumped right in and is busy working on several projects. “While I am still meeting with people and getting oriented to the organization, I still have to deal with normal practice operation issues that come up,” he said. “We are also talking about what the medical group’s needs are and trying to build some brand identity. West Tennessee Medical Group is a significant group of physicians that are employed by West Tennessee Healthcare. Physician recruitment is also at the top of my list.”

Down the road, King expects healthcare will continue to change and looks forward to being a part of it. “I think there will still be an integration of physicians and health systems. I am not a doctor but having worked with them for so long I hope to bridge the gap between what they do and what is needed for our community,” he said. “This is a big busy place and it has become so evident to me what a regional healthcare system it really is. The scope of services we provide is a testament to the medical hub Jackson is.”

Moving to Jackson has been coming home for King, but it has not come without some adjustments. While his oldest daughter Kathryn is a sophomore in college, his son, Will, is finishing his senior year in high school. “Tracey and Will are staying in Jonesboro until he graduates this spring and will move here this summer,” said King. “While we are still sort of working through the transition, Jackson feels like home to all of us and we cannot wait to be involved in the community.”

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: subscribe@medicalnewsinc. com for information.

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PUBLISHED BY: SouthComm Business Media, Inc. MANAGING PUBLISHER Pamela Harris pharris@medicalnewsinc.com 501.247.9189 LOCAL EDITOR Pamela Harris pharris@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Abbie Leali Liz Loewenstein CONTRIBUTING WRITERS Suzanne Boyd. Peggy Burch, James Dowd, Lynne Jeter Judy Otto, Cindy Sanders CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: westtneditor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com

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West TN Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Business Media, Inc. ©2016 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

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GrandRounds West Tennessee Healthcare Foundation Announces Noah Chamberlin Memorial Fund

JACKSON - The West Tennessee Healthcare Foundation announces the establishment of the Noah Chamberlin Memorial Fund to honor the two-year-old that disappeared in Pinson.

Noah’s disappearance created an unbelievable outpouring of prayers and support in searching for Noah. Noah was highly active and full of life. The search for Noah captured the hearts and minds of thousands of West Tennesseans. The outpouring of support was an amazing comfort for the family.

This fund will be a great help in keeping the memory of Noah alive according to Jacob Chamberlin, father of Noah.

First responders provided personnel in leading the organized effort that involved 400 – 500 volunteers a day. This effort impressed leaders of national organizations. The effort was a strategic, systematic search where professionals came to join in this search. Chester County Sheriff Blair Weaver, Madison County Sheriff John Mehr and Fire Chief Eric Turner expressed gratitude for the first responders that helped organize the massive search.

Plans for this fund will be to provide counseling for the family, assist in paying for expenses incurred by the family during the search efforts and to provide a lasting memorial for Noah that will enable his spirit to live on through the lives of others. More details of the memorial will be released after the family has had time to deal with this tremendous loss.

All donors receive a receipt for their gift as a record for their taxes and a card will be sent to the family, notifying them of your donation to the fund.

Memorials may be sent to: The Noah Chamberlin Memorial Fund, WTH Foundation, 620 Skyline Drive, Jackson, TN 38301.

To find out more about the Foundation, email Frank McMeen at Frank.McMeen@wth.org

West Tennessee Healthcare Celebrates Opening of New Trenton Medical Center

JACKSON- West Tennessee Healthcare recently held a ribbon cutting ceremony to commemorate the opening of the new Trenton Medical Center. The event was held in conjunction with the Greater Gibson County Chamber of Commerce on Tuesday, January 19.

West Tennessee Healthcare Executive Vice President System Services, Dr. Lisa Piercey said that The Trenton Medical Center realigns healthcare services in Gibson County and provides better access to those services. He added that Trenton Medical Center ensures that the highest quality healthcare is available in Gibson County.

The nearly 13,000 square foot facility includes occupational and physical therapy services provided by Sports Plus Rehab Centers, lab and x-ray services along with primary care provided by Christian Family Medicine, walk-in or drive-thru pharmacy services provided by Duncan’s Express Pharmacy as well as rotating specialty clinics.

The Trenton Medical Center opened in January 2016. For more information, please visit www.wth.org.

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WTH Foundation Now Accepting Proposals for 20162017 Fiscal Year

The Foundation announced it plans to accept proposals from area non-profits. The organization will focus on projects and initiatives benefitting Madison County for the upcoming 2016-2017 fiscal year.

Vice President of Operations, Beth Koffman said the Foundation has supported area initiatives for the past 30 years, and we are now looking for innovative ways to make a difference in the lives of our citizens in Madison County.

While there are no specific areas of focus requested, the Foundation has stipulated grant awards must serve the residents of Madison County. Proposals will be accepted from 501(c)(3) organizations or funds of the Foundation until Monday, February 29, 2016 at 11:59 p.m..

A complete listing of the proposal guidelines can be found at www.wthfoundation.org/what-we-do/communitygrant-awards.

For more information, contact the Foundation’s Beth Koffman at Beth.Koffman@wth.org. westtnmedicalnews

.com

For The Jackson Clinic’s Board Certified Cardiologists, your heart is their specialty. Supported by the highest level of diagnostic technology, our cardiologists use the latest cardiovascular treatment methods to provide you and your family the best in care close to home.

Front Row (left to right): Dr. Shahzad Shah, Dr. Antwan Robinson, Dr. James H. Crenshaw, Jr., Dr. Sandra V. Dee, Dr. Jason C. Cherry, Dr. T. James Humphreys Back Row (left to right): Dr. Chibuzo Nwokolo, Dr. Abdul Rashid, Dr. John W. Baker, Dr. Joseph Okolo, Dr. Michael O. Osayamen

We Specialize In You. 700 West Forest Avenue | Suite 300 | Jackson, TN 38301 | www.jacksonclinic.com | 731-422-0213 | Hours: M-F 8am - 5pm FEBRUARY 2016

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