West TN Medical News July 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 3

John Bates, MD

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Ranks and Roles of Nurse Practitioners Accelerating With the Affordable Care Act pushing cost-effective healthcare and coinciding with a shortage of primary-care physicians, nurse practitioners are becoming more numerous ... 4

Electronic Health Records: How Far Have We Come? By SUZANNE BOyD

Much progress has been made, but much work remains to be done, in getting healthcare providers to embrace electronic health records as a way to improve patient care. Among those pushing hard for EHR adoption are the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technology (ONC). The U.S. Department of Health and Human Services reported that as of the end of April, more than half of all doctors and other eligible providers had received incentive payments for adopting, implementing, upgrading or meaningfully using EHRs. More than 80 percent of eligible hospitals and critical access hospitals have demonstrated meaningful use. That equates to $14.6 billion in incentives having been paid to Medicare and Medicaid providers and hospitals. According to data collected by the state of Tennessee, 3,197 eligible professionals and 127 eligible hospitals have received incentive payments totaling more than $78 million since the program began in January 2011. A survey from CMS indicated that the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 has dramatically accelerated providers’ use of key health IT capabilities across the nation. Office-based physician use of e-prescribing has increased from less than 1 percent in 2006 to 53 percent in early 2013, with more than 94 percent of all pharmacies actively e-prescribing. Physicians are also exchanging information (CONTINUED ON PAGE 13)

HealthcareLeader State Pharmacy Board Strengthens Oversight of Drug Compounding In the wake of another suspect drug case with reports of adverse patient events, the Tennessee Board of Pharmacy has announced actions to better assure the safe, sterile compounding of drugs by state-licensed entities ... 8

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Deena Kail Executive Director, Ayers Children’s Medical Center By SUZANNE BOyD

As a child, Deena Kail always knew she wanted to be a nurse. Management, however, was not included in her childhood dream but is ultimately how she is fulfilling that dream of being a nurse. As executive director of West Tennessee’s Ayers Children’s Medical Center, Kail is still applying what drew her into health-

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care into her daily routine, the love of caring for others. “When I graduated with my associate’s degree in nursing from Union University in 1981 I went to work in labor and delivery at Jackson General. My heart was at the bedside and I loved taking care of women and children to the point that I thought I would never leave it.

(CONTINUED ON PAGE 12)

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ColonosCopy:

Screening Can Save Your Life by: Dr. Ami Naik

The diagnosis of cancer is something that no one wants to hear. Unfortunately, for most cancers there are no preventative measures that can be taken. Colon cancer is one of the few malignancies for which there is a known screening measure that has been proven effective. Yet, we still have a long way to go. In the United States, only 60% of eligible people are being screened for colon cancer. It is estimated that 1 in 17 people will develop colon cancer and it is the third leading cause of cancer deaths in both men and women. The majority of colon cancers arise from growths of tissue called polyps. It is important to understand that there are two main histological types of polyps – adenomatous and hyperplastic. Hyperplastic polyps are benign and do not have the potential to become malignant; however, adenomatous polyps (also referred to as tubular adenomas) are also benign growths of tissue but have the potential to become malignant. When looking at colonoscopy screening/ surveillance intervals, the number, the size, and the histology of the polyps are taken into consideration. Screening just indicates the interval between colonoscopies when no adenomatous polyps are found. Surveillance indicates the interval between colonoscopies when adenomatous polyps are found. Oftentimes, primary care physicians are the ones who monitor screening and surveillance intervals. We often get calls questioning when a patient is due for their next colonoscopy. There is also confusion about findings of hyperplastic polyps, as patients will tell their doctors that they had “polyps” on prior colonoscopies. The importance of correct time intervals between colonoscopies cannot be emphasized enough. No one wants to go through this procedure more than what is indicated and insurance will not reimburse for unnecessary procedures. The following are guidelines agreed upon by the major gastroenterology societies and cancer societies regarding colon cancer screening and surveillance. • Average risk screening is to be done at the age of 50. • If this does not show any adenomatous polyps, repeat colonoscopy in 10 years. • If polyps are present but histology comes back hyperplastic, repeat colonoscopy in 10 years.

* Remember that we are only interested in adenomatous colon polyps in terms of determining colonoscopy intervals. • A first-degree relative with colon cancer necessitates an initial colonoscopy at age 40 or 10 years younger than the affected relative’s age of diagnosis. • Repeat colonoscopy every five years. • There is no definite consensus on how to evaluate patients with first-degree relatives who have colon polyps. We err on the side of caution and use the same guidelines as a first-degree relative with colon cancer. • A second-degree or third-degree relative with colon cancer or colon polyps follows average-risk screening guidelines.

JULY 2013

There are also some special situations in which the screening/surveillance interval can be changed. Some examples are patients with a fair or poor bowel preparation or where a polyp is removed piecemeal. No matter what the situation, we maintain a logbook where we note when the patient’s next colonoscopy is due and send a reminder letter to the patient a few months prior to make an appointment. We are always available if there is a question or concern about colonoscopy intervals. We at The Jackson Clinic GI Department are committed to providing appropriate and timely colonoscopy screenings and surveillance and thus doing our part to decrease the incidence of colon cancer.

• Patients with tubular adenomas will need surveillance colonoscopies depending on the characteristics of the polyps. • One to two tubular adenomas less than one centimeter in size – repeat in five years. • Three to ten tubular adenomas OR one tubular adenoma equal to or greater than one centimeter – repeat in three years. • Greater than ten tubular adenomas – repeat in one to three years. • A tubulovillous adenoma is an adenoma that is more advanced towards malignancy and is diagnosed by histology – repeat in three years. • Future colonoscopies are determined by the findings of polyps. If two subsequent colonoscopies after the index colonoscopy showing polyps are negative, then the interval is lengthened to ten years. If subsequent colonoscopies also show polyps, the interval is three to five years based on surveillance guidelines. • No routine screening colonoscopy is recommended at or after the age of 75. If the patient is between the ages of 75 and 85 and in good health, surveillance colonoscopy is recommended. No screening or surveillance colonoscopy is recommended after the age of 85.

Jackson Clinic Gastroenterology Department 700 West Forest Ave., Suite 300 • Jackson, TN 38301

• Because of the increased risk of developing colon cancer with increased duration of the disease, patients with ulcerative colitis and Crohn’s disease should have surveillance colonoscopies every one to two years after eight to ten years of the disease.

Dr. Ami Naik

www.jacksonclinic.com • 731.422.0213 westtnmedicalnews

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PhysicianSpotlight

John Bates, MD By SUZANNE BOYD

It was in Middle School that John Bates, declared he would go into medicine, mainly because it sounded interesting. While studying biology in college, he found the way the body works fascinating and what a miracle it is that we can heal certain things which pointed him even further toward medicine. Combining his biology degree with one in biblical studies planted the seed of service to others which was the final motivation he needed to become a doctor. Today, Bates is putting that motto of service to others to work on some of the ‘smallest and least of these’ as a pediatrician and a father of three. Bates, who grew up in Arab, Alabama, a small town just 30 miles south of Huntsville, credits Freed Hardeman with helping prepare him for life far beyond the two degrees he earned while there. “While visiting my sister at Freed, I realized its outstanding Christian environment was the only place for me. Their motto of teaching how to live and how to make a living helped prepare me for life beyond any degree I could earn,” said Bates. “While an undergraduate, I studied abroad for a summer in Florence Italy and realized that not everyone is like me.” While in medical school at the University of Alabama School of Medicine in Birmingham, Bates also realized that not all specialties were for him. “When I entered medical school in 2000, I thought I would go into surgery partly because of my fascination with anatomy. Unfortunately, my personality does not fit that very well since I like to talk to people who are awake a little too much,” said Bates. “In rotations it really hit home with me how much I enjoyed pediatrics and it became obvious you have to enjoy the type of medicine you practice. Most people go into a specialty that matches their personality. My wife, whom I met in college and married while I was in medical school, says I have the humor of a twelve year old so I guess that fits my specialty.” After finishing medical school in 2004, Bates completed his pediatric residency at Duke University’s Children’s Hospital and Health Center in Durham, North Carolina. “Early in my residency, I got a call from Baptist Memorial Hospital – Union City, which is my wife Mandy’s home town and yes she is named for the Barry Manilow song,” said Bates. “It seems that the OB/GYN, Dr. Cameron, who had delivered my wife had run into my father-in-law, Mr. Garrett, and in the process of catching up, he heard I was a pediatric resident. He immediately said they needed a pediatrician in Union City.” After living in large cities such as Birmingham and Raleigh-Durham, the Bates knew that a small town was probably the fit for them, just they had never considered Union City. After spending time in the city over Christmas and looking at westtnmedicalnews

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Dr. John Bates letting his son, Nolan, listen to his heart at his clinic.

the town as a possible home rather than a place to visit family, they started to realize all that Union City had to offer them as a family and the opportunity it presented for a pediatrician. “The Union City idea was on the table early which allowed us to consider it thoroughly as well as develop relationships over time,” said Bates. “Being close to family was important to us and we did look at other opportunities in Middle and West Tennessee as well as

North Alabama but we realized the great opportunity facing us in Union City. I had never thought of opening my own practice but at the time there was only one other pediatrician in the town along with a few family practice groups that would treat kids. There was lots of opportunity here and this area seems to always be having kids.” In 2007, Pediatric Place of Union City opened its doors. “There was a bit of

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anxiety with that. The hospital is actively involved in trying to build the medical community and help recruit whatever specialty is needed. They provided me support for business cost and getting us here as well as a grace period to make sure I made it but ultimately the clinic had to make a profit. Our original agreement was for support for up to two years after the clinic opened, we reached profitability in six months which speaks to needs of this community and the number of kids needing healthcare,” said Bates. “One of the great things about a small town is that people talk and that is a lot cheaper than running an ad. Fortunately we run off mostly word of mouth referrals and are all but at capacity. We even see patients from as far away as Kentucky, the Missouri Bootheel and across West Tennessee.” Today the clinic, which is open five days a week, has a staff of six which includes Stephanie Harder, a nurse practitioner that was added three years ago. “Adding Stephanie added not only to the clinic but to my quality of life,” said Bates. “I still take all the calls but having her helps my daily office schedule because with two providers we can see everyone we need to in the time we need to see them. We see an average of 20 kids per day in the summer and 25-30 during the winter. About a fourth of those are healthy patients there for physicals and check-ups. We have been searching for another pedi(CONTINUED ON PAGE 10)

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Ranks and Roles of Nurse Practitioners Accelerating By GINGER PORTER

With the Affordable Care Act pushing cost-effective healthcare and coinciding with a shortage of primary-care physicians, nurse practitioners are becoming more numerous. Brett Snodgrass, MSN, APRN, FNP-BC and two-term president of the Greater Memphis Area Advanced Practice Nurses, believes the role of the nurse practitioner will be even more pivotal over the next few years. “NPs will be the face of primary care,” she said. “We assess, diagnose and treat acute and chronic illness. We will still be working with a team approach, but more physicians will be going into specialties and be in a referral capacity.” Changing reimbursement is also dovetailing with the expanded role of the nurse practitioner, Snodgrass said. Primary care providers have been paid on a fee-for-service basis for years. Movement

toward a quality-based payer system – in which a patient’s staying healthier means more reimbursement – is the correct fit, she said. “The healthier I keep my patients, I will see more reimbursement. It goes perfectly with the NP philosophy of treating the whole patient instead of the disease process,” she continued. “Where a physician is trained in the disease process, the nurse is trained to focus on the whole

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patient – what can I do besides medicine to make this better? How can I give them lifestyle choices to aid in their health? How does this challenge affect their family and that dynamic?” A primary concern for nurse practitioners in Tennessee is designation as a “supervisory state,” meaning they have to have a supervising physician. Nineteen other states do not have this restriction. In Tennessee, NPs can have their own offices and practice in their own settings, but they have to have a supervising physician available to answer questions and sign 10 percent of their charts. What the physician is supervising is the nurse practitioners’ prescriptive authority, not overseeing their ability to order tests. The concern is the expense of paying the physician, which makes access to healthcare in rural areas a concern. If small towns can’t afford to pay a physician, then they can’t afford to pay a supervising physician and a nurse practitioner, Snodgrass said. “It’s not going to change our role . . . we want to be a team with our physician counterparts. Changing the language in our governance will just allow better access to care. The team approach will never change, as physicians and nurse practitioners need each other,” she said. Her role as a nurse practitioner activist is paramount for Snodgrass, who has worked at the capitol in Nashville and in Washington, D.C., to communicate how NPs can best be used to the extent of their education. Calling for changes

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in legislation restricting practitioners, she goes armed with studies and white papers, speaking about patient satisfaction under the care of nurse practitioners and the quality of care rendered by NPs. Snodgrass was a hospital nurse for 10 years before returning to school to become a family nurse practitioner. She joked she ate her words when she said she would never be an NP because it was not fast-paced enough for her. She found she thrived on the hands-on approach and getting to know each patient better. Brett These days she finds the Snodgrass pace invigorating. She has had her NP practice within the offices of Clay Jackson, MD, in Atoka and Bartlett for eight years. Functioning as a preceptor there as well, she calls their sites “teaching offices” as nursing, nurse practitioner and physician assistant students from Union University, University of Memphis and University of AlabamaBirmingham rotate in and out. She also functions as a legal consultant, expert witness and lecturer, speaking at least once or twice a month on a speaker’s bureau for a drug company. She also is doing a guest lecture series. “I love to speak and teach – it is a passion. It keeps you current. It keeps you on your toes,” she said. Snodgrass also loves technology, which she says enables her to juggle things. She developed a blog in 2011 to answer common medical questions. Covering well over 50 topics, TheNPMom.wordpress. com has won the “100 Best of 2012 Nurse Practitioners, Online Nurse Practitioner Program,” as well as the “Top 30 Nursing Blogs of 2012, Best Nursing Masters” two years running. The blog arose from her experiences with people stopping her with questions as soon as they found out she was a nurse practitioner. “It was also a thought I had, as I would leave the pediatrician’s office – ‘Oh, I forgot to ask this,’” she said. “So the motivation was I want to give you answers to the questions you always forget to ask whether it be for your kid, yourself or your spouse. It is not to be substituted for a real healthcare consult, but at least empower the patient with more information to ask educated questions or seek more help.” She also uses printouts on blog topics to reinforce teaching with her patients. She has some providers who use them with their clinics as well. Topics range from menopause and bioidentical hormones to heart disease and hair loss. The blog does not keep her as busy as it did in development, as the maintenance is just responding to inquiries and adding topics. She is going to add opportunities for people to guest post and looks to add advertising in the future as the readership grows.

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Training APNs to Meet Coming Demand By JUDY OTTO

The cliché is true, especially in the medical field: The only constant is change. If you hope to have a career as an advanced practice nurse, it behooves you to remain fleet, alert and flexible — because things change quickly. Education is evolving to keep pace as well, explains Patricia Cowan, PhD, RN. Cowan is associate dean of academic affairs at UTHSC (University of Tennessee Health Science Center) School of Nursing. Early UT nurse practitioner certificate programs were available as 28-week continuing education programs; content and length of programs expanded when the school transitioned to the master’s program. In 1997 it began focusing on doctoral programs for nurse practitioners as well. In response to the national trend, in 2010 all UT APN programs became doctoral level, Cowan said. “Our students now graduate with a doctor of nursing practice degree; last year we graduated 65 students from our DNP program, and this year we’re going to admit over 100 new students into that program.” As program registration increases, six faculty positions are being added for the DNP program. “One of the impetuses for that is the start of the pediatric nurse practitioner program — that is new for us,” Cowan said. Why the sudden significant growth? Susan Patton, DNSc, APN, PNP-BC, forensics, pediatrics and neonatal nurse practitioner option coordinator, points out that the need for more primary-care providers is not new. “Increasingly you find that medical doctors are going into specialties and less into primary care. But overall there’s just an increased need for primary-care providers — including MDs, DOs, APNs and PAs. There are certain specialties that are tremendously in need, and we are responding to the call from our own community and statewide for specialty care, including the inpatient and acute care practitioner.” The UTHSC doctoral program uniquely reflects that need, offering options leading to specialties such as adult gerontology acute care, family care, mental health, neonatal care, anesthesiology and pediatric care. Patton points out that there are five neonatal intensive care units in Memphis alone, with similar large neonatal ICUs across the state, including Chattanooga and Knoxville — all of which have 24-hour-aday staffing needs. “We are answering the appeal statewide and will have the only public university neonatal nurse practitioner program in Tennessee, Arkansas and Mississippi,” Patton said. “The technology is increasing so much,” Cowan said, “that an infant born at 24 weeks’ gestation is actually a patient that now is being resuscitated and given intensive care, where in the past that was just not true. The top technology is there now to take care of an ever broader group of patients.” westtnmedicalnews

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In serving that need, the neonatal nurse practitioner is accepting a role once filled by medical residents, she adds. Patton, who operates her own clinic, observes that APNs have also owned and operated their own practices for several decades, often in collaboration with other primary-care providers. This role is not a new one for APNs, but it may be evolving. “With the Affordable Care Act, not only are nurse practitioners beginning to associate with hospitals and large practice organizations, but physicians groups are doing the same. I think we’re going to see relationships change because of the need for reimbursement agreement,” Patton said. Cowan points out that the ACA will offer access to primary care to individuals who may seldom or never previously have seen medical providers, further fueling the increasing demand for nurse practitioners to deal with potentially complex medical cases. The Institute of Medicine’s report on the future of nursing, released in 2010, emphasized the need for nurses to be allowed to practice to the full extent of their training and education. Cowan observes that UTHSC School of Nursing graduates have demonstrated their ability to lead patient care teams and operate their own practices, and Patton also expects that reimbursers will be looking at the things their programs emphasize: evaluation of practice, healthcare economics, health policy — all of which prepare doctor of nursing practice graduates to take leadership roles in primary care with regard to assuring quality and patient safety. Cowan says their curriculum includes courses in business ethics and legalities associated with ownership, and students also learn how to develop business plans for their future practice. Across the board, everyone in medicine is going to have to be a better businessperson, Patton agrees. “That’s one reason that the federal government, under increasing scrutiny to justify expenses to ensure that quality care is being given, continues to stipulate that the advance practice nurse will be a leader in providing service to programs such as Medicare and Medicaid.” UTHSC’s unique program, which uses on-line education for didactic courses, also arranges clinical experiences accessible to students where they live — regionally or nationwide. It allows candidates who reside in rural and inner city areas — where the shortage of primary-care providers is most severe — to obtain a doctoral degree, become an APN and serve where they are most needed — at home, Cowan said. The program continues to pioneer innovative techniques including simulation laboratories with standardized patients paid to provide feedback to students, and a recent $1 million grant provides inter-professional education between the Colleges of Nursing, Dentistry and Dental Hygiene. “(Such innovations) … make full use of all the technology in other colleges that we interface with in these experiences,” Patton said, “and that’s very cutting edge.”

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A HIPAA Compliant Physician Portal: it slices, it dices, and it even lets the dogs out in the morning. Well, it should with all the adjectives in this headline, shouldn’t it? But, in all seriousness, Health Information Exchanges (HIEs) promise to eliminate the back and forth between referring doctors, reduce unnecessary tests and improve patient care while practice professionals question the probability of a system working across the healthcare spectrum. We all know that new ways to exchange useful information can be challenging. This is why the Pediatric Independent Practice Association (PIPA), (135 primary care pediatricians in the Greater Memphis Area) is facilitating discussions between physicians, disseminating information and alerts (such as letting the other physicians know that a supply of a certain vaccine is low in Memphis and there most likely will be a shortage) and communicating group purchasing discounts that have been secured, since they are a group purchasing organization. Because of the current Health Reform environment and the different pieces of clinical integration, PIPA decided to build and phase into another application that will become a part of our Physician Portal. We went through much due-diligence and research and consulted with different technology experts during our decision making process. During discussions PIPA had with different resources, PIPA decided on internal venues. Since PIPA’s membership is exclusively general pediatricians, our organization can move faster in our development of the physician portal. With 135 primary care physicians who practice independently, both small and large groups can communicate and build tools that will keep this group of pediatricians connected in order to share outcomes of PIPA initiatives such as asthma, obesity, type II diabetes and other diseases, behavioral issues and patient centered medical homes. Collaborative work (don’t let the term “independent association” fool you) such as this has been going on for 10 years. PIPA started out as a insurance contracting entity focused on building toward more clinical integration – particularly with the amount of TennCare pediatric patients and now with a direction toward accountable health care. Obviously, healthcare reform as it is now was not even part of our initial planning. But, I guess unintentionally on our journey we have built an infrastructure which as positioned us very well. I love when unintentional consequences turn out positive instead of negative like most of them usually do. As I mentioned a couple of articles ago, “Gallup continues to find that for more than 75 years, having a lot of money is rarely the solution to the big problems. Sometimes, in fact, the bigger

the problem, the less expensive the solution. What’s more expensive is trying to fix after-the-fact outcomes rather than creating the strategies that get at the behaviors and cause. PIPA operates void of a discussions about what insurance company may be paying our members for a certain procedure and communicating that to another provider. The fact that physicians cannot discuss their fees with each other has been driven into our heads by our council, Denise Burke with Butler Snow at the full PIPA membership meetings. What our physician members can do is discuss the costs that other groups are experiencing with a certain type of episode of care. We can discuss the cost of the resources we incur and what resources and protocols etc. Having these types of educational discussions with physicians PIPA has accentuated the benefit our members have in working with a group purchasing organization. Are the physicians receiving discounts which have been previously negotiated by the Group Purchasing Organization which we are a part? Keeping up with the costs of immunizations and other injectables is like trying to trade on a daily commodity exchange. The prices can vary so much. Through the previous negotiations from the GPO, PIPA physicians usually get better prices and faster delivery. We’ve chosen to focus on the following: Work toward medication adherence. According to a number of publications, there are three reasons patients aren’t adherent. • They don’t understand the importance • They are afraid of the side effects • They can’t afford it There are certain applications that are free or very low cost that we can put into our portal. To help address the unaffordability, there is an application called Lowest Meds. With this you can put in the medication name and your area code, and it will list the medication prices at which locations and sort them by lowest price. As most of you that read my article know, I have almost 20 years experience in healthcare, and I have never worked with a group of physicians and their staff (and I have worked or consulted with physicians all over the country) who are always looking to do the right thing and collaborate and work as ladies and gentlemen, like PIPA physicians do. As you can imagine, we wanted be sure about who we chose to be our technology/solutions partner. We wanted to feel comfortable with them and wanted them to be a strong local company with experience and staying power. One of our major criteria was this (CONTINUED ON PAGE 10)

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State Pharmacy Board Strengthens Oversight of Drug Compounding By CINDY SANDERS

In the wake of another suspect drug case with reports of adverse patient events, the Tennessee Board of Pharmacy has announced actions to better assure the safe, sterile compounding of drugs by state-licensed entities. The latest incident found officials with the Tennessee Department of Health (TDH) and other state and federal agencies working through the Memorial Day weekend to investigate problems with methylprednisolone acetate (MPA) products produced by Main Street Family Pharmacy, LLC, in Newbern, Tenn. Reports of adverse events first surfaced in Illinois and North Carolina from patients who received injections of preservative-free MPA (80 mg/mL) after Dec. 6, 2012. By May 24, seven reports of illness had been logged with no report of meningitis or other life-threatening in-

fection. The suspect MPA was shipped to physicians and clinics in 14 states. In Tennessee, seven facilities received the questionable drug — Quality Care, Jackson; Pinnacle Pain Management Clinic, Union City; Getwell Family Clinic, Jackson; Walker Pain Management Center, Jackson; First Choice Clinic, Dyersburg; Christian Care Clinic, Newbern: and Axis Medical Clinic, White House. The Tennessee Board of Pharmacy

first licensed Main Street Family Pharmacy in 1985, with a license as a manufacturer/wholesaler/ distributor being added in 2010. State officials reported the staff of Main Street Family Pharmacy had fully cooperated with the investigation and launched a voluntary recall of all its sterile products even though no known adverse effects have occurred from any other product. The pharmacy is currently on probation as a result of this investigation. The new measures adopted by the Tennessee Board of Pharmacy collectively address the need for safe, effective medicines while preserving access for patients. “The board is working cooperatively to identify solutions to improve safeguards for public health while not placing unnecessary barriers on sterile compounding pharmacies that would hamper produc-

tion of much-needed drugs already in short supply,” said Charles E. “Buddy” Stephens, DPh, president of the Board of Pharmacy. “We believe our actions enhance existing safeguards and offer new steps to ensure safe and effective medications are there when needed.” The board has taken action to: • Expedite suspension of sterile compounding by a pharmacy or manufacturer when a serious problem is discovered. With cause, a sterile compounder’s license can be suspended jointly by an officer of the Board of Pharmacy, its authorized executive director, and the commissioner of the Tennessee Department of Health without having to wait for Dr. John a full Board of Pharmacy Dreyzehner meeting. • Enhance oversight and regulation of drug manufacturing operations in the state. The license for manufacturers will be a separate category. Prior to this move, manufacturers were included in a combined classification with wholesalers and distributors. • Work more closely with the U.S. (CONTINUED ON PAGE 10)

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Recruiting in an Era of Reform New Landscape Requires Different Leadership Skills By CINDY SANDERS

As healthcare continues to transform and evolve, the skill sets needed to be an effective leader and provider are changing, too. From HIPAA and HITECH to the Affordable Care Act, the regulatory and reimbursement environments have impacted the recruiting process by demanding that physicians, nurses and management teams be able to provide the best outcomes in the most efficient manner possible. “The hospital model is changing so those leaders don’t look the same anymore,” said Brian Kelley, a partner with The Buffkin Group, LLC. “You better have a deep bench,” he continued of the need to have an executive team with different areas of expertise. Just as the ideal ap- Brian Kelley plicant is changing, the most effective way to recruit that candidate is also undergoing a transformation. “We’re doing a lot of things differently than we did five or six years ago,” noted Susan Masterson, national vice president of provider recruitment for TeamHealth. “The day of placing an ad and waiting for the right candidate to appear is long

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gone.” As for the true impact of health reform on job recruitment, the experts all agreed that has yet to fully play out. “We’re building the plane engine as we fly it,” Masterson said wryly. So how are recruiting and management Susan firms attracting and reMasterson taining the right people in a period of great transition, and what skills should candidates hone to answer new challenges posed by the nation’s complex healthcare system? Medical News asked a number of recruiters to share their insights.

Physicians

In addition to her national provider recruitment duties with TeamHealth, Masterson is a past board member and committee chair for the National Association of Physician Recruiters and a current committee member for the Association of Staff Physician Recruiters. On the national front, she said the need for primary care physicians is anticipated to rise dramatically. Yet, she continued, only about a quarter of the applicants coming out of training are headed that

direction. “We need more family practice and internal medicine physicians,” she said. “The government is going to have to make more slots for internship and residency, and they’re going to have to incentivize physicians to be primary care doctors,” Masterson added of anticipated demand in the wake of ACA. “Regardless of the specialty,” she continued, “I think there are different competencies for doctors that are a ‘must have’ today than (were necessary) years ago.” A focus on quality, prevention and evidencebased medicine were included on her list. Masterson also noted the need to be comfortable with technology and said two of the biggest skills were to be team-oriented and effective in mentoring and working alongside advanced practice clinicians (APCs). “Another thing I think we’ll see is there will be a lot of physicians that are in small, private practices that will choose to join larger companies or hospitals,” Masterson said. She added that her company is recruiting many physicians who are ready to hang up their shingle because of heavy workload, decreasing reimbursements, increased regulation and uncertainty over how healthcare reform will impact their practice. Another factor driving this trend, she added, is that the ‘new millennials’

(born between the early 1980s and 2000s) are very focused on a work-life balance and value personal time as much as career … which often translates into a willingness to be hospital employees rather than taking on the stress of owning their own practices. In her own company, Masterson said they have taken a much more proactive strategy to recruit residents for their key focus areas of emergency medicine, anesthesiology, urgent care and the ‘ists’ — hospitalists, laborists, surgicalists. TeamHealth has created a number of support services … from online resources to shadowing opportunities to hosting discipline-specific boot camps … to help the young recruits settle into their new roles. “We’re also signing many more APCs … probably three or four times more than we did just four or five years ago,” she noted of the increased demand for physician assistants, nurse practitioners, nurse anesthetists and other mid-level providers. As demand increases for providers, it has become increasingly competitive to fill open spots. Locum tenens companies have been springing up, said Masterson. Where those temporary providers had been filling in for short periods during vacation or maternity leave, Masterson said it is increasingly common to see them in place for (CONTINUED ON PAGE 11)

JULY 2013

Spotlight, continued from page 3 atrician to bring in as a partner for several years. There are plenty of patients we just have a hard time getting someone to move to a small town.” Another enticement for a pediatrician to come to Union City is that the clinic just broke ground on a new ‘green’ facility in April. The 6300 square foot clinic will have nine exam rooms as well as three provider offices. “We are trying to balance the fun stuff with bringing in as much technology as we can while being as green and cost efficient as we can,” said Bates. “We are even installing high voltage outlets in the parking lots for electric cars.” For Bates, life in a small town has many advantages over a big city although many of those are not material in nature. “Being a small town forces us to have continuity with our patients as we see them at the ball park, church, store as well as do business with them,” he said. “It is just how a small town works, how we survive. There is definitely a need and more than what some think, rural medicine can be more profitable than medicine in an urban area, plus the cost of living is much less. We may not have the selection of shopping that larger towns do but several major metropolitan areas, Memphis, Nashville and St. Louis, are only a short drive away.” The Bates family, which includes Nolan, who was born in 2005, Jude, who was born in 2009, and Eve, who is the only girl and was born in late 2012, enjoy trips to the big cities to see Broadway plays and like to try new foods. The family also enjoys traveling and recently returned from a trip to Alaska. They have spent time in Europe touring Italy with the kids and grandparents. Their favorite vacation spot is the Outer Banks of North Carolina. “We have always talked about having four kids but will have to see and hope that our sanity holds out for that,” said Bates. “Even though I fill my day with kids, I am still daddy and come home ready to play with the kids.”

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State Pharmacy Board, continued from page 8 Food and Drug Administration. The new requirements call for drug manufacturers in Tennessee to show proof their operations are registered with the FDA. • Add a sterile compounding registration to the regular pharmacy license, to the manufacturer license, and to the wholesaler/distributor license. These initial actions are not expected to be the last. A workgroup from the Board of Pharmacy is collaborating with staff at the TDH to identify additional measures and improvements to address the manufacturing and distribution process. Items under consideration include more proactive inspection with additional emphasis on critical reviews of maintenance and quality control records, interim self-assessment and applicable reporting by the licensed entities, and adoption of applicable U.S. Pharmacopeia Standards. Additionally, three more licensed pharmacists are being recruited by the Board of Pharmacy to serve as inspectors and another administrative staff person will be added to facilitate the new self-assessment and reporting responsibilities. “It’s a great challenge to strike a thoughtful, protective balance between addressing the daily drug shortages faced by patients and healthcare providers across Tennessee with the absolute need to assure safety and effectiveness in the compounded product,” said TDH Commissioner John Dreyzehner, MD, MPH. “While we wish the current situation associated with a Tennessee pharmacy had not happened and that patients had not been affected, the actions taken by the board, along with legislation passed recently, are moving us forward in assuring the safety and availability of important medications.”

partner knew the medical community, so there would not be a learning curve, since we planned to move fast. PIPA selected PCS Medical Solutions as our technology partner. Their 25 years in our community and their physician base had a lot to do in helping us reach our decision. They have a very strong team and a breadth of talent, including Paul Cheek, who helped start up the Tennessee Regional Extension Center and other professionals who understand Electronic Health Interchanges and the importance of moving data which is compliant with privacy, security and HIPAA regulations. Before any work was done, PIPA and PCS Medical Solutions sat down and discussed what we wanted to do, where to start, and looking at possible next areas we wanted this physician portal to do. In his book, Managing Transitions, 3rd Edition, 2009, William Bridges says: “Transition is the gradual psychological process individuals and groups go through to reorient themselves so they can function and find meaning in a changed situation. Change is emergence of a new situation, likely made up of one or more external events. Change and transition are dependent upon one another to make the change successful. As changes are implemented in organizations, it is

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often assumed that people will adjust to them. Experience suggests that the psychological process that changes initiate is more like distress and disruption than adjustment.” Surely Mr. Bridges has heard of disruptive technologies. Experience as discussed above sounds too academic and clinical. Let’s eliminate the work experience (we all know what that means) and get out of the neutral zone; that time where we are between what has been and what will be in the future. Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at appj54@aol.com.

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JULY 2013

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Recruiting, continued from page 9 months at a time while the search continues for a permanent hire. TeamHealth has their own internal group known as Special Ops physicians to answer this need. Hiring, however, is only one part of the puzzle. “It’s one thing to recruit the doctors, but then we have to retain them so there is a tremendous focus on retention,” Masterson said.

Advanced Practice Providers

MedPlacer, a national recruitment and operational process improvement firm, places healthcare providers and executives in a variety of positions. However, said Jeff E. McCracken, founder and managing director, the company’s core business is on emergency, surgical and cardiovascular service placement. Jeff “When we originally McCracken founded our company, we had a broader approach,” he noted. Over time, he continued, “We’ve really focused in more on a couple of key niche areas, and it’s really driven by the market.” McCracken added, “About 90 percent of the professionals we place have a nursing background of some sort.” The company, he explained, has three main divisions — permanent nursing leadership recruitment, staff nursing recruitment, and interim departmental leadership. Although MedPlacer doesn’t

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always put an interim director on site, when the company does have a leader on the ground, that person helps clients assess operations, identify weaknesses, outline process improvements, set departmental objectives and align staff appropriately to achieve those goals. McCracken said the strategy has been to not only glean the technical needs of a department but to understand the culture to recruit the right person. “The retention rate has been much higher because we’ve had an on-the-ground experience within the hospital,” he noted. Like physicians, McCracken said nurses are now recruited nationally. As the housing market has improved, he has found an increased willingness among nurses to consider positions in other parts of the country. An area of rapid growth has been placing staff level nurses in departments to help alleviate dependence on travel nurses. He was quick to add that travel nurses play an important role in helping a facility staff up for seasonal peaks or to meet the needs of increased patient populations for short periods of time. However, he added, hospitals ultimately want staff members who are engrained in their community. Kipper Latham, RN, chief clinical officer for MedPlacer, is the person on the inside. “It helps the nurse understand that hospital before they pick up and move from Pittsburgh to Texas,” he said of being embedded in the hospital while assessing a

department’s operations, staffing and processes. Additionally, he spends his time learning about the area … schools, activities, the housing market, and quality of life … to best match a job candidate with both the hospital and community. He added finding the right match is more than just aligning skill sets. “You have to look not only on paper but also understand that professional’s long-range goals and motivation,” he said. Like McCracken, Latham said travel nurses play an important role in staffing solutions but likened them to renters vs. owners. “Travelers are needed, but it’s not the same as if 80-90 percent of your nurses are part of the community,” he explained. During a seven-month stint in the emergency department at a Texas hospital, Latham saw the number of travel nurses decrease from 25 to two, and the Press Ganey hospital scores rise from the bottom 25th percentile to the top 15 percent. “Patient satisfaction scores went through the roof because now you had ownership in the community,” Latham noted. As with physician recruitment, retention is a key to success. McCracken reiterated turnover not only hurts the bottom line, but it takes a heavy toll on key areas impacting quality and efficiency including morale, institutional knowledge, cultural sensitivity, and patient and employee satisfaction. He added there is no crystal ball to

know exactly how ACA will impact hospital staffing, but McCracken pointed out increased volumes are often seen in the Emergency Department first and then have a domino effect in other areas of operation. He said MedPlacer is working collaboratively with colleagues in other firms to try to prepare for increased demand. “We’re continuing our strategic alliance with other recruitment companies nationally. That way we can scale appropriately,” he concluded.

The Executive Suite

The Buffkin Group focuses primarily on placements at the C-suite level for service providers and end payers. The landscape … and the skills needed to successfully navigate the new terrain … are definitely changing. “When you’re in the heat of your business, it’s sometimes difficult to take a strategic look at your executive team and ask, ‘Do we have the team in place to meet the regulatory demands that take place in 2014?’” said Craig Craig Buffkin Buffkin, managing partner and founder of the firm. For non-profit hospitals, he added, that could mean a shift in attention. Previously, these facilities were much more focused on outcomes than on cost factors. (CONTINUED ON PAGE 13)

JULY 2013

Healthcare Leader: Deena Kail, continued from page 1 I would even say that I would never get into management,” said Kail, who earned her bachelor’s degree in nursing from the University of Tennessee – Martin. “But for the past 22 years of my 32 year nursing career, management is where I have been.” Kail spent ten years on the labor and delivery unit as a registered nurse. When the director of the floor added the postpartum unit to her responsibilities, she did so with an agreement that she would hire an assistant, which turned out to be Kail. From there Kail took the position of director for the post-partum unit. While in that position, she combined nursing staffs for the unit with the nursery staff. After six years as director of the combined unit, Kail was named executive director of the hospital’s Women’s Center which subsequently expanded to include the Ayer’s Children’s Medical Center. Over the past 16 years, the position has continued to grow and evolve. As a manager, Kail still draws from her nursing background, trying to always look at things from the ‘bedside’ perspective. “I strive to keep patients, nurses and families in the forefront of my decisions while having to balance that with management’s perspective,” said Kail. “I listen to the front line staff and am very much team oriented. Although I am not physically at the bedside, I try to look at how I can make a difference in patient care from wherever I am in the hospital and in whatever role I am in.”

Because Kail’s background was clinical, she decided to go back to school to earn her Master of Business Administration degree to allow her to better understand the business side of things. Although she learned a great deal from the course work, she was surprised by all that she learned from her classmates who were not in the healthcare field. “There were lots of students from other industries and I found there was so much you could learn from other industries that was applicable in my job,” said Kail. “Basically we could all learn from others and I learned to draw on the skills of others.” In 2006, a generous donation from the Ayers Foundation allowed all children’s services to be bundled and coordinated under the Ayer’s Children’s Medical Center. The center also allowed for those services to also be enhanced and expanded. This included an outpatient clinic where subspecialists from larger regional facilities come in on a regular basis to see patients in Jackson. “One of our biggest challenges is to meet the needs of children across West Tennessee. Those can be so wide spread and what may be a real need for one family may not be for another. Our job is to find a way to utilize resources in the best manner while meeting the greatest needs balanced with trying to meet needs of the individual,” said Kail. “Within the first few weeks of the clinic opening and the subspecialist coming, families could come here rather than having to travel to receive care. The center also means families do not have to make multiple trips to Nashville for visits, they can have them here. Being able to provide as many services as possible locally to alleviate as much burden from our families makes it so worthwhile.” The Center has grown over the years in terms of both volume and services. Today, as director of the Ayers Center, Kail oversees the services that are in the hospital, the Therapy and Learning Center, Healthy Start and Healthier Beginnings home visitation programs, community education and the pediatric

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outpatient clinics. Subspecialists including urologist, endocrinologist, nephrologist, and gastroenterologist, primarily from Vanderbilt with two cardiologists and a geneticist from Memphis, are in the clinic five days a week. “We have to constantly address needs,” said Kail. “We still have specialties that we need to add and it can be a challenge to get physicians here.” Currently a strategic plan for children’s services is being formulated with Vanderbilt University Medical Center that will result in new programs and services being developed. The process involved an extensive group from West Tennessee Healthcare working with personnel from Vanderbilt to evaluate services and identify opportunities to expand the affiliation between the two facilities in terms of children’s services. “We are always looking to grow and enhance the services we can provide for kids so that West Tennessee families can get quality care as close to home as possible,” said Kail. Looking over her career, Kail is proud of the strides made in caring for women and children. “We have come such a long way since I became a nurse,” she said. “We have expanded our educational services and community events. Our lactation services have grown from having no one to do it to three people today and it has had a positive impact on breast feeding rates. The continuum of care we provide allows us to deliver more than 3000 babies with a Level III-B Neonatal ICU that can care for small and sick babies so they are not separated from their mothers. Then there is the Therapy and Learning Center that can take care of special needs children and now has an adult program.” With the growth and expansion of the hospital over her 32 years there, Kail sees women at all stages of their lives receiving even better care as with the creation of a women’s unit, they can specialize in what a woman needs while in the hospital. One other advantage Kail says the hospital offers for families is a child life specialist. “This is a huge accomplishment for a facility of our size and a real bonus for our kids,” she said. Another accomplishment that causes Kail to smile is her family. She has been married for 32 years to Scott Kail, a project manager at Lashlee Rich. They have two daughters. Their youngest daughter is 19 and still lives at home. The oldest daughter is married but lives in Crockett County and visits the family farm daily to see the other family members which include horses, chickens and five dogs. “We love to travel and spend lots of time in Jamaica. We have even made close friends there that we visit and who have made the trip to Crockett County,” said Kail. “I love my work and what I do but have always said I could go back and be happy at the bedside. It is still where my heart is. I love patient care, fixing things and making things happen.”

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Electronic Health Records, continued from page 1

Recruiting, continued from page 11

much more often. Some 62 percent of physicians said they receive clinical results in their EHR system. EHRs are also supposed to make practices more administratively efficient and therefore lower the cost of care. But on this measure the results are mixed. Only 57 percent of EHR adopters nationwide report that their systems have made their practices more efficient, and only 43 percent report that they have yielded a return on their technology investment. “When done right, bringing an EHR into a practice can streamline workflow to make a practice more efficient. Efficiency doesn’t occur when a practice tries to make the EHR fit their paper record workflow,” said Amanda King, manager for the Direct Project, who also works for Qsource, a nonprofit healthcare quality improvement and information technology Amanda King consultant group headquartered in Tennessee. “Many practices end up doing more work to make this happen.” While patients will ultimately benefit from improved practice-workflow efficiencies, a more direct advantage to patients is promised as part of a modernized, interconnected and improved system of care delivery, according to Dawn FitzGerald, Qsource’s CEO. “By putting in place EHR systems that meet rigorous functionality and ease-of-use standards, Dawn both providers and pa- FitzGerald tients will reap tangible benefits in quality and affordability such as easy access to health records and data, reminders and alerts for providers and patients, and reductions in medical errors,” she said. “As we move forward with implementing the next Stage (2) of meaningful use, you’ll see a continued focus on increasing health information exchange between providers and care settings, but also a heightened level of patient engagement by giving patients secure online access to their digital records and health information.” The Department of Health and Human Services has moved the start date for Stage 2 of the EHR meaningful use program from 2013 to 2014. As providers move into Stage 2, they will need to demonstrate they are effectively using electronic health records and securely sharing patients’ health information with other providers. “There are a lot of initiatives coming up that impact hospitals and providers,” King said. “I believe delaying Stage 2 until 2014 was a necessary step in order for providers and vendors to be prepared.” The Direct Project, a nationwide effort by the Office of the National Coordinator of Health Information Technology (ONC), is designed to help providers meet Stage 2 requirements. The simple, affordable and secure technology known as Direct satisfies these requirements by allowing doctors access to various healthcare data sources and offering data exchange at transitions of care.

Now, both must be equally weighed. “It’s put a lot of pressure on having a different type of leader in different parts of their organizations that didn’t exist five years ago because not only do they have to worry about outcomes but also on driving costs and efficiencies,” Buffkin said. The new regulatory environment and shifts in reimbursement models have brought about some consolidation of acute care facilities and hospitals taking over physician practices. In the short run, said Buffkin, consolidation shrinks the leadership market. However, he continued, “In the long term, it typically increases the need as companies get bigger.” In fact, he continued, “We’ve doubled the number of searches we’ve been completing on an annual basis in the last several years, and the majority of that demand has come from our healthcare clients because of regulatory pressures.” Brian Kelley, a partner based in the firm’s Connecticut office, added the complex delivery and regulatory environment has made it nearly impossible for one person to have all the skills necessary to meet the hospital’s or practice’s needs. Three areas he identified as ‘critical in any management setting’ are knowledge and experience of healthcare services, profit and loss expertise to understand reimbursement challenges and a robust understanding of IT from both a quality and efficiency perspective. “You have to have a team … it’s not

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The Tennessee Office of eHealth Initiatives (OeHI) has adopted Direct protocols for secure messaging of health information. The mission of the Tennessee OeHI is to facilitate improvements in Tennessee’s healthcare quality, safety, transparency, efficiency and cost effectiveness through statewide adoption and use of electronic health records (EHR) and health information exchange (HIE). OeHI received grant funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to support the Direct Project and other projects to implement secure health information exchange. Through these stimulus funds, ARRA gives Tennessee the opportunity to advance the secure exchange of health information and to expand the adoption and meaningful use of EHRs and HIE. The project is spearheaded by the Tennessee Regional Extension Center, or tnREC, a division of Qsource. “Qsource works with providers to familiarize them with Direct technology, an email-like service that will be the infrastructure that facilitates secure health information exchange among trusted providers across Tennessee,” King said. “Providers who register for a Direct email address can securely send and receive messages containing health information to each other. The project provides a way for healthcare providers to comply with federal requirements governing health information exchange.” For eligible providers and hospitals that have not adopted an EHR or made meaningful use a priority, 2015 might bring a cut in Medicare reimbursements due to payment adjustments built into the EHR Incentive Programs. “Starting in 2015, Medicare providers and hospitals will be subject to a payment adjustment for not meeting meaningful use by 2014,” King said. “The payment adjustment is 1 percent per year and is cumulative for every year that a provider is not a meaningful user. It could reach as high as 5 percent.” The Tennessee, the OeHI website (www.tn.gov/ehealth) is a resource for hospitals and healthcare providers seeking to understand meaningful use criteria for EHR adoption and Health Information Exchange (HIE). The site can also direct stakeholders to resources that identify best practices for successful adoption, allowing them to receive Medicaid and Medicare incentives available under the act. It is also a resource for Tennessee consumers to increase awareness of the benefits of EHR adoption and HIE by the Tennessee hospitals and providers who serve them. “Websites I recommend as excellent resources for understanding meaningful use and implementation are www.healthit. gov and www.cms.gov,” King said. “They have links to information on implementation timelines. It can get confusing looking at the graphs. The CMS website has a page that will walk the provider through their personal timeline to see where they should go next. It is an excellent tool, as it is per provider and not practice. Of course, if anyone needs assistance in understanding this information, tnREC can assist providers with meaningful use.”

one person,” he said. “For one person to have all three of those skill sets is few and far between.” That, however, has opened the door for others to break into healthcare. In hospitals, Kelley said, “The old world was to build from within … not so much anymore. They are willing to recruit from outside the hospital’s four walls,” he continued, noting this is particularly true in terms of technology positions. Buffkin added it has also opened a greater need for marketing professionals … both to draw patients and to reach healthcare professionals as demand begins to exceed supply. “We work with academic medical centers, and one of the areas we’re seeing an increase is in chief marketing officers. They are increasing their marketing departments as they try to attract more applicants to medical school and nursing school to meet the rising demand.” On the flip side, the push for quality has also opened the door for more physicians to take on leadership roles. Kelley said he is seeing more doctors return to school to get a graduate degree in business. Ultimately, he noted, you have to look at the leadership in place at any given facility and fill in the gaps. “We all are seeing more candidates who are taking the time to be better educated,” he added. “Healthcare has a lot of complexities, and I think people are preparing themselves better for the changes.”

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JULY 2013

GrandRounds West Tennessee Healthcare Adds Executive Director Of Marketing

West Tennessee Healthcare has announced the addition of an Executive Director of Marketing. Bernie Grappe accepted the position and started in May. Grappe has a BA in Communications-Journalism and a Master of Business Administration from Louisiana State University, Bernie Grappe Shreveport. Grappe has more than 20 years of experience and has served in leadership roles in Louisiana, Florida, Texas and most recently at DCH Health System in Tuscaloosa, Alabama. Bernie will be responsible for marketing, communications, public relations and media services.

West Tennessee Healthcare Announces Changes In Organizational Chart

Dr. Lisa Piercey has accepted the position as West Tennessee Healthcare’s Vice President of Physician Services. Dr. Piercey joined the executive team at West Tennessee Healthcare in 2011 as Vice President of Hospital Services and lead the development Dr. Lisa Piercey and opening of the LIFT

Wellness Center, developed community wellness initiatives and disease management programs, along with other areas of responsibility. Dr. Piercey has assumed the responsibilities for the West Tennessee Medical Group, the physician clinics operated by West Tennessee Healthcare, as well as the Jackson-Madison County General Hospital Hospitalists and physician services.

WTHF Grants $1 Million

The recently announced expansion of a registered nursing program at UT Martin Parsons Center got another significant boost with a $1 million commitment from the West Tennessee Healthcare Foundation, officials announced today. UT Martin officials announced in May that the school’s four-year Bachelor of Science nursing degree would be extended to the Parsons campus beginning in fall 2014. The expansion was made possible by Gov. Bill Haslam, who included $1 million for the project in his budget. The General Assembly approved the budget before adjourning in May. Foundation officials said the gift will comprise a combination of cash contributions in the first two years and a $714,000 nursing endowment that will provide scholarships for nursing students at the Parsons Center.

We can help guide your path. Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR. Through special funding, tnREC is oﬀering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds. We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply online www.tnrec.org This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Oﬃce of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reﬂect ONC policy. 90RC0026/01 13.TREC.04.049

JULY 2013

The gift marks the largest financial commitment by the Foundation outside of its work with West Tennessee Healthcare. Construction on a 10,000-squarefoot addition to the current facility is expected to begin this summer. The addition will include classrooms, a skills laboratory and a high-fidelity computerized simulation laboratory. UT Martin Parsons Center will have openings for up to 30 students annually for the program, with 20 slots designated for traditional students and 10 slots for licensed practical nurses (LPNs). Graduates of the BSN program will be eligible to take the National Council Licensure Exam for Registered Nurses (NCLEX-RN) and obtain licensure as registered nurses (RNs).

Physicians Quality Care Opens New Clinic in Milan

Physicians Quality Care is expanding with a new clinic to Milan. The 6,100-square-foot facility on South First Street between Walmart and Lowe’s was designed with patients’ comfort in mind. The massive children’s playroom will be the building’s centerpiece. It will feature a 22-foot glass tower with a slide, computer-simulated games and handson activities. The building itself is set to become Milan’s newest landmark. The exterior will feature an LED lighting system that can be programmed to dance and illuminate the façade in 16 million different colors. Motorists on South First Street will see light displays change for holidays and Milan community events. In addition to the amenities for patients, the clinic will feature six standard exam rooms, an emergency treatment room and an audiometry room. It will also have full digital X-ray and laboratory facilities. And, like the clinic in Jackson, Physicians Quality Care Milan will be open seven days a week from 7:00 AM until 11:00 PM. There will also be a full-time patient concierge tasked with helping guests feel more comfortable before they see a doctor.

Methodist Fayette Welcomes New Emergency Department Medical Director

Dr. Daniel Cofie was recently named the new emergency department medical director at Methodist Fayette Hospital. He has also served as the consultant endocrinologist and clinical director for the Texas Technical University Division of ManDr. Daniel Cofie aged Health Care, John T. Montford Medical/Surgical Hospital in Lubbock, Texas. Dr. Cofie received his pre-med and medical degree from the University of Ghana. He received his master’s and doctorate degrees in public health from the University of Texas Health Science Center in Houston, Texas.

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GrandRounds Healthcare Services In Gibson County To Match Community Needs

After three years of study, management teams at West Tennessee Healthcare have a plan that realigns healthcare services in Gibson County to provide more access to the services people use regularly. The plan includes new medical services that people need close to home. Inpatient visits to the three hospitals in Gibson County have dropped significantly over the past five years and now average only 2.3 patients per facility per night. Outpatient and ER visits have dropped steadily in Humboldt and Trenton as well. The declining demand for hospital services, coupled with the results of an extensive community health needs assessment, showed that a realignment of services that would better meet community needs was in order. Bobby Arnold, CEO, said Gibson County is incredibly important to West Tennessee Healthcare and that nearly 1,000 employees call it home, so they are aligning their services to be in the county for years to come. They are announcing the realignment plan now although it wonâ&#x20AC;&#x2122;t be fully in place until at least January 2014, which gives a significant amount of time to work with employees. During that time, Gibson General Hospital in Trenton will be replaced by a medical center tailored to the health care needs of the people in the community. The medical center will offer primary care with walk-in after hours care, postdischarge follow-up patient care, screenings, on-site lab and x-ray. Disease management, especially related to heart conditions and diabetes care, is an area of service the community health needs assessment helped identify. The medical center will also offer rotating specialty clinics with the types of specialists matched to the needs of the community. In Humboldt the hospital will be transformed into an emergency center. It will operate as a north campus of the Jackson Madison County General Hospital emergency room. Sports+ in Humboldt, Trenton and Milan, which offers outpatient physical therapy, will continue current operations in all three locations. The athletic training programs provided to Gibson County high schools will be continued as well. Milan General Hospital will remain an inpatient hospital with surgical and emergency services, and a hospitalist program will be added. The number of staffed beds in Milan is enough to meet the current level of patient demand from Gibson County and other surrounding communities. A hospitalist program will provide doctors who specialize in the care of

hospitalized patients. The hospitalist will collaborate with local primary care doctors and the relatively large base of nursing homes located in Gibson County and the surrounding area. Pathways Behavioral Health Services will continue operations in Milan. The school health clinic operated by West Tennessee Healthcare in Milan will remain unchanged. In Bradford, the existing primary care clinic will stay in place. West Tennessee Healthcare has 285 employees working at all facilities in Gib-

son County. Of that number, 175 work at Gibson and Humboldt General Hospitals. West Tennessee Healthcare has operated Humboldt General Hospital since 1989. Gibson General Hospital was purchased in 1994 and Milan General in 1998. Jackson Madison County General Hospital is one of the top ranked hospitals in the country. It treats more heart attack patients than any other hospital in Tennessee and offers the latest advances

in stroke care, surgical procedures, intensive care services and other centers of excellence. Jackson General exceeds national averages in key measures of patient outcomes and has won national awards for patient safety. The Gibson County Community Health Needs Assessment (CHNA) was completed in 2012. The CHNA identified five priority health issues for Gibson County: heart conditions, diabetes, high blood pressure, obesity and cancer.

Leanna Fendley

Ginger Warmath

Suzanne Ward

Catherine Talbot

FNP

ANP

FNP, ONC

FNP

NURSE PRACTITIONERS: A N E S S E N T I A L PA R T O F O U R T E A M Our team of physicians and nurse practitioners provide surgical and non-surgical orthopaedic care. Each of our nurse practitioners and fellowship trained orthopaedic surgeons focus on their specialty area of sports medicine, spine, hand & upper extremity, foot & ankle, shoulder, hip & knee, total joint replacement, or bone and soft tissue tumors of the extremities in children and adults.

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JULY 2013

Heart Valve Replacement Without Open Heart Surgery This week a special team of doctors performed the first three Transcatheter Aortic Valve Replacement (TAVR) procedures in Jackson. The Federal Drug Administration approved TAVR in November 2011. The Jackson team of doctors, working together through the West Tennessee Heart & Vascular Center at Jackson-Madison County General Hospital, has undergone intensive training and preparation to bring this ground breaking procedure to Jackson.

wthvc.org

Before the approval of TAVR, heart patients that were not healthy enough to undergo aortic valve replacement had no long-term options for extending their lives.

Congratulations to the West Tennessee Heart & Vascular Center TAVR Team Cardiologists | Cardiothoracic Surgeons | Radiologists | Anesthesiologists

Dr. Michael Bearb Anesthesiologist

Dr. Greg Bruno Radiologist

Dr. Jason Cherry Cardiologist

Dr. James Crenshaw Cardiologist

Dr. John Crocker Radiologist

Dr. Arthur Grimball Cardiothoracic Surgeon

Cardiac Anesthesia Group

Jackson Radiology Associates

The Jackson Clinic

Jackson Radiology Associates

Cardiothoracic Surgery Center

Dr. Tommy Miller Cardiologist

Dr. Michael Osayamen Cardiologist

Dr. Shahzad Shah Cardiologist

Dr. Eric Sievers Cardiothoracic Surgeon

Scott Sweat, R.N. Valve Clinic Coordinator

Dr. Ronald Weiner Cardiologist

Mid-South Heart Center

The Jackson Clinic

Cardiothoracic Surgery Center

West Tennessee Healthcare

Skyline Cardiovascular Institute

Scott Sweat, R.N., Coordinator | West Tennessee Heart & Vascular Center at Jackson-Madison County General Hospital | 620 Skyline Dr | Jackson TN | Toll Free 855.731.8284 Office 731.541.6906