West TN Medical News July 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Jay Shires, MD ON ROUNDS

Professional Development: Programming Hones Clinical, Business & Leadership Skills Health Science Schools Make Strides in Diversity Health educators keep close count of the race and ethnic origins of their students, as well as their faculty and staff members, and not just because recruiting minorities is the right thing to do, they say ... 4

Measuring the Impact of Interprofessional Education

By CINDy SANDERS

Education plays a key role in the daily operations of both the Tennessee Medical Association (TMA) and Tennessee Nurses Association (TNA) as the statewide organizations strive to ensure providers deliver efficient, effective care of the highest quality.

TMA & CME

“We’ve got a lot going on with CME and have really ramped up over the last year,” said Dave Chaney, director of Communications for TMA. In fact, he noted, the organization recently completed a 20-month process through the Accreditation Council for Continuing

(CONTINUED ON PAGE 6)

HealthcareLeader

IPE … or interprofessional education … has become a popular buzzword among educators preparing the next generation of providers. An interprofessional, team-based curriculum has been lauded as the best way to prepare healthcare professionals to work collaboratively in a value-based system where efficiency and quality are rewarded ... 7

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Medical Education (ACCME) to create original CME content.

TMA received provisional accreditation last November. At the end of two years, they will undergo another ACCME review to receive a four-year standard accreditation or six-year accreditation with commendation. This expanded capability is in addition to the organization’s longstanding accreditation to approve other’s CME programming.

Angie Madden, director of Practice Solutions for TMA, explained, “We felt as a medical society that we needed to be more nimble and be able to provide education to physicians in Tennessee and particularly our members.” She added much of TMA’s content

Bringing the Benefits of Hospitalists to Rural West Tennessee Hospitalist Program Paying Off for Hardin County Medical Center

By SUZANNE BOyD

As a child riddled with asthma, Timothy Klein, MD, saw first hand what a blessing a caring devoted physician can be. As an internist, he strives to follow the Golden Rule by giving his pa-

ING COMON: SO NEW THE

tients the same compassionate care he received.

While that may not be an innovative approach to patient care, Klein over his career has been on the cutting edge of the hospitalist trend. Today, as Medical Director of the hospitalist program at (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Loving the Life of a Hospitalist Young Hospitalist Leading Growth of Program

By SUZANNE BOYD

With a younger brother with cerebral palsy and a mother who owned a nursing home, Jay Shires, had more than his share of exposure to doctors from an early age. Seeing the interaction between doctors and his brother planted the idea of becoming a doctor in him. He also found that family practice was where his heart was and knew that was what he would pursue in medical school. It was during his residency training that he discovered that being a hospitalist gave him the challenge he longed for with the flexibility in scheduling that fit his lifestyle.

Shires grew up in Henderson and graduated from Chester County High School in 2000. He majored in biochemistry at UT-Knoxville then went to UT-Memphis for medical school, which he completed in 2008. “Throughout high school I had been around family practice doctors and even did a summer internship in college at the UT Family Medicine Program in Jackson. So I had a pretty good idea from day one that I wanted to do family practice,” said Shires. “Although most medical students bounce around with what specialty they will pursue, I really always knew I wanted family medicine for the variety it provided in terms of the patients you see.”

When it came for his family medicine residency training, Shires returned to Jackson and the UT Family Medicine Program. He completed his training in 2011. “As a part of the residency program you work with the hospitalist group,” said Shires. “It really appealed to me and I found myself gravitating toward it. I liked the challenge of sicker patients as well as the flexibility that a hospitalist’s schedule allowed for travel as well as time at home.

When I finished my residency I joined the Jackson-Madison County General Hospital’s Hospitalist Group, which was the group we worked with as residents.”

Over the past four years, Shires has steadily increased his administrative duties with the group, eventually taking over as medical director. “Dr. Monico Banez had been medical director for the past ten years and he was looking to transition out of that position,” said Shires. “When I joined the group I started helping him as his assistant. It was something I wanted to do and others in the group encouraged me in that endeavor. I liked the administrative side as well as the medical so when

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the opportunity to be medical director came available it was easy to transition into the position.”

As medical director, Shires main role is to serve as the liaison between the hospital administration and the medical

group. “It is really my job to try to convey to the group what administration wants from us and how our role can enrich patients’ lives while they are in the hospital. I let the administrative staff know what things we need to do the best job we can for patients,” said Shires.

“My administrative duties account for about 20-25 percent of what I do. While I have an office in the hospital and sometimes get pulled in for administrative things, a lot of it can be done on my off weeks or from home.”

As across the country, the hospitalist program at Jackson General has grown dramatically since Shires came on board. “We started with 15 when I joined in 2011. Today we have 20, four of which were hired in the past year and are in the process of being phased into the group,” said Shires. “We are planning to hire more and I would expect that over the next five years our number grows to 30. Having the family medicine program on campus helps us with a pool from which to draw but we also recruit from other programs. We love

Healthcare is Changing.

ADMINISTRATORS How can you stay on top of the issues?

to have folks with ties to the area, because they are usually more likely to stay long term.”

Shires says the growth in the number of hospitalists utilized at the hospital has been driven by not just total patient volume in the hospital but also the acceptance of hospitalists in general by other physicians. The closing of several rural hospitals across West Tennessee is also driving the need for hospitalists at Jackson General. “We are admitting more patients with chronic issues. There are very few patients with chronic issues that do not have a hospitalist on their team.

With all the doctors have to manage on the clinic side, it is getting harder for them to run in and out of the hospital to check on patients,” he said. “We are there 24/7 to manage the patient’s care issues. We even have OB hospitalists and pediatric hospitalists who focus just on those patients and can be invaluable to physicians in small practices who may have to cover multiple facilities.”

The flexibility in scheduling being a hospitalist provides is about to come in handy for Shires, because he and his wife are about to welcome a baby in August.

“Our group is great about trading off with one another when needed, so I am planning on being home a little bit after the baby is born,” said Shires.

Join MGMA in 2015!

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Health Science Schools Make Strides in Diversity

By PEGGY BURCH

Health educators keep close count of the race and ethnic origins of their students, as well as their faculty and staff members, and not just because recruiting minorities is the right thing to do, they say.

Since the national Institute of Medicine (IOM) released its landmark study, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” in 2002, health science schools have focused on diversifying the graduates they send to the workforce. The IOM study found “significant variation in the rates of medical procedures by race, even when insurance status, income, age and severity of conditions are comparable,” and determined that “bias, prejudice and stereotyping on the part of healthcare providers” may contribute to the problem. “More minority healthcare providers are needed, especially since they are more likely to serve in minority and medically underserved communities,” the study found.

Leaders at the University of Tennessee Health Science Center (UTHSC), the University of Memphis Loewenberg School of Nursing and Baptist College of Health Sciences say they are devoted to attracting minority students and teachers, and describe

a variety of means for drawing candidates.

At UTHSC graduations this spring for 698 students, 68 African-Americans and 12 Latino-Americans were among the graduates. The number of African-American students enrolled at UTHSC has hovered at 12 to 13 percent since 2011.

The new UTHSC chief academic officer, Lori S. Gonzalez, PhD, says one of her jobs will be trying to increase that percentage by 5 percent, to reflect the

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JULY 2015

size of Tennessee’s black population.

“The Health Center believes it’s important that we model the demographics of Tennessee, and try to educate healthcare providers that look like the residents of the state,” Gonzalez said.

“So when you look at the African-American population of the state right now, in that last Census Dr. Lori S. about 17 percent of the Gonzalez population is AfricanAmerican. Right now at UT Health Science Center, the population of African-American students is 12 percent, so that means we have a way to go to meet this demographic profile that we’d like see in this state.”

The U.S. Department of Education requires schools to ask about race and ethnicity on applications, but students do not have to answer the questions. The UTHSC Office of Academic, Faculty and Student Affairs said the school gives strong preference to Tennessee applicants who meet admission standards, though acceptance requirements vary among the 34 programs.

At the College of Medicine, for instance, applications for the 165 places in a class are only considered from residents of Tennessee and its eight contiguous states, and children of UT alumni regardless of their residence.

Lin Zhan, dean of the Loewenberg School of Nursing at University of Memphis, which enrolls about 1,000, said 26 percent of undergraduate students and 48 percent of graduate students are minorities.

Zhan, PhD and RN, said diversity is one of four “core values” at the school.

At Baptist College of Health Sciences, Dr. Arnold Arredondo, dean of enrollment management, said 42 percent of the 1,142 students are African-American, while 2 percent are Hispanic and 2 percent are Asian. Seventy percent of the college’s students are in the nursing program.

Arredondo, PhD, who calls himself “a minority who benefited from education opportunities,” said Baptist has gotten help recruiting minority students from such organizations as the Memphis Talent

Dividend, the Emmanuel Center and Metropolitan Inter-Faith Association.

Gonzalez and Zhan said increasing minority representation among faculty and staff is one way to draw students. Gonzalez, who became UTHSC vice chancellor of Academic, Faculty and Student Affairs in June, said Chancellor Steve J. Schwab, MD, and other administrators see faculty and staff diversity as an “institutional imperative.”

“One of the kinds of recruitment in higher ed that’s the most successful for yielding a diverse pool of applicants for a job is called targeted recruitment,” she said. “Just reach out and say, ‘We’d really love it if you’d apply for this job.’”

And current faculty can be emissaries, she said. “Faculty members can go to their professional meetings and try to meet people. They get those connections where they know the strong programs, where they know the best PhD and the best MD who might be interested in a faculty career and encourage them to apply.”

Gonzalez previously was provost and executive vice chancellor at Appalachian State University in North Carolina and spent 20 years at the University of Kentucky, ending her time there as dean and professor for the College of Health Sciences. She was drawn to Tennessee because it’s a freestanding academic health center, she said. And, “I really have to tell you I was excited about the diversity here.

We talk about it, we write plans about it, but this campus already had a considerable amount of diversity.”

Of 1,339 regular faculty members employed at UTHSC last fall, 1,000 were white, 210 were Asian, 75 were black and 50 were Hispanic/Latino. Enrollment for fall 2014 included 2,109 white students, 362 black students, 245 Asian students and 57 Hispanic/Latino students.

Gonzalez said one longstanding diversity effort called TIP, or Tennessee Institutes for Pre-Professionals, brings college undergraduates to the Memphis campus in the summer. More than 1,600 students from under-represented groups have graduated through the program, she said.

“They may be first generation (attending college), they may be low-income students, they may have a military status, they may be under-represented,” Gonzalez said of the TIP participants. The potential health-science students learn interview skills and receive coaching on standardized exams. The Office of Student Academic Support Services and Inclusion connects with them when they arrive on campus.

“They make a point to email, to call, to keep in touch,” Gonzalez said.

“We’re also trying to develop closer partnerships with historically black colleges and universities so those programs can be pipelines,” she said, noting that it’s competitive work. “One of the issues all health sciences deal with is, when (CONTINUED ON PAGE 7)

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MedicalEconomics

BY BILL APPLING

Let’s Take a Moment to Look at This On Monday, June 16th, the lead story in the Washington Post was, “Study Finds 50 Hospitals Charge Uninsured More Than 10 Times the Actual Costs of Patient Care.” The study cited was published in the June issue of Health Affairs, and co-authored by Gerard Anderson, professor of the Johns Hopkins Bloomberg School of Public Health.

“These are the hospitals that have the highest markup of all 5000 hospitals in the United States.

This means when it costs the hospital $100, they are going to charge you on average, $1,000.”

By comparison, the researchers said, a typical hospital charges 3-4 times the cost of patient care.

All but one of the facilities are owned by for-profit entities and the largest numbers of hospitals – 20 – are in Florida.

Rick Scott (aka Lex Luther) is the current two-term governor of Florida, with a net worth of $220 million.

Governor Scott was former CEO of Columbia/HCA about a decade ago, when the hospital company was fined $1.7 billion for Medicare Fraud including criminal fines, civil damages and penalties. Scott resigned as CEO in July, 1997, less than four months after the inquiry became public. The Justice Department described it as the largest healthcare fraud in U.S. history.

Community Health Systems (CHS) operates 25 of the hospitals on the list and is head-quartered in Brentwood, Tenn. Hospital Corporation of America (HCA) is headquartered in Nashville, Tenn.

Topping the list is North Okaloosa Medical Center, a 110 bed hospital in the Florida panhandle, about an hour outside of Pensacola. Uninsured patients were charged 12.6 times the actual cost of patient care.

Other for-profit-entities such as reference laboratories also over-charged uninsured. I can speak from personal experience about this. I received a bill from American Esoteric Laboratories (AEL) for laboratory tests ordered by my physician. The bill was $1,109.00. When I called the laboratory to inquire about the bill I spoke to a telephone representative.

Apparently the physician submitted the wrong name of the insurance company.

She said they would file with the appropriate insurance company and adjust my bill accordingly. Around thirty-days later I received a corrected bill in the amount of $213.39. I was westtnmedicalnews

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Stephen Hensley realized a potential gain of more than $45.6 million from exercising stock options (2014) as the share price of the largest health insurer topped $100 on the way to setting all-time highs.

Cigna, David Cordani • $13.0 million • ($39,589 per day) Centene Corporation, Michael Neidorff • $14.5 million • ($42,560 per day) Aetna, Mark Bertolini • $30.7 million • ($90,029 per day) Humana, Bruce Broussard • $8.8 million • ($25,807 per day) flabbergasted at the difference.

I asked if the same tests were run when the bill was $1,109.00 as it was with the corrected bill of $213.39. I inquired about the difference. If the quality and outcomes were consistent with such a large difference.

I requested itemized statements to support that the same tests were performed. After my first call and a few weeks later, I received an itemized statement, but it was for the adjusted bill for $213.39 not a copy of the itemized statement for the original bill of $1,109.00. I called and made the request again. The representative told me it would take a while because they would have to go back and research and pull up the statement I was requesting. She asked me if I knew how many pieces of paper that would require.

A few weeks later I received the itemized statement that I had requested previously. After looking over the bill at each item I said that the tests which I was charged for was the same. Within a couple of weeks I received a letter from American Medical Collection Agency, a national collection agency. They informed me that AEL had turned my account over to them. They informed that further collection efforts would be pursued.

Medical bills account for about half, or 52 percent of all overdue debt that shows up on credit reports.

Let’s take a moment to look at this…

Health Insurance Company CEOs’ Compensation in 2013 WELLPOINT, Joseph Swedish • $17.0 million • ($49,853 per day) UnitedHealth Group, Stephen Hensley • $12.1 million • ($35,484 per day)

Is any corporate executive really worth $90,000 per day? What contribution could one human being possibly make to a company that could justify this?

Nearly three out of four Americans report that they do not always take their medications as directed. And, obviously, for the medicines to work, a person’s got to take them.

One of the biggest issues is cost.

People are often prescribed a brandname that they can’t afford. A generic alternative may be just as effective.

The cost of one Advair (asthma inhaler) in the United States will buy you seven inhalers in France. There are no generic asthma inhalers available in the United States. But they are available in Europe, where health regulators have been more flexible about mixing drugs and devices and where courts have been quicker to overturn drug patent protection.

in US history. That was in 1997. While that was a record at the time for healthcare fraud, it has been surpassed. In cases related to improper promotion of certain drugs, Johnson & Johnson agreed to a $2.2 billion settlement in 2013, Pfizer settled for $2.3 billion in 2009 and GlaxoSmithKline settled for $3 billion in 2012.

Christopher Flavelle of Bloomberg News said, “The problem isn’t an absence of options but an absence of time. By wasting the past five years on a fake debate over Obamacare — premised on a theoretical Republican alternative that the party still can’t agree on, culminating in a disingenuous argument over the precise meaning of ‘established by the state’ – Congress and the states have squandered time that could have been spent fixing some of the actual problems that still plague U.S. health care.”

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

Healthcare Law Commercial Litigation Business Law

“Merger Would Make Generic Drug Giant” In a deal that would combine two generic drug makers who recently left the US for Europe, Mylan says it wants to buy Perrigo for $205 per share or $28.86 billion.

A combined Mylan and Perrigo would be one of the world’s largest makers of generic and over-the-counter medicines.

Mylan says the combined company would have had $15.3 billion in revenue in 2014 and would be a leader in specialty drugs and nutritional products. It said the combined company would be able to grow even further with additional acquisitions. (AP, May, 2015) As stated earlier, the Justice Department described the Columbia / HCA case as the largest healthcare fraud

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Professional Development: Programming, continued from page 1 focuses on broad issues impacting all physicians but noted specialty-specific breakouts are featured at the annual meeting or in collaboration with other organizations as needed to meet physician needs.

Chaney said, “Physicians have a lot of sources out there where they can get CME. We want all physicians in Tennessee to look to TMA as the authoritative source for education on the most important and timely topics affecting their profession.” He added, “TMA is plugged in on every legislative Dave Chaney and regulatory issue.

When we combine what’s happening on a macro level and state level with on-theground clinical healthcare delivery, we’re in a unique position to deliver CME.” Chaney noted the organization uses a mix of online and in-person formats to deliver programming and featured more than 21 hours of onsite education at the April annual meeting. He added some programs, such as this summer’s ICD-10 Coding Camps, are presented in a roadshow format with a series of workshops being held at key points across the state.

Madden said the association is continually adding new offerings and is rolling out two new options this month. The first, Tennessee Health Care Innovations Initiative 101 is an overview of new payment models by the state. The second onehour course, Tennessee Physician Employment Angie Madden Contracting, helps physicians know what to look for when crafting or signing contracts and is presented by TMA’s legal counsel.

For a complete list of options, go online to tnmed.org and click on Professional Development.

TNA & CNE

The staff of the Tennessee Nurses Association is also passionate about ensuring providers are equipped to face the challenges of delivering quality care in an era of reform.

“We are accredited by the American

Nurses Credentialing Cenleadership for details and ter as an approver and proan application. vider of continuing nursing The new Physician education,” explained Leadership Lab, which TNA Executive Director does span nine months, foSharon Adkins, MSN RN, cuses on team-based care, who added her organizasafety and quality initiatives tion is the only one in Tenand includes LifeWings’ nessee that can approve Lean plus TeamSTEPPS CNE courses. process improvement tools She continued, “We’ve and programming. Madgot a whole committee of den pointed to changes reviewers, and they make tied to value-based reimsure the program meets bursement as an impetus to the ANCC standards for launch this new leadership quality of education and offering. objectives and provides the “We wanted to create learner with expected outthis new track to address comes.” the changing healthcare Adkins said the aslandscape,” said Madden, sociation also collaborates adding the goal is “to really with others to meet needs. help equip and train phyDr. John Ingram with Physician Leadership College Graduates Dr. Robin Williams of Working with the TMA, Nashville, Dr. Christi Witherspoon of Hermitage, and Dr. Jane Siegel of Nashville. sicians with the skill set to she noted, “We partnered practice medicine with all with them last fall on a diathese new initiatives.” tion, collaboration and influence, medical betes workshop and are currently partnerAdditionally, she noted the Physiadvocacy, media and communications, ing on the ICD-10 workshops being held cian Leadership Lab includes a hands-on resonated strongly with those who particiacross the state.” project for participants. “They will pick a pated, Madden said the nine-month comIn addition, the organization teams up project in their community that they are mitment made it difficult or impossible for with the Tennessee Association of Student passionate about and will work to impact some physicians to tap into the impactful Nurses to provide continuing education at outcomes, processes, and safety. They will curriculum. the annual conference each fall. This year’s take skills they have learned in Team“What we decided to do was create a meeting – Nursing Ethics: Commitment, STEPPS-Lean Healthcare and put them weekend emersion where they would get Compassion, Quality Care – will be held into practice.” all the training but in an accelerated, more Oct. 23-25 at the Franklin Marriott Cool While details were still being fleshed convenient platform,” Madden explained.

Springs. To register, go to tnaonline.org. out at press time, the plan is to launch in To be eligible, an applicant must the fall and run through April with gradube a member of the TMA. Madden and John Ingram Institute for ation at the 2016 annual meeting. Madden Chaney noted the cost is kept low to make Physician Leadership said the program would be a mix of live the program accessible. “We underwrite 90 In addition to their new course ofsessions, webinars and conference calls. percent of the costs through grants,” Madferings, the TMA recently rebranded the “With team models emerging, physiden added.

Physician Leadership College as the John cians need a different type of leadership The next offering of the Leadership Ingram Institute for Physician Leadership, skills they might not have needed in the Immersion Weekend runs July 23-26 at honoring the East Tennessee internist and past,” said Chaney. “Taking care of pathe Hutton Hotel in Nashville. Those interformer president who helped create and tients is number one, but any time you have ested in attending or nominating someone launch the program. In its new incarnation, physicians building skill sets, that’s going to to attend should go online to tnmed.org/ physicians will now have two track options benefit patients.”

– the Leadership Immersion Weekend Retreat and the nine-month Physician Leadership Lab. Madden noted the first class graduated from the Physician Leadership College in 2008 with the eighth class graduating this past May at the 2015 annual meeting.

While the core leadership topics of negotiation, decision-making, conflict resolu-

TMA’s educational efforts reach across the state to ensure physicians and other health professionals have access to information critical to the delivery of efficient, effective, compliant care.

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Health Science Schools, continued from page 4 you have these wonderful students they can go anywhere they want. The challenge is talking them into coming to UT.” Among UTHSC graduates in May, 410 were women and 288 were men.

“Nationally, you’re seeing a shift, and it started in the ‘80s, and it’s actually really pretty prevalent, that fewer males are seeking or obtaining bachelor’s degrees,” Gonzalez said. “Then there are just some disciplines that are either male- or femaledominated. One that’s female-dominated is nursing, as you might expect,” she said.

“But the nursing college has been very purposeful to try to increase the number of males they have in their programs.

Nationally when you look at the nursing workforce, 5.5 percent are male. At the UT College of Nursing, 9 percent of the students are male.”

Like Gonzalez, the dean of the U of M’s nursing school, Lin Zhan, stressed that admissions decisions are based on academic ability: “We admit students based on their academic performance, not based on their race, their gender or their age or their social class,” criteria published in the university catalog.

Zhan, a Fellow of the American Academy of Nursing, talked about the minority presence among faculty as a selling point. “We publicize our faculty on our website, and I believe that the minority faculty who have achieved academically attract and serve as a role model for minority students,” she said.

“We have 46 percent of the faculty, including me, are from ethnically diverse backgrounds. If you look at the American Association of Colleges of Nursing national data, their average in terms of faculty diversity is around 20 percent.”

In 2014, the undergraduate classes at the Loewenberg School included 113 African-American students, 21 Asian Pacific Islanders, and six Hispanic non-white students. At the graduate level, there were 80 African-Americans, 10 Asian Americans and one Hispanic non-white. Of about 1,000 students, 94 were male, including 12.4 percent of undergraduates and 9.5 percent in the graduate program.

Like UTHSC, the Loewenberg school provides after-class support services for minority students, Zhan said, and the student association has a branch for minority nursing students.

“For the graduate school, we have an executive leadership program, a federal grant to recruit minority nurses, to develop them as leaders and nurse managers.”

She said about 40 percent of those students are from ethnic minority backgrounds.

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Measuring the Impact of Interprofessional Education

By CINDY SANDERS

IPE … or interprofessional education … has become a popular buzzword among educators preparing the next generation of providers. An interprofessional, team-based curriculum has been lauded as the best way to prepare healthcare professionals to work collaboratively in a valuebased system where efficiency and quality are rewarded.

But does it work? Do the lessons learned in the classroom effectively translate into the clinical setting? And does this model of delivery actually have an impact on patient outcomes and the healthcare system itself?

Those were some of the questions posed by the Institute of Medicine’s Global Forum on Innovation in Health Professions Education. In late April, a sixmember committee, chaired by Malcolm Cox, MD, published their findings in the IOM report “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.”

The short answer to a long list of questions is that while the empirical evidence suggests this is a desirable way to train future providers, there simply isn’t enough scientific research to validate that opinion.

Asking the Question Cox, who is an adjunct professor of Medicine at the University of Pennsylvania Perelman School of Medicine and the former Chief Academic Affiliations Officer of the U.S. Department of Veterans Affairs, noted IPE became a common topic of discussion and debate among members of the Global Forum.

“One of the things that came up early on was that health professions education was ‘faith-based’ when it came to outcomes … that is we believed, without much data, that interprofessional education would be helpful, if not essential, to producing the kind of clinical workforce that the U.S. and world need in the future,” he said.

Cox noted a common sentiment among many educators is ‘the era of the Lone Ranger’ is over. He added, “I think that’s true … no one doubts that. Moreover, no one doubts that the U.S. health system is rapidly moving in that direction.”

And in fact, Cox pointed out, data exists showing teams can provide safer, more effective, efficient care … but that isn’t the same as proving the best route to get there.

“How do we prepare health professionals to hit the ground running when they reach the clinical workforce so they are ready to work in teams rather than as individuals?” he asked. “What we discovered is that while teams are known to be effective, how to create great teams is unclear,” Cox continued.

No ‘I’ in Team “The leaders of healthcare systems are not pleased with the graduates we are sending them,” Cox stated. While these new professionals might be well versed in

disease recognition and the medical sciences, they aren’t well trained in working together, noted the physician-educator, who previously served as dean for Medical Education at Harvard Medical School Even when professionals from multiple disciplines are grouped together, Cox said it’s often more a matter proximity than actual teamwork. “Team leadership should be expertise- and situation-based rather than hierarchically based,” he pointed out. “Physicians are still giving orders and nurses are taking orders, which is fine if the physician has the most knowledge on a subject, but there are times when the nurse or physical therapist or pharmacist should lead. The most effective team is where the expertise of professionals overlap so that the whole is greater than the sum of the parts.”

While a lot of emphasis is placed on leadership, Cox said the concept of ‘followership’ is equally important. “Physicians are great leaders but poor followers … I’m allowed to say this because I’m one of them,” he added with a chuckle.

In his experience, he added, “The only way you can really learn to work together as a team … is to work together as a team.”

IPE & Outcomes Cox said the committee studied the available research and literature for both the intermediate and final outcomes of IPE. The intermediate outcomes side of the equation is tied to learning outcomes and whether or not students understood, gained knowledge and developed new skills. “There’s pretty good information that interprofessional education begins to promote collaborative behavior within students,” he said.

“But,” he continued, “we haven’t taken it to the final endpoint, which is do those learning outcomes lead to enhanced patient health and health system outcomes?” Cox said, “The conclusion was there is no data that links the learning outcomes to health and system outcomes … that’s where the gap is.”

While this committee was focused specifically on measuring IPE, Cox said he personally believes that all health education innovations should be held to the same evidence-based standard. “We keep changing the way we educate, and there’s little solid data that any of these changes lead to measurable changes in health or system outcomes,” he said. “Belief is one thing, but data is another.”

Filling the Gap Cox pointed out IOM studies are not geared to go beyond the question at hand … in this case, a question of measurement.

However, the report included recommendations on how to move forward to produce more data to assess the real world outcomes of IPE on patients, populations and healthcare systems.

The committee highlighted four areas that should be addressed in order to truly

evaluate the impact of IPE on collaborative practice – 1) more closely align the education and healthcare delivery systems, 2) develop a conceptual framework for measuring the impact of IPE (see graphic), 3) strengthen the evidence base for linking IPE to health and system outcomes, and 4) better link IPE with changes in collaborative behavior. Furthermore, the committee made two recommendations: Interprofessional stakeholders, funders and policymakers should commit resources to a coordinated series of well-designed studies of the association between interprofessional education and collaborative behavior, including teamwork and performance in practice. These studies should be focused on developing broad consensus on how to measure interprofessional collaboration effectively across a range of learning environments, patient populations and practice settings.

Health professions educators and academic and health system leaders should adopt a mixed-methods research approach for evaluating the impact of IPE on health and system outcomes. When possible, such studies should include an economic analysis and be carried out by teams of experts that include educational evaluators, health services researchers, and economists, along with educators and others engaged in IPE. Cox said the first recommendation is focused on collaborative learning outcomes. The second, which he said is “the real crème de la crème” of the report, looks at linking IPE to health and system outcomes by using ‘mixed methods’ … incorporating both qualitative and quantitative research designs. “We need to know the how and why, as well as the what,” he stated, adding that without the qualitative piece, it’s difficult to generalize the quantitative results and apply findings to the larger population.

The IPE Study Team Not surprisingly, Cox pointed out the report on interprofessional education took teamwork and was a collaborative effort of the six-member committee. In addition to Cox, the team consisted of Barbara Brandt, EdM, PhD, director, National Center for Interprofessional Practice and Education at the University of Minnesota; Janice Palaganas, PhDc, RN, MSN, director of Educational Innovation and Development, Center for Medical Simulation, Massachusetts General Hospital, Harvard Medical School; Scott Reeves, PhD, MSc, professor of Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St. George’s, University of London; Albert Wu, MD, professor and director, Center for Health Services and Outcomes Research at John Hopkins Bloomberg School of Public Health; and Brenda Zierler, PhD, RN, FAAN, co-director of the Center for Health Sciences Interprofessional Education, Practice and Research at the University of Washington.

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Bringing the Benefits of Hospitalists to Rural West Tennessee, continued from page 1 Hardin County Medical Center, he is playing a huge part in the success of the facility.

Klein spent his formative years in Birmingham suffering with severe asthma. Thanks to the devoted physicians who took care of him, he found he enjoyed medicine rather than feared it as some children do. When his father died at age 13, Klein and his mother moved to Atlanta where he encountered one of the biggest influences on his career choice.

“I met a physician who was right out of medical school, who was young and energetic,” said Klein. “I had always been drawn to medicine and so I started asking him questions. He let me hang out with him after school making rounds at nursing homes and hospitals. It solidified that medicine is what I would do.”

After graduating from the University of Alabama, Klein returned to Birmingham for his medical training at the University of Alabama School of Medicine.

He completed a one-year straight medical internship followed by his internal medicine residency at Methodist Hospital in Memphis. “There was no question about what I wanted to do. I had always leaned toward internal medicine since it was such a broad specialty that covers prevention, diagnosis and treatment of disease in adults so you are always challenged,” said Klein. “My desire to be an internist came from my exposure to nursing homes and hospitals in high school. I even made rounds in nursing homes for physicians in medical school to make money. The elderly and geriatric care are important to me.”

When it came time to launch his ca-

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reer, he initially planned to join a group but decided to open his own practice. “At the time I was married to a classmate and we were going to join the same group,” said Klein. “When they offered her $2030,000 less than what they did me for same position, we started our own group.”

of the hospitalist trend. “I started managing patients in the hospital for physicians,” said Klein. “This allowed for better coordination of care and more time with the patient while letting the physicians cover their patients at the office hours. At the time, I basically had found a niche in

“With the movement toward a hybrid system that is insurance based and more of an Accountability Care Organization model, all the players will have to come together and work together.”

Klein says that was the best decision because the practice grew like kudzu. “We were blessed early on that there was a new Methodist Hospital in Germantown that courted me to work with them,” he said.

“As they were trying to direct market share to the new facility, they wanted me to work with three area nursing homes. I eventually became the Medical Director of all three facilities. I was still seeing patients in the office and had a growing population of nursing home patients, which thus provided ongoing acute hospitalized patients which was great since I had always known I wanted to have nursing homes as a part of my practice.”

With insurance regulation changes in the late 1980’s that required more from doctors to manage their nursing home patients, Klein found himself at the forefront

healthcare and decided to run with it.

With the fee for service market this provided an opportunity to build a referral basis for the hospital. We also did some outreach to rural hospitals to help expand the market base. ” At the end of the 1990’s, Klein divorced and felt the need to make a professional change from private practice to become a hospitalist. Although at the time it was a relatively new concept in healthcare, he was already managing patients in four hospitals in the Memphis area, which created a need for more physicians to help with the patient load. Volume reached such that he narrowed his hospitalist practice to only Baptist Hospital where he flourished.

To help balance his busy practice as a hospitalist, in 1991 Klein purchased a lake

house on Pickwick Lake and fell in love with the Savannah community. In 2005, Klein moved to Savannah, commuting to Memphis for work. When the administration at Hardin County Medical Center started discussing a hospitalist program with him for their facility, Klein knew it was a perfect match for him; the hospital and the community. “They knew it was important for them to maintain their patients in their facility since they had been sending more acute patients to Jackson or Memphis and there was a desire to be able to keep folks closer to home” said Klein.

“By nature they had a small number of doctors responsible for managing their patients, and they were swamped in their office. Through his extensive hospital experience, having managed thousands of acute patients, he felt there was an opportunity to keep more acute patients at Hardin Medical Center.

Klein could also show the hospital the value of building a hospitalist program.

“The problem we have is the financial margin for rural hospitals is so small,” he said. “If we kept one patient a day that may have otherwise been sent somewhere else for acute care, that can positively impact the bottom line. The only way to survive is to increase volume to make up for decreased revenue. In a small hospital we can develop a program to capture more patients but can only do so much that way. We are only going to get a fixed amount based on DRG coding. That can increase if we are able to accept a higher acuity of patient. From the establishment of the hospitalist program, we have also been able grow other service areas that best address the needs of the community such as cardiology and orthopedics. We have been able to keep our census up and can maintain ourselves as a beacon for healthcare in our county. We are really a mini-tertiary care center now. ” In his time at Hardin County Medical Center, Klein has worn several hats that were both administrative as well as clinical in nature. He is part of an employed model for physician services and currently serves as Director of Hospitalist Program as well as Chief Medical Officer.

“In a small facility you wear many different hats,” he said. As such, he not only attends patients in the acute care setting and the Wound Care Clinic but also serves his administrative duties.

The challenge of interacting with multiple clinical areas and playing a role in salvaging the healthcare system for the community is something Klein is proud to be a part of. “I think we have weathered the initial storm and are moving forward.

With the movement toward a hybrid system that is insurance based and more of an Accountability Care Organization model, all the players will have to come together and work together,” he said. “We are looking at the ACO model to see if we can develop our own or join one. We are a county owned hospital and want to maintain our independence, we just don’t have the deep pockets that large healthcare systems have.”

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Rolling Out the President’s Precision Medicine Initiative NIH’s Collins, Sen. Alexander Discuss Next Steps in Nashville

By CINDY SANDERS

During a National Institutes of Health Precision Medicine workshop held in Nashville at the end of May, NIH Director Francis Collins, MD, PhD, and Sen. Lamar Alexander (R-Tenn.) discussed the steps necessary to roll out a national effort to deliver highly personalized care.

The Precision Medi- Dr. Francis cine Initiative (PMI) has Collins near-term goals focused on diagnosing and treating cancer and longerterm goals that look to expand the scope to the full continuum of health and disease. In announcing the initiative earlier this year, President Sen. Lamar Alexander Barack Obama highlighted the impact of ivacaftor – a new class of drug to target the underlying cause of cystic fibrosis that is now approved for patients with 10 different mutations to the CF transmembrane conductance regulator (CFTR) gene. For those with one or more of the mutations, ivacaftor has demonstrated improvement of CFTR function and has significantly extended quality and quantity of life.

Collins, a physician-geneticist who is known for his landmark discoveries in disease genes and his leadership in mapping the human genome, said the plan is to launch a million-person (or more) PMI research cohort in the next few months.

“We do expect by the fall to begin the process of implementing what we are designing right now,” Collins said. He spoke from Vanderbilt University where he was onsite for a two-day PMI workshop focused on digital health data and research cohort design.

In order to deliver individually tailored approaches to prevention and risk assessment, health maintenance, diagnosis and treatment, Collins said it was critical to build a large evidence base encompassing gender, race, ethnic, age and geographic variances. By sharing genomic information from participants, along with important clinical data from electronic health records and lifestyle and environmental information from mobile health devices and applications, researchers hope to better understand how genomic variations, in concert with other factors, impact the development and progression of disease.

Some participants will have their entire genome mapped, which has become much more cost effective over the past decade. Collins, who was director of the westtnmedicalnews

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National Human Genome Research Institute when human DNA sequencing was completed in April 2003, noted that first map cost about $400 million. Today, the price is about $2,000.

Collins said the hope is that individuals already enrolled in several large research cohorts like those with Kaiser Permanente, Mayo Clinic, Geisinger and the Veterans Administration might give permission to roll their data into this national effort. In addition to ‘stitching together’ some of the existing cohorts, Collins noted, “We will also have to find ways to fill gaps and invite highly motivated people who want to take part to come join.”

The goal is for patients at a family practitioner’s office in a small town to be able to participate as easily as those at major academic centers or large health systems. However, Collins stressed, having an electronic health record would be crucial to participation. Even with EHRs, Collins admitted interoperability and data sharing could be an issue.

Alexander, who has been a vocal critic of the current EHR program, said problems ranging from excessive documentation to disrupted workflow to interoperability issues have electronic health records “in a ditch, nationally.”

Alexander, who is the Senate health committee chair, and Patty Murray (DWash.) recently announced a bipartisan work group to pinpoint ways to improve EHRs. “The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that

physicians and providers look forward to instead of something they endure,” Alexander said in announcing the new committee at the end of April.

That work, he noted in Nashville, would be critical to the success of personalized medicine. While there is a long road from the $215 million included in the president’s proposed fiscal 2016 budget for PMI and congressional approval, Alexander did say this was an area where bipartisan support exists. ”Precision medicine – tailoring treatments and cures to individuals – has the potential to affect and improve the life of every American,” he said.

Another concern addressed by Alexander and Collins was the impact … in terms of time and cost … of creating new therapies tailored to smaller numbers of people.

“I’m working with Sen. Patty Murray, the committee’s top Democrat, to examine how we can get safe, cutting-edge drugs, medical devices, and treatments from the discovery process through the regulatory process into medicine cabinets and into doctors’ offices more quickly,” Alexander said. He added work groups currently are looking at ways to lower costs and shorten timeframes while maintaining safety. “We hope to have that legislation ready by the first of next year,” Alexander said.

Collins noted precision medicine might actually help get more drugs on the market. “The era of blockbusters may no longer be one that is going to apply as we understand more and more differences between people,” he said.

“But look at it the other way,” he

continued, “The failure rate in developing a new therapeutic is about 99 percent.”

Collins noted after spending an average of 14 years from idea through human trials, most therapeutics don’t wind up approved. “That’s why the cost of the whole pharmaceutical industry is so high … because you have to pay for all those failures,” Collins said. “What precision medicine gives you is an opportunity, first of all, to pick the right target because we really understand at a much more detailed level what is happening with diabetes or cancer or heart disease.”

He added researchers not only start with more evidence before embarking on developing new therapeutic agents, but they also have the ability to pick groups that fit the target profile. A drug crafted to impact a specific mutated gene would not be tested in patients without that genomic profile. “”That means you can run a clinical trial that is much smaller, and therefore much cheaper … and you also will have a much higher likelihood of success.”

Collins pointed out such a drug used in a broad trial, as is often the case now, might look like a massive failure because it only worked 10 percent of the time.

However, he added, if only tested in the 10 percent of patients that fit the target profile, that ‘failure’ suddenly becomes a roaring success.

For more information on Precision Medicine Initiative and upcoming workshops, go online to nih.gov/ precisionmedicine.

THE STRENGTH TO HEAL and rediscover my passion for medicine.

The new experience you’ll gain as a member of the Army Reserve will help you remember why you became a physician. By practicing in your community and serving when needed, you could receive $250,000 in student loan repayment and $75,000 in Special Pay. You’ll feel an increased sense of pride when you care for our Soldiers and their Families.

To learn more about the U.S. Army Reserve health care team, visit healthcare.goarmy.com/mednews or call 901-388-9760.

©2010. Paid for by the United States Army. All rights reserved.

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GrandRounds Henry County Healthcare & Plumley Rehab Receives Bronze National Quality Award PARIS – Henry County Healthcare Center & Plumley Rehab has been recognized as a 2015 recipient of the Bronze – Commitment to Quality Award for its dedication to improving the lives of residents through quality care. The award is the first of three distinctions possible through the National Quality Award Program, presented by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). The program honors centers across the nation that have demonstrated their commitment to improving quality care for seniors and individuals with disabilities.

Implemented by AHCA/NCAL in 1996, the National Quality Award Program is centered on the core values and criteria of the Baldrige Performance Excellence Program. The program assists providers of long term and post-acute care services in achieving their performance excellence goals.

The program has three levels:

Bronze, Silver, and Gold. Centers begin the quality improvement process at the Bronze level, where they develop an organizational profile with essential performance elements such as vision and mission statements and an assessment of customers’ expectations. Bronze applicants must also demonstrate their ability to implement a performance improvement system. Trained Examiners review each Bronze application to determine if the center has met the demands of the criteria. As a recipient of the Bronze - Commitment to Quality Award, HCHC may now move forward in developing approaches and achieving performance levels that meet the criteria required for the Silver - Achievement in Quality Award.

The awards are sponsored by AHCA/NCAL Associate Business Members My InnerView, by National Research Corporation and PointRight. HCHC was one of 545 centers to receive the Bronze level award. The award will be presented to HCHC during AHCA/NCAL’s 66th Annual Convention and Exposition, October 4-7, 2015, in San Antonio, Texas.

Baptist Hospice Receives Prestigious Honor UNION CITY – Baptist HospiceUnion City has been named a 2015 Hospice Honors recipient, a prestigious award recognizing hospices providing the best patient care as rated by the patient’s caregiver. This is the second consecutive year that Baptist Hospice-Union City has received this award.

Established by Deyta, this prestigious annual honor recognizes hospices that continuously provide the highest level of satisfaction through their care as measured from the caregiver’s point of view. Deyta used the Family Evaluation of Hospice Care (FEHC) survey results from more than 1,700 partnering hospice agencies contained in Deyta’s FEHC database with an evaluation period of October 2012 through September 2013.

Deyta identified Hospice Honors recipients by evaluating hospices’ performance on a set of eighteen satisfaction indicator measures. The set of questions included only indicator measures, omitting qualifying, leader and demographic questions. Individual hospice performance scores were aggregated for the evaluation period and were compared on a question-by-question basis to a national average score calculated from Deyta’s FEHC database.

Suzie McWherter, director of Baptist Hospice-Union City, credits staff teamwork, physician engagement, and commitment to quality as factors for being named a 2015 Hospice Honors recipient.

Foundation Now Accepting Nominations For 2015 Jackson Awards JACKSON – Nominations are now being accepted for the Jackson Awards which are given annually by the Foundation. Nomination forms are available online at www.thecharitygala.org/jackson.

The submission deadline is Friday, July 31.

The Jackson Awards were first given in 2006 as a means to honor those in our community who exemplify the truest qualities of a leader. The awards, named for President Andrew Jackson, our city’s namesake, are presented to individuals who have served as leaders in one of the following areas: The Arts, Community Service, Education, Health Care, Leadership and Volunteer Service. The award recipients will be honored at the Foundation’s Annual Charity Gala on Saturday, November 14.

For more information on the Foundation, the Jackson Awards, or the Charity Gala please visit www.thecharitygala. org.

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

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GrandRounds Leigh Ann Brandeberry joins West Tennessee Bone & Joint Clinic DYERSBURG – Adult Gerontology Acute Care Nurse Practitioner Leigh Ann Brandeberry has joined West Tennessee Bone & Joint Clinic, P.C. She works with J. Douglas Haltom, M.D. and Jason T. Hutchison, M.D. in the clinic’s Dyersburg office.

Leigh Ann Brandeberry has a Brandeberry master’s degree in nursing from the University of Alabama at Birmingham. Her credentials include Adult Gerontology Acute Care Nurse Practitioner, Advanced Cardiac Life Support and Basic Life Support. She is a member of the American Academy of Nurse Practitioners.

Amy Wren joins West Tennessee Bone & Joint Clinic JACKSON – Acute Care Nurse Practitioner Amy Wren joined West Tennessee Bone & Joint Clinic, P.C. to work with Eric J. Homberg, M.D., and treat patients with chronic pain.

Wren’s clinical specialties include acute care, interventional pain manageAmy Wren ment, total wellness and health management. She has a master’s degree in Nursing from Vanderbilt University.

Her credentials include Acute Care Nurse Practitioner, Certified Clinical Lipid Specialist, Certified Advanced Life Support, and Certified Provider of Bale/Doneen method of Heart Attack and Stroke Prevention. She is a member of the National Lipid Association, American College of Cardiology and American Academy of Nurse Practitioners.

WTHC Foundation Announces Vice President JACKSON - The West Tennessee Healthcare Foundation announces Beth Koffman as its new Vice President.

At this week’s Executive Committee meeting of the Board of Trustees, Frank McMeen received unanimous approval for Beth Koffman the selection of Beth Koffman as Vice President of Operations of the Foundation.

Koffman joined the Foundation in April 2007 as Marketing and Fund Development Coordinator for Ayers Children’s Medical Center. In 2012, she assumed the role of Events and Community Relations Coordinator working with the Foundation’s volunteer boards and managing all Foundation events including its annual Charity Gala.

She is a graduate of Union University, a 2008 graduate of Leadership Jackson and 2014 graduate of WestStar.

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Andre’ D. Worrell, MD, Joins Medical Staff at HCMC PARIS – Henry County Medical Center is pleased to announce that Andre’ D. Worrell, MD, FAAP, Pediatrician, has joined the medical staff and is now seeing patients at Paris Pediatrics.

Worrell completed his undergraduate studDr. André D. ies in Biochemistry at Worrell Aberdeen University in Scotland, UK, in 1982 and obtained his medical degree from The University of the West Indies in 1989. He later completed his General Pediatric Residency and Neonatal-Perinatal Medicine Fellowship training, respectively, at Howard University and Brown University Medical School.

He is board certified in General Pediatrics and Neonatology and credits his childhood Pediatrician for the inspiration to enter the field of Medical Science. He has joined Paris Pediatrics, PC and has admitting privileges at Henry County Medical Center.

His wife, Darlene, a Substance Abuse and Family Counselor, has been involved in Women’s Prison Ministry. Worrell has volunteered over the years with Catholic Social Services, Habitat for Humanity and in Cost Rica. His daughter, Leigh, has her undergraduate degree in Accounting, while son, Kahlil, enters his second year at Essex University Law School, UK, in the fall. In his free time, Dr. Worrell enjoys cycling, swimming and chess.

HMC Wound Care Services recognized as a Center of Excellence SAVANNAH – Hardin Medical Center physicians, leaders, and clinicians, along with Healogics representatives, gathered to celebrate the Robert A. Warriner III, M.D., Center of Excellence award, which was presented to HMC Wound Care Services. For the third consecutive year, HMC Wound Care Services achieved high quality metrics. The center ended 2014 by healing 99 percent of their patients with median days to heal of 24 and an outlier rate of 17 percent. The Center was awarded this prestigious honor

by Healogics, Inc., the nation’s largest provider of advanced wound care services. The award is named for Dr. Robert A. Warriner III, a pioneer in wound care and the former Chief Medical Officer for Healogics.

HMC Wound Care Services offers highly specialized wound care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds which have not healed in a reasonable amount of time. Advanced treatments included hyperbaric oxygen therapy, negative pressure wound therapy, bio-engineered skin substitutes, biological and biosynthetic dressings and growth factor therapies.

Presenting HMC Wound Care Services staff with the Healogics Center of Excellence honor is Ron Gobble (far left), Healogics Area Vice President; HMC Wound Care Services staff members include (l-r) Robin Moore, Tina Cathey, Misty Hurt, Amy Powers, and Dr Gade Rao. Not Pictured: Leah Teague, Shari Cossey, Dustin Scott, and Dr Tim Klein.

Hardin Medical Center Partners with Studer Group® SAVANNAH - Hardin Medical Center (HMC) announces partnership with Studer Group®, an outcomes-based healthcare performance improvement firm based in Gulf Breeze, Florida. HMC and Studer Group share the same commitment to providing the best possible care for patients, their families and the community, as well as the best possible working environment for employees.

Studer Group® has worked with over 1,000 healthcare organizations in the U.S. and beyond, teaching them how to achieve, sustain, and accelerate exceptional clinical, operational, and financial outcomes. They help bring structure and focus to organizations through the creation of cultures of accountability and help set them up to be able to execute quickly. It’s this commitment to helping organizations accelerate their ability to execute that led to Studer Group receiving the 2010 Malcolm Baldrige National Quality Award.

HMC CEO Nick Lewis and the entire leadership team at Hardin Medical Center are committed to making HMC a great place for patients and residents to receive care, physicians to practice medicine, and employees to work, The goal of the team is to promote the culture at HMC of being certain patients and residents receive quality care with every medical service

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