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PHYSICIAN SPOTLIGHT PAGE 3

Dafnis C. Carranza, MD ON ROUNDS Hospitals Prepare For Costly Coding Changes Coding for medical diagnoses will change dramatically on Oct. 1, 2014, when the ICD-9 codes are replaced

by ICD-10, but Memphis-area hospitals say that despite the addition of thousands of codes, they are ready ... 4

Patient Safety Takes Flight in Tennessee

TCPS, LifeWings Partner to Implement TeamSTEPPS

By CINDy SANDERS

The Tennessee Center for Patient Safety (TCPS) recently announced a collaborative agreement with LifeWings Partners LLC, a West Tennessee company that has adapted the best practices of high reliability organizations to create safer patient environments for hospitals across the nation.

Headquartered in Collierville, Tenn., LifeWings has brought together a team of physicians, nurses, and healthcare risk managers ‌ along with former NASA astronauts, military flight surgeons, officers, pilots, and flight crew ‌ to train healthcare professionals in the communications and teamwork skills used by pilots to ensure safety. TCPS and LifeWings are partnering on a program to enable Tennessee hospitals to adopt the healthcare version of crew resource management (CRM) training that is known as TeamSTEPPS. At the helm of LifeWings is Steve Harden, a former Navy pilot and TOPGUN instructor and current international pilot for FedEx. Harden, a Naval Academy (CONTINUED ON PAGE 10)

As Concerns Rise, Will More Doctors Retire Early?

Physicians are weighing their options for retirement in a pessimistic environment complicated by rising healthcare costs, legislation affecting Medicare, and overall healthcare reform ... 8

ONLINE: WESTTN MEDICAL NEWS.COM

HealthcareLeader Sherry Scruggs Administrator, Gibson County Hospitals

By SUZANNE BOyD

Growing up on a farm outside of Trenton, Tennessee gave Sherry Scruggs plenty of opportunities to care for others, even if at the time they were of the four-legged variety. As she grew up, her desire to care for others led to a career in nursing. Today, the country girl at heart finds herself not far from her childhood

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home and still in a caretaker role. Just now she is responsible for taking care of employees, staff, patients and families as administrator of three West Tennessee Healthcare hospitals in Gibson County. Ironically, one of those hospitals, Gibson General in Trenton has been a significant part of her life. She was born there, got her first experience in healthcare and has spent her pro(CONTINUED ON PAGE 12)

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Tubal Reversals: Delivering Dreams by: Lisa Rogers, M.D.

Have you ever made a decision that you later regretted, or done something that you would like to “un-do?” I’m sure that we all have at one time or another. Some decisions are easy to change, while others are more difficult.

When women reach the point in their lives when they do not plan to have more children, many of them decide to have a tubal ligation.

This is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. It is considered to be a permanent form of birth control.Many women who have had their tubes tied are happy with their decision, and feel that it works well for them for contraception. However, there are many women who regret having a tubal ligation, some of them almost immediately after the surgery is done. They realize that a door has been closed, and the opportunity to have more children in the future is gone. The regret of that decision can be very intense.

Thankfully, there is a way to reverse a tubal ligation and give couples hope for having more children. A surgical procedure called a “tubal reversal” or “tubal anastomosis” reconnects the tubes where they had been damaged during a tubal ligation. zDr. John Curlin, who retired in 2004, began doing tubal reversals in the 1970s. He felt called to learn the procedure and help women who experienced regret over their decision of sterilization. He worked with Jackson-Madison County General Hospital to keep costs low and make it affordable.

Many doctors charge over $10,000 for a tubal reversal, and it is usually not covered by insurance. The total cost through The Jackson Clinic is $5,400 (surgery, pre-op visit, and lab, anesthesia, and hospital charges).

I worked with Dr. Curlin for several years to learn his successful methods of repairing tubes. I am honored to be able to continue this ministry. My surgical practice is focused on tubal reversals, and I perform about 100 of them each year. I still see general gynecology patients in my office practice.

For women who were age 39 and under when they had their tubal reversal and had a tubal length of at least 4 cm, their chance of having an intrauterine pregnancy (not ectopic) was 81%. For women of all ages with a tube of at least 4 cm, the success rate was 67%. Our ectopic (tubal) pregnancy rate was 7%. Some women had an HSG (x-ray dye test) that showed that their tubes were open, but had not become pregnant. We have had at least two women who had dye tests that showed their tubes were blocked, but later became pregnant and had a baby. Only a small percentage of women had an HSG that showed blocked tubes and did not conceive.

There are several surgical methods used to perform a tubal ligation. Almost all of these can be reversed. Clips or bands usually damage only a small segment of the fallopian tube, and leave a good length to put back together. If a long segment of the tube has been removed or destroyed, the success rate of tubal reversal may be lower. Studies have shown that pregnancy rates are higher if the tubes are at least 4 cm long. There are newer methods of tubal ligation called Essure and Adiana. I am unable to reverse those at this time, due to the damage of the tube as it passes through the uterine wall.

I had my tubal reversal in April 2012 with Dr. Rogers. She is the most polite woman I have ever met and she had a wonderful disposition which made me immediately comfortable. I am proud to report that in June 2012 only three cycles from my reversal, I have a positive pregnancy test!

Thank you so much!

If you or someone you know have had a tubal ligation and would like more information on having a tubal reversal, please call The Jackson Clinic OB-GYN department at 731-660-8300. If you will leave a message with your name and address, we would be glad to send you some information. You can also visit our website at http://www.jacksonclinic.com/tubal-reversals.

God has blessed our tubal reversal ministry at The Jackson Clinic. Some time ago, we sent surveys to all of our patients to see how they were doing. We gathered the information from the surveys and calculated our success rates.

OB/GYN Department www.jacksonclinic.com 731-422-0330

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PhysicianSpotlight

Dafnis C. Carranza, MD

By SUZANNE BOYD

Even as a child in El Salvador, Dafnis Carranza was affected by the lack of basic services available in her native country. When her parents immigrated to the United States in the 1980’s to escape the war in her country, she knew she was handed an opportunity to do good for others and was committed to that goal. For her continued dedication to serving others in 2009 she was awarded the President of United States Volunteer Service Award.

As the first fellowship-trained Mohs micrographic skin cancer surgeon to practice in the West Tennessee area, Carranza is making a difference in the lives of patients dealing with skin cancer and skin related conditions.

“Growing up in Los Angeles, I always knew I would pursue a medical career,” said Carranza. “My parents had no education and came from humble beginnings, so in order to have money for college I worked as a nursing assistant during high school. Based on that I thought I would do nursing. A trusted mentor of mine encouraged me to look at medical school over nursing. At the time I was looking at college there was a shift in healthcare from the inpatient to the outpatient setting and we were not sure where nursing was headed.”

Carranza, who worked throughout her college career, graduated from the University of California at Los Angeles with a bachelor’s degree in physiological sciences. For her commitment to community service while an undergraduate, she was awarded the Chancellor Service Award. To save money for medical school applications, Carranza worked for a year after graduation. She was accepted to the David Geffen School of Medicine at UCLA where she received a Dean’s Scholarship and completed her medical degree in 2003.

“Initially, I thought OB/GYN was the specialty for me because I loved surgery and women’s health,” said Carranza.

“But then I did my dermatology rotation which included melanoma research for which I received the Edith and Carl Lasky Memorial Award for excellence in melanoma research. I spent a year doing melanoma and other skin cancers research which showed me this was the path for me as dermatology would let me do both medical and surgical procedures.”

Carranza remained at UCLA to complete her dermatology residency and was named Chief Resident. She also completed a Mohs micrographic surgery fellowship at UCLA. She is a fellow of the American College of Mohs Micrographic Surgery.

For her work in dermatology and Mohs surgery she was recognized in Who’s Who in Medicine and Healthcare, 2011-2012 and was voted one of America’s Top Dermatologist in 2010 and 2011 by the Consumer’s Research Council of America. westtnmedicalnews

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When Carranza finished her fellowship in 2008, she and her husband, Michael McGillen, knew they wanted a slower pace than what LA had to offer but also had hefty school loans to repay.

“We looked at clinics in 12 states but found everything we were looking for in Jackson. I was most impressed with the medical community in Jackson. But really it was the people in Jackson that we fell in love with” said Carranza, who initially went into practice at the Jackson Clinic, P.C. “I have family in Nashville and got a generous loan repayment package from the hospital which just made it the perfect move for us.”

In 2011, Carranza and Catherine Lucas, MD, opened Dermatology & Skin Cancer Consultants, PLLC in Humboldt, Tennessee. “We really love Humboldt, it is a great community. We have been so pleased with how our practice has flourished and our patients find it an easy drive to Humboldt,” said Carranza. “Our focus is skin cancer treatment and prevention, but we see the whole gamut of patients from clinical and surgical dermatology to cosmetic treatments.”

In her years of treating adult skin conditions and disorders, Carranza has seen a shift in the approach to treating photo damage and skin cancer. “The focus now is preventing sun damage, treating photo damage when it occurs and detecting skin cancers at a much earlier stage. We certainly have many more options for treating sun damaged skin today than we did when I was in residency a few years ago.”

Some of these options include topical treatments that only need to be used twice or three times like the recently approved Picato® (ingenol mebutate) gel.

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The newest treatment on the block is photodynamic therapy, the topical application of aminolevulinic acid, followed by exposure to blue light. “It is an exciting time for the older population because we have many tools available to treat photo damaged skin,” said Carranza. “Photodynamic therapy can improve all three aspects of photoaging: color changes, dermal remodeling, and precancerous changes.”

Carranza is finding that she is diagnosing skin cancer earlier than she used to and the prevalence of it is higher. She attributes some of this to the increased awareness patients as well as the medical community have to the disease. “We are seeing patients earlier, which means we detect cancer at an earlier stage and have a greater chance of curing it,” said Carranza. “This is especially true with melanoma in situ, which is when the melanoma cells are only in the top layer of skin. If we detect melanoma at this early stage, we can offer the patient about a 100 percent cure rate.” For patients who are beyond the in situ stage, a new test is available which can help doctors in determining the risk of melanoma metastasis.

Decision-Dx-Melanoma was developed to identify at-risk node-negative patients.

The test analyzes the expression of 31

genes within a patient’s tumor to predict individual metastatic risk independent of tumor stage. “This test is a good tool for melanoma patients and can impact how closely these patients are monitored and which treatment options to pursue.”

When surgical intervention is necessary for skin cancer, Carranza says that Mohs micrographic surgery is ideal, especially for the elderly. “It is an outpatient procedure that utilizes local anesthesia,” she said. “We can remove and repair the tumor in the office all in same day making it a safer, more cost effective alternative for the elderly population over general surgery.”

Carranza is a big proponent of sunscreen as a first line of defense against skin cancer at any age. “What I like to tell patients is that it is never too late to start using sunscreen,” said Carranza. “We used to think that the damage to skin came from sun exposure a patient got before age 18 but we are now finding that the damage comes in our later years. Retirees are out in the sun more playing golf, fishing and such, their skin is thinner and they are very susceptible to photo damage. For this population I recommend sunscreens with a higher percentage of physical blockers such as titanium dioxide and zinc oxide.”

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Hospitals Prepare For Costly Coding Changes

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Coding for medical diagnoses will change dramatically on Oct. 1, 2014, when the ICD-9 codes are replaced by ICD-10, but Memphis-area hospitals say that despite the addition of thousands of codes, they are ready.

“ICD-10 implementation is a huge change for the American healthcare system,” said Bill Griffin, vice president of corporate finance for Baptist Memorial Health Care. “In the U.S. we currently code using ICD-9 while the rest of the world has been on Bill Griffin ICD-10 for years. Moving to ICD-10 is a positive thing, as it results in a more accurate and specific documentation of a patient’s diagnosis and the procedures applied in treatment.”

In essence the change means that each diagnosis represented by an ICD-9 code will soon blossom into an entire range of extremely specific diagnoses, each with its own code.

“The codes all drive the claims that a hospital or physician office generates and sends to the insurance company, Medicare or the patient,” Griffin said. “So not only does the coder have to be proficient at ICD-10, but so do the payers.”

The new codes will come with a cost for hospitals, though, as they retrain coders and update systems.

“ICD-10 will impact a large number of business and clinical documentation processes as well as the information systems that support those processes,” said Chuck Lane, CFO of Methodist University Hospital.

“Methodist Le Bonheur Healthcare (MLH) is still in the process of providing staff training, ensuring information sys-

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tem readiness, and planning for a robust physician communication plan that will support the conversion. MLH is supportive of the conversion to ICD-10, and we believe that over the long term, improved documentation will help drive quality improvement nationally.”

Still, neither hospital system is waiting for the deadline. The AMA said it should take three to six months to implement ICD-10, but many major hospital systems began planning for the change over the last two years. Or more.

“At Baptist, we started to address the change about three years ago,” Griffin said. “This included the development of an educational strategy for our hospital and physician coders and some support staff which we put in place about 18 months ago. We will complete our coder education in spring of 2014. We also have addressed the software transition that is necessary to provide the support for the coding initiative, too. The goal is to be ready to code proficiently when the mandatory adherence date of Oct. 1, 2014, arrives.”

“While the three- to six-month time frame may be appropriate for small hospitals or physician practices,” Lane said, “large integrated healthcare organizations like MLH will take longer to implement. We began planning in 2011 for an implementation date that was originally set for 2013. We were pleased that the implementation timeline was delayed to 2014, as it gave us more time to prepare our staff and upgrade our systems.”

The cost of healthcare systems, namely for training, could reach into the millions depending on the size of the hospital.

“All this education and software preparation will cost our organization a significant amount – millions of dollars – when completed in personnel training time, the training program and in IT products,” Griffin said.

“There’s no question that conversions of this magnitude can be costly,” Lane said. “There is a great deal of staff education and training that must be done along with an assessment and often an upgrade to a variety of information systems. A well-executed plan can help to contain those costs and avoid any potential delays or losses in reimbursement.”

But in terms of patient treatment, Griffin and Lane agreed that the cost is worth it.

“There is clearly a new level of specificity required for medical coding,” Lane said. “Our physicians understand the care that we are providing; we just have to make sure that our documentation contains the required level of specificity.”

“It’s a very complicated and challenging change to the healthcare industry, but it is a good change overall,” Griffin said.

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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.

Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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Hey Doc, Your Website is Dead

By TIM NICHOLSON

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Our exceptionally talented teams of cardiovascular professionals are focused on bringing high quality heart care to several convenient locations across West Tennessee. We’ll partner with you to offer your patients comprehensive consults and clinical evaluation (incorporating the latest evidence based research data) and complimented by advanced and sophisticated diagnostic services.

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Remember the Tamagotchi? It was popular with teens and preteens in the late 1990s. Owners of these pocketsized toys were told, “The Tamagotchi is a tiny pet from cyberspace that needs your love to survive and grow. If you take good care of your Tamagotchi pet, it will slowly grow bigger, healthier and more beautiful every day. If you neglect your little cyber creature, it may grow up to be mean or ugly.”

The question or game of it all was to know, “How old will your Tamagotchi be when it returns to its home planet?” Or, as the kids knew, before it died. Its survival was up to the owner, or virtual caretaker as the toy manufacturer referred to them.

But its death was inevitable. As with everything else that comes into the life of a child, it runs its course. The ecosystem for the pet would change considerably if the owner discovered the opposite sex, lost his backpack, was grounded, joined a cheer or sports team, or otherwise got busy with something more interesting than the digital pet in their pocket.

It’s that way in the real world too.

We live in an always tuned in, on-thego world where apps own every conversation and Facebook is the Internet. Yet, you have a website that like that forgotten Tamagotchi hasn’t adapted to the changes in the (web) ecosystem. And now? It’s dead.

It’s dead to the referring physician upon whom you rely for business development.

It’s dead to prospective patients who rely on it to determine the role you might play in their care beyond medical jargon and outdated resources.

It’s dead to the caregiver, referring physician or healthcare partner who learns through images and video.

And it’s dead to anyone who might dare expect to connect, gather or interact with you when they’re sitting with an ailing family member or on the bleachers at soccer practice.

It’s dead because five changes occurred within the web ecosystem and you failed to adapt.

The web became about shared experiences.

People want to be where their friends are and where people with shared values or common interests and concerns can interact.

The web became about personalization.

People want to know that you know who they are. You have to know what returning audiences find useful, recognize

what they need more of and allow them to share what they’ve found useful elsewhere.

The web became about engagement.

Users are no longer content to simply look at your info.

They want to talk about it. Leave comments.

Share ideas. See comments from others. See comments from you regarding their comments.

The web became mobile.

Smartphone ownership is a pandemic.

Your website has to have meaningful functionality and legible text on the smartphone form factor. For many, it has become the preferred touch point. But at the very least it must be a capable companion to the desktop experience.

The web became more visual.

Pictures are still worth a thousand words. And they are among the most valuable assets your website can use to communicate your values, present your service, educate your audience and entice them to share what they learned on your site with others through a variety of sharing utilities.

What happened to the web ecosystem? It became social. You know social, right?

It’s that thing you do every time you share an article, click like, reply to a friend’s comment, upload a photo or subscribe to content from those who engage and inform you. And it’s not just for Facebook, Twitter and Pinterest. It should drive your website strategy.

People on social websites feel like somebody. And while you might not have noticed, sites that use social plugins and methods have empowered your patients and their friends. They’ve set an expectation for something more than well, what you’re doing on your website.

The Tamagotchi had a speaker. It was the cyber pet’s mouth, so to speak. Certain tones or beeps would convey the pet’s status – I need water. I need sleep. I need you to play with me – it’s a plea that you’d do something.

So, consider this your website’s plea for you to do something. The savvy Tamagotchi pet owner knew how to reset the toy when he or she recognized it was near death. I bet I know a kid or two who might be able to reset your website. And now you know what must be done for it to “grow bigger, healthier and more beautiful every day.”

Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email tim@gobigfishgo.com

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7

As Concerns Rise, Will More Doctors Retire Early?

By JONATHAN DEVIN

Physicians are weighing their options for retirement in a pessimistic environment complicated by rising healthcare costs, legislation affecting Medicare, and overall healthcare reform.

In Tennessee, not much is known yet about the possibility of changing trends in retirement. Nationally, however, medical media are reporting that cuts to Medicare reimbursement are having an effect on when doctors will plan to retire.

Of course, this scenario has played out before.

Gary M. Zelizer, director of government affairs for the Tennessee Medical Association, said that historically there is nothing new about doctors exploring retirement options when government-funded programs become uncertain.

Zelizer said this has Gary M. Zelizer happened “about every time in the last 10 years that the SGR cuts hit the deadline. I imagine that some physicians threatened retirement in 1993 with the advent of (TennCare) and the prospect of greatly reduced reimbursement.”

As late as 2011, Tennessee physicians

expressed concern over potential 8.5 percent cuts to TennCare reimbursements for mental health services, nursing homes, Xrays and dental services.

Zelizer didn’t recall that a mass exodus of physicians ever occurred.

While it is possible to find out how many physicians retired their licenses in any given year, the reasons for retirement are not recorded, Zelizer said, unless specific surveys are conducted. Zelizer did not know of any surveys regarding retirement

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in the wake of 2013 Medicare reimbursement cuts.

In 2005, the Tennessee Medical Association gathered data on physicians’ feelings regarding reimbursement cuts and found that while 19 percent considered terminating participation in managed care organizations (MCOs), only 8 percent actually did, joined by .17 percent who terminated shortly before the survey.

At that time, more rural physicians (93 percent) were participating with TennCare than doctors in metro areas (83 percent), but the rural physicians said they were more likely to leave the program.

According to the study: The “business as usual” response reconfirms physicians’ willingness to continue to provide care to their patients as long as possible. However, closer analysis raises possible concerns for the economic health of rural medical practices, particularly specialists. While 81 percent of all metropolitan specialists said they would stay with TennCare, only 56 percent of rural specialists responded that way. Significantly, 38 percent of rural specialists said they would consider terminating participation in TennCare at the earliest possible date, compared to 10-12 percent of their rural primary care peers or all metropolitan physicians.

More recently, a 2013 Deloitte “Survey of U.S. Physicians: Physician perspectives about healthcare reform and the future of the medical profession” found attitudes much the same on the national scale.

Dealing with Medicare/Medicaid was the second most common reason that physicians were dissatisfied with practicing medicine (22 percent) after having less time with each patient (26 percent).

In 2009, the Oregon Medical Association reported in a survey that 19.1 percent of Oregon doctors, mostly rural, had closed their practices to Medicare patients and that 28.1 percent had restricted the number of Medicare patients.

Four in 10 physicians reported that their income decreased between 2011 and 2012, with decreases of 10 percent or less.

Fifty-one percent said they believe physicians’ pay will fall in the next one to three years.

Strikingly, 60 percent in the Deloitte survey reported considering an early retirement. The effect of large numbers of retiring physicians is unknown, and Zelizer noted that “true retirees are obviously getting older and their productivity may not be equitable to someone younger.”

But the concern remains that rural patients would suffer the most from physicians’ early retirement because fewer physicians are available in rural areas as it is, and large numbers of retirees who depend on Medicare live in rural areas.

Medicare pays less for reimbursements to rural doctors as well, because of lower costs.

That compounds existing shortages, according to the American Association of Medical Colleges, which said that rural areas lack about 20,000 primary care doctors, while only about 16,500 medical doctors graduate annually.

The Affordable Care Act represents one more possible shift in the market as potentially millions of new patients nationally, who did not have health insurance before, seek primary care in 2014. The question remaining is whether physicians will be able to afford their patients.

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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

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Doctors Need a Financial Plan, Much Sooner Rather Than Later

By GINGER PORTER

The practice of medicine, once a sure return on investment, has in recent decades become more of a high-risk venture. Rising malpractice insurance, larger school loans, dwindling reimbursement, a forecasted shortage of physicians, lower physician salaries and a sluggish economy have made physician wealth management a minefield.

A recent survey by Deloitte indicated 57 percent of doctors view changes in medicine under the Affordable Care Act as a threat, leading six in 10 physicians to report they might retire earlier than they had planned. Some will work for hospitals rather than deal with the load of new regulations, and more than half surveyed have already seen a 10 percent or less decrease in their paycheck (2011-2012).

Financial planners specializing in physician accounts have a variety of approaches: put 30-40 percent of investment money in bonds and cash and the rest in stocks; save 20 percent of income across the board for retirement starting with the first real paycheck past residency; or, keep ample liquidity to capitalize on the purchasing opportunities of falling markets for greater return later.

All advisors interviewed agreed, as one said, to “live by design and not default.”

They say when it comes to getting a handle on physician finances, start early.

Don’t procrastinate. And if you’ve made mistakes, get help or it will only get worse.

“We advise doctors straight out of residency to think of the long-term goals first and look backward. Have a plan for that first paycheck where your income rises exponentially,” said Tom Martin, partner and regional director, Lawson Financial Group, the nation’s largest financial firm exclusively for doctors. Martin is the primary author of For Doctor’s Eyes Only, A Financial Guidebook for Doctors and Dentists (published in 2012).

“Where are you heading long term? Is it retirement, education planning, purchasing a dream home, taking care of your parents as they age?” Martin said. “We start by saving and investing for the long-term things and then take care of the short-term things. The leftover income is still gigantically larger than in residency.”

Martin said that due to poor financial decisions it is common to see some practicing physicians in their 50s as financially strapped as they were in residency. The issue gets personal. He blames extravagance, poor planning and divorce. He cited the average age of divorce for doctors as 42. He sees the repeated example of physicians working long hours and “retail therapy” by spouses to compensate for the time away, then the doctor’s increased need to work to cover those bills, resulting in cycle perpetuation.

Then there are great success stories.

William Howard of the local firm William westtnmedicalnews

.com

Howard and Company Financial Advisors, Inc., has been counseling doctors for 34 years. He told the story of a young physician starting out in the ‘80s. He had some really large income years and saved a lot of money. His portfolio now generates as much as he is earning from his practice. Some of this is because his income William has been reduced from Howard salary cuts and decreased reimbursements. But some is due to sound decisions and steady financial growth.

“The best approach is a well-balanced, diversified portfolio,” Howard said. “If you are on the long-term horizon, the biggest risk is not the volatility of the investment, but it’s a loss of purchasing power from inflation. A diverse portfolio with at least 30 percent in bonds and cash is the way to go.”

He added that four years ago, when the Dow was in the 6,500 range, was an incredible buying opportunity that lots of physicians missed because they panicked and pulled out of stocks. “No one could have predicted that stocks would be where we are now – at 15,000. If you are not there participating, you miss out.”

The biggest mistake he sees physicians making financially is using emotion to make investment decisions. This could be selling out of the stock market in a reactionary mode. It could be taking a financial course of action just because a colleague is doing it. It could be not getting financial help or putting off getting it.

Echoed by both Martin and Philip Moser, a financial advisor with Dixon Hughes Goodman Wealth Advisors, LLC of Memphis, there is a need for a higher standard of wealth advisor for physicians.

They encourage doctors to select advisors who owe a fiduciary standard of care, meaning they are legally obligated to do what is in their client’s best interest. Moser recommends a team of advisors covering risk management, asset protection, debt management, cash flow management, retirement, investment planning, contract negotiations, tax planning, education planning and estate planning.

One advisor compares the financial path of the physician to charting a boat’s course. If someone is in the Atlantic with a destination of Miami and the boat is found to be on course for Boston, a small adjustment of the compass sets the boat back on course for Miami. But if the captain waits until the boat is almost all the way to Boston, it’s a huge problem and hard to correct. Diligence is key.

“Today, it is not so much about how much you make as about how much you keep,” Martin said. “So doctors have to pay attention more to do everything right, because there is just not the extra fluff to cover it.”

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Patient Safety Takes Flight in Tennessee, continued from page 1 graduate with more than 300 aircraft carrier landings, has been involved in safety training during the majority of his career and has personally trained more than 20,000 physicians, nurses, staff and administrators in TeamSTEPPS over the last decade.

After joining FedEx, he began training pilots in CRM, which was a relatively new discipline for commercial airlines at that time. CRM was born from work done out of NASA that found that 70-80 percent of airline accidents were the result of a breakdown in communication and teamwork.

The specific course created for FedEx was so highly regarded that Harden began getting calls from outside organizations asking for similar training. With blessings from FedEx, Harden helped found Crew Training International (CTI) in 1992. A few years later, CTI brought its expertise to the healthcare industry.

“Quite honestly, it wasn’t our idea,” Harden noted with a laugh about what has become a major focus of their business.

That first foray into patient safety came at the request of a hospital emergency department director who knew a CTI employee.

Harden recalled, “He said, ‘I really think it could make a difference in my emergency department. Could you come in here and see if my instincts are correct?’”

After observing many similarities to the types of interactions and protocols used on flight decks during a site visit to the hospital, the CTI group came back with suggestions to improve safety and teamwork. “We

said if we were kings for a day, here’s what we’d do. He said, ‘OK, do it,’” Harden said.

From there, word-of-mouth spread quickly, and the group began sharing their expertise with other hospitals and departments.

By 2005, the healthcare group had become so large that it was spun off into a separate entity … LifeWings.

Following the landmark Institute of Medicine Report, “To Err is Human,” the Agency for Healthcare Research & Quality (AHRQ) created a CRM course specifically designed for healthcare and called it TeamSTEPPS. Harden noted TeamSTEPPS is really the generic term for crew resource management courses in the healthcare setting, and the term is often used interchangeably with CRM. Harden has been responsible for innovating a number of subsequent generations of CRM training program, and the LifeWings team uses a program they call TeamSTEPPS 2.0.

When LifeWings trains healthcare staff, the focus is on one department or area. “We don’t train the entire hospital at once. It’s just too big an elephant to eat at one setting,” Harden noted. Once a focus area has been determined, the hospital must decide who should attend. Harden said the standard answer is anyone responsible for good patient care, which very probably includes non-clinical staff in addition to physicians and nurses.

It is, however, crucial for physicians to attend training. “We won’t work with a hospital unless they agree to interdisci-

plinary training that includes physicians,” Harden stated. “It would be like a football team running plays without the quarterback.”

While the checklists and processes vary by specialty, Harden said the common element in all programs is the ability to have effective assertion … what is commonly known as a ‘stop-the-line’ conversation.

“All the research shows facilities that have a stop-the-line culture have the fewest number of patient-harming events,” he said.

Harden continued, “Can your most junior and inexperienced nurse have a stop-the-line discussion with your most senior and experienced physician if they perceive a problem with patient care? If the answer is ‘no,’ you’re going to have patientharming events.”

Those conversations are easier said than done considering the hierarchical nature of most healthcare facilities. “There’s such a great power distance,” Harden noted between a neurosurgeon who has spent years in medical school, residency and fellowships and a brand new scrub nurse who has been employed for six months. Still, that scrub nurse must feel confident in speaking up if a problem is perceived.

“One of our mantras for the hospitals we work with is ‘It’s the right thing to do for the patient, and the right thing for the hospital’s bottom line,’” Harden continued. He noted that safe care is also cost efficient care. With fewer mistakes come fewer penalties and lawsuits and greater

market share. “As your quality goes up, your metrics and reputation improve,” he pointed out.

Empowering the entire team also improves staff satisfaction and reduces turnover rates. “The average cost to turn over a nurse is $25,000,” Harden noted. In departments where they have implemented TeamSTEPPS, Harden said they’ve seen turnover rates drop from 10-15 percent to 2-3 percent, which is a huge savings to the bottom line. Between decreased malpractice costs and increased savings, Harden noted two hospitals systems that used LifeWings’s TeamSTEPPS program in Illinois increased profit margin to 16 percent … considerably higher than the national average of 3 percent.

“Hospitals are not going to survive unless they do a program like this and do it well,” he stated.

Harden noted best practices and evidence-based protocols aren’t kept secret so ostensibly everyone should know the right steps to take. Without a stop-the-line mentality, however, it’s almost impossible to achieve the desired outcomes. “If you have high infection rates, it’s typically not a process problem. It’s typically a culture problem,” he said.

TeamSTEPPS training helps turn that culture around. “It’s the mutual support and crosscheck and holding one another accountable and communicating as you use the process … that is the secret sauce,” Harden concluded.

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High-Quality Rehabilitative Services Yield Positive Outcomes

It’s a well-documented fact that patients who have the opportunity to participate in rehabilitation after an injury or illness show improved functional outcomes over those who do not. Rehabilitation, in the appropriate setting, provides the greatest potential for recovery. The higher level of care provided in an acute rehabilitation hospital–like HealthSouth Cane Creek Rehabilitation Hospital–allows for improved outcomes to return home in a shorter amount of time.

Acute Rehabilitation Hospital In an acute rehabilitation hospital setting, HealthSouth offers a full continuum of rehabilitative programs and services for individuals who have suffered a major accident or illness, including trauma, stroke, head injury, spinal cord injury, amputation, arthritis, chronic pain, neuromuscular and pulmonary diseases. A team of highly skilled independent private practice physicians, therapists, nurses and support staff provide a more intense regimen, greater physician involvement and therapy time, and increased availability of pharmacy and laboratory services compared to other levels of rehabilitative care.

Each HealthSouth Rehabilitation Hospital is lead by a medical director who supervises the hospital’s multidisciplinary team to provide a coordinated program of care including goal setting, treatment plans, family education and discharge planning. Careful physician supervision ensures that each patient’s rehabilitation is compatible and appropriate for his or her medical condition.

“We are team oriented and hands on in our approach to rehabilitation,” says William Eason, M.D., medical director at HealthSouth Cane Creek. “Here, an independent private practice physician sees patients frequently and rarely less than four or five times a week. Independent private practice physicians also lead weekly meetings to discuss each patient’s progress toward meeting their rehabilitation goals.”

Patients at HealthSouth benefit from fully equipped therapy gyms housing the

latest in rehabilitative technology. These innovative technologies help patients walk again, regain use of their arms and hands, swallow more efficiently, improve communication and regain concentration and balance. Specifically, the AutoAmbulator®, created by and exclusive to HealthSouth, improves a patient’s ability to walk. This sophisticated treadmill device uses the therapeutic concept of body-weightsupported ambulation and robotics to help patients with gait disorders.

“The AutoAmbulator helps the patient safely replicate natural walking patterns while accelerating the patient’s rehabilitation,” says Eric Garrard, FACHE, PT, chief executive officer at HealthSouth Cane Creek. “It’s an excellent example of assisting a patient to perform a functional task so they can reach a higher functional level in a shorter period of time. When used within a targeted therapy program, this state-of-the-art technology makes remarkable strides in helping patients return to normal lives.”

Demonstrating Results For each patient admitted, HealthSouth Rehabilitation Hospitals use FIM® instruments to measure a patient’s functional ability in 18 areas. A collective FIM® score is obtained upon admission to and during discharge from the hospital. In addition to tracking and reporting the two scores for each patient, the scores are rated against each other, measuring the success of the hospital’s rehabilitative programs and services to improve functional abilities such as mobility, activities of daily living, bladder and bowel control, and cognition.

“Our goal is for patients to become as independent as possible,” said Garrard.

“Considering that continence is highly correlated to a patient’s self esteem and can be the single greatest determinant of whether a patient is discharged to home, patients in a rehabilitation hospital reach their full potential because patient need for caregiver training, bladder and bowel control, proper seating and splinting, training in feeding, guidance in transfer technique are met.”

Sherry Scruggs, continued from page 1 fessional career there.

Scruggs was a member of the last graduating class from Spring Hill High School, a feat that, in order to achieve, required her to attend summer school.

While growing up, she knew that God was calling her to nursing, so throughout high school and college she worked as a lab tech at Gibson General. When she entered college at Union University, she went straight into the nursing program and, upon graduation, Gibson General hired her as a Registered Nurse.

“When I was first hired I worked on the medical/surgical floor as a nurse but within the first year I had taken on the position of supervisor. Since then I have worked in all areas of nursing. Gibson General was purchased by West Tennessee Healthcare in 1995 and a year later, I became Director of Nursing for the facility,” said Scruggs. “In 2000, I moved into the administrator position at Gibson General which is licensed for 77 beds. In 2011, I was named administrator for the other two West Tennessee Healthcare hospitals in Gibson County: Milan General which is licensed for 70 beds and Humboldt General which is licensed for 62 beds.”

Being a nurse prior to becoming an administrator is a huge advantage according to Scruggs. “It really makes it easier for me to run the hospital because I understand all areas of the hospital, staff and doctors as well as the needs of what it takes to provide care and run the hospital.

When there is a request, I can determine if it is a true need. It is also easier for the staff and physicians to relate to me,” she said. “Having been in the trenches, it really helps in evaluating what we are doing and how to do it. Since we are a rural hospital, I have a unique situation in that I still work as a nurse whenever we need the help which gives me chance to stay up on my nursing skills and be with patients.”

Scruggs’ nursing background also posed a challenge early on with the business side of administration. “Honestly, I was lacking in those areas initially,” said Scruggs. “But I got my MBA from Warren University in 2007 which caused me to have to research, learn and take classes to get a better handle on the financial and business side of things.”

As with many rural hospitals, financial pressures are high on the list of challenges facing Scruggs but being part of a health system is an advantage helping rural hospitals survive. Another advantage Scruggs attributes to rural hospitals is a low employee turnover rate. Staffing issues are further alleviated by having three affiliate hospitals located so close together which allows department managers to oversee more than one facility and share staff.

“Inpatient volume has declined over

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the 30 years I have been here. In 1983, census would be over 10. Today, with most of our patients being considered outpatient, due to the services they are receiving, we may have five patients in the hospital which is pretty typical for all three facilities,” said Scruggs. “Services have had to change to some degree as well.

With three hospitals in one county and all providing the same services we had duplicates in some instances. To try to reduce that, some services such as mammography have been moved so that we are providing them at only one of the three facilities. This move has fortunately been well received because we have had no drop in volume across the facilities for these services.”

Scruggs is most proud of the hospitals’ quality of care. “Patients say they would much rather be here than in a large facility because they are treated like family and I think we have always tried to provide that type and level of care,” she said. “We try to look at Gibson County and assess what services are needed and being utilized in the community. That is how we determine what goals to set for the future.”

From Rotary Club to Chamber Boards to Relay for Life, Scruggs places a high importance on community involvement both on a personal and professional level. She received the Nurse Image Maker Award in 1996, is a WestStar alumna, is a Board Member for the Rural Hospital Improvement Plan (RHIP) Policy Maker Committee and is the President of the West Tennessee Hospital Council.

“People relate me to the hospital so it is important for me to be involved and work to make these communities a better place to live in,” she said. “At the hospital we sponsor women’s conferences, educational activities in the schools on obesity and all three hospitals are very involved with Relay for Life. I am always a part of the Gibson General team and even chaired Trenton’s Relay for Life for two years.”

Besides being a cancer survivor, Scruggs lists providing a Christian home for her children and being married for 30 years as her greatest accomplishments.

“Home is where my heart is and Gibson County is my home. I married my high school sweetheart while I was in college.

We live on a farm that is two miles from our parents, where they raise cattle,” she said. “Both my children are married and live close by in Rutherford. My daughter, Heather Scruggs Jones (husband Jason) teaches at the elementary school she attended and is a coach at the high school she graduated from. My son, Will Scruggs, works for the Marathon Gas company and his wife, Abbye is an RN. We currently have grand dogs but hopefully in future we will add grandchildren to the list of accomplishments.”

Scruggs is very involved with her church as a Sunday school teacher, pianist, vacation Bible school worker and volunteer with children’s ministries. She has also served patients abroad by going on Medical Mission trips to Romania.

“Service above self is what I try to live by daily,” said Scruggs. westtnmedicalnews

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by Bill Appling and Jonna Elzen

Accelerating Change in Population Health Management Sometimes the bigger the problem, the less expensive the solution. What’s expensive is trying to fix after-the-fact outcomes rather than creating strategies that get at the behaviors and cause. If these two sentences sound familiar, it’s the ending of my article last month, Accelerating Change in Education.

I asked Jonna Elzen, CEO of MetroCare, to co-author this article because of her personal experiences.

After Jonna wrote a portion of this article, there was a relevant article in the Commercial Appeal (originally written for the Los Angeles Times) by Beth Ann Swan, dean and a professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, Pennsylvania, titled, After Hospital Care, the Test Begins.

I have known Jonna for a number of years, respect her tremendously and consider her a friend. Here is her contribution: “I am a conflicted healthcare executive. I have worked for and with physicians almost 30 years and know firsthand most of what is written that is wrong in our healthcare delivery system.

I learned from the physician’s viewpoint, my own experience as a cardiac patient and, most recently, when my husband had a stroke.

“After my second heart surgery, I developed a passion for change because 80 percent of heart disease is preventable.

I contacted women’s groups, churches and the American Heart Association looking for audiences to educate women about their greatest health risk and understanding the very modifiable risk factors we face. I even made use of my work contracts and convinced one of the hospitals to allow me to work with their Coronary Intensive Care unit and Patient and Family Centered Care teams to develop a program so patients and their families who face open heart procedures didn’t have to be afraid, that they could see firsthand what equipment and units looked like and ask questions. This was important to me because I met a very engaged nurse who described in vivid detail what it would be like immediately following my bypass surgery. It was just as she said, and I was at peace, even though my family was a basket case. As patients and families, we only have fear of the unknown.

“Even as I continue in my job and have the opportunity to hear and work with some of the leading reformists in healthcare, one fact continues to resonate with me: accountable care must start with engaged patients. Yet patient engagement is one of the biggest obstacles in executing the transformation change both for the individual and healthcare delivery. You are not cured of heart disease, but bypass surgery gives people another opportunity, and know ultimately, it’s up to the individual.

“I have tried and am putting westtnmedicalnews

.com

this belief system into a format plan.

I investigated formal educational opportunities for patient navigators/ advocates. I have a passion and will continue to have a passion for reinvention, transformation, change or what ever you want to call it. I am one person, but I know there must be others who want to help me be an instrument for change. I know it can be done.”

— Jonna Elzen.

In the article I spoke of earlier, After Hospital Care, the Test Begins, Beth Anne Swan said, “In 2011, my husband was felled by a brain stem stroke. From the outset, we knew his recovery and rehabilitation would be long and difficult.

We didn’t know his transition to posthospital medical care would be just as challenging.

“I thought my training and access to resources would aid in managing my husband’s care. Instead, our experience showed me the many flaws in the world of medical ‘care coordination’ and ‘transition management.’

“We did not have an actual comprehensive care plan, and no contact within the system could help us coordinate my husband’s extremely complicated care once we got home. (He had his stroke while we were out of town.)

“One in five elderly patients is readmitted to the hospital within 30 days of discharge. Data suggests that 76 percent of these readmissions are preventable, and poor care transition are most certainly to blame. According to a recent study, they are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions or get the necessary follow-up care. Some of the patients in the survey were not ready to change their behaviors, such as smoking cigarettes or clocking in long hours at the office.

While the patient struggles to manage his own care, there is a distinct lack of communication between hospitals and the individual’s primary-care physician. We need change to reform the patient care and transition systems inside and outside the hospital. We need to change ‘patient centered care’ from a trendy phrase to true coordination that prepares a patient and his family for the outpatient care that keeps him at home instead of back in the hospital.”

Jonna and Beth Ann have said it better than I could, especially since I have not experienced it. I hope Jonna will give Beth Ann a call and together they can help accelerate this needed change.

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.

Jonna Elzen is CEO of MetroCare Physicians and can be reached at Jonna@metrocaredocs.com.

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CONNECTing Caregivers to Prevent Patient Falls

By CINDY SANDERS

Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall prevention programs have only proven to be marginally successful over the long term.

Cathleen S. Colón-Emeric, MD, MHS, and colleagues focused on the gap between quality improvement (QI) protocols and sustained bedside implementation in the nursing home setting. An associate professor of Medicine in the Division of Geriatrics at Duke University School of Medicine, ColónEmeric said previous studies found the desired improvements occurred when outside trainers and researchers stepped in to Dr. Cathleen S. Colóncreate interventions. The Emeric external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. However, she continued, “When you try to train the existing nursing home staff to do those things, it doesn’t seem to work.”

Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a direct link between the failure to successfully deploy fall interventions and the hierarchical culture present in most skilled nursing facilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Education & Clinical Center (GRECC), noted the vertical command structure doesn’t foster broad-based, interdisciplinary staff interaction.

“They lack the connections with their coworkers that they need to share information and problem solve,” she said. “Nursing home staff tend to work in silos.”

Colón-Emeric continued, “Coordination of a multi-factorial risk reduction

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program requires a great deal of communication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.”

She added reasons for a fall might include any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pressure upon standing or suboptimal choice of an assistive device.

“In order to improve fall rates,” ColónEmeric said, “the team needs to know what the resident’s behavior is like.”

However, the person with the most hands-on knowledge often isn’t the one creating that resident’s specific care plan.

Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted.

In an article published in Implementation Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educational intervention to foster improved connections within and between disciplines, heighten communication flow and encourage cognitive diversity in solving problems on behalf of residents.

The next step was to see if the “all hands on deck” approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mastery of content and process change.

Colón-Emeric said eight nursing homes in North Carolina and Virginia were selected with half randomized to receive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiving only the QI program training. The eight participants included a mix of community nursing homes and VA facilities.

The CONNECT intervention included interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and relationships for problem-solving activities.

“We designed the CONNECT intervention to show staff where their communications weren’t working … where gaps existed … and to teach them some practical tools to better communicate,” she explained.

Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. ColónEmeric said to measure communication, the team used surveys before, during and after the intervention. The team also re-

Falls Hurt Physically & Financially According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.

viewed documentation of the types of prevention interventions in the medical record. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites.

“What we found was that the staff communication levels improved a little bit in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communication was more pronounced in the community settings, as Colón-Emeric said the VA facilities already had high levels of communication.

Charting turned out to be a non-factor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good measure of what is happening at the bedside … at the site of patient care.”

As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said.

Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites.

However, she said the group is now in the second year of a larger trial of 24 nursing homes with 12 each in the CONNECT and control groups.

“If we see the same magnitude of benefit, that would be statistically significant.”

She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.”

Colón-Emeric added that if the improved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing America’s growing senior population.

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GrandRounds West Tennessee Healthcare and Vanderbilt University Medical Center Announce Academic Affiliation Leaders of West Tennessee Healthcare (WTH) and Vanderbilt University Medical Center today announced an academic affiliation agreement which further establishes a collaborative relationship between the two institutions, now for the creation of new cancer programs in West Tennessee.

The new agreement creates a framework for the future development of cooperative programs between Vanderbilt-Ingram Cancer Center (VICC), Nashville, Tenn., and WTH’s Kirkland Cancer Center, Jackson, Tenn.

Specific goals of the new affiliation agreement may include: • Educational program support • Opportunities to enhance the delivery of oncology support programs for physicians and patients • Consultative services to build upon clinical programs • Joint clinical research trials Construction is underway for a new building housing the Kirkland Cancer Center which is scheduled to open in the fall of 2013. The multi-story facility is designed with the patient in mind, providing a supportive, easy-to-access environment and will be one of the largest cancer centers in the region.

Through this affiliation with Vanderbilt-Ingram Cancer Center, the goal is to provide the latest technology and support for those seeking cancer care, including access to new clinical research trials and educational programs, according to Bobby Arnold, president and CEO of WTH. Under this agreement, all parties will remain independent, but they will be able to pursue joint projects and design new initiatives that are more efficient for the delivery of cancer care.

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.”

I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

Outdoors Group Gives To Children In Need The Hatchie River Club of Kids Hunting for a Cure presented Ayers Children’s Medical Center with a check for more than $1,200. Kids Hunting for a Cure is a nation-wide non-profit which helps children between the ages 6-16 participate in all types of hunting and fishing activities regardless of their abilities. Local chapters donate proceeds to children’s hospitals or foundations in their area. The Hatchie River Club supports Ayers Children’s Medical Center and St. Jude.

Ayers Children’s Medical Center offers high quality compassionate healthcare close to home. Children and families can benefit from the expertise of pediatric specialists without the need to travel to Memphis or Nashville. The Ayers Children’s Medical Center offers a Pediatric Specialist Outpatient Clinic featuring physician specialists from several disciplines of medicine.

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

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JUNE 2013

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