West TN Medical News October 2015

FOCUS TOPICS NEUROLOGY HEALTH EDUCATION

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PHYSICIAN SPOTLIGHT PAGE 3

E. Lee Murray, MD

ON ROUNDS

Two Mid-South Surgeons Performing New Heart, Chest, Lung Procedures

By BETH SIMKANIN

Doctor’s Company Coaches Clients on Lifestyle Changes David Wright’s Adventia Does What PCPs ‘Don’t Have Time to Do’ For David Wright, MD, the guiding principles for both his medical practice and the ultimate creation of his health management company, Adventia, started to form in 1979 and took years to come to fruition ... 5

Do Something End Slavery Tennessee Calls for Awareness, Action During the third annual luncheon benefitting End Slavery Tennessee on Sept. 22 in Nashville, nearly 800 audience members listened in stunned silence as guest speakers detailed the state’s slave trade. Far from being a history lesson about a past shame, the program outlined the very real … and very current … issue of human trafficking ... 9

ONLINE: WESTTN MEDICAL NEWS.COM

Two Mid-South surgeons with Baptist Medical Group now are using the skills learned in cardiovascular and thoracic surgery fellowship training in Boston to offer alternatives to open heart surgery which in some cases save lives and enhance patients’ recovery from surgery.

John Craig, MD, a cardiovascular surgeon, and Christopher Mutrie, MD, a cardiac thoracic surgeon, are performing minimally invasive procedures and treatments not available a decade ago for adults with chest, heart and lung issues.

The two physicians met during their cardiothoracic fellowship at Massachusetts General Hospital in Boston in 2010 and established a strong friendship. Craig, a native Memphian, began a cardiothoracic practice with Baptist Medical Group. He recruited Mutrie, a native of Boston, to the practice in 2013.

The two physicians offer a unique set of skills that are rare in the MidSouth.

“These procedures and treatments are being performed in major cities in the U.S., but to my knowledge we are the only physicians to offer them in the Memphis area,” Craig said.

Mutrie performs the Nuss procedure, which is a minimally invasive technique that treats pectus excavatum, a deformity in which the chest wall is concave. It is the most common chest wall deformity in the United States.

(CONTINUED ON PAGE 4)

Dr. John M. Craig (left) and Dr. Christopher J. Mutrie

HealthcareLeader Mark Allen Continues Family Legacy as Healthcare Administrator Second-generation Administrator Facing Different Environment

By SUZANNE BOyD

With parents who were both healthcare administrators, Mark Allen definitely knew what he was getting into when he decided to follow in their footsteps. Just his path to administration did not come with an accounting degree but rather included time as a paramedic, working in a car-

Don’t Miss the Big Event

diac catheterization lab and in the Emergency Department. For the past seven years, he has been in administration at the Jackson Clinic, taking the reigns as COO three years ago.

Moving from Mississippi at the age of five, Allen considers Jackson his home. He graduated from Jackson Christian School and went on to (CONTINUED ON PAGE 8)

From industry conferences and continuing educational units to fun ways to support the area’s many non profits ... check the online calendar for healthcare happenings. www.WestTNMedicalNews.com PRINTED ON RECYCLED PAPER

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PhysicianSpotlight

West Tennessee Neurologist Brings Experience and Education to Classrooms E. Lee Murray, MD, West Tennessee Neurosciences

By SUZANNE BOYD

When his eighth grade general science class studied the human body, Lee Murray found that he was fascinated by the human body and knew medicine was the path he would take. His stint as an emergency medical technician in college had him thinking the ER was where he would ultimately practice but it was a neuroscience class his first year in medical school that opened his eyes to neurology. Today, Murray not only sees patients through his practice at West Tennessee Neurosciences, he also helps educate medical students in the classroom as a teacher and an author.

Hailing from Southern Missouri and a family of teachers and engineers, Murray was the first to pursue medicine as a career. He double majored in biology and chemistry at Missouri State University in Springfield. After a year doing research, Murray headed to Caribbean to attend Ross University Medical School in Dominica, West Indies for his first two years of medical school training. His clinical rotations were in New York at Kings County Hospital in Brooklyn.

“While in college, I had worked as an EMT and really thought emergency medicine is what I wanted to do. But in my first year of med school, it was the basic neuroscience course that every med student has to take that peaked my interest in neurology as a specialty,” said Murray who completed his medical training in 2006. “While some of my friends struggled with the class, to me it made sense, even things we don’t understand about the nervous system intrigued me. It is a specialty that at times requires you to not only run diagnostic tests but also rely on old time medicine and science to arrive at a diagnosis.”

Murray returned to the South to the University of Mississippi Medical Center in Jackson for a one year internal medical internship followed by a three-year residency in neurology. He then completed a fellowship in neuromuscular medicine at Duke University in Durham, North Carolina. “This ultimately transitioned into a neuro-hospitalist experience for me,” said Murray. “I mostly dealt with things such as strokes, comas, refractory seizures and other neurological issues that do not typically run into in a clinical setting.”

After his fellowship was completed, Murray knew he wanted to settle down closer to Southern Missouri and his family. “I was looking for a strong group of neurologists to join,” he said. “I did not even know where Jackson, Tenn. was, but got a call from a recruiter about the group westtnmedicalnews

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Dr. Lee Murray is not only a neurologist but an author and educator.

at West Tennessee Neurosciences. All the research indicated it was a very strong group with stellar credentials who were well-respected physicians. I was also very impressed with the overall medical community in Jackson and knew it was the place for me to practice.”

Murray admits he is busier than he thought he would be initially when he joined the group in 2011. “The pathology that is here is very complex and the complexity of problems is quite significant here,” he said. “I wanted to be challenged and being in a large group lets that happen.

The challenges here are actually nice because they keep me from getting into a rut.”

While Murray enjoys life as a clinician, he has also always had an interest in the academic side of medicine. For the past year and a half, he has been on the staff at UT Medical Center in Memphis.

“It’s a clinical appointment that allows me to teach medical students and residents a couple times a year while maintaining my private practice. I do peer review for several journals and have written a couple of commentaries for Southern Medical Journal,” said Murray. “I also co-authored with my partner, Dr. Karl Misulis, several chapters that will be published in the seventh edition of a neurology textbook. We are also

working on a textbook on hospital neurology, which is a significant undertaking.

We started it last April but hope to have

it completed and published in a year. It is our hope that it will be incorporated into neurology residency training.”

Life outside of the office includes family time with his wife of nine years, Carmen and their three-year-old son, Bennett. The family enjoys returning to Southern Missouri where Murray’s parents have a cattle farm. “It is like reverting to my childhood for me when we go.

My dad was an industrial arts teacher for 40 years before getting into cattle farming and my mom was a homemaker,” said Murray. “I love being outside and working. Even though I love nature, I am not much of a gardener but it is a great change of pace from the office life.”

Murray admits that his wife, who is from a large town in Peru, had some reservations at first about life in a small town but those have all gone away. “This has been such a good move for us and we know this is a great place to raise a family,” he said. “I am also so impressed with the caliber of clinicians in the group and it is such a pleasure to work with them.”

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

WESTTNMEDICAL NEWS.COM OCTOBER 2015

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MedicalEconomics

BY BILL APPLING

Healthcare Briefs • One-third of the total U.S. prescription-drug spending in 2014 went to specialty drugs which made spending grow by 27 percent to $124 billion.

• The cost of insulin has increased by 325 percent over the past 4 years. This increase has and will hinder the efforts of preventative care and add to the cost and quality of life because limb amputation, heart disease, and the need for dialysis. I believe that it will take state and federal intervention regarding the rising cost of drugs in our country.

IMS Institute for Healthcare Informatics

• 28 percent of Americans who said obtaining cheaper or better health insurance would be a reason to relocate to another county or state. Do you hear this lawmakers?

Survey by financial news Website Bankrate

• An increase from $12,000 to $14,500 for a hospital stay for adults with multiple chronic conditions between 2003 and 2014.

Healthcare Costs and Utilization Project

• 6.4 percent...Physicians’ self-rating of their confidence level, on a 1 to 10 scale, in accurately diagnosing a difficult case, despite only 6 percent of them getting the diagnosis right.

Study published in JAMA Internal Medicine

• 7.7 percent increase in the availability of primary-care appointments for Medicaid beneficiaries after reimbursement levels were raised to Medicare levels.

New England Journal of Medicine

• 29 percent...increase in emergency visits from 103.1 million to 133.6 million from 2000 to 2013.

American College of Emergency Physicians, American Hospital Association

• 13 percent...increase in behavioral-health-related hospital emergency department visits between 2005 and 2012, while the number of inpatient psychiatric facilities declined 7.8 percent between 2005 and 2013.

American College of Emergency Physicians, American Hospital Association

• Financial markets have sent another signal that the coming era of precision or personalized medicine could wind up making cancer care unaffordable for millions of people.

Modern Healthcare March 9, 2015.

• 48,900…projected surplus of pharmacists by the year 2025, with an expected demand for 306,400.

Health Resources and Services Administration

• For the second year, that CMS has awarded bonuses to one in four accountable care organizations working under a Medicare model intended to spur providers to deliver lower-costs care. They will share $422 million out of the $833 million they collectively saved the government in 2014.

• ACO networks get to decide for themselves how to distribute the money

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and primary-care appear to be benefiting the most according to a review of disclosures by ACOs participating in Medicare Shared Savings published in August 31, 2015, Modern Healthcare.

• “We don’t have a good distribution model for ACO savings,” said Dr. Kavita Patel, managing director of clinical transformation at the Brookings Institute’s Center for Health Policy, citing a study published in August, 2015.

• Since, October of 2009, the HHS Office for Civil Rights has fined healthcare organizations 1142 times for data breaches affecting at least 500 people.

• Largest healthcare fraud settlements from 2014 1. DaVita Healthcare Partners $400.0 million 2. Endo Health Solutions and Endo Pharmaceuticals $ 192.7 million 3. Amedisys $150.0 million 4. Omnicare $124.2 million 5. GlaxoSmithKline $105.0 million 6. Community Health Systems $98.2 million • Healthcare’s biggest spenders on lobbying in 2014 1. American Hospital Association $20,763,146 2. American Medical Association $19,650,000 3. Pharmaceutical Research and Manufactures of America $16,640,000 4. America’s Health Insurance Plans $9,200,000 5. Amgen $8,560,000 6. Pfizer $8,470,000 7. Biotechnology Industry Organizations $8,280,000 8. Eli Lilly & Co. $8,216,000 9. Johnson & Johnson $7,667,500 10. Novartis $6,520,000 11. Bayer $6,180,000 12. Sanofi $5,973,000 13. Blue Cross and Blue Shield Association $5,880,000 14. Medtronic $$5,310,000 15. Roche Holdings $4,953,000 16. AbbVie $4,940,000 17. Merck & Co. $4,790,000 18. GlaxoSmithKline $4,370,000 19. DaVita Healthcare Partners $4,330,000 20. Fresenius Medical Care $4,075,000 Sources: Healthcare Prostitutes, J William Appling, U.S. Senate Lobbying Disclosure Act Database

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.

Two Mid-South Surgeons, continued from page 1

“It is generally considered a cosmetic deformity, but it can cause chest pain, shortness of breath, fatigue and fainting episodes in patients,” Mutrie said. “It can be upsetting for the patient psychologically as well.

Most patients are born with the deformity and it worsens over time, so it gets harder to fix as the patient ages.”

The procedure involves inserting an infection-resistant titanium bar through two small incisions on either side of the chest.

Another small incision is made to insert a camera to allow the surgeon to see the inside of the chest during the operation.

According to Mutrie, the operation takes between an hour and an hour and a half to perform, and the patient is in the hospital for four to five days. The patient wears the bar for two years as it reforms the chest wall.

“The bones remodel and reshape, and a normal chest wall is achieved,” Mutrie said. “After two years, the bar is removed and the patient goes home the next day. The patient can resume a normal life with exercise without endangering the chest wall.”

Mutrie said that traditionally surgeons performed the Nuss procedure only on children, but due to technological advancements within the last 10 to 15 years, surgeons can perform the procedure on adults. According to Mutrie, the incision is much smaller, the hospital stay is shorter and the patient experiences less scar tissue than before.

“This procedure has gotten more popular in the last 10 years because we have learned more about the deformity, and technology has gotten better,” Mutrie said. “This procedure is a good alternative to reconstructive surgery and avoids excessive scar tissue. There are other ways to reconstruct the chest wall, but this is the most minimally invasive way. ” After Mutrie learned the procedure as part of his fellowship training in 2010, he brought this knowledge with him when he was recruited by Craig to relocate to Memphis. He performed 12 Nuss procedures last year. Other Mid-South cardio thoracic surgeons refer their patients to him because he performs the procedure.

“This is a fairly rare procedure, but it’s a good technique to have,” Mutrie said.

“With technological minimally invasive improvements, more surgeons are learning about the procedures in fellowship training.

In time, you will see more surgeons perform the procedure.”

Craig performs a procedure with a device called an AngioVac system, which removes blood clots in the circulatory system.

According to Craig, before the device was first used in 2009, the only other option to extract blood clots from the heart or lungs was through open-heart surgery, which involved opening the chest and stopping the heart.

“It works like a big vacuum cleaner and removes blood clots and other dangerous material from the heart,” Craig said. “Retrieving a clot used to require open heart surgery, resulting in longer hospitalization, recovery and rehabilitation times compared to this minimally invasive approach. It optimizes a patient’s quality of life and reduces the chance for infection.”

The AngioVac device employs large suction catheters capable of filtering all of the blood in the body through a cardiac by-

pass machine in as little as one minute. It removes blood clots and other foreign matter and returns the purified blood back to the patient. The entire procedure usually takes a couple of hours to perform, and the recovery time is minimal.

“Most patients are back at work within two to three days, whereas prior it would have been two to three months,” Craig said.

“We can accomplish the same results and now patients can walk the same day, are often home in less than 24 hours and fully recover in a few day’s time.”

Craig was introduced to the AngioVac system during his fellowship at Massachusetts General Hospital, which was one of the first test centers in the world to use the device and train surgeons to perform the procedure.

Craig performs five to 10 procedures with the AngioVac system per year, and while that is not many, Craig says he is the only physician currently using the device in the Mid-South.

“This technology is new, and the device is used in only a few major cities across the United States,” Craig said. “I hope that more physicians will learn about this new technology and its advantages.”

In addition to the AngioVac, Craig is trained in extracorporeal membrane oxygenation, or ECMO, which is a technique that provides both cardiac and respiratory support to patients whose heart and lungs are unable to work on their own.

“These patients are profoundly sick, and this is a last-ditch salvage attempt,” Craig said. “There is no other way to save them. At least 80 to 90 percent of the patients we support with the machine would die without it. It saves lives.”

ECMO works by removing blood from the patient’s body and artificially removing the carbon dioxide and oxygenating red blood cells.

“Typically, it is used to support patients with severe heart or lung failure due to an acute illness such as the flu or a heart attack, for example, “ Craig said. “It performs the function of the patient’s own heart and lungs so failing organs can heal. It’s like a second-string quarterback coming in to play while the star quarterback is sidelined by an injury.”

According to Craig, a patient is on the machine usually for three to five days for heart support and 10 to 14 days for lung support. Craig says most adult ECMO centers see up to a 60 percent survival rate for lung failure and a 40 percent survival rate for heart failure in patients who would have otherwise died of their illness. Most survivors expect to make a full recovery.

“In some cases, ECMO gives patients a chance to heal so they can undergo major heart surgery and be strong enough to survive,” Craig said.

Traditionally used on children, the technique is now being used more on adults with cardiac and respiratory failure. He projects to treat 15 to 20 patients this year and has been using ECMO since he joined Baptist Medical Group in 2012.

“This is not a common treatment and has only been used with consistent success in adults for the last five to 10 years,” Craig said. “It is done so infrequently that not everyone knows it is available. Through education, we hope to raise awareness of this life-saving technology.” westtnmedicalnews

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Doctor’s Company Coaches Clients on Lifestyle Changes David Wright’s Adventia Does What PCPs ‘Don’t Have Time to Do’

BY LANCE WIEDOWER

For David Wright, MD, the guiding principles for both his medical practice and the ultimate creation of his health management company, Adventia, started to form in 1979 and took years to come to fruition.

Today, Adventia provides software, training and education to corporate and clinical clients. The software for corporate clients was creDr. David ated in 2013, and in 2014 Wright for clinic settings. Wright closed his practice in 2014 as his focus shifted to Adventia.

Back in 1979, while Wright was in Memphis for his residency in internal medicine at Baptist Hospital, his father had a heart attack back home in Florida. He was 52.

Wright realized heart problems could not only affect him but his children. After finishing residency in 1982 and a stint in the Air Force, Wright returned to Memphis in 1985 to practice internal medicine, focusing on patients dealing with heart attacks, stroke and diabetes.

His frustration built while watching patients continue to have events even as medicine advanced. Wright implemented prevention as part of his treatment, and patients began improving. But it’s more than just advising patients to lose weight, eat better and get more exercise.

“It requires the person to do things,” Wright said. “That’s one of the challenges in medicine. How do you engage the person in the changes they need to make? We need to find a better way to have people get engaged. That was from the science of motivational interviewing that was developed in the drug and alcohol treatment world. Researchers in that field said if we ask questions differently, we can improve the likelihood they will change.

“We try to create those ‘ah ha’ mo-

ments. People really are nutritionally illiterate and activity illiterate. What we do is use better information to reveal better what their risks are. And, if they are heading toward a heart attack, stroke or diabetes, get them on that road to change.”

Clinical providers, hospital systems, physician practices and providers can use Adventia’s software to help patients create a plan that gives them a better chance to prevent health problems years before they need to be treated. Employees can use the corporate model to take control of their wellness in much the same way.

Wright points to Varsity Brands, a Memphis-based company that first used the software in 2011. He said 20 percent of the company’s employees lost more than 2.5 inches on their waistline.

Among 650 participating employees, 28 percent lowered total cholesterol an average of 20 points, more than 30 percent lowered blood pressure an average of 10 points, 31 percent lost an average of 8.5 pounds, 34 percent lowered bad cholesterol an average of 17 points and 44 percent raised good cholesterol an average of nine points.

“This is without drugs,” Wright said.

“It’s having better information to help them make decisions. Lots of folks made dramatic changes just by having this information.”

Adventia’s model isn’t smoking cessation or weight loss programs. But what it does provide is tailored information that helps people create individual plans that naturally lead to better lifestyle choices.

The first part of the process is a health risk assessment. Clients learn levels of risk based on factors they can’t change such as age or gender as well as factors they can change.

The next step is a lab report that goes into detail on waist measurement, blood pressure and levels of triglycerides, HDL cholesterol and glucose and what the specific risk levels are for each.

An examination of the carotid arter-

ies is next to determine levels of plaque buildup. The artery age can help determine the lifetime risk for heart attack and stroke.

Finally, a personalized treatment plan goes beyond instructions to eat healthier; it now includes specifics on diet. People with higher risks also receive health coaching.

The next step for Adventia is getting the software in more physician practices and corporate settings so more people can prevent heart episodes.

“Prevention evidence has exploded in the last decade, but doctors are busy taking care of sick people,” Wright said. “Keeping people healthy isn’t in the front of our minds. We’re taking care of urgent problems in front of us. … It struck me I know how to do this. I’ve refined it just to take care of my patients. The software is a clinical decision tool. It simplifies the doctor’s practice.”

It makes sense to start in Memphis, a city with many health problems among its residents. But one of the first expansions of the software’s use was in Alabama, a state that is 50th in diabetes and strokes, 49th in cardiovascular disease deaths and 47th in heart attack deaths. In August, Ivy Creek Healthcare opened three Alabama Wellness and Prevention Centers in com-

munities outside Montgomery. Adventia’s software, training and education are at the heart of these clinics.

Wright said he wants the direct-toconsumer model to expand. The first opportunity comes this month with the opening of the Wellness and Prevention Center Memphis on Brookfield Road in East Memphis. The clinic is staffed by a nurse practitioner who worked with Wright in private practice, and one of his former residents now in private practice will be supervising physician.

The stand-alone clinic is one of two ways Adventia’s technology is used in a consumer setting. The other way is to have doctors open clinics that are part of an existing private practice.

The first is in the works in North Carolina. Adventia will go on site to train a doctor’s staff on how to use the software. The physician will refer his patients to the clinic.

“Our strategy is to link arms with primary care doctors,” Wright said. “We don’t want to take the place of primary care doctors. We are there to link arms to extend the reach of the primary care doctor. We do what they don’t have time to do. They don’t have time to coach lifestyle.”

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OCTOBER 2015

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WHO’S TENDING OUR DOCTORS?

Streamlining Prescription Management Synchronizing Patient Prescriptions Could Save Practices an Hour Daily

By LYNNE JETER

Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.

Consider a patient on multiple medications who might generate several phone calls throughout the year as each medication comes due for renewal. Multiply it by hundreds of patients with chronic illness seen by a typical primary care physician, and it could quickly add up to thousands of phone calls every year. At two or three minutes per call, demands on the staff to manage prescription renewals could easily add up to an hour daily of unnecessary work.

An easy solution: a streamlined approach to prescription management.

Instructions on how to effectively manage the practice change are available online free via www.STEPSforward.org through the American Medical Associa-

Healthcare Law Commercial Litigation Business Law

TODD D. SIROKY, ATTORNEY 316 South Shannon Street Jackson, TN 38301 731-300-3636 www.sirokylaw.com

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tion (AMA).

“Streamlining prescription management allowed me to go home earlier,” said Christine A. Sinsky, MD, FACP, an internist with Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois, and the AMA point person for STEPS Forward, its ambitious new initiative offering physicians strategies to revitalize their medical practices and improve patient care. “It’s made Dr. Christine Sinsky a huge difference not only with my personal time, but it’s also meant less inconvenience to patients and more personal time for them to do things other than worry about getting prescriptions refilled.”

In a study published in 2012 by Sinsky and Thomas A. Sinsky, MD, “A Streamlined Approach to Prescription Management” in Family Practice Management, the top priority is to eliminate waste.

“The work of prescription renewal has become so ingrained in practice that many physicians no longer recognize it as waste,” said Sinsky. “In fact, physicians commonly renew scripts for an arbitrary number of refills, thus guaranteeing unnecessary work for themselves and their staff a few months later.”

Physicians often use prescriptions as a prompt for patients to schedule subsequent appointments, a practice that burdens itself with unnecessary phone calls for prescription renewals and appointment scheduling, while also increasing the chances of patient non-adherence.

“A less organized approach to prescription renewal may have worked 20 years ago, when patients had fewer chronic conditions and took fewer medications,” said Sinsky. “Now, more than 40 percent of patients over age 65 are on five or more medications.”

Synchronizing prescriptions around the annual visit – providing sufficient refills to last until that time, and insuring the next annual visit is scheduled at the

conclusion of the current annual visit – will take care of all those problems, said Sinsky.

“In our experience, it’s not uncommon for a group of six to eight primary care physicians to hire one full-time nurse whose main responsibility is prescription renewals,” she said. “This nursing time could be wisely deployed for advanced medical home activities, such as direct patient care, self-management support, or population management.”

A rough, conservative calculation suggests that if all practices implemented yearly, synchronized, bundled renewals, more than 46 million hours of primary care physician and staff time could be saved every year, noted Sinsky.

Most states limit prescription renewals to 12 months. A few states have a longer time period, such as a 15-month window, which further streamlines prescription management.

Policy makers could facilitate the elimination of waste by modifying state regulations to allow prescription renewals for an interval longer than 365 days.

“Several states already provide this

A rough, conservative calculation suggests that if all practices implemented yearly, synchronized, bundled renewals, more than 46 million hours of primary care physician and staff time could be saved every year in the United States.

important expanded window for renewals: Idaho and Maine (15 months), Iowa (18 months), and Oregon and California (two years),” Sinsky pointed out. “This allows patients and their physicians to balance insurance coverage rules – mammograms can’t be obtained more than once every 365 days, for example – and patients’ personal schedules with prescription renewal constraints.”

In summary, simple prescription renewal workflow changes in primary care practices, accompanied by modification of some state pharmacy regulations, would go a long way toward eliminating a source of significant waste in the U.S. healthcare system, improving the work life of nurses and physicians, and increasing access to primary care services, said Sinsky.

State-by-State Prescription Refill Limits in Medical News Markets Alabama: Limits refills for controlled substances.

Arkansas: Limits refills for controlled substances and also prohibits refills on a non-controlled substance after one year from the date of issue of the original prescription.

Florida: Limits refills for controlled substances and also prohibits refills on a non-controlled substance after one year from the date of issue of the original prescription.

Kentucky: Limits refills for controlled substances and also allows prescriptions marked “prn” or “ad lib” to be refilled up to one year from the date of the original prescription. Also prohibits refilling a prescription after one year from the date of issue of the original prescription.

Louisiana: Limits refills for controlled substances and requires all prescriptions for drugs other than controlled dangerous substances to expire one year from the date of issue of the original prescription.

Mississippi: Limits refills for controlled substances and also prohibits refilling prescriptions after 12 months from the date of issue of the original prescription.

Missouri: Limits refills for controlled substances and also prohibits filling or refilling any prescription after one year from the date of issue of the original prescription without consulting the prescriber.

North Carolina: Limits refills for controlled substances and also allows prescriptions marked “prn” to be refilled up to one year from the date of the original prescription.

Tennessee: Limits refills for controlled substances and also prohibits prescriptions marked “refill at will” from being refilled after the expiration of time specified or one year from the date of the original prescription, whichever falls first.

SOURCE: “A Streamlined Approach to Prescription Management” by Thomas A. Sinsky, MD, and Christine A. Sinsky, MD, FACP.

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THA 2015 Conference Overview

THA’s 77th Annual Conference Addressed Industry Challenges, Shortfalls

By MELANIE KILGORE-HILL

Each year, more than 1,000 healthcare professionals from Memphis to the Tri-Cities converge in Nashville for the Tennessee Hospital Association’s annual meeting. The 2015 conference, “Mission Innovation: The Power of People,” took place Sept. 30 – Oct. 2 at the Gaylord Opryland Resort & Convention Center. This year’s event focused on navigating trends and overcoming shortfalls in an evolving healthcare delivery system.

A Changing Industry

“A lot of the meeting has to do with the sharing of information and best practices, and it’s really important for attendees to hear from national speakers to help them continue to improve on quality indicators,” explained THA President Craig Becker.

He said the biggest change facing hospitals is the evolution of reimbursement. “We’ve done Craig Becker things the same way for 50 years, and now we’re seeing a significant swing in how we’ll be paid,” Becker explained in a late-September interview with Medical News. “We have to be able to provide care in a much more

cost effective way, and we have to do more for less. We want to use innovation but not leave behind the people who have to do the innovating,” he said, referencing the event’s theme.

Becker readily admitted there are many ways to accomplish that, with “population-based health” being an especially popular buzzword that’s garnered lots of conversation but no concrete answers.

Becker said the difficulty is populations vary by state, region and hospital. “Still, we wanted to get speakers to get people to think about how to best take care of our populations,” Becker said. “We need leaders to understand that things aren’t staying the same … and if you’re standing still, you’re going to get run over.”

Quality, Safety, Value

Few speakers can communicate the challenges of the quality, safety and value movement like THA’s leadership summit keynote speaker Robert M. Wachter, MD. Wachter serves as professor and interim chairman of the Department of Medicine at the University of California, San Francisco and is chief of the Division of Dr. Robert M. Wachter Hospital Medicine. His

2015 book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,” was a New York Times science bestseller.

“It’s become a relatively familiar refrain that we’re now being pressured to improve quality, safety, patient experience and cost effectiveness in ways we never have before,” Wachter said in a pre-conference interview. “People get that. In some ways we’re getting better at it, but we’re beginning to understand how hard it is.”

Among today’s challenges are the added pressures on clinicians. “In the beginning of value-based care, there was a feeling that you could load this responsibility up on top of a clinician’s existing work,” Wachter said. “While some can be baked into existing work, we’ve come to realize that if you have an overwhelmed, overworked group of clinicians, it’s hard to have them engaged.”

He continued, “We have a new appreciation and understanding of the importance of training clinicians and making sure they have bandwidth and enthusiasm to do this well.”

Wachter said it was also naïve to believe information technology would solve all the problems. He admits advances have been more beneficial than harmful but said many unintended IT-related consequences are still coming to light. “Innovation and

technology should ultimately help, but when you just throw technology at a dysfunctional process, you speed up dysfunction,” Wachter said.

Bottom line, he added, is everybody is overwhelmed.

“What we’ve done is said to everybody in the healthcare system, ‘Keep doing what you’ve been doing in terms of volume … and layer on top of that a huge number of new imperatives,’” he explained, pointing to the growing numbers of signatures and committee involvement required of each provider. “In a vacuum it doesn’t sound bad, but in the big picture it’s 1,000 ‘one more things,’” Wachter said.

“I tell students all the time, what’s weird isn’t that we’re being asked to improve quality, safety and efficiency. What’s weird is that we’re just being asked to do it today, where it hasn’t traditionally been expected in the healthcare system,” he concluded.

Engaging Your Board

The types of changes impacting healthcare have trickled up from patient rooms to boardrooms, and that’s where THA guest speaker Kimberly McNally, MN, RN, focused her attention in her conference presentation, “Strategies to Engage your Board as Quality Champions.”

(CONTINUED ON PAGE 8)

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Mark Allen Continues Family Legacy as Healthcare Administrator, continued from page 1 Mississippi State to study turf management, something he quickly realized was not the career for him. He returned to Jackson, to, as he said, “get back on track.”

“My parents were both accountants who had careers in healthcare administration. My dad spent 25 years as a vice president with West Tennessee Healthcare and recently retired as the administrator of a smaller multi-specialty group in Mississippi which he ran for 10 years. My mother is the regional CFO of a group of behavioral health hospitals. They both had great work ethics and were very fulfilled in their careers,” he said. “I never felt like getting into this was expected of me but more of a matter of doing what I knew and what I wanted to do for a career. I knew the quickest way to get into healthcare was to be a paramedic so I did and also finished my business degree and also got my masters from Union University.

Since joining the clinic seven years ago, Allen has had a variety of responsibilities including project management, physician liaison and recruitment that let him work his way up to becoming COO. He attributes much of his management style to his mentor, Carl Rudd. “He always said to hire good management people around me, set direction then let them go,” said Allen, who oversees more than 550 of the clinic’s 750 employees and physicians.

“Being a paramedic as well as my clinical experience, helps in that I understand the day to day flow of patient care and what it

Mark Allen and family are avid Mississippi State Bulldog fans

takes to take care of patients. I have been in the trenches and know what it is like. I feel as though I have been trained to manage train wrecks both literally and figuratively.”

Allen says that just trying to change the decades old culture of reactive healthcare to proactive or population health management medicine is one of the chal-

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lenges facing the clinic that they are taking steps to address. “Managing a patient’s health while they are still healthy is challenging, but I think we are working on that and making progress,” he said. “We want to provide the best medicine at the best cost and we are not just putting lip service to that we are actually putting that into play.”

The clinic has created a population management department with ten registered nurses. Predictive analytic software is utilized to predict high-risk patients for admission or diseases that they have not been diagnosed with yet. The nurses take a proactive role and reach out to patients with chronic issues to see what we can do to keep them well. To address cost of care, the clinic has created departments that provide high quality procedures at lower cost such as a clinic-based GI lab that can do diagnostic scopes.

While Allen deals more in the day-today operations at the clinic, he says that through programs such as establishing themselves as a Medicare savings-driven accountable care organization they are increasing the quality while decreasing the cost of care for the program’s 40,000 lives in West Tennessee that are attributed to the clinic.

“We are learning to practice medicine the way it is going to be practiced in the future,” said Allen. “Our goal is to create a system that looks at the 40 year old working male patient that is not sick and determine how to engage that person to be concerned about their health in the future.

How do we do preventive medicine with that person at whatever point they are in life. We want to make preventive healthcare affordable and efficient for the working person who is not sick. That is a big part of what we are working on. We are testing different theories on that and have a few initiatives in the works. We are looking where we need to be in two or three years and start putting things in place.”

Since the Jackson Clinic is not alone

in its desire to move forward in this endeavor, Allen says they utilize other clinics and professional organizations to stay on top of latest trends. “We look at what other clinics across the country are doing and how they are dealing with these issues,” he said. “I am also very involved with a national COO Leadership Council. We meet twice a year to discuss these issues and see how others across the country are handling them.”

Like his parents before him, Allen has to balance family and work, a challenge he says is made easier by having a very supportive family. “Jennifer and I have been married for 12 years and she really takes the pressure off me. We have two children ages ten and seven. We are very involved in our church, Medina First United Methodist and the kids are involved in sports and music so they have something to do just about everyday,” said Allen. “I have a family that understands that there are just times I have to be at work. But now I have been known to be the most overdressed person at a sporting event or playing dodge ball on Wednesday night at church.

You just have to make it a priority in your life and that helps you balance it all.”

THA, continued from page 7 The president of Seattle-based McNally & Associates told Medical News common safety and quality challenges are facing hospital boards nationwide. “Boards should include a triad of collaborative leadership – meaning the board, executive team and physician leaders working together,” she said. “Their influences are connected so it’s important to have all three sides of the triangle working collaboratively.”

Not unlike clinicians, the biggest obstacles for board members are busy schedules.

That’s why having a shared understanding of direction is critical. “Without that, it’s very hard to get everyone pointed in the same direction,” she said, adding it begins with education and letting board members know why quality initiatives are important.

“Education like that at THA is essential because people need to know why they’re doing what they’re doing,” McNally said.

“People have to feel like they’re making a difference so meetings about safety and quality can be effective with clear roles.”

She noted common board mistakes include not being certain on the front end about intended pictures of success or not having clear metrics. “Oftentimes members aren’t prepared for the role they’re expected to be in, and board members aren’t typically people with clinical training,” she said.

McNally also urged hospitals to seek board members from industries with a shared focus on quality and safety. She said she also encourages the use of patient stories to help set a tone for a meeting, to avoid using insider medical jargon, and to ensure lay explanations are given for industry terms. “Invest in leadership development so members can make their optimal contribution,” McNally said. westtnmedicalnews

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Do Something

End Slavery Tennessee Calls for Awareness, Action

By CINDY SANDERS

During the third annual luncheon benefitting End Slavery Tennessee on Sept. 22 in Nashville, nearly 800 audience members listened in stunned silence as guest speakers detailed the state’s slave trade. Far from being a history lesson about a past shame, the program outlined the very real … and very current … issue of human trafficking in the United States and Tennessee.

By legal definition, human trafficking is an act or attempted act of recruiting, transporting, transferring, harboring or receiving a person by means of force, abduction, fraud, coercion, purchase, sale, threats, or abuse of power for the purpose of exploitation.

“Human trafficking is the second – and fastest growing – crime on the planet after drug trafficking,” said Jeremy Finley, chief investigative reporter for Nashville’s local NBC affiliate, who opened the program.

In fact, those who have trafficked in drugs and weapons are finding it to be more profitable and less risky to sell humans. In sex slavery, an individual can be put on the market multiple times a day. In the case of labor slavery, goods are continuously produced without labor costs or laws hampering profitability.

But it isn’t a global problem that only happens elsewhere, Finley continued.

“Ninety-four minors a month, on average, are estimated to be trafficked right here in Tennessee.”

In 2011, 85 counties in Tennessee reported at least one case of human trafficking. In Nashville that same year, more than 100 cases of minor sex trafficking were reported in Davidson County, and a similar number was reported for adults.

Since July of this year, just a few of the headlines tied to human trafficking arrests around the state have come out of Knoxville, Johnson City, Franklin, Jackson, Clarksville and Murfreesboro.

The average age of trafficked adolescents is 12 years old. “The average life expectancy for children and young people who are trafficked is seven years – trafficked at 12, dead at 19,” said Finley.

He added, “The number one vulnerability that traffickers target is the desire for love and acceptance and a place of belonging.” To battle back, Finley said everyone must ask, “What are we willing to do to make children in Tennessee feel loved? What are we to do to help Tennessee’s children be less vulnerable?’”

Before turning the program over to Derri Smith, founder and executive director of End Slavery Tennessee, Finley noted the nonprofit organization is taking a lead role in answering those questions, helping survivors heal, and strategically confronting slavery within the state.

In her address, Smith recalled how she came to found the organization.

“Once upon a time, I learned that 11- and 12-year-old children were being groomed westtnmedicalnews

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and sold for sex right here in my beloved home state. There’s no way I could know that and not do something,” she said.

From educating the public and training professionals to providing Derri Smith victims and their advocates with a single point of contact for comprehensive, long-term services, the organization continues to grow and adapt its work to address needs.

“Even five years ago, our system of laws was an unintentional welcome mat for traffickers,” Smith said. “Most people thought trafficking didn’t happen here.

Even many law enforcement agencies doubted it was a problem.”

Through work at the state level, letter and phone campaigns to legislators, and heightened community awareness, Tennessee now has some of the strongest trafficking laws in the nation. Smith pointed out, “In a few short years, Tennessee has gone from a mediocre response to human trafficking to a model state.”

One of the driving forces behind that change, she continued, is the work of Margie Quin of the Tennessee Bureau of Investigation. Smith presented Special Agent Quin with the First Annual End Slavery Tennessee Human Trafficking Impact Award. Smith said human trafficking has become a major focus of the TBI largely because of Quin.

Grammy Award-winning musician Alison Kraus served as the event’s keynote speaker. In her talk, she passionately stated, “We live in a time where atrocity is often defined by arguing freedom against freedom, and I can’t tell you the privilege that I feel to be in the presence of people whose mission is to rescue and deliver those whose choices have been stolen from them.” She continued, “This organization is in a war not only against the loss of choice of freedom for these victims but

LUNG CANCER IS THE DEADLIEST CANCER IN THE WORLD. WE CAN CHANGE THAT.

against the devaluation of human beings.”

Although the current human trafficking crisis is often rooted in the sex industry, the loss of choice and devaluation of human life mirrors the slave trade of more than a century ago. Referencing a speech

by British politician and abolitionist William Wilberforce before Parliament in 1789, End Slavery Tennessee Board President Bill Decker said hearing the story of those impacted by the slave trade forces

you to make the choice to look away or to take action. ‘Do something’ was a recurring theme throughout the event.

In the healthcare setting, that could include being more alert to the red flags of trafficking (see box). For more information on the issue and how to be involved, go online to endslaverytn.org. If you suspect a case of human trafficking, call the Tennessee Human Trafficking Hotline: 855558-6484.

Red Flags There are a number of red flags that a person might be a victim of human trafficking. For a more comprehensive list of possible indicators, go online to endslaverytn.org/redflags. Below are a few that might be noticed by healthcare professionals in a clinical setting.

• Injuries/signs of physical abuse (that they may be reluctant to explain); • Untreated illnesses or infections such as diabetes, cancer, or tuberculosis (because they haven’t been able to see a healthcare provider regularly); • STDs, HIV/AIDS, pelvic pain or inflammation, rectal trauma, urinary difficulties, abdominal or genital trauma (and this is an even brighter red flag if the patient in question is a minor); • Emotional distress such as depression, submissiveness, anxiety, panic attacks, confusion, phobias, disorientation, self-inflicted injuries or suicide attempts; • Inconsistencies when describing and recounting events; • Unable or unwilling to give a local address or information about parents or a guardian; or • Presence or fear of another person (often an older male or boyfriend who seems controlling).

Healthcare is Changing.

ADMINISTRATORS How can you stay on top of the issues?

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Join the fight by giving a gift to the American Lung Association today.

For more information, contact J. Neal Rager at 731-661-6340 or nrager@pscjackson.com.

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GrandRounds Kim Tedford Appointed Director of Jackson-Madison County Health Department JACKSON – Madison County Mayor Jimmy Harris and Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, announce the appointment of Kim Tedford, RN, as public health director of the Jackson-Madison County Regional Health Department.

Tedford, who has nearly 25 years of service with the Madison County department, has served as interim director since October, 2014.

Among Ms. Tedford’s many contributions to residents of Jackson and Madison County is service as regional director of nursing for eight years said Harris. In that capacity, her responsibilities included oversight of clinical staff and budgets to ensure the department performed optimally. She eagerly accepted the role of interim director for the last 10 months.

Tedford joined the Jackson-Madison County Regional Health Department in October, 1990, as a public health nurse.

She had previously served as a hospital floor clinical manager for a 42-bed medical unit. In 2007, she was named regional nursing director for the health department. She serves as a member of the Mayor’s Advisory Council on Domestic and Sexual Violence; as a member of the Coding Support Team and as a subject matter expert on electronic public health records for the Tennessee Department of Health; and is the Emergency Response Medical Task Force leader for the Jackson-Madison County Regional Health Department.

Foundation Announces Check Presentation For Jackson Generals

JACKSON – In September, the Jackson Generals Wheelchair Basketball Team received a $2500 donation from Human Technology Prosthetics & Orthotics. Human Technology is a local business specializing in state-of-the-art lightweight, durable artificial limbs, custom orthotics, and orthopedic/diabetic shoes.

The mission of Human Technology is to provide quality care to their patients and help them attain the highest possible level of comfort, independence, and activity. Human Technology serves al of West Tennessee, with offices in Jackson, Paris, Germantown, and Southaven, Mississippi.

Ramesh Dubey, president of Human Technology, is excited about being a sponsor of the Jackson Generals because it is a good fit for the company.

Wheelchair Basketball is made up of members with varying types of disabilities, but the sport allows them to be both active and competitive. This falls in line with Human Technology’s mission statement of wanting patients to reach their highest possible activity level. Ramesh Dubey believes that making the donation to the wheelchair basketball team provides a good chance for Human Technology to give back to the

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community, as well as to support wheelchair athletics.

Human Technology is dedicated to bringing the latest technology, experience and unparalleled service to the communities they serve. Supporting the Jackson General Wheelchair Basketball Team is just another way of extending the company’s service to the community. Ramesh Dubey will be presenting the donation on behalf of the company; the presentation will take place at the Human Technology office located at 2813 N. Highland, Jackson, Tenn.

New Additions Make Tennova One of Largest Health Networks in Tennessee JACKSON – Tennova Healthcare—a network of seven hospitals in east Tennessee known for high quality care—announced its expansion westward with the addition of four more hospitals.

Dyersburg Regional Medical Center, Regional Hospital of Jackson, Volunteer Community Hospital (Martin) and McNairy Regional Hospital (Selmer) are now part of a system formed four years ago to enhance access and improve coordination of care for patients at all member hospitals.

Tennova is now one of the largest healthcare systems in the Volunteer State with 11 hospitals and more than 80 physician clinics. The network includes approximately 1,800 licensed beds, 1,700 physicians on the combined active medical staffs, and 6,800 employees, with more than 51,000 admissions and 300,000 emergency department visits each year.

Hospitals already in the network in-

clude Jefferson Memorial Hospital (Jefferson City), LaFollette Medical Center, Lakeway Regional Hospital (Morristown), Newport Medical Center, North Knoxville Medical Center (Powell), Physicians Regional Medical Center (Knoxville) and Turkey Creek Medical Center (Knoxville).

As part of a statewide network, hospitals have access to shared expertise and resources that improve access to care, physician recruitment and quality of care.

Other programs and services are also part of the network, including affiliated physician clinics and emergency medical services. All network facilities are affiliated with Community Health Systems.

West Cancer Center Receives Multi-Million Dollar Gift from Moores West Cancer Center has received what officials call “a significant gift” from Jack and Betty Moore to The University of Tennessee/West Institute for Cancer Research, the fundraising arm of West Cancer Center. The commitment to the UT/West Institute’s Capital Campaign is in honor of West Clinic’s founder, and the Moore’s brother-in-law, William H. West, MD, who lost his mother to breast cancer.

The gift will rename West’s and Methodist Healthcare’s Comprehensive Breast Centers to the Margaret West Comprehensive Breast Center.

The philanthropic gift, indicated to be in the “multi-million dollar” range, will provide much-needed funds to support research and initiatives within the UT/ West Institute’s Center of Excellence in Women’s Cancers.

New Post Anesthesia Care Unit Enhancing Patient Experience at HCMC PARIS – Henry County Medical Center and staff are committed to providing the highest quality of healthcare services to the region.

HCMC’s current remodel of the surgical suites includes the addition of a new large operating room and spacious seven bed Post Anesthesia Care Unit (PACU). With the close proximity of the PACU to the operating room as well as with our expert surgical nursing team, the new unit provides our patients with the best care following surgical procedures.

Diana Bevill, RN, Director of Surgery said they are very pleased with the remodel. It expands the PACU from a 4 to a 7 bed unit, allowing for better patient flow and a quieter and more comfortable environment for patients emerging from anesthesia.

Upon completion of the entire remodel, HCMC will be hosting an open house to give members of the community the opportunity to get a behind the scenes look at the new surgical suite as well as to meet members of the team.

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Pictured are two bays in Henry County Medical Center’s new Post Anesthesia Care Unit.

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GrandRounds HIPAA Compliant SelfEncrypting Rx App In 2014, more than 4.02 billion prescriptions were filled at retail pharmacies in America. Writing and refilling prescriptions is a high-volume, repetitive task for physicians and their staff that can be time consuming both in and out of the office. A new mobile app, getRx, uses smart phones, tablets or PCs to connect patient, prescriber and pharmacy. The app is available in both a physician and a patient version and can be downloaded from ITunes, Google Play as well as Amazon and is compatible with Apple and Android smart phones, tablets and PC’s.

GetRx, is a tool that eliminates the need to call or fax a pharmacy, which saves a significant amount of time according to Dan Rudd, MD, in Murfreesboro who developed the app with software developer Metova Inc. The cloud-based app is a mobile prescription pad that is HIPAA compliant with encrypted texting within the app. It is linked to a medication database, which allows the physician to select from a drop down menu the medication and dosage.

Google maps is also embedded in the app making selection of a convenient pharmacy easier when the patient is not at home.

More efficient than a traditional prescription pad, getRx lets physicians and their office staffs write and refill prescriptions and communicate with patients and pharmacies directly from a smart phone, tablet or PC. Prescriptions can be written and sent to the pharmacy of choice in 20 seconds. Once the prescription is sent, both the patient and the office receive written notification of the prescription, making charting easier. Any dialogue between patient and physician within the app is also sent to the office for placement in the patient’s chart.

When open, getRx, looks like a prescription pad. As you type, drop down menus let you select the correct patient, medication and dosage so there is little margin for error. And there is no charting; the app does that for you by sending the script back to the office. The app even remembers my preferred prescribing patterns on medications which further reduces the time to complete prescriptions said Rudd.

For patients, the app is free. It connects them to any and all of their physicians that use the getRx app. This allows the patient to request refills and communicate securely with their physician or their office in mere seconds, right from their smart phone, tablet or PC, which eliminates office staff time answering and returning phone calls for refills or prescriptions. Find more information at www.getrx.com

We are excited to announce the addition of 10 new healthcare providers to our team. We offer care in 25 medical specialties and subspecialties so that we can provide complete care for you and your family. Our newest providers bring the latest medical knowledge as they join our top rated team recognized for achieving the highest outcomes for patient health and wellness.

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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