West TN Medical News September 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Michelle Puzdrakiewicz, MD

ON ROUNDS

Financial Incentives Are Helping Providers Meet Tough Challenges

By JAMES DOWD

As medical costs continue to rise, healthcare organizations are being forced to re-examine practices and procedures to find the most economical ways to balance quality care with sustainable pricing.

Locally, physicians and healthcare providers are implementing new measures to operate more efficiently, say leaders at Baptist

Tennessee’s Hep C Epidemic Recent TDH Advisory Draws Attention to Disease, New Treatments This summer, the Tennessee Department of Health (TDH) issued a public health advisory in the wake of a nationwide increase in the rate of Hepatitis C infection.... 7

Institutions Join Fight Against Childhood Obesity Pediatricians Sound Warning About Sports Specialization When local institutions create a team that includes a doctor, a nurse, physiologists, dietitians, a psychologist and other researchers to tackle childhood obesity, you know they consider the problem more than a passing trend ... 9

Memorial Health Care. And while these leaner processes are cutting hospital costs, they also are benefiting patients.

Baptist participates in the voluntary Medicare Shared Savings Program, which was established by the Affordable Care Act and was intended to decrease unnecessary healthcare costs. Facilities designated as Affordable Care Organizations receive financial rewards and incentives by lowering healthcare costs while meeting federally mandated patient care standards.

Dr. Mark Swanson, chief medical officer for Baptist, said the organization, which operates 14 hospitals in the Mid-South, is managing rising costs through collaboration between caregivers at every level.

“It has to be a concerted effort in order to effectively control costs while providing quality care,” Swanson said. “We don’t want to incur unnecessary costs for the patients or the hospital.”

Adopting new cost-saving procedures sometimes requires a shift in mindset, Swanson acknowledged. And that may vary from vendor relations to patient care.

“We have to look more closely at how hospitals can control costs, and perhaps that may be by reducing the number of vendors we use,” Swanson said. “It also means (CONTINUED ON PAGE 8)

HealthcareLeader

Merging Clinical and Administrative Patients and Physicians Benefiting from Experience and Technology at Medical Center Lab

By SUZANNE BOyD

It was his love for chemistry that attracted Mark Burton to medicine but it was the challenge pathology posed for him as a medical student that piqued his interest in the specialty. His years as a commissioned officer in the Air Force gave him his first taste of administrative duties.

Today, Burton is using both his clinical and managerial experiences in his role as Medical Director of West Tennessee Healthcare System’s Medical Center Laboratory.

(CONTINUED ON PAGE 4)

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PhysicianSpotlight

It’s All About Kids

Balancing Life as a Busy Pediatrician and Mom

By SUZANNE BOYD

While her family may have been into the lighting business, it is taking care of kids that lights up Michelle Puzdrakiewicz’, world. The California native not only branched out from the family business to pursue pediatrics as a career, she left the Golden State for the Volunteer state. After five years as a pediatrician in Dyersburg, today, Puzdrakiewicz sees most of her patients in the hospital setting as a pediatric hospitalist for Jackson-Madison County General Hospital.

Sacramento, California was where Puzdrakiewicz’ family called home and where her grandfather started the family’s eco-friendly lighting company over fifty years ago. While she remained in the same zip code to attend college at California State University where she majored in biology, it was definitely a big adventure.

The product of an all-girls Catholic high school, having boys in class was a new experience. And as luck would have it, the first boy she met on the first day of class ended up becoming her husband.

“Thad was my biology lab partner my freshman year. We ended up dating throughout college and getting married after graduation,” said Puzdrakiewicz.

“Although he was a military child, he had grown up in Sacramento since he was eight but lived in a different area than I did so our paths had never crossed until college.”

Puzdrakiewicz had known since junior high she would not follow in her parents’ and siblings’ footsteps to work for the family business. “I just knew I wanted to pursue medicine,” she said. “I did not have a profound medical experience as a child, in fact my only exposure to physicians was working as a babysitter for several. Two physicians in particular, one an orthopedist and one a pediatrician, were in my eyes exceptional people. I think my admiration for them sparked my interest in science and being a doctor.”

Although a newlywed, Puzdrakiewicz headed to medical school without her husband. “Thad and I had decided we would focus on careers first. I was accepted to Tulane Medical School and he got a job as a project engineer with a large contracting firm based in St. Louis but worked in California. We tried to see each other once a month. I lived with a woman who was also married but whose husband was in Montana so I had someone to commiserate with. I was also working on my Masters in Public Health during my first two years of medical school so I was very busy studying. Thad was busy building his career so it made the first years go by quickly,” said Puzdrakiewicz. “The second year he was transferred to Destin so we were able to see each other almost every weekend. My westtnmedicalnews

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Pediatric Hospitalist Dr. Michelle Puzdrakiewicz enjoys time out of the office with her family.

third year of medical school he was finally transferred to New Orleans with his job so we bought a tiny 800 square foot home in the suburbs where we could hear the train at one end of the street and the steam boats at the other. It was definitely a more normal married life.”

In her third year of medical school, Puzdrakiewicz was debating between pediatrics and urology as a specialty. “They are very different specialties but I had strong mentors in both. One is a highly focused surgical setting while the other is very broad spectrum,” she said. “I chose pediatrics and love that decision. With kids, the dynamics change all the time and you see diseases at different stages due to their age. They are resilient and have a

great ability to heal and get better.”

For her pediatric residency, Puzdrakiewicz only applied to two places, Tulane and University of California Davis.

“Thad had been diagnosed with lymphoma when I was in medical school. And while he had done very well and actually worked while in treatment it was very important to us to be home and close to family for my residency,” said Puzdrakiewicz.

While at the University of California Davis completing her pediatric residency, Puzdrakiewicz was not only busy taking care of kids but also starting her own family in a big way by having twins. “I became pregnant my intern year and had twin girls, Madison and Kayla, in July between my first and second year. My great

grandmother had three sets of twins so we were not terribly surprised”, she said.

In her third year she had their first son, Thaddeus and as she completed her year as chief resident, she was pregnant with her fourth child, Luke. “I learned a lot about sleep deprivation being on call and a being new mom,” Puzdrakiewicz recalls.

The busy mom of four stayed at UCDavis practicing general pediatrics as an associate professor. By 2007, the Puzdrakiewicz’s had four kids under nine in private school and both were working full time. “It was just too difficult to keep that pace,” said Puzdrakiewicz. “We made the decision to move so we could have a slower paced life and enjoy our family.

We looked at Virginia, Kentucky, East and West Tennessee as well as Oregon.

My husband’s engineering background kicked in and he made a spreadsheet of our options taking in to consideration demographics, schools and practices. We ended narrowing it down to a position in Oregon and one in West Tennessee.”

It was the opportunity to work in a medically underserved area in West Tennessee with Med-South that won out and the Puzdrakiewicz’s moved to Dyersburg.

In 2011, the family relocated to Jackson for the kids to attend private school and Puzdrakiewicz commuted to Dyersburg to practice. In 2012 family came first again and she joined the Jackson Clinic to do outpatient pediatrics closer to home. Five months later, Jackson Madison County Hospital needed a full time pediatric hospitalists and Puzdrakiewicz took the job.

“The hours are worse but when I am off, I am off unless I have administra(CONTINUED ON PAGE 4)

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Merging Clinical and Administrative, continued from page 1 Burton grew up in California. His dad was an attorney and his grandfather a surgeon. He had always enjoyed chemistry, which led him to pursue medicine early on. He also had a passion for the German and Japanese languages. His college degree was earned at Brigham Young University in Provo, Utah. For medical school, Burton turned to the United States Air Force, which allowed him to earn his degree with no debt at the Uniformed Services University of the Health Sciences in Bethesda, Maryland where he spent all four years as a commissioned officer.

“Pathology was the most challenging in that there was so much to learn. It is the basis of medicine and most clinical decisions are based on it. I focused on it and did well,” said Burton. “When my clinical rotations started to bore me, I gravitated back to pathology and was always following things down to the lab to be in that environment. I also had five kids and pathology was a residency that allowed me to be home at reasonable hours and be involved with my kids.”

His post medical school training would take him to San Antonio, where he would spend the next twelve years. His fellowship in hematology and molecular diagnostics at the University of Texas Health Science Center was completed in 1997.

During his training, he also completed a rotating surgical pathology fellowship with an emphasis on neuropathology at the Armed Forces Institute of Pathology in

1997 and a five-year combined anatomic and clinical pathology residency at the Air Force’s flagship hospital, Wilford Hall Medical Center. He remained on staff at Wilford Hall for seven more years during which time he managed the Air Force’s Pathology Services worldwide as a consultant to the Surgeon General, directed the largest pathology residency program in the Department of Defense, as well as built its first molecular clinical laboratory.

Although he is still a reservist in the Air Force, after 12 years, Burton knew it was time for a change. His job search took him to Jackson, Tennessee and West Tennessee Healthcare. “I had a friend, Jeff Sims, who was here. I interviewed and was sold on it immediately. We loved the town, the hospital and the educational opportunities here for our children,” he said.

“So eleven years ago, we moved.”

At the time Burton joined the staff, the hospital had just built a forensic toxicology lab and was looking to bring in a molecular pathology lab. A new two-story standalone facility was also under construction that would allow laboratory services to move from the basement of Jackson Madison County General Hospital. The new state of the art facility included the latest technological advancements in anatomic and clinical diagnostics. Over the next few years, the lab underwent more changes and seven years ago Burton was asked to take over as Medical Director.

Today, Medical Center Laboratory

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SEPTEMBER 2015

reports 40 million results annually. The service includes five separate clinical laboratories under its umbrella and provides services for 22 locations including nine clinics, nursing homes as well as extensive outreach and currier services. The lab also covers affiliate hospitals in Bolivar, Camden and Gibson Hospital, the Lift Center, Kirkland Cancer Center as well as manages and directs lab services for smaller clinics across West Tennessee. The lab is also responsible performing autopsies.

In addition to his role as Medical Director, Burton is also the Department Chair. As Medical Director, he has direct responsibility for the molecular lab, histology and toxicology services as well as MedSouth Clinical Laboratory in Dyersburg. Due to state regulations, Burton can manage no more than three labs, so supervision of the remaining laboratory services are split between his five partners. “As Medical Director, I am the final arbitrator for the lab and am ultimately liable and accountable for every result and report that goes out from the lab,” said Burton, who also serves as president of Jackson Pathology Group, PC. “We are a very large department in terms of staff, but we work very well together to communicate successfully. The lab is the basis of medicine as about 80 percent of all clinical decisions are based on data, biopsy and lab results.

It is our findings that allow the physicians and specialists to make decisions regarding their patient and their treatment. We give clinical staff and patients the most accurate, precise and cost effective testing we can. I think we do it very well and provide great customer service.”

Technology is constantly evolving in the lab as it is across other health disciplines. “We work closely with administration. We trust one another and value the other’s opinions,’ said Burton. “We meet weekly to evaluate new technology and testing practices. When vendors or physicians push for new or different tests, it

is our job to determine the best and most cost effective. We develop relationships with others labs to perform tests that may be too expensive for us to run in-house.

Finding what is right for the patient, clinicians, administration and the institution can be challenging, because they do not always line up with one another. I have to find middle ground to adjudicate those difficult shores and waters.”

Heading one of the largest departments in the system is something Burton finds fun and exciting. “We have 380 staff members, five full time and one part time anatomic and clinical pathologists who are all board certified or sub-specialty trained.

We work with every medical specialty and have to be able to interact with them on their level 24/7,” he said. “It can be an overwhelming area, but everyday I am learning and growing.

The lab is the most highly regulated department in medicine. “We are accredited by the Collage of American Pathologists, which is the gold standard of testing,” said Burton. “They send a team in every couple of years to look at our program and every team that has come in is blown away at the phenomenal facility we have.”

Being able to balance family, church and his career is something Burton is very proud of. “I have five great kids, two are married. They live in Arizona, Singapore, LA, Pennsylvania and my youngest is about to embark on a two-year mission trip,” said Burton, who is also collaborating with five of the top pathologists in the country to author and edit resource guides in addition to publishing several academic articles. “My military background and church involvement have played a big role in helping me to be a good manager and counselor across all aspects of my life. I hope to make a difference here. Every day I am scratching my head at how exciting and exhilarating I find my job and yet I still get to go home and have a nice life.”

It’s All About Kids, continued from page 3 tive things to attend to,” said Puzdrakiewicz, who serves as medical director of the pediatric hospitalist program. “It is a different kind of pressure than in an office and I wouldn’t say it is any easier or harder. It is just different. Our unit has 13 beds but census fluctuates, as does the intensity. Summer is typically slower but in the winter we are busy and I can be on service for several days straight. You have to learn to pace yourself but with having four kids, I am sort of used to sleep deprivation.”

While the majority of her time is on the inpatient side of pediatrics, Puzdrakie-

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wicz still sees patients in Dyersburg twice a month. The bulk of these patients are kids with chronic care needs and special needs patients. “Most of what I do is administrative health with these patients,” said Puzdrakiewicz. “Mainly it is nursing care orders and prescheduled chronic needs care. There is such a need for this in every community.”

Believe it or not, Puzdrakiewicz says life is easier now even with four busy teenagers and her doctor duties. “There is an event every night with the kids and often we are spread out all over the state. The twins are juniors this year, one runs crosscountry and track and the other plays soccer and participates in theater. Our sophomore plays football and baseball and our eighth grader plays football and soccer,” she said. “Thad is a very involved dad and with the kids being older they can help out and keep me on track with the schedule. It is a busy life, but we love it.”

westtnmedicalnews

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MedicalEconomics

BY BILL APPLING

What a tremendous task it is to weed through government requirements and adjust to new payment models that shift more risk to providers. Plus, now we are preparing for the impact of the new ICD-10 coding. This common, but important, duty is the role of the administrator in connecting the dots between processes and high-quality care.

I was at fund raiser recently and talked with the CEO of a major bank in Memphis. He commented, “I don’t see how physicians and hospitals can be prepared for all the changes going on. I thought we had it tough regarding the Dodd- Frank bill and the overreach of regulatory requirement. The requirements you have in healthcare keep moving and I don’t see how the medical industry and your stakeholders can meet all the new regulations which keep changing and be expected to make one of the biggest changes in the history of healthcare.”

Which posed the question: Does healthcare reform represent incremental change or a fundamental shift?

I would say both. Parts require incremental change (which is difficult with the speed of change in our industry) and also a major fundamental shift. But the different forms of integration suggest it

The State of the Medical Practice is more of a fundamental change that demands new types of collaboration.

You can see that the challenges facing medical practices and hospital/IDS challenges are very similar and speak to a need for more collaboration.

Top 10 independent medical practice challenges • Participating in the CMS EHR meaningful use incentive program.

• Dealing with rising operating costs.

• Preparing for the transition to ICD-10 diagnosis coding.

• Preparing for value-based payments (shared savings, capitation/global payments, quality outcomes).

• Preparing for reimbursement models that place a greater share of financial risk on the practice.

• Managing current practice planning and strategy (which is a moving target) and being proactive in future planning and strategy (which is difficult with a moving target.)

• Collecting patient-due balances (self-pay, high deductibles and HSAs instead of quality improvements and costs savings.) We face the challenge of not being able to respond to improvement and changes when the high costs of self-

pay and high deductibles force many patients to put off care until the health of the patient has become critical thus requiring more costs and not being able to meet quality criterion.

• Participating in quality reporting programs. (Interoperability is still a significant challenge and I do not see this changing much for the next few years.)

• Understanding payers’ criteria for physician performance ratings and their effect to provider networks and tiering.

• Collecting and reporting nonstandardized health plan/government quality measures.

Top 10 hospital/IDS challenges Preparing for value-based payments (shared savings, capitation/global payments, quality/outcomes).

• Dealing with rising operating costs.

• Preparing for reimbursement models that place a greater share of financial risk on the providers.

• Managing physicians’ expectations of their compensation levels.

• Recruiting physicians and nonphysician providers.

• Managing finances and change with uncertainty with changes going on

in the insurance industry.

• Understanding the total cost of an episode of care.

• Preparing for the transition to ICD-10.

• Adapting the physician compensation model to incentivize quality, productivity and/or outcomes.

• Engaging patients to improve outcomes.

Practice professionals keep a close eye on the business aspects of care delivery to ensure the financial viability of their groups, but still greatly attempt to ensure the delivery of high- quality patient care. The two are inextricably tied.

Despite multifaceted barriers, practice professionals continue to experiment with new methods to keep patients healthier and disrupt the progression of disease. The common theme of this article is improving patient outcomes by ensuring that every piece of the practice puzzle aligns to deliver on the desired promises.

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.

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WHO’S TENDING OUR DOCTORS?

The AMA Steps Up with STEPS Forward Ambitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

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.

Several years ago, Christine A. Sinsky, MD, FACP, made two significant time-saving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The first: taking a streamlined approach to prescription manage- Dr. Christine Sinsky ment.

Second: taking proactive planned care measures with patients via previsit laboratory tests.

“Just making a single change – prescription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes

of nursing time per doctor per day,” said Sinsky, an internist and partner in Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois.

Sinsky is also the point person at the American Medical Association (AMA) for an ambitious new initiative offering physicians strategies to revitalize their medical practices and improve patient care.

The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recommendations and go home earlier by reengineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction physicians derive from their work is

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SEPTEMBER 2015

quickly eroding as time continues to be taken away from direct patient care because of grueling, bureaucratic obstacles.

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent,” said AMA CEO James L. Madara, MD. “That’s why the AMA is taking a hands-on approach to meeting their day-to-day concerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four Dr. James L. Madara key areas: practice efficiency and patient care, patient health, physician health, and technology and innovation.

Specifically, the modules cover these topics: • Conducting effective team meetings • Creating strong team culture • Electronic health record (EHR) implementation • EHR software selection and purchase • Expanding rooming and discharge protocols • Improving blood pressure control • Improving physician resiliency • Medication adherence • Panel management • Preventing physician burnout • Preventing type 2 diabetes in at-risk patients • Pre-visit laboratory testing • Pre-visit planning • Starting lean healthcare • Synchronized prescription renewal • Team documentation Each module requires only snippets of time to study either online or printed in PDF format for a more traditional approach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, participants must view the module content in its entirety, successfully complete the quiz

answering four of five questions correctly, and complete the evaluation.

Modules include steps for implementation, case studies and downloadable videos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effective team meetings begins with a 10-step process: • Identify the team.

• Meet routinely and “on the clock.”

• Agree on ground rules.

• Set a consistent meeting agenda.

• Rotate meeting roles.

• Solve problems as a group.

• Record action steps, owners and due dates.

• Practice good meeting skills.

• Have fun!

• Celebrate success.

Under ground rules, helpful hints include starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for their time. To stay on topic and maintain efficiency during the dedicated meeting time, it’s suggested that: “if the discussion wanders, the chair or other member can say, ‘Let’s take that offline,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Management Association (MGMA) issued a practice innovation challenge, seeking more high-value, easy-to-adopt, and transformative medical practice solutions. Proposals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to having the ideas developed into future STEPS Forward modules. Winners will be announced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.” westtnmedicalnews

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Tennessee’s Hep C Epidemic

Recent TDH Advisory Draws Attention to Disease, New Treatments

By CINDY SANDERS

This summer, the Tennessee Department of Health (TDH) issued a public health advisory in the wake of a nationwide increase in the rate of Hepatitis C infection.

The alert called for Tennesseans to learn more about the life-threatening disease and to consider being tested for chronic Hep C infection.

A Centers for Disease Control and Prevention report issued in May showed Hepatitis C as the most common bloodborne infection in the United States with approximately 3 million people living with Hep C. While the increase in disease is nationwide, the largest increases have been in the Appalachian region. The rate of acute Hepatitis C cases in Tennessee has more than tripled in the last seven years.

When announcing the public health advisory, TDH Commissioner John Dreyzehner, MD, MPH, said, “In addition to reported cases of acute Hepatitis C, it is estimated that more than 100,000 Tennesseans may be living with chronic Hepatitis C and not know it.”

Tim Jones, MD, who has served as the state epidemiologist since 2007, noted, “The state of Tennessee is number four in the country for the amount of Hepatitis C that we see.

We have three times the national average of rates of disease.” Looking at the map of Tennessee, Jones said there are a particu- Dr. Tim Jones larly high number of cases along the eastern border and northeastern part of the state.

The good news, Jones added, is that along with increased rates of disease are improved treatment options. “One of the reasons it’s getting more attention now is that there are better treatments available, and they are relatively new to the market.”

In the past, he continued, the treatment regimen was difficult, not terribly effective and included a lot of side effects for many individuals. “Now there are much more rapid and effective treatments so there is more enthusiasm for getting people tested and into treatment,” said Jones, who has been with the TDH for 18 years and previously worked for the CDC. “You can now treat it in 12 weeks … and these drugs cure it.”

Additional information for healthcare providers and patients is available through the Tennessee Department of Health website.

Go to tn.gov/health/article/ health-advisories for Hepatitis C statistics, answers to frequently asked questions, and prevention messages. There is also a direct link to the information from our website at WestTNMedicalNews.com.

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However, he continued, the problem is the cost of the three-month regimen, with a price tag coming in at $60,000-$90,000.

He added it’s an issue public health officials, providers and insurers are all struggling to address. Time, he continued, could provide at least a partial solution. “It’s likely as more medications come on the market, and there are several in the pipeline, those costs will be driven down.”

And, Jones pointed out, the slow progression of the disease gives those infected time to get into appropriate care. “About 20 percent of people will get rid of it on their own. For the other 80 percent, the disease progresses very slowly. If people catch it early, it can take 20-30 years before getting to the end stages,” he said.

Although price is an issue, another con-

sideration is the cost not to treat. “As (Hepatitis C) progresses, it can lead to fibrosis of your liver up to liver failure. It’s the number one cause for liver transplants,” Jones noted. He added, Hep C is also the main cause for cirrhosis of the liver. If the disease progresses to one of these conditions, the price of caring for individuals with Hep C could far outstrip the cost of the drugs to cure it.

A blood-borne pathogen, Jones said the nation’s blood supply up until the late ‘80s/early ‘90s helped spread the disease.

Today, however, the biggest risk factor is IV drug use.

“There are pretty negative connotations when a disease is associated with IV drug use, but even one indiscretion decades ago can lead to these problems years later,”

he pointed out.

Ideally, Jones said the following people should be tested: • All baby boomers (anyone born 1945-1965), • Anyone who has ever injected drugs (even once), • Anyone who received a blood transfusion or organ transplant before 1992, • Any healthcare worker who might have had a needle stick injury, • Anyone who has gotten an illegal tattoo or unsanitary piercing (from an unlicensed provider), • Anyone with HIV or AIDS, • Those with abnormal liver tests or other liver disease, and • Anyone on dialysis.

While healthcare providers might be able to rule out some of the risk factors for their patients, Jones said the only way to really determine if an individual should be tested is to broach the topic and ask questions.

Of course, he continued, the best defense is a good offense … namely prevention. With no vaccine for the disease, efforts to avoid exposure are the best weapon in stopping the spread of Hep C. Don’t share needles is the key message, and that includes the ‘diabetes curious’ … the person who wants to see what their blood sugar is so they try out a diabetic friend’s testing equipment.

“Don’t share needles … period,” Jones stated firmly.

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At the Intersection of Education and Healthcare

By CINDY SANDERS

According to statistics from the Centers for Disease Control and Prevention, one in 68 children falls somewhere on the autism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost five times more common in boys (1 in 42) than girls (1 in 189). Additionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still no cure for ASD, research has shown early intervention can have a significant impact on a child’s development and ability to more fully interact with peers at school. It’s at this intersection of education and healthcare where Educational Services of America (ESA) offers resources to help these children thrive.

Headquartered in Nashville, Tenn., the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark ClayMark pool, who founded the Claypool company in 1999. “We work primarily with public school sys-

tems,” he said, noting the company partners with about 250 different systems. He added ESA also works directly with some state governments and insurance carriers.

“Providing quality services to children and young adults who need them is more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in business for more than 15 years, Claypool said many of the programs being used have been around much longer with measurable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early intervention space,” Claypool explained. “Autism is a very dynamic disability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.”

Today, EAP reaches four times the number of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Carolina and

Tennessee in the Southeast.

“We’re growing very rapidly,” Claypool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied Behavior At the heart of the program is the use of Applied Behavioral Analysis (ABA).

“We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive living skills including self-care, toileting, understanding time and money, and honing work skills.

“The same model of behavioral therapy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of children diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition

to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable outcomes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to have their potential unlocked,” he continued.

That was certainly true for one South Carolina mom. Told it would be best to find her son a residential program because he would never function on his own, she took matters into her own hands and became the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with autism will perform at that level, Claypool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education

Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the Individuals with Disabilities Education Act requires public school systems to identify preschool children with special needs.

However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really (CONTINUED ON PAGE 10)

Financial Incentives Are Helping Providers, continued from page 1 working with physicians to see how they practiced and find ways to prevent incurring unnecessary costs while at the same time being careful not to alter the outcome for the patient.”

For example, in years past multiple tests may have been routinely ordered for patients who were admitted to hospitals for conditions such as diabetes, heart failure or pneumonia. But more tests did not necessarily indicate better patient care or lead to quicker recovery, Swanson explained.

Similarly, whereas some healthcare facilities may have adopted a standard length of stay for certain ailments, more time spent in a hospital may not be the best treatment option for most patients.

“We looked at the diagnoses for areas with frequent admissions, such as heart failure or pneumonia, and we tried to determine the best tests and medicines and how quickly these patients will get better,” Swanson said. “Some of the tests that were routinely performed may have been necessary in only a small number of cases and not for every patient. And if some guidelines suggested that a patient should be in the hospital for three days, but we were keeping them four or five days, then we began trying to treat them more efficiently so that they could feel better and go home 8

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sooner.”

A 2013 Health Care Cost and Utilization Report ( http://www. healthcostinstitute.org/files/2013%20 HCCUR%2012-17-14.pdf ) by the nonprofit, non-partisan Health Care Cost Institute (HCCI) found that despite decreased brand prescription drug use, admission rates and outpatient services that year, average prices in all three of those areas increased, and at higher rates than the previous year.

The study mirrored a 2013 Journal of the American Medical Association (JAMA) report (http://jama.jamanetwork.com/ article.aspx?articleid=1769899 ), which indicated that of increases in healthcare costs between 2000 and 2011, more than 90 percent stemmed from escalating prices of drugs, hospital care and medical devices.

Eight years before the Affordable Care Act was signed into law, “Medical Professionalism in the New Millennium: A Physician Charter” (co-authored by the American Board of Internal Medicine Foundation (ABIMF), the American College of Physicians (ACP) Foundation, and the European Federation of Internal Medicine and published in the spring of 2002) suggested that the U.S. healthcare system needed to self-regulate in order to

remain sustainable.

That article began a national dialogue that led the American Board of Internal Medicine (ABIM) to establish the Choosing Wisely initiative in 2012. The campaign promotes quality care that is more efficient and less costly, and achieved by reducing unnecessary tests, procedures and treatments.

That is the focus of patient care throughout the Baptist system, said the organization’s chief nursing officer, Susan Ferguson.

“The key is to prevent readmission,” she said. “We work toward that in a number of ways, including enhanced admission processes that include family members or caregivers and determining what support systems our patients will have once they are released. In addition, we have developed an extensive patient evaluation system that involves every healthcare professional involved with that patient’s case.

We discuss every patient every day to see how they’re progressing and responding to care.”

And in an effort to reduce patient hospital stays, facilities are developing procedures that are less invasive and require shorter recovery periods. At Stern Cardiovascular Foundation, a new device known as the MitraClip is being offered

at Baptist to treat mitral regurgitation, caused by a leaky mitral valve that creates a backward flow of blood in the heart.

The condition, which affects about 10 percent of people 75 and above, is regularly treated through open heart mitral valve surgery. However, for patients for whom such surgery is too risky, the minimally invasive MitraClip treatment is a welcome option.

“After a lot of hard work and dedication, we finally started the MitraClip program,” said Dr. Basil Paulus, cardiologist with the Stern Cardiovascular Foundation. “We completed our first two cases in June at Baptist Memphis, and they were both successful.”

So far, the incentives for decreasing costs and improving patient care are working, Swanson said. And that bodes well for the future of the healthcare system and patients alike.

“This is a motivator for physicians to provide the absolute best care for their patients as possible, without having them undergo procedures or treatments that may not have a positive impact on their condition,” Swanson said. “It helps us focus on treating patients in a better, more efficient way that helps them get healthier faster, and that is the best result for everyone.” westtnmedicalnews

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Institutions Join Fight Against Childhood Obesity Pediatricians Sound Warning About Sports Specialization

By PEGGY BURCH

When local institutions create a team that includes a doctor, a nurse, physiologists, dietitians, a psychologist and other researchers to tackle childhood obesity, you know they consider the problem more than a passing trend.

Last October, the University of Tennessee Health Science Center (UTHSC) and Le Bonheur Children’s Hospital opened a Healthy Lifestyles Clinic as part of their joint Pediatric Obesity Program under the direction of Joan Han, MD, a Harvard-educated endocrinologist and former U.S. Public Health Service officer.

Exercise – a recommended one hour a day, seven days a week – is a key aspect of the individual plans for clinic patients.

“We know that children are certainly less active now than they’ve been at any point, and it stands to reason that has impacted their physical ability,” said Webb A. Smith, PhD, a clinical exercise physiologist for Healthy Lifestyles and an in- Dr. Webb A. Smith structor in pediatrics at UTHSC. According to data measured by the U.S. Centers for Disease Control and Prevention, more than 19 percent of high school-age youth in Memphis were obese in 2013, a rate that was 5 percent higher than the national figure. From 2003 to 2013, the number of obese high schoolage youth in Memphis increased by 3.6 percent. Children whose body mass index were at the 95th percentile or higher are considered obese and at increased risk for diabetes, cardiovascular disease and osteoarthritis, among other conditions.

Pediatric health workers say “screen time” often stands between children and exercise.

“I certainly see in my clinical work lots of patients are spending lots of time watching a screen of some sort,” Smith said. Though Wii and Xbox Kinect video games encourage movement, he said, “most screen time is a competing interest in having fit, healthy children.”

Grant Newman, MD, says in his practice at Pediatrics East that he advises families to follow the American Academy of Pediatrics’ 5-2-1-0 daily plan. That’s five servings of fruit and vegetables per day, no more than two hours of screen time, one hour of exercise and zero sugary drinks.

“We go through that with most of our families, and most of them agree,” he said. “But some (patients) want to negotiate with me on the video games . . . ‘What if I do six hours and then only one hour?’”

A child’s screen time must be monitored, he said. “Once they get into that westtnmedicalnews

.com

video game, they get in a trance and lose track of all time. They can’t enforce it, and they don’t have the ability to control whether they do something else.”

Newman, who has practiced for 15 years, said while “the average kid is still pretty thin in elementary school, there’s a trend in early middle school toward kids getting heavier.”

“Sometimes I feel like ‘Where are all these obese kids you hear about?’ I’ll go days when I see thin kid after thin kid.”

But he says they most often “come from active, athletic families.”

Monitoring the body mass index, the body fat measure based on weight and height, on a growth chart is a reliable way to detect problems, he said.

“You may have a kid whose BMI is steadily in the 75th or 80th percentile, and that’s probably OK. But if they go from the 30th to 50th, to 75th to 80th percentile, we look at that differently. After the first few years of elementary or middle school, that usually coincides with being less active and what they’re eating.”

The approximately 250 patients who’ve been referred to the Healthy Lifestyles Clinic at Le Bonheur have BMIs that are at least in the 95th percentile, which means they’re candidates for serious health problems related to their weight.

“We try to encourage increases in physical activity, optimally at least 60 minutes of activity each and every day,” Smith said. “We also counsel them to spend no more than two hours a day either looking at a screen or playing a game of that sort.”

The plans are tailored to individual families.

“Some families are ready for us to give them a specific program and work with us directly,” Smith said. “They’re interested in what exercise to do, how many times to do it, how hard should they push.

Other families are more interested in trying to make some basic changes like just going for a walk.”

The clinic monitors at-home exercise by asking patients to keep journals and notes on their activities and with fitness trackers. “We also have them walk us through their exercise to see how proficient they are at it,” he said, “which is usually a good indicator of how many times they’ve tried.”

And while doctors and clinicians worry about children who get too little

exercise, they also worry about those who get too much of one kind.

In July, when pitcher John Smoltz was inducted into the National Baseball Hall of Fame, he criticized the trend toward early specialization in youth sports, saying it could lead to injuries. He said he wanted parents to realize “that you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports.” (Had he gone to Michigan State instead of signing a professional baseball contract, Smoltz planned to walk on to play basketball.)

A recent study by the National Institutes of Health found: “For most sports, there is no evidence that intense training and specialization before puberty are necessary to achieve elite status. Risks of early sports specialization include higher rates of injury, increased psychological stress, and quitting sports at a young age.”

Smith also laments the phenomenon.

“Awhile ago when I was playing sports, baseball season was a season, and it ended and you had to find another thing to do. So you played football or you played basketball,” he said. “Now the way youth sports is structured, it’s reasonable

that you can play your specific sport year around, or at least train for it.

“I think those athletes that specialize really early are more likely to have injury issues, and I would argue that you’re not developing them into the best athletes they can be.”

“There’s been some data here in the last couple of years show that those who are pushed hard early actually are less likely to be lifelong exercisers,” he said. “As an exercise physiologist, I would rather see children learn a diverse group of activities they can continue throughout their lifetime. I think that in a lot of ways the sport is the culmination of the training, and the training is what you want them to fall in love with.”

He pointed out that in recent years at the NFL Combine for college players hoping to play professionally, “a shockingly high number played multiple sports in high school.” Tracking Football’s website reported that 224 of the 256 players at this year’s NFL entry draft were multisport athletes in high school.

Smith observes, “So it goes back to the idea that if you’re trying to raise a professional athlete, then you should focus on raising an athlete.”

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

WESTTNMEDICAL NEWS.COM SEPTEMBER 2015

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GrandRounds Sutherland Cardiology Clinic Opens Clinic in Atoka ATOKA - Memphis-based Sutherland Cardiology Clinic is expanding its cardiology services to residents living in and around Atoka. The new satellite office, located at 76 Capital Way, Suite B, in Atoka is open every other Monday.

Bill Breen, senior vice president of physician alignment for Methodist Healthcare said the new clinic in Atoka gives them the opportunity to extend their clinical expertise to many more patients who can benefit from high-quality care, with the additional benefit of being close to home.

Cardiologist Dr. James Stamper will lead the clinic in Atoka.

James Stamper, M.D. graduated from Vanderbilt University with a Bachelor of Science degree. He earned his medical degree from Baylor College of Medicine and completed his resiDr. James dency and cardiology felStamper lowship at the University of Alabama at Birmingham. He is board certified in internal medicine and cardiovascular disease.

New Administrator for NHC Homecare in Milan MILAN - Matt Curtis has recently been named administrator of NHC Homecare in Milan. He has worked in homecare for 7 years in both West and Middle Tennessee and has his bachelor’s degree in Health and Human Performance from The UniverMatt Curtis sity of Tennessee at Martin

and his Master’s degree in Healthcare Administration from Bethel University.

West Tennessee Healthcare to Invest $10 Million For Employee Compensation JACKSON - West Tennessee Healthcare is excited to announce an investment of $10 million dollars toward employee compensation. The funds represent $2.5 million dollars from the 2015 fiscal year operating budget as well as $7.5 million dollars from the 2016 fiscal year operating budget which was approved by the organization’s Board of Trustees on July 1, 2015.

The $7.5 million dollar investment will be distributed in several different methods. The organization and its board have committed to increasing the minimum pay for West Tennessee Healthcare employees to nine dollars per hour. Most full-time and part-time employees will be eligible to receive a merit based award.

The range for the merit award is zero to four percent. Market adjustments will also be made to specific positions based on market information, and organizational needs. These funds will be administered and distributed separately from the merit award, and their allocation will be based on an ongoing review process.

In addition to the compensation increases, it was announced there will not be an increase in employee premiums for health, dental and vision coverage in January of 2016.

Bobby Arnold, President and CEO of West Tennessee Healthcare says the investment comes after several challenging years. Arnold gives credit on the previous year’s success to the organization’s employees, physicians and volunteers.

At the Intersection, continued from page 8

drove parents who had children with autism to find another way to have their children identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law.

“That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than education systems to bridge the gap.”

According to the Autism Health Insurance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded,

state-regulated insurance plans must provide the benefits specified by law. While the specifics vary from state-to-state, each of the mandates requires insurers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of enacting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016.

Additionally, the federal government has recently told all states their Medicaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

Nurse Navigator Joins Lung Nodule Clinic at JacksonMadison County General Hospital JACKSON - West Tennessee Healthcare is pleased to announce Anne Washburn, RN, BSN as its Nurse Navigator in the Lung Nodule Clinic at JacksonMadison County General Hospital.

The newly established Lung Nodule Clinic is the Anne Washburn only comprehensive lung nodule program in the region. A lung, or pulmonary nodule, is a small round or oval shaped growth on the lung. The goal of the lung nodule clinic is to provide early diagnosis of lung nodules followed by expert care and treatment for patients.

In addition to the nurse navigator, the Lung Nodule Clinic will be staffed by pulmonary specialists, pulmonary medicine physicians, cardiothoracic surgeons and radiologists.

Anne Washburn is a graduate of Union University’s nursing school.

New School-to-Work Program Kicks Off at Jackson-Madison County General Hospital JACKSON - Jackson-Madison County General Hospital kicked off a new program, Project SEARCH, in June. Project SEARCH is a worldwide high school transition program that is a unique, businessled, one-year, school-to-work program that takes place entirely at the workplace.

Total workplace immersion facilitates a seamless combination of classroom instruction, career exploration, and relevant job-skills training through strategically designed internships. The program is a collaboration including Jackson-Madison County General Hospital as the host business, Jackson-Madison County School System (JMCSS), The STAR Center, and TN Vocational Rehabilitation.

Project SEARCH serves students with significant intellectual and developmental disabilities. Typically, these are students who are on an Individual Education Program (IEP) and in their last year of high school eligibility. Twelve students from JMCSS have been accepted for the inaugural year. They will rotate through three ten-week internships within different departments at the hospital.

The goal for each student participant is competitive employment. Melissa Whitaker, JMCSS Special Education teacher, will be on site for classroom instruction each day. In addition, the students will have two job-coaches who will assist in training and daily management.

For more information about the program, contact Katie Chandler at 731-6931400.

For More Info & Referrals For more information on autism and other programming by Educational Services of America, go online to esa-education.com. For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

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Be a Part of the Historic Inaugural Induction!

With a mission to honor men and women who have made significant and lasting contributions to the health care industry, The Tennessee Health Care Hall of Fame seeks to recognize and honor the pioneers and current leaders that have formed Tennessee’s health and health care community and encourage future generations of health care professionals. Don’t miss the induction of the first class, featuring these health care legends:

Thomas F. Frist, Sr., M.D. Co-Founder, HCA

Thomas F. Frist, Jr., M.D. Co-Founder, HCA

Ernest W. Goodpasture, M.D. Physician, Pathologist, Professor

Jack C. Massey Co-Founder, HCA

R. Clayton McWhorter Co-Founder, HealthTrust and Clayton Associates

David Satcher, M.D., Ph.D. Former U.S. Surgeon General

Mildred T. Stahlman, M.D. Pediatrician, Pathologist, Professor

Danny Thomas Founder, St. Jude Children’s Research Hospital

BELMONT UNIVERSITY  CURB EVENT CENTER  OCTOBER 12, 2015 10:30–11:30 a.m. Registration  11:30 a.m.–1 p.m. Lunch & Ceremony

Sponsorships and Individual Tickets available at tnhealthcarehall.com

The Tennessee Health Care Hall of Fame has been created by Belmont University and The McWhorter Society and is supported

by Founding Partner, The Nashville Health Care Council.

GRAND SPONSORS

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SEPTEMBER 2015

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Margie Hopper, Henderson, TN

Dr. Alice Cherqui, West TN Neurosciences

“When I rushed down my steps to go to church, I never dreamed that I would fall, break my neck, and require surgery. Dr. Cherqui believed that I would make it, and here I am!”

731-541-9490 / 700 West Forest Avenue, Jackson, TN 38301 / To learn more about Margie’s story, visit: www.wthneuro.org

Satellite locations in Paris and Dyersburg