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Physicians Are Thinking Earlier About Retirement But Many Are Unprepared, Financial Advisers Say National surveys indicate that in recent years physicians have begun to aspire to retire earlier due to increased government healthcare regulation, but some financial planners in the Mid-South believe physicians aren’t necessarily retiring sooner, but are inquiring earlier about retirement ... 5 New Interim Director at VA Memphis Puts Emphasis on Quality Employees When VA officials removed C. Diane Knight, MD, as director and CEO at the Memphis Veterans Affairs Medical Center in late February, they simultaneously announced that William Mills, director of the VA Medical Center in Altoona, Pennsylvania, would be interim director in Memphis  ... 9 December 2009 >> $5 ONLINE: MEMPHIS MEDICAL NEWS.COM PRINTED ON RECYCLED PAPER April 2016 >> $5 BY JUDY OTTO Early this year, Acadia Healthcare moved forward with plans to begin operations this spring at the new Crestwyn Behavioral Health Center in Germantown by recruiting Missou- rian Phil Willcoxon to serve as CEO — a deci- sion that may prove to be apt on more levels than are immediately obvious. Holder of a bachelor’s degree in science, business and marketing from Kansas State and a master’s in hospital/healthcare administration from the University of Missouri, Willcoxon served the Freeman Health System in Joplin, Mo., for 22 years. His service included duty as the hospital’s CEO and, most recently, as CEO of its Ozark Center -- a community mental health organization that provides service to a four-state area (CONTINUED ON PAGE 14) Willcoxon Hopes to Find Best Recipe for Success at Crestwyn Psychologist Sees Increased Stress in Healthcare Helplessness Can Lead to Depression, Thoughts of Retiring BY JAMES DOWD For years, clinical psychologist Frank T. Masur, PhD, has noticed a growing number of medical pro- fessionals who are becoming burned out with their professions and suffering from various forms of de- pression. The trend is occurring nationwide, Masur has found, and it is affecting healthcare practitioners across multiple disciplines. Masur suggests medical professionals are sinking under the weight of increased federal regulations and guidelines, and this situation sometimes has stymied healthcare systems rather than improved them. “We don’t have managed care; we have man- gled care and managed cash,” said Masur, director of Health Psychology Associates in Memphis and founder of Excaliber Coaching. “I’m seeing more and more doctors and medical personnel who are spending too much time filling out forms and worry- ing about billing procedures than actually caring for (CONTINUED ON PAGE 10) PRST STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.318 Keep your finger on the pulse of Memphis’ healthcare industry. Available in print or on your tablet or smartphone www.MemphisMedicalNews.com SUBSCRIBE TODAY PAGE 3 PHYSICIAN SPOTLIGHT William Mihalko, MD, PhD ON ROUNDS FOCUS TOPICS BEHAVIORAL HEALTH FINANCIAL PLANNING ORTHOPEDICS HealthcareLeader

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Page 1: Memphis Medical News April 2016

Physicians Are Thinking Earlier About RetirementBut Many Are Unprepared, Financial Advisers Say National surveys indicate that in recent years physicians have begun to aspire to retire earlier due to increased government healthcare regulation, but some fi nancial planners in the Mid-South believe physicians aren’t necessarily retiring sooner, but are inquiring earlier about retirement ... 5

New Interim Director at VA Memphis Puts Emphasis on Quality EmployeesWhen VA offi cials removed C. Diane Knight, MD, as director and CEO at the Memphis Veterans Affairs Medical Center in late February, they simultaneously announced that William Mills, director of the VA Medical Center in Altoona, Pennsylvania, would be interim director in Memphis  ... 9

December 2009 >> $5

ONLINE:MEMPHISMEDICALNEWS.COM

PRINTED ON RECYCLED PAPER

April 2016 >> $5

BY JUDY OTTO

Early this year, Acadia Healthcare moved forward with plans to begin operations this spring at the new Crestwyn Behavioral Health Center in Germantown by recruiting Missou-rian Phil Willcoxon to serve as CEO — a deci-sion that may prove to be apt on more levels than are immediately obvious.

Holder of a bachelor’s degree in science,

business and marketing from Kansas State and a master’s in hospital/healthcare administration from the University of Missouri, Willcoxon served the Freeman Health System in Joplin, Mo., for 22 years. His service included duty as the hospital’s CEO and, most recently, as CEO of its Ozark Center -- a community mental health organization that provides service to a four-state area

(CONTINUED ON PAGE 14)

Willcoxon Hopes to Find Best Recipe for Success at Crestwyn

Psychologist Sees Increased Stress in Healthcare Helplessness Can Lead to Depression, Thoughts of Retiring

BY JAMES DOWD

For years, clinical psychologist Frank T. Masur, PhD, has noticed a growing number of medical pro-fessionals who are becoming burned out with their professions and suffering from various forms of de-pression.

The trend is occurring nationwide, Masur has found, and it is affecting healthcare practitioners across multiple disciplines. Masur suggests medical professionals are sinking under the weight of increased federal regulations and guidelines, and this situation sometimes has stymied healthcare systems rather than improved them.

“We don’t have managed care; we have man-gled care and managed cash,” said Masur, director of Health Psychology Associates in Memphis and founder of Excaliber Coaching. “I’m seeing more and more doctors and medical personnel who are spending too much time fi lling out forms and worry-ing about billing procedures than actually caring for

(CONTINUED ON PAGE 10)

PRST STDU.S. POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.318

Keep your fi nger on the pulse ofMemphis’ healthcare industry.

Available in print or on your tablet or

smartphone

www.MemphisMedicalNews.com SUBSCRIBE TODAY

PAGE 3

PHYSICIANSPOTLIGHT

William Mihalko, MD, PhD

ON ROUNDS

FOCUS TOPICS BEHAVIORAL HEALTH • FINANCIAL PLANNING • ORTHOPEDICS

HealthcareLeader

Page 2: Memphis Medical News April 2016

2 > APRIL 2016 m e m p h i s m e d i c a l n e w s . c o m

WE’RE PROUD TO ANNOUNCE a new campus IN EAST MEMPHIS.

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Page 3: Memphis Medical News April 2016

m e m p h i s m e d i c a l n e w s . c o m APRIL 2016 > 3

Orthopedic Surgeon Utilizes Dual TalentsWilliam Mihalko Benefits from Medical and Engineering Training

BY RON COBB

It’s hard to put a label on William Mihalko, MD, PhD, at least one that’s not a mile long.

He’s an orthopedic sur-geon. He’s a teacher and a mentor. He’s a biomedical en-gineer. He’s a surgeon-scientist.

He is a Campbell Clinic or-thopedic surgeon who in 2012 was appointed the J.R. Hyde Chair of Excellence in Reha-bilitative Engineering at the University of Tennessee Health Science Center (UTHSC).

And it all was triggered by a torn ACL he suffered as a freshman at the University of Rochester, where he was ma-joring in engineering.

As a result of the injury, he said, “I participated in some gait lab studies through the football team that made me think about medical school. I fashioned my degree for bio-medical engineering so I could minor in biology and get my pre-med requirements as well.

“My senior year I was still not certain about medical school, so I ap-plied to grad schools that were affiliated with medical schools,” he said. “After my first semester at the Medical College of Virginia, I joined the orthopedic biome-chanics lab to do my master’s thesis and started going to orthopedic grand rounds.

“It was then that I realized this was my calling.”

To trace his interest in healthcare even farther back, the place to start is his mother, Jane, a nurse who he says was one of the influences that led him to medicine. Mihalko’s older sister, Rhonda, followed the path to healthcare as well and is now an office manager for a dental practice in western New York.

He grew up in Jamestown, New York, Sumter, South Carolina, and then Clar-ence, New York, a suburb of Buffalo. As a youngster he played all the major sports and enjoyed putting together model cars and planes. (“I still wish I had time to do this kind of hobby on a more serious level.”)

By grad school he knew he wanted to be an orthopedic surgeon.

“I obtained a biomedical engineering undergraduate degree and focused on bio-mechanics during my graduate degrees,” he said. “I studied the best fixation tech-niques to utilize for fractures about a total hip replacement stem for my master’s and the best tensioning techniques for ACL reconstruction grafts to normalize knee kinematics for my doctorate.

“There are less than 2 percent of or-thopedic surgeons who have a medical

scientist training program dual MD PhD, but the number of engineering students applying to medical school is on the rise.”

Having training in both engineering and medicine, Mihalko believes, gives him certain advantages.

“Most of orthopedic surgery involves reconstruction of the musculoskeletal sys-tem,” he said. “Many of these reconstruc-tive techniques involve the use of medical

devices and involve engineering principles to obtain the most sound methods to allow patients the best chance at a good out-come.

“Knowing the biomaterial properties and biomechanical attributes involved in the recon-structive procedures, I believe, allows me to be a better orthope-dic surgeon.”

Mihalko divides his time between clinical practice at the Memphis Veterans Administra-tion Hospital and in research and administering the joint graduate program in Biomedical Engineering at UTHSC. The doctor derives a great deal of sat-isfaction from treating veterans.

“As I tell them, they have served us, and now it’s my turn to serve them,” he said. “On the research front we have identified how people with tight hamstrings have impaired functional hip mechanics that may predispose them to early hip arthritis.

“We are working on a larger scale interventional study to see if we can improve their hip me-

chanics. We have also started a multi-center implant retrieval program that we are looking into genetic predilection to hip and knee implant failures.”

In 2014, the website Expertscape.com rated Mihalko as one of the top 50 world-wide experts in knee arthroplasty.

He has worked in the Northeast, South, Midwest and now the Mid-South, and he has been in Memphis since 2008.

He and his wife, Lori, a speech language pathologist, “like the diversity within the Memphis area, and the Southern charm.”

It was while he was at the University of Virginia that Dr. James Beaty and the Campbell Clinic recruited him to Mem-phis.

“Memphians may take it for granted,” Mihalko said, “but the Campbell Clinic is considered one of the top orthopedic pro-viders in the country, and I could not give up the chance to come to Memphis.”

Among the advances that the doctor finds most promising are in the total joint replacement field of orthopedic surgery.

“We’re focusing on patient modifi-able risk factors that can improve patient outcomes,” he said. “Patient-centered care pathways and improvements in pain man-agement are all being utilized to advance recovery times and decrease complications after total hip and knee replacement.”

In the future, Mihalko believes, “we will be able to do a biologic resurfacing of arthritic joints within the next 20 years.”

The doctor met his wife, Lori, while he was doing clinical rotations in medical school. They have five children: Robert, 18, a freshman at Georgia Tech study-ing chemical engineering; Rachel, 17, a junior at Harding Academy; Matthew, 16, a sophomore at Harding Academy; Michelle, 11, a sixth-grader at FACS, and Marcus, 8, a third-grader at FACS.

Mihalko’s hobbies, he says, are his wife and kids and being active members of Harvest Church.

“My free time is spent with them,” he said. “I like doing do-it-yourself projects around the house that might drive my wife a little crazy, but I find it relaxing.”

PhysicianSpotlight

Page 4: Memphis Medical News April 2016

4 > APRIL 2016 m e m p h i s m e d i c a l n e w s . c o m

Using Data to Deliver Care, Decode ComplexTreatment OptionsNew Platform Looks to Improve Outcomes, Decrease Costs

BY CINDY SANDERS

There are few areas of medicine as complex and compelling as delving into the intricacies of the human mind. The very uniqueness that creates individuality means there are rarely “one size fits all” solutions to multifaceted physical and be-havioral health issues.

However, the team behind a newly launched national company believes they have crafted a way to inform clinical deci-sions and improve outcomes on a highly individualized basis while simultaneously lowering costs. Faros Healthcare, LLC – a spinout of Centerstone Research In-stitute and Indiana University Research & Technology Corporation (IURTC) – has developed a clinical tool that com-bines advanced predictive analytics with a patent-pending artificial intelligence (AI) platform.

The need for more sophisticated means to effectively treat the whole per-son has become increasingly evident as the industry moves toward value-based healthcare. “Behavioral health, in general, is really exploding,” noted Tom Doub, PhD, CEO of Centerstone Research Institute, one of the nation’s largest not-for-profit providers of community-based behavioral health and addiction services. “The rest of healthcare is beginning to re-alize, based on data and their own prac-tice experience, that behavioral health is a very important part of achieving good health outcomes.”

When depression or other behavioral health conditions are layered on top of chronic diseases such as diabetes or heart disease, Doub continued, the cost to care for that patient is two to three times higher than if the patient was dealing solely with the physical condition. And studies over the last two decades have consistently shown an increased prevalence of depres-sive disorders or other psychiatric condi-tions in the presence of chronic illness.

“I think all of healthcare is really con-verging on not separating the body and the mind, and that goes along with the sci-ence,” Doub said of the rise in integrated care.

Jim Stefansic, PhD, a biomedical engineer who serves as president of Faros, said finding the optimal route to treat complex physical and behavioral issues is part of the company’s core mission. Casey Bennett, PhD, the company’s co-founder and chief scientific officer, invented the analytics tool while working with Doub at Centerst-

sone Research Institute as a data archi-tect and research fellow during graduate school at Indiana University’s School of Informatics and Computer Science.

“We wanted to see if we could essen-tially develop a smart algorithm,” Doub said. “It’s not just one decision you have to make in healthcare, it’s many decisions; and the better you make those series of decisions, the better the outcome for pa-tients.”

With data and demographics from more than 6,700 Centerstone patients with a clinical diagnosis of major clinical depression, of which between 65-70 per-cent also had a chronic physical co-mor-bid condition, Bennett and IU Assistant Professor Kris Hauser showed the efficacy of applying the augmented intelligence platform. Using 500 randomly selected patients for simulations, the team was able to utilize AI to improve outcomes by nearly 40 percent compared to baseline while simultaneously lowering the cost of care by about 50 percent. The results were published in Artificial Intelligence in Medicine in January 2013,

Stefansic explained Faros AI & Ana-lytics Platform, which is co-owned by Centerstone and IURTC, personalizes the approach to care through the use of ma-chine learning. Not only does the software make recommendations on the optimal course of treatment for complex condi-tions through data analytics from an initial set of parameters and markers, but it has the ability to learn over time and suggest adjustments to the protocol based on pa-tient outcomes or changes in parameters while also calculating treatment costs.

The cloud-based platform can update in real time to provide point-of-care noti-fications to providers, who can then fac-tor the new cost and outcomes data into the decision-making process to determine whether or not a treatment plan should be modified. Stefansic stressed it was equally critical that providers both feel confident in the results and be able to access the information as part of their natural work-flow.

“Moving both sides of the costs-of-care value equation is essential in trans-forming our healthcare system, and we’re incredibly excited to bring this power to providers,” Stefansic said of the platform that integrates with existing EHR and population health software.

“What’s great about our technology,” he continued, “is it’s perfectly suited to treat complex health conditions, and behavioral health fits right in that wheelhouse.” He added the technology is not limited to those with a behavioral

Dr. Jim Stefansic

(CONTINUED ON PAGE 12)

Page 5: Memphis Medical News April 2016

m e m p h i s m e d i c a l n e w s . c o m APRIL 2016 > 5

BY BETH SIMKANIN

National surveys indicate that in recent years physicians have begun to aspire to retire earlier due to increased government healthcare regulation, but some financial planners in the Mid-South believe physicians aren’t necessarily retir-ing sooner, but are inquiring earlier about retirement.

Additionally, financial experts say physicians today are faced with more challenges when making decisions con-cerning retirement, including saving and allocating enough money, factoring for long-term healthcare costs and deciding if they want to work part-time.

“It depends on the specialty, but I have seen more physicians frustrated with government regulation,” said Wil-liam Howard, president and certified financial planner with William Howard & Company Fi-nancial Advisors. “There is some dissatisfaction and unhappiness there that we didn’t see a de-cade ago.”

According to the lat-est survey by The Physicians Foundation, 39 percent of physicians indicated they would be accelerating their retirement plans due to changes in the healthcare system.

Although physicians may be dissat-isfied with mounting paperwork and the shift to electronic heath records, Howard said physicians are retiring around 65 or 70, which he said are the traditional ages for retirement.

“We are seeing physicians show an interest in planning for retirement ear-lier,” Howard said. “They are more knowledgeable and aware of the topic be-cause information is more accessible than it was 25 years ago. This is largely due to the media embracing the profession, and doctors discussing it with each other.”

Karen Kruse, president and certified financial planner with FTB Advisors, ad-visory services division, says the main concern for those seeking retire-ment is wondering if they have saved enough money to do so.

“We aren’t see-ing baby boomers re-tire early,” Kruse said. “Even though they may want to, most of the time, they aren’t pre-pared.”

Kruse says this is for a variety of rea-sons.

“We work with a lot of physicians and physician groups, and the most com-

mon issue we see is that many clients don’t properly allocate their investments,” Kruse said. “Either clients are too aggres-sive with their investments or they aren’t risk tolerant at all and will put money away in a money market fund or CDs, which don’t generate enough growth.”

In addition, Kruse says healthcare professionals need to maximize their tax-deferred investments such as a 401k or 403b, as well as look at other options that are advantageous such as an annuity, IRA or a 457 deferred compensation plan.

“Higher income earners have more options than the average person for saving money,” Kruse said. “It’s important to get with a certified financial planner who can help see where you are. There are other vehicles you can look at that are tax ef-ficient that you may not know about.”

Kruse says estate planning is crucial to retirement.

“Baby boomers are a unique group because they have aging parents who are still living and children who are still in college,” Kruse said. “It is important to prepare for these two groups when con-sidering retirement by creating a compre-hensive plan.”

Howard says physicians must allocate for more than just monthly expenses.

“It’s important when saving to ac-count for big life events, too, such as college, private school or a wedding,” Howard said.

According to Kruse, there is a poten-tial crisis for retirees because many are un-prepared for long-term healthcare costs, and as a result they don’t allocate enough for it.

“If a physician plans to retire early, they must have an accumulation of as-sets and plan for long-term healthcare,” said Bill Drennan, financial adviser with Northwestern Mutual. ”Healthcare costs have been growing at a rate of 7 percent, which is very high. Retirees are living lon-ger, sometimes 30 years after retirement, and they need to allocate enough for long-term health insurance needs.”

According to Howard, the biggest decision for physicians considering retire-ment isn’t just a financial one sometimes.

“For some physicians, deciding what they want to do outside of work can be hard,” Howard said. “Some are used to working in a vibrant practice and enjoy what they do. We encourage doctors to think about their hobbies. Some clients stay just as busy with their families and hobbies after retirement, and some want to work part-time.”

Howard says he encourages physi-cians to make a “trial run” to discover what a typical day of retirement might be like.

Physicians Are Thinking Earlier About RetirementBut Many Are Unprepared, Financial Advisers Say

William Howard

Karen Kruse

(CONTINUED ON PAGE 13)

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A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

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If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

A partnership of the highest clinical quality.We understand that pain management is not a stand-alone practice, but an integral piece of a holistic care program. That is why we have developed a referral-based practice from the start.

Our treatments include:

• Dorsal Root Blocks/Radio Frequency• Epidural Steroid Injections• Facet Injections/Medial Branch Nerve Blocks• Genicular Nerve Blocks/Radio-Frequency• Sacroiliac Joint Injections/Radio-Frequency• Sympathetic Nerve Blocks• Management of Medications• Medical Massage• Counseling Services

If you would like more information concerning referrals, please call us at 901.249.5905 or contact us via email at [email protected].

For Referring Healthcare Providers

Germantown Park8001 Centerview ParkwaySuite 215Memphis,TN 38018

Phone: 901.249.5905Fax: 901.249.5940

Corporate Office716 W. Brookhaven CircleMemphis, TN 38117

Phone: 901.844.1590Fax: 901.844.1592

To learn more, visit www.lifelincpain.com

Page 6: Memphis Medical News April 2016

6 > FEBRUARY 2016 m e m p h i s m e d i c a l n e w s . c o m

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Chris Trimble is on a mis-sion. A Dartmouth adjunct professor for the Master in Health Care Delivery Science and MBA programs, Trimble is well-known for his exper-tise on innovation inside es-tablished organizations. He’s traveled the world speaking to organizations ranging from healthcare systems to Fortune 500 companies that touch on healthcare, like General Elec-tric.

Trimble, co-author of the New York Times bestseller Beyond the Idea: How to Execute Innovation in any Organization (AAPL, 2013), and more recently his sixth book, How Physi-cians Can Fix Health Care: One Innovation at a Time (AAPL, 2015), spoke with Medical News about resource allocation, key steps to take, opportunities to seek, pitfalls to avoid, and why full-time transition teams are necessary.

Medical News: Taking a clue from your book, How Physicians Can Fix Health Care, what major aspects of healthcare need fi xing?

Trimble: So many. We focus on care redesign, chang-ing the care model, and inno-vation initiatives that take the form of small, but full-time teams that redesign care for a very particular patient population.

For senior executives in particular, innovation resources are being al-located in a way that overlooks a huge area of opportunity. And I’d like to describe that a little bit, because there’s

a pretty solid history of investment in qual-ity improvement work in healthcare systems. That’s all very good, but quality improvement work tends to constitute initiatives that can be squeezed into people’s slack time on the job, and also into their existing job descriptions.

On the other end of the spectrum,

we’re in-vesting in

h igh- tech innovations

– new cell phone apps

to improve health, new

wearable de-vices. It’s fun to

be on the cutting edge, but a whole

category is sort of in the middle. And

in the middle, we’re typically working with

common sense, very straightfor- ward ideas, like doing a better job of coordinating care, keep-ing high-risk patients healthy, or helping patients consider consequential medical decisions very carefully.

It’s best done beyond the reach of quality improvement programs and specif-ically by commissioning small but full-time teams of three or four people to improve care for a very particular patient popula-tion. That full-time piece is so critical.

Businesses are designed for on-going operations, not necessarily innovation, which exposes deep, fundamental confl icts between the two. Tell us about the complexities of originating and managing these teams inside established organiza-tions.

It’s diffi cult because those teams are inevitably going to experience confl ict with existing ways of doing business. And yet, to get anything done, they can’t really isolate themselves. They have to engage. There are always people involved in the initiative part-time with supporting roles so there must be a healthy relationship between those working on the initiative full-time and the supporting cast. It’s a delicate balance that’s tricky and counter-intuitive. The core of my latest book is a

step-by-step guide for physician leaders of these initiatives so they may avoid many mistakes their peers made in other orga-nizations.

Have you come across any sort of formula that gives a good ratio of number of people needed on a full-time team to the number of patients the organization has under its care?

Wouldn’t it be nice if there was such a guideline? But there’s not because it depends so heavily on the type of patient population. For example, what about chil-dren with complex medical conditions, their families and families’ needs? In that case, it was a full-time team of four that served 600 families.

On the other end of the spectrum, we have examples of initiatives to maximize the throughput and to maximize the pro-viders’ delivery of services. The best exam-ple is the high volume joint replacement center where the idea, again, is just the opposite: to spend as little time on each patient as possible in a way consistent with high quality.

Physicians seem to have been taken out of the equation for pro-viding input into these decisions. Tell me what you see as their place in innovating these teams and inno-vating an organization.

The physician’s role is so crucial. In the past, under fee-for-service, it’s been nearly impossible to do with a pitiful few exceptions where the incentives just hap-pen to work for a variety of quirky reasons. By and large, the fee-for-service stands in the way of the kind of work we’re discuss-ing.

The most powerful reason to feel opti-mistic about the future of healthcare in the United States is the steady transition to ac-countable care and value-based payments. There’s no going back. While physicians initially may be anxious about the fee-for-service transition to accountable care, they’ll fi nd it’s also extremely liberating. Once fully implemented under account-able care, fee-for-service payers won’t be telling physicians what they can and can-not do, how much time they may spend with each patient, or what they can and cannot bill for. Instead, payers are saying: send us the results. If they’re good and costs are low, we’ll reward you fi nancially. That’s the way it should be.

Are you encouraged by the num-ber of ACOs that have been growing the last few years?

Yes. In a couple of isolated cases, people have lost money by perhaps being a little bit too aggressive too quickly. But the overall trend seems very positive, and I’m very encouraged by the targets that CMS has set about the number of patients that will be under some sort of value-based payment by 2018. It bodes extremely well for U.S. healthcare.

At the Crossroad of Innovation & OperationsChris Trimble Discusses Solutions to a Broken Healthcare System

: So many. We focus on care redesign, chang-ing the care model, and inno-vation initiatives that take the

located in a way that overlooks a huge area of opportunity. And I’d like to

On the other end of the spectrum,

innovations – new cell

phone apps to improve

health, new wearable de-

vices. It’s fun to be on the cutting

edge, but a whole category is sort of

in the middle. And in the middle, we’re

typically working with common sense, very

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Sustainable Solutions for Long-Term CareBY CINDY SANDERS

Choices impacting where and how to age have never been more abundant. Technology and assistive care companies have made it easier to age in place. In-dependent, assisted, skilled nursing, and continuum of care facilities offer a broad spectrum of accommodations and ac-tivities to suit any taste and ability level. Memory care units make it possible for couples to stay in close proximity when one needs additional resources. And re-habilitation facilities allow individuals to return to a lower level of acuity after an interval of intensive therapy.

“The range of options is absolutely critical,” said Maribeth Bersani, chief op-erating officer for Argentum (formerly the Assisted Living Federation of America). “There is no one answer for everyone.”

Noting the senior housing industry has continued to grow and innovate, she pointed out, “Assisted living is now 25 years old so it’s already not the way the pioneers built it.” Bersani added with a laugh that quite a few of the original ice cream parlors and sundae socials have given way to stocked bars and happy hours. “As the resident changes, the com-munities will change, as well,” she said.

Despite the array of possibilities, she continued, families too often find them-selves with limited options in the face of urgent need.

“It is a need-driven business because people wait too long, and then the situ-ation is so critical that you almost don’t have the opportunity for choice,” Bersani said.

There are a number of factors im-pacting choice. One issue is supply and demand for services as people live longer. With the first of the baby boomers turning 70 this year, the need for long-term ser-vices and supports is only expected to rise.

According to the Administration on Aging, individuals 65 and older numbered 44.7 million in 2013 (the latest year for

which data is available). That figure repre-sents 14.1 percent of the U.S. population. By 2040, those 65 and older will represent 21.7 percent of the total U.S. population. By 2060, the projection is there will be about 98 million Americans, more than twice the number in 2013, who are clas-sified as seniors.

The range of options can also be overwhelming. “There is no one place you can direct people,” Bersani said, add-ing seniors really have to do some soul searching to think about what works best for them on both a physical and emotional

level. “It’s a very individual, personal deci-sion.”

Savings … or lack thereof … is per-haps the biggest factor impacting what options are truly viable. Bersani said baby boomers aren’t really saving for long-term needs. The Government Accountabil-ity Office released a report last year that showed Social Security provides most of the income for about half of the house-holds age 65 and older, and nearly one-third of households age 55 and older have no retirement savings at all. For those who do have some savings, the GAO report pegged the median amount at just over $100,000 for households with members aged 55-64.

Katie Smith Sloan, president and CEO of LeadingAge, pointed out that 12 to 18 months in a skilled nursing facility or as-sisted living community could completely erase that savings.

“We’re on a path that is completely un-sustainable and fairly irrational,” she said of the current system. “When (individuals) deplete their savings, they have to go on Medicaid so people are impoverishing themselves … and Medicaid was never meant to be the long-term care payer of last resort. People are drowning, and it is

Katie Smith Sloan

(CONTINUED ON PAGE 8)

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8 > APRIL 2016 m e m p h i s m e d i c a l n e w s . c o m

straining state budgets.”Finding a rational, equitable, af-

fordable way to pay for the services and supports people need is central to Lead-ingAge’s mission and public policy efforts. Sloan said LeadingAge supports a solution used to offset risk in many other aspects of life – insurance. “We believe long-term care is an insurable event,” she stated, adding her organization is pursuing uni-versal coverage. “It needs to be universal to create a big enough risk pool,” she con-tinued. “Insurance just doesn’t work when there’s not a big enough risk pool.”

Currently, Sloan noted, “There’s a very paltry long-term care insurance mar-ket – about 5 percent have coverage.”

Both Sloan and Bersani said their organizations were supportive of the CLASS Act (Community Living Assis-tance Services and Supports Act), which passed as part of the Affordable Care Act and created a voluntary and public long-term care insurance option for employees. However, it was deemed unworkable and was later repealed.

“We’re both working at the federal level to try to get some incentives for peo-ple to save,” Bersani said of Argentum and LeadingAge, among other groups charged with advocating on behalf of seniors.

Similarly, Sloan said her organiza-

tion and colleagues across the senior care spectrum are working to answer key ques-tions about the best way to put a broader insurance product in play so that it could be workable and sustainable. Issues to be addressed include:

How individuals pay for coverage,• When benefi ts kick in and what they

cover, and• How benefi ts are paid out on behalf

of those covered.“What I fi nd hopeful right now is that

we have really strong data to support the need for action that we didn’t have before, and I think there is a growing interest on part of policy makers,” said Sloan.

Bersani echoed the sentiment, noting, “We are seeing renewed interest in trying to help people plan. I’m very encouraged by that.”

Sloan noted, “Every lawmaker in this country has someone in their family who has accessed long-term services and sup-ports for a loved one so it’s an issue near and dear to people’s hearts.”

Saying CLASS might have been a bit ahead of its time, Sloan concluded, “We have a window of opportunity now that we didn’t have before. People are more aware of our aging population. Now we need some champions in Congress.”

How Providers Can Help

Maribeth Bersani, COO of Argentum (previously the Assisted Living Federation of America), said providers could play a valuable role in helping seniors consider their options … even if long-term care is still a long way down the road. In fact, thinking about what supports and services might be necessary at age 85 is much better done when an individual is still an active 65-year-old instead of when a precipitating event forces everyone’s hand.

Encourage patients to:• Talk about their wishes with their children and siblings so everyone is on

the same page. • Do research online about different types of communities, supports and

services but know that nothing takes the place of actually walking through the door to tour a facility.

• Attend the open houses, lectures and community events that are often offered by senior communities in the area to get a feel for the staff, amenities and costs.

Providers can also make the task easier by pointing patients and their families to national organizations and associations that work with seniors such as Argentum, LeadingAge, and the National Council on Aging. The National Care Planning Council offers a long list of useful links to these and other eldercare resources at longtermcarelink.net/frames/lm_associations.htm.

Sustainable Solutions for Long-Term Care, continued from page 7

Maribeth Bersani

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m e m p h i s m e d i c a l n e w s . c o m APRIL 2016 > 9

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BY PEGGY BURCH

When VA officials removed C. Diane Knight, MD, as director and CEO at the Memphis Veterans Affairs Medical Center in late February, they simultaneously an-nounced that William Mills, director of the VA Medical Center in Altoona, Pennsylvania, would be interim direc-tor in Memphis.

The announce-ment’s reason for the change was cryptic, cit-ing “underperformance” at the facility. John Patrick, director of the VA Midsouth Healthcare Network, said in a statement that Mills would work to “ensure veterans receive the qual-ity and timely care they deserve.”

The 65-year-old Mills is circling back to the site where he began his VA career as a recreation therapist 40 years ago after earning his master’s degree in education at then-Memphis State Uni-versity. An internship in 1974 led to the job at the Memphis VA hospital, where Mills worked with spinal cord injury and mental health patients. That led next to a human resources job at the VA Medical Center in Newington, Connecticut.

“That kind of started me down that journey in human resources for the next 25, 26 years,” he says, and HR positions in Kentucky, North Carolina, West Vir-ginia and Pittsburgh followed.

In October 1996, Mills was ap-pointed human resource officer for the VA Pittsburgh Healthcare System and after stints as associate director and in-terim director at Pennsylvania VA facili-ties – which “gave me some experience, as we say, sitting in the chair” – Mills was named director at the VA’s Altoona hos-pital, which has about 700 employees.

The Memphis medical center cur-rently has about 2,300 employees, in-cluding 512 registered nurses and 258 physicians. In the 2015 fiscal year, the facility served 68,700 veterans.

Knight was transferred to a job as primary care service line chairperson in the Veterans Integrated Service Network 9 in Nashville. She had been director of the Memphis facility since July 2013 after stepping in as interim director in Septem-ber 2012. There had been three deaths of patients who sought treatment at the Memphis VA’s emergency room in 2012, and an Inspector General’s report in 2013

described the causes. In one case, drugs were not ordered

through an electronic health record that would have alerted the staff to a patient’s aspirin allergy; in another case, a heav-

ily medicated patient stopped breathing with-out being noticed; the third case involved short-comings in treatment of a patient’s extreme high blood pressure.

While Mills has full authority as an interim director, it’s not a per-manent assignment. In-terim directors in the VA system serve in 120-day increments not to exceed a year.

“If I were to be con-sidered to be director here, I would probably have to apply with every-

body else,” he said. “Myself and my boss (Patrick) are not at that point yet.” Mills, who grew up in Jacksonville, Florida, and earned his bachelor’s degree from Univer-sity of Florida, said his wife, a Memphis native, did not leave her job in Pennsyl-vania to move with him for the temporary appointment.

After his first two weeks on the job, Mills said employee satisfaction was a key concern for him, perhaps not a surpris-ing focus given his background. “The research shows that employee satisfaction correlates with patient satisfaction,” he said.

The turnover rate among registered nurses at the Memphis VA hospital wor-ries Mills. “From the indications I got, it might be a little higher than the national average is. I’d like to get into the reasons why and maybe do more exit interviews when people are leaving.”

He also hopes to streamline the hir-ing process by reducing the number of days between a “committed offer” and the day an employee begins work. “We have a lot of vacancies, and it’s disruptive. We need to get as many vacancies as we can filled in a timely manner,” he said.

Veterans’ access to care “is the No. 1 priority” for VA facilities across the country, Mills said, and medical record backlogs and appointment delays have inspired complaints and criticism nation-ally.

“I’m still waiting on the most recent numbers to come out, but there’s not that much of a backlog (in Memphis),” Mills said. “It’s very manageable, I guess, is the word I want to use.”

New Interim Director at VA Memphis Puts Emphasis on Quality Employees

“We have a lot of vacancies, and it’s disruptive. We need to get as many vacancies as we can filled in a timely manner.”

– William Mills

(CONTINUED ON PAGE 14)

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10 > APRIL 2016 m e m p h i s m e d i c a l n e w s . c o m

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patients, which is what drew them to the healthcare profession in the first place.”

Masur will address stress and de-pression among healthcare profession-als and discuss coping mechanisms during the upcoming Spring Up-date conference at Saint Francis Hospital. His workshop entitled PDR: Psychologically Designed Resiliency will focus on helping health care pro-viders strengthen their personal resiliency by increasing optimism, fostering social connectedness, and learning cognitive-be-

havioral techniques to manage the strain that is the result of stressors.

“Research conducted by the Uni-versity of Pennsylvania shows that when there is a constant irritant that is neither predictable nor controllable, a condition that is known as learned helplessness oc-curs,” Masur said. “These are situations that can’t be escaped or avoided and al-most always lead to depression and de-spondency, and I’m seeing it happen in medicine today, from physicians to nurse practitioners to nurses.”

One factor in growing levels of frus-tration among physicians and medical workers is the decreasing amount of time

available to diagnose and treat patients. To make up for losses in income due to some insurance providers refusing to pay claims and rising costs of maintaining practices, physicians are increasingly forced to see larger volumes of patients in shorter amounts of time.

The result is diminished patient care and increased pressure on medical profes-sionals to see patients for profit.

“I see more and more doctors going to a VIP practice where they treat a limited number of patients, but that’s not an option for most,” Masur said. “We’re losing some really talented physicians because some of them who could practice 10 or 15 more

years or longer are instead opting to retire and get away from all the frustration.”

And just as mental health professionals are seeing increased depression and frustra-tion levels among medical workers, the lev-els of patients suffering from depression are also rising.

Roland Gray, MD, medical director of the Tennessee Medical Foundation’s Phy-sician’s Health Program in Nashville, said that in the last decade the number of vic-tims of fatal drug overdoses has exceeded that of those who die in car accidents across the state. And increasing numbers of babies are born to mothers who are addicted to prescrip-tion narcotics.

“There has been a tendency to overprescribe opiates for a variety of be-havioral health problems, and this can lead to seri-ous drug problems,” Gray said. “In some areas you can buy heroin cheaper than a pack of cigarettes, and once the users are hooked that creates a terrible burden on our communities and law enforcement agencies and healthcare systems to try to treat these people.”

Gray will discuss prescription guide-lines for pain management at the Saint Francis conference, which runs May 4-6. Also at the event will be David Bienenfeld, MD, attending physician at Summit Be-havioral Health in Cincinnati.

Bienenfeld will discuss depression in primary care, which affects up to 10 per-cent of patients in the U.S.

“We have got to get a better handle on depression and its costs, both directly and indirectly,” Bienenfeld said. “For every dollar spent on direct care to treat depression, there may be $6 or $7 in in-direct costs associated with the condition due to patients missing work and suffering from other medical conditions. Depressed patients tend to get sick more and recover more slowly than patients who are not suf-fering from depression.”

The relationship between mental health and physical health is being studied by the U.S. Senate, with lawmakers dealing with a bipartisan effort to address the issue. The Health Reform Act of 2016, which the Senate is set to vote on this spring, is being promoted by Tennessee’s Republican Sen. Lamar Alexander, chairman of the Senate committee on healthcare, and Sen. Patty Murray, a Democrat from Washington.

The legislation aims to increase men-tal healthcare across the country and provide more training for healthcare pro-fessionals.

And that’s a step in the right direction for Masur and his colleagues.

“One out of four adults will suffer from depression in his or her lifetime, and even more will suffer from depression as a secondary diagnosis,” Masur said. “There is a significant relationship between men-tal illness and physical illness, and we have to do more to treat these conditions. Doc-tors, employers, insurance providers and patients themselves have to gain a better understanding of this relationship and work together to gain more effective and affordable treatment.”

Psychologist Sees Increased Stress in Healthcare, continued from page 1

Dr. Frank T. Masur

Dr. Roland Gray

Page 11: Memphis Medical News April 2016

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The most frequent cause of chronic hip pain is arthritis. Hip arthritis can be treated with medication, physical therapy and other conservative methods to help relieve pain. But for patients who are still in pain despite conservative treatment, total hip replacement may be recommended. Total hip replacement helps relieve pain and may allow patients to perform some activities that were previously limited. Historically, doctors had advised patients to put off hip replacement operations as long as possible due to limited life expectancy of the prostheses. However, Americans rising expectations of quality of life have meant having surgery sooner. Fewer people are willing to tolerate years of pain or limited activity. And with newer, more advanced technology and longer lasting prostheses, getting a hip replacement at a younger age is an option. Each patient is different and has different needs, so surgical approaches are chosen with those needs in mind. However, the direct anterior approach (from the front) for hip replacement is gaining in popularity. For the patient, there is reduced tissue trauma and less muscle damage, because an interval between the muscles is used—the muscles actually spread apart. So, unlike other hip surgical approaches, there is no detachment or cutting of the muscles during surgery. The hip has more normal mechanics because you have not disrupted muscle connections, and the patient can have a more normal gait (walk). There is usually a smaller incision and less scarring, less usage of pain medication, a quicker return to function, reduced physical therapy requirements and a reduced dislocation rate.

Benefits of this approach to surgery include: potentially an easier recovery since the muscles have not been cut, allowing the patient to get a head start with physical therapy; lying on the back instead of the side; using X-rays during surgery to ensure proper alignment of the prostheses; better equalization of leg length during the procedure; decreased chance of dislocation. The standard risks for a hip replacement regardless of

the type of procedure are: bleeding, infection, scar tissue, dislocation, blood clots, and weakness. With anterior hip replacement, one risk factor is lessened—the chance of sciatic nerve damage. The surgeon is not near the sciatic nerve since it is located on the back side of the hip joint. I tell my patients that it is not wrong to do the surgery one way or the other. This is just another technique to use. Physicians are taking extra courses and visiting other physicians to learn the

direct anterior approach. This technically difficult procedure has gotten easier due to new technology and modifications in hip replacement tools. Refinements in implants lend themselves better to placement from the direct anterior approach. All of these modifications mean a less invasive procedure for the patient. Discover more about relief options for chronic hip pain at:www.orthomemphis.com.

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BY CINDY SANDERS

It’s a fine line to walk … managing patients’ physical pain without exposing them to the pain of addiction. Making the balancing act even more difficult is the in-ability to tell which patients will use medi-cations only as directed and which ones will escalate, sometimes very quickly, to drug abuse.

The face of drug addiction in Ten-nessee and across the country has rapidly changed with images of the strung out, di-sheveled junkie being replaced by pictures of the quintessential soccer mom, estab-lished corporate executive or bright young college student.

Recent assessments by the U.S. Drug Enforcement Agency and others have found drug overdose deaths, driven largely by overdose from prescription opi-oids and heroin, have surpassed motor vehicle accidents and firearms as the lead-ing cause of injury death in America. The report found 46,471 people died of drug overdoses in 2013 compared to 35,369 killed in car accidents and 33,636 killed by firearms.

The Federal ResponseIn February, the U.S. Food & Drug

Administration called for a sweeping re-view of agency opioid policies in the face of a national epidemic. FDA Commis-sioner Robert Califf, MD, MACC, said the agency would take a number of steps to reassess its approach to opioid medica-tions including convening an expert advi-sory committee before approving any new drug application that does not have abuse-deterrent properties. Additionally, he said the agency would improve access to nalox-one and support better pain management options, including alternative treatments. In March, Califf announced the FDA would require new overdose warnings for all immediate-release opioids.

On March 15, the Centers for Dis-ease Control and Prevention released new guidelines for prescribing opioids for chronic pain for patients 18 and older in the primary care setting. The guideline recommendations are specific to chronic pain outside of active cancer treatment, palliative and end-of-life care. In making the recommendations, the CDC noted healthcare providers wrote 259 million prescriptions for opioids in 2012, which is enough for every American adult to have a bottle of pain medication.

“More than 40 Americans die each day from prescription opioid overdoses; we must act now,” said CDC Director Tom Frieden, MD, MPH. “Overprescribing opioids — largely for chronic pain — is a key driver of America’s drug-over-dose epidemic,” he continued, adding the guidelines will help physicians and

patients make informed decisions about treatment.

In a teleconference announcing the guidelines, Frieden said the risks of using opioids far outweighs the benefits for most patients and noted safer alterna-tives exist.

The 12 recommendations focused on three areas of consideration: deter-mining when to initiate or continue opi-oid treatment; selecting, dosing, duration

and discontinuation of a treatment plan; and assessing the risk and addressing the harms of opioid use.

Key points include recognizing non-pharmacologic therapy and non-opioid therapy as preferred for chronic pain, establishing treatment goals with patients including realistic goals for pain and func-tion, considering how opioid therapy will be discontinued if benefits do not outweigh risk, and engaging in ongoing discussions

about the known risks and realistic ben-efits of opioid therapy.

When starting opioid therapy, the recommendations call for prescribing at the lowest effective dosage, avoiding in-creasing dosage to ≥ 90 MME/day or carefully justifying that decision, prescrib-ing for three days or less for acute pain and rarely more than seven days, evaluat-ing benefits vs. harms within one to four

Prescription for Disaster?The Rise of Opioid Addiction in Tennessee & the U.S.

Dr. Tom Frieden

(CONTINUED ON PAGE 12)

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12 > APRIL 2016 m e m p h i s m e d i c a l n e w s . c o m

Top Three Health Law Issues Of 2016by Denise Burke

With the flurry of healthcare changes, it is difficult to pick the top issues for 2016, but alternative payment methodologies, cybersecurity and increasing fraud and abuse focus on individuals are at the top of the list and are receiving a lot of at-tention so far in 2016.

1. Alternative Payment Models will explode on the scene: The Department of Health and Human Services (HHS) has announced that it will move 50% of traditional Medicare payments to alternative payment models (such as accountable care organizations or bundled payments) by 2018. Large commercial insurance carriers are also moving away from fee-for-service pay-ments. TennCare plans to implement 75 bundled payment episodes by 2019. Late last year, the Centers for Medicare and Medicaid Services (CMS) issued the first mandatory bundled payment program for lower joint replacements, the Comprehensive Care for Joint Replacement(“CJR”) model. The program goes live April 1, 2016 for 67 Metropolitan Statistical Areas, including Memphis. CJR retrospectively bundles acute, post-acute and physician services for Medicare patients having lower extremity joint replacements. All providers are paid in the traditional manner during the episode of care, with retroactive reconciliation. If CMS’ total cost for the bundled services is below the target price (historical cost minus 2%), CMS will make an additional payment to the hospital. The hospital, in turn, may share part of the payment with other collaborators in the bundle. Beginning in 2017, hospitals may have to return payments to CMS if the total spend exceeds the target, and may, in turn, collect up to 50% of the payment from the collaborators. Hospitals, physicians and post-acute providers will need to engage in complex care redesign and monitoring efforts and enter into detailed agreements to comply with the CJR requirements and fraud and abuse laws. It is a near certainty that most providers will be forced into risk-based pay-ment methodologies, and those who embrace the change and gain early experi-ence will be in a better position to thrive in the new environment.

2. Cyber attacks on healthcare entities will increase: Cyber at-tacks are a growing threat to healthcare entities due to the value of the data on the black market. Such attacks can give rise to civil and criminal penalties, law-suits and reputational damage. The Health Insurance Portability and Account-ability Act (HIPAA) Security Rule requires covered entities and business associ-ates to implement appropriate safeguards to ensure the security of electronic protected health information. It also requires entities to perform a risk assess-ment of potential risks and vulnerabilities to electronic protected health infor-mation (ePHI). Phase I HIPAA Audits revealed that two-thirds of entities had not conducted a valid risk assessment. It is anticipated that Phase II HIPAA Audits will penalize entities that have not appropriately completed the required risk as-sessment. Healthcare entities should ensure they have performed the required risk assessment, implement cybersecurity programs to prevent and respond to cyber attacks and consider insur-ance to protect against losses due to cyber attacks.

3. Fraud and abuse enforcement will focus on individuals: On September 9, 2015, Deputy Attorney General Sally Yates issued new guidelines in a memoran-dum entitled “Individual Accountability for Corporate Wrongdoing” which instructed her subordinates that one of the most effective ways to combat corporate miscon-duct is by seeking accountability from the individuals who perpetuated the wrongdoing. The guidelines require civil and criminal prosecutors to focus on individuals, not just corporations, from the inception of an investigation and prohibit including the release of liability in corporate settlements absent extraordinary circumstances. To be eligible for any cooperation credit during an investiga-tion, the new guidelines require corporations to provide information about the individuals who were involved in the misconduct, which may put corporations and their employees at odds during investigations and require individuals to be represented by separate counsel.

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weeks of starting opioids or escalating dosage, and continuing to evaluate every three months or more frequently.

To assess risk, the CDC calls for cli-nicians to review the patient’s history of controlled substance prescriptions and to check state databases before and during opioid therapy, to use urine drug testing before staring opioid therapy and consider using urine drug testing at least annually, to avoid prescribing pain medication and benzodiazepines concurrently whenever possible, and to offer or arrange for ev-idence-based treatment for patients with opioid use disorder.

Go online to NashvilleMedicalNews.com for links to the FDA announcement, CDC guideline recommendations, and CDC prescribing checklist.

The Problem in TennesseeIn February, the Tennessee Depart-

ment of Mental Health & Substance Abuse Services (TDMHSAS) reported the state has seen a steady decline in pre-scription opioid drugs seizures according to data from the Tennessee Bureau of In-vestigation.

In 2012, there were 6,988 opioid seizures compared to 4,696 in 2014. The drop coincides with the launch of Tennes-see’s Prescription for Success initiative. However, the law of unintended conse-quences might be in play as the state is seeing an increased appetite for heroin and painkiller replacement medication buprenorphine, which is now widely pre-scribed to ease opioid withdrawal symp-toms and cravings.

“It’s troubling to see these ‘so called’ painkiller replacement therapies dis-pensed by unlicensed clinics getting pa-tients hooked and dependent on another drug, just as they were to prescription pain pills,” said TDMHSAS Commis-sioner Douglas Varney. “Our statewide, multi-agency Prescription for Success strategy did an excellent job of reducing demand for prescription pain opioid medications, but once again I’m very concerned about what’s emerging in our state.”

There were 82 heroin seizures by the TBI in 2009, rising to 341 in 2014. Similarly, the 437 buprenorphine seizures in 2009 had increased to 1,085 by 2014. While approximately half of Tennessee counties had buprenorphine seizures in 2011-2012, that number rose to nearly 70 percent of counties in 2014-15.

“There were very few heroin seizures by law enforcement in 2011 and 2012,” said Varney. “By 2015, seizures were oc-curring routinely in Tennessee’s larger cities and surrounding counties.”

While the numbers of opioid seizures were down, information released late last year from TDMHSAS showed prescrip-tion pain medicine remained the reigning ‘drug of choice’ across most age groups and illustrates the gap between seizures of illegally held opioids and the potential abuse of legally held prescribed drugs.

Reviewing two decades of state-funded substance abuse treatment ad-mission data (1992-2012), the research highlighted a trend of prescription drug use across multiple age groups. “Prescrip-tion drug use increased among all the age groups we looked at and jumped signifi-cantly among those in their 20s and 30s,” said Varney.

Based on the data, 59 percent of those aged 21-24 listed prescription drugs as their primary substance of abuse, and 49 percent of those aged 30-34 said the same. While alcohol remains the sub-stance of primary abuse among those 50-54, the number citing prescription drug abuse was also on the rise.

“It’s very clear the addiction to prescription drugs continues to ravage Tennesseans of all ages with the great-est impact occurring among our young people in communities across the state,” said Varney. “We will continue to focus on strategies to reduce the supply and easy availability of prescription pain medicines, in cooperation with law enforcement and other Tennessee agencies. Additionally, we will ensure all Tennesseans have the opportunity to seek treatment and recov-ery for their addictions.”

health diagnosis but also could be deployed for patients with any number of variables and co-morbid conditions that might complicate a treatment plan.

Stefansic noted there are ‘big tent’ considerations when treating for a set of conditions. However, he continued, when you drill down into the patient population under that big tent, there are many variables. For example, he said, a 65-year-old, widowed diabetic who lives alone in the country probably faces differ-ent challenges … and potentially different outcomes … than a 45-year-old diabetic mother of two in the inner city.

Doub likened the additional layer of machine learning on top of the predictive analytics component to the refinements over time in way-finding technology. “It’s like Waze vs. MapQuest,” he explained. “A decade ago, MapQuest told us the straightest route between two points, but it didn’t allow for variables like road clo-sures or a traffic accident.” Similarly, he continued, both of the women in Stefan-sic’s example were trying to arrive at the same destination of optimal health, but their journeys would likely look different so the most effective approach to treating them might also vary.

Stefansic added, “We trust the clini-cian knows how to get from point A to point B, but sometimes you still use your GPS because you don’t know what the conditions will be like. We just want to give them more tools.”

Prescription for Disaster? continued from page 11

Douglas Varney

Using Data to Deliver Care, continued from page 4

Page 13: Memphis Medical News April 2016

m e m p h i s m e d i c a l n e w s . c o m APRIL 2016 > 13

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Senate Health Committee Introduces Plan to Address Mental Health Crisis in America

Last month, a bipartisan group of U.S. Senate Health, Education, Labor & Pensions (HELP) Committee members, including Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.), announced their plan to address the country’s mental health cri-sis and ensure Americans suffering from mental illness and substance abuse disor-ders receive the care they need.

The senators said the bipartisan draft legislation of the Mental Health Reform Act of 2016 works to bring the nation’s behavioral healthcare system into the 21st century by embracing mental health re-search and innovation, giving states flex-

ibility to meet the needs of those suffering, and improving access to care.

“One in five adults in this country suffers from a mental illness, and nearly 60 percent aren’t receiving the treatment they need,” said Chairman Alexander. “This bill will help address this crisis by ensuring our federal programs and policies incorporate proven, scientific approaches to improve care for patients. States like Tennessee and local governments are on the forefront in treating mental illness and substance abuse, and this legislation will support their efforts so people can get the help they need.”

Ranking Member Murray added, “I hear far too often from families in my home state of Washington and across the country about loved ones who are unable to get mental healthcare they desperately need, with tragic consequences.” She continued, “Our mental health system has been broken for far too long, and I’m pleased that Democrats and Republicans were able to break through the gridlock and agree on policies to help deliver qual-ity, integrated care to our neighbors, friends, and loved ones who struggle with mental illness.”

Sen. Chris Murphy (D-Conn.) said the current system fails those who need it most and noted that individuals strug-gling with mental illness could go years without receiving treatment. “Too many

Americans with serious mental illness slip through the cracks, and Congress must act to stop it,” Murphy stated.

The bill’s sponsor Sen. Bill Cassidy, MD, (R-La.) concurred, calling the system ‘broken.’ However, the physician said the Mental Health Reform Act of 2016 is a step toward beginning to fix the issues plaguing the system. Cassidy added, “We have all seen a promising life destroyed by untreated mental illness – destroying not just the person, but also their family. By focusing and making resources avail-able for patients and families, we can help

restore mental health to the emotionally broken. I thank Senators Murphy, Alex-ander and Murray for joining me in this priority.”

The bipartisan group introduced ad-ditional measures to the full HELP Com-mittee on March 16 to further strengthen access to quality mental care as part of a manager’s amendment. At that time, the HELP Committee also began looking at legislation to tackle the nation’s opioid epidemic by addressing treatment, pre-vention and other efforts to fight opioid addiction and abuse.

Key Points of the Mental Health Reform Act of 2016

Ensure mental health programs are effectively serving those with mental illness: The bill will improve coordination between federal agencies and departments that provide services for individuals with mental illness and will improve accountability and evaluations of mental health programs.

Help states meet the needs of those suffering from mental illness: This bill helps ensure federal dollars support states in providing quality mental healthcare for individuals suffering from mental illness by updating the block grant for states.

Promotes the use of evidence-based approaches, promising best practices in behavioral healthcare: The bill requires the federal agencies and programs involved in mental health policy incorporate the most up-to-date approaches for treating mental illness and requires agency leadership include mental health professionals who have practical experience. 

Increase access to mental healthcare: The bill increases access to care for individuals including veterans, homeless individuals, women, and children. It also helps improve the training for those who care for those with mental illnesses and promotes better enforcement of existing mental health parity laws.

“Sometimes a client may not be sure what they want to do after retirement,” Howard said. “We tell them try four days without being on call and see if they like that and go from there.”

Drennan says the biggest challenge for financial planners is that most people procrastinate planning retirement.

“It’s important to start planning at least 10 years from when you plan to retire,” Kruse said. “The earlier the better. We see many people put it off. It’s easier to make adjustments in your saving and spending

habits 10 years out than two years out.”Howard says the key to retirement is

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“A good time to start planning is out of residency,” Howard said. “Get back to basics and maximize your retirement plan, develop habits to save money and spend less than you make. It takes hard work and discipline, but the reward pays off.”

Physicians Are Thinking Earlier About Retirement, continued from page 5

Page 14: Memphis Medical News April 2016

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with more than 450,000 residents. As a student, Willcoxon had begun his training at ground level, with a summer job as an OR orderly at the medical center where his father, a surgeon, was on staff.

While such credentials are valuable assets for the CEO job, Willcoxon may also have a secret weapon that gives him an edge. In his free time, he loves to cook — and learned his skills as a child from a grandmother who cooked by instinct, using a dash of this and a pinch of that. So perhaps his proven ability to build suc-cessful teams that perform seamlessly and productively together relies in part on that instinct acquired as a child — to select the right ingredients and blend them cre-atively to achieve impressive results.

“(At Crestwyn) we’re starting from scratch,” Willcoxon said. “We have to hire all new people and develop those relation-ships. That’s been a challenge, but it’s also what drives me. I love to build relation-ships — build a team around a common mission.”

The Crestwyn project, a 60-bed, 61,000-square-foot psychiatric hospital, is near completion. The unique collabo-ration between Nashville-based Acadia Healthcare and Saint Francis Hospital, Baptist Memorial Health Care and Delta Medical Center offered Willcoxon an ex-citing chance to bring together his choice of ingredients for a successful venture.

“What really appealed to me about this opportunity is that it is a brand-new

hospital, in the final stage of construction, so it would be my responsibility to build the team, to hire, train and develop all that. I felt it was a way to put my culture and my legacy into this brand-new effort.

“Dealing and talking with the (Crest-wyn) board members and representatives from Baptist and Saint Francis, it was obvious that all three of us came into this partnership fully aligned and on the same page, with Acadia managing day-to-day operations at Crestwyn.”

Willcoxon reported recently that con-struction was nearly complete, with some furniture already in the building. Antici-pated April 1 occupancy would allow time for tech installation, staffing and shake-down before the first patients arrived.

“We still have to train and hire staff and get all the IT systems, computers, forms and such in place,” he said. “But we’d like to start seeing patients in May or June.”

His introduction to the behavioral health area was largely trial by fire: Free-man Health System’s CEO offered him the CEO job at Ozark Center, which is “quite large by mental health standards,” said Willcoxon, who had initial misgivings about the post due to his lack of experi-ence in the mental health arena.

He accepted the job and nine months later got “a real eye-opener” when the 2011 tornado hit Joplin. “We lost half of our 20 locations in the community over-night, so it was a very quick learning curve

on how to treat people’s trauma, mental illness and anxieties. It was unfortunate, but really a great time to learn and grow in the behavioral health area.”

He gleaned valuable lessons concern-ing “the toll it takes on people physically when they have emotional trauma in their lives. Behavioral health people learned long ago that you’ve got to treat the emo-tional needs of patients. We tend to forget that on the traditional medical-service side — and treat only the illness.

“The (Joplin) community was expe-riencing tremendous stress, turmoil and exhaustion; the number of patients we treated for suicide tendencies or stress, de-spair, depression, anxiety and PTSD, was a big issue. We were gearing up for the better part of a year before we really dealt with the onslaught of people in need of medical behavioral health attention. This cycle of how it affects the human body is one major lesson I took from the experi-ence.”

Willcoxon’s plans for Crestwyn in-clude developing relationships with all classes and all payors, and relying on a corporate structure that promises ample resources for continued growth. The facil-

ity’s strengths will transcend technology, Willcoxon said. “What we offer is the pas-sion and the caring and the understanding of how to deal with people who are suffer-ing from mental health issues.”

He views his management style as servant-leader — one who supports, coaches, mentors and makes sure people have the tools, resources and talent to do their job. “When a doctor or caregiver lays hands on a patient, that point of inter-action has to be 100 percent perfect. My job is to make sure they have staff in place to do that — the facilities, the equipment, the technology. That philosophy has done very well for me in my career.”

He points with professional pride to his belief that he has always left an orga-nization or a role better than he found it, whether financially or in terms of patient or staff satisfaction.

In his leisure time, Willcoxon enjoys spending time with his wife of 25 years and his two children, both students at Ole Miss.

(And if you’re interested in Will-coxon’s ability to cook on a more visceral level, just ask about his famous scratch cinnamon rolls!)

He said he hopes to improve the medical center’s “flow process” for consults, the documents required to set up appointments. “In other words, are we creating additional work for our providers? Are we adding extra steps to the process before we can open and close a consult?”

During a National Stand Down Day on February 27, Mills said, a concentrated effort cleared about 2,000 consults at the Memphis facility. “We probably had close to 60 people in here that Saturday just doing nothing but addressing open con-sults. . . . A lot of times the close-out is strictly a matter of getting a final signa-ture, a co-sign signature, on a document, but it’s hanging out there. So we cleaned up close to 2,000 consults that one day. That helped clean up the backlog.”

(The number did not simply repre-sent 2,000 patients waiting for appoint-ments, he noted, but closing consults allows the facility to address new appoint-ments in a more efficient manner.)

The Memphis VA Medical Center plans to lease space soon to move its pri-mary care operation out of the center’s main building.

“Space is one of my highest areas of concern,” Mills said, “so we’re moving primary care off the main campus and we’ll reposition all that square footage into other means.” He did not identify the new location: “We’ll put out a press re-lease in the near future. We’re still having to work out the details, and we’re several months away from doing that.”

Meanwhile, construction continues on an emergency department renovation and expansion on the east side of the cam-pus on Jefferson east of Dunlap.

In late March, the Memphis center

was still waiting on a final report following a Joint Commission visit. The year after Mills took over as director at the Altoona VA Medical Center, the Joint Commis-sion named Altoona one of the VA sys-tem’s 32 “top performers.”

In his first two weeks in Memphis, Mills held “town hall meetings” for all employees and for managers and supervi-sors, in which he “laid out my expecta-tions.”

“It’s easy to say that the people who work in (a specific) program are respon-sible for that program. and the Joint Commission visit is a good example,” he said. “If something falls under quality management, they’re the ones who over-see the implementation of Joint Commis-sion standards, but it’s the employees who have to carry it out, and you can’t carry it out unless you know what it is.”

So, two or three “tracers” walked around the Memphis facility to talk about specific objectives with employees, Mills said. “That’s what Joint Commission does – they’ll pull you aside and say, ‘Now tell me again, how do you evacuate a patient in case of an emergency?’ And the em-ployee should be able to go right down a mental checklist. If they don’t know, it’s actually okay as long as they know in their area of work where to find that informa-tion.”

Mills said his “short-term philosophy” is to address three issues: accountabil-ity, transparency and communications. “I think if I concentrate on those three, many other things will fall into place,” he said.

“I want to get back to being the em-ployer of choice in this region. Surround yourself with good employees; everything else will start falling into place.”

New Interim Director, continued from page 9

Willcoxon Hopes to Find Best Recipe for Success at Crestwyn, continued from page 1

Page 15: Memphis Medical News April 2016

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Although recent advancements in

surgical techniques and a more preventa-tive approach to medicine now allow or-thopedic surgeons to treat patients more effectively than ever, several Mid-South orthopedic surgeons say physicians are struggling to find a balance between see-ing patients and complying with govern-ment regulations.

Presently, orthopedic surgeons play a large role outside the operating room by taking more preventative measures in treatment, according to Kurre Luber, MD, orthopedic surgeon with Oxford Orthopedics and Sports Medicine.

“Instead of only treating the fracture, we monitor patients and take steps to decrease the chance of it happen-ing again,” Luber said. “For instance, we will review the vitamin D and calcium lev-els and bone density studies in a female patient who may be more likely to have osteoporosis and suffer a hip fracture.”

But while improvements and ad-vancements have been made, orthopedic surgeons are being challenged to treat pa-tients in a timely manner while complying with government regulations.

“Due to increased involvement of government oversight and regulation resulting in more and more paperwork, orthopedic surgeons are currently facing challenges in seeing patients in a timely fashion as well as taking time away from the doctor-patient experience,” said Lane Line, MD, orthopedic surgeon with Southern Bone and Joint Special-ists in Hattiesburg and current president of the Mississippi Orthopaedic Society (MOS).

“Additionally, the challenge of decreasing reimbursement coupled with the government shifting the cost burden of regulation and overhead to the physician in order to be compliant has been especially challenging,” Line added.

In addition, orthopedic surgeons face challenges as practices transition from a fee-for-service scenario to value-based care, according to George Russell, MD, professor and chairman of the department of orthopedic surgery at the University of Mississippi Medical Center.

This means physicians will be paid based on the value of care they provide and not by the number of visits and tests they order.

“This volume-to-value transition will expand across medicine and practices

must learn how to prepare for it,” Russell said.

Still, orthopedic surgeons are taking a more preventative approach, and not just with their aging patients.

“We do pre-injury treatment with young athletes,” Luber said, “Children and adolescents no longer cross train in sports, but play one sport year round. Their bodies don’t have time to rest and when that happens, they are more prone to injuries. We teach them proper stretches and exercises and stress the im-portance of rest so their bones and joints stay healthy.”

Luber is the orthopedic surgeon and sports medicine specialist for the Univer-sity of Mississippi athletic teams. All ath-letes at the university are screened, so that physicians can initiate preventive treat-ment immediately.

In addition to a more preventative approach, there have been surgical tech-nique improvements in joint replacement. Procedures such as a total knee replace-ment, in some cases, can be done on an outpatient basis.

“The field of joint replacement con-tinues to improve as we strive to provide better outcomes and faster recovery for our patients,” said Benjamin Stronach, MD, assistant professor of joint replace-ment and general orthopedics at the Uni-versity of Mississippi Medical Center in Jackson. “We are also able to minimize the inpatient hospital stay with improved pain management techniques and are even providing some joint replacements on an outpatient basis.”

Luber agrees and says that these ad-vancements are advantageous because the patient can go home after surgery and re-cover at home. In addition, less time spent in the hospital means more cost savings for the patient.

Looking ahead, Line says a future en-hancement in orthopedics is telemedicine, which allows a physician to visit with a pa-tient face-to-face remotely for postopera-tive issues. No longer will a patient have to travel – sometimes at a long distance – to the physician’s office.

“Instead of a patient going to the emergency room and another physician treating the problem, we now can visu-alize the problem in a safe, cost-efficient fashion,” Line said.

“The meeting will provide a great opportunity for networking with other skilled professionals in orthopedic sur-gery,” Stronach said. “It offers continuing medical education programs and credits, and briefings on the latest in technological and legislative developments. It also allows for surgeons an opportunity to meet one another and spend time socializing with one another in a relaxed setting outside of their practices.”

Orthopedic Surgeons Must Balance Progress with Government Regs

Dr. Kurre Luber

Dr. Lane Line

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Page 16: Memphis Medical News April 2016

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The University Of Tennessee College Of Medicine has introduced a mobile stroke unit capable of conducting and producing advanced quality imaging for stroke diagno-sis and noninvasive CT-angiography with a Siemens SOMATOM® Scope CT scanner.

According to UT, it is the first time CT capabilities of this magnitude have been available in a mobile setting, creating the ability to diagnose and launch treatment including tissue plasminogen activator (tPA) treatment and the potent blood pressure drug nicardipine within the critical first-hour time frame and select patients for en-dovascular interventions, neurosurgery and neuro-critical care directly from the pre-hospital arena.

While other Mobile Stroke Units have been launched in a small number of com-munities, the combination of many firsts in terms of mobile application and utiliza-tion make UT’s the most complete Mobile Stroke Unit in the world.

Other Mobile Stroke Units allow for ini-tial treatment to begin quickly and for prep-ping for emergency room arrival, while the sophistication of The UT College of Medi-cine Mobile Stroke Unit means a patient will be prepped to go straight to the catheteriza-tion laboratory, Neuro Intensive Care Unit or Hospital Stroke Unit, bypassing the stop in the emergency department entirely.

The Mobile Stroke Unit, weighing in at more than 14 tons, includes features and capabilities, including:

• A hospital-quality CT scanner with advanced imaging capabilities to not only allow brain imaging, but also imaging of blood vessels in the brain.

• The features allow it to bypass hospital emergency departments and take patients directly to endovascular suites, operating rooms, stroke or neurocritical units.

• Its size and internal power source is

capable of matching regular electrical outlet access and facilitates staffing of stroke fel-lowship-trained, doctorally-prepared nurses certified as advanced neurovascular practi-tioners, ANVP-BC.

• The Mobile Stroke Unit will be staffed with stroke fellowship-trained, doctorally-prepared nurses certified as advanced neu-rovascular practitioners, ANVP-BC.

• The Mobile Stroke Unit capacity in-cludes the ability to transport trainees and researchers interested in building the science of early stroke management.

“We have a tremendous burden of stroke in Shelby County, with a stroke rate per 100,000 population that is 37 per-cent higher than the national average,” said David Stern, MD, Vice-Chancellor for Clinical Affairs for the UT College of Medicine and UT Health Science Center (UTHSC). “The goal of the Mobile Stroke Unit is to minimize morbidity and mortality, to have more patients walk out of the hos-pital fully functional. Time is everything for stroke treatment; the quicker we are able to assess and attend to a patient, the better his or her chances are for recovery.”

According to the American Stroke As-sociation, stroke is the fifth leading cause of death in the United States, killing someone approximately every four minutes. African Americans have nearly twice the risk of a first-ever stroke and a much higher death rate from stroke.

“If we eliminate the treatment delay getting to and through the emergency room, we can save up to 90 minutes, and as a neurologist, I know that time is brain, so the more time we save, the less likely it is that permanent brain damage will occur in a pa-tient. Our hypothesis is that we will deliver hospital-level standard of stroke care faster, equally safe, but with better outcomes due to the ability to intervene much earlier,” said Andrei V. Alexandrov, MD, Chairman of the Department of Neurology at UTHSC and Semmes-Murphey Professor.

“Our ‘time to treatment’ target is less than one hour.”

The UT Mobile Stroke Unit is funded through a public -private collaboration for which more than $3 million has been raised, which will enable operation for up to three years. The Unit will operate 12 hours a day,

one week on and one week off beginning late April 2016.

“The Mobile Stroke Unit will be based in the heart of a 10-mile, most critical needs areas of Memphis with the highest incidence of stroke, but can be deployed within the en-tire metro region. We estimate that 300 pa-tients will need to be treated by the Mobile Stroke Unit to prove its effectiveness over the course of three years,” Alexandrov said. “We believe this study will help establish a baseline of results that medical communities worldwide can use to develop and deploy similar programs to affect stroke outcomes. Our goal is a sustainable model for future funding and an overall lowering of morbid-ity and mortality through early treatment.”

“The launch of this Mobile Stroke Unit is a true community collaboration of donors, hospitals, local EMS and the Uni-versity,” said Stern. “Beyond the highest quality education and research, our focus at the UT College of Medicine is to ensure our research and clinical efforts translate into a positive impact on the health of our com-munity. The Mobile Stroke Unit is a perfect example of this commitment.”

The Mobile Stroke Unit will be oper-ated by a subsidiary of the UT College of Medicine’s faculty practice plan – University Clinical Health, an affiliated tax-exempt, nonprofit corporation.

UT Launches Mobile Unit with Advanced CT Imaging Capabilities

Page 17: Memphis Medical News April 2016

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Behavioral Healthcare Center Opens Memphis Facility

Behavioral Healthcare Center at Memphis has opened The Harbor View Nursing Home a 16-bed geriatric psy-chiatric facility near downtown Mem-phis that will specialize in the care of seniors 65 and older.

Its location at 1505 North Second affords it the opportunity to reach an underserved area while maintaining a small, home-like environment for those entrusted to its care. BHC Memphis will serve as a short-stay facility and stabili-zation hospital where both medical and psychiatric assessments and treatments are performed.

Officials say BHC will provide com-passionate, acute psychiatric care for se-niors who are experiencing a psychiatric episode requiring immediate care, such as those with dementia or those who suffer from mental illness. Goals of the facility include relieving the distress of its patients, balancing prescriptions to meet the needs of their diagnosis and educating family and loved ones so that they can manage the disease process. Individuals can be self-referred, referred by loved ones, physicians, nursing facili-ties or other medical providers.

THM has four other Behavioral Healthcare Centers, located in Clarks-ville, Columbia and Martin in Tennessee and Huntsville in Alabama, all special-izing in geriatric care. The BHC facility in Memphis will be a teaching hospital, made possible by a partnership with the Universtiy of Tennessee Health Science Center. Medical students, residents and fellows will participate in inpatient psy-chiatric rotations at the facility.

Satellite Healthcare Opens Fourth Dialysis Center

Satellite Healthcare opened its fourth dialysis center in Memphis last month as Satellite Healthcare Chickasaw Gardens marked its grand opening with a kidney disease health resource fair.

The Chickasaw Gardens clinic, at 2980 Poplar Avenue, Suite 102, will be open Monday through Friday, 8 am to 6 pm.

Tennessee Doctors Rally forHealthcare Policies on ‘The Hill’

More than 300 people from across Tennessee gathered at the state capitol to advocate for better healthcare poli-cies.

The Tennessee Medical Associa-tion’s Day on the Hill is the association’s biggest annual advocacy event, regu-larly drawing hundreds of participants.

During last month’s Day on the Hill, doctors spoke to their representatives and senators about bills including:

• Regulation of In-Office Dispens-ing SB2060/HB2126 is one of TMA’s top legislative priorities. It would eliminate confusing or ambiguous language in a statute outlining requirements for phy-sicians’ offices dispensing medication.

• Workers’ Compensation Silent

PPO SB1758/HB1720, another of TMA’s legislative priorities, would add an en-forcement mechanism for existing laws regulating workers’ compensation silent PPOs.

• Payer Accountability TMA is work-ing on alternative language for a bill to require more stability in contracted re-imbursement rates from health insur-ance companies.

• Cost-Sharing Parity for Oral Can-cer Therapies TMA Members support SB2091/HB2239, which would prohibit an insurance policy that provides bene-fits for both injected or intravenous can-cer medications and oral cancer medica-tions from requiring a higher copayment, deductible or coinsurance amount for either of the treatment options.

West Cancer Center Selects Candace Wilder as COO

West Cancer Center has named Candace Wilder as Chief Operating Of-ficer. Wilder previously served as Vice President of Operations.

Wilder joined West Cancer Center as Director of West Clinic’s Compre-hensive Breast Center in 2012 where she managed staffing and operations for the two breast center lo-cations. Prior to joining West, Candace served in leadership roles at the Mem-phis Heart Clinic (MHC).

As COO of West Cancer Center, Wilder is responsible for leading stra-tegic planning for clinical operations throughout the region, customer ser-vice initiatives, breast center operations and outreach, and the surgical oncology teams for the system.

A native of Memphis, Wilder gradu-ated from the University of Tennessee in Knoxville with a Bachelor of Science in communications. She has been actively involved with the Healthy Memphis Common Table, the American Heart As-sociation and Conservation through Art, a partnership between ArtsMemphis and Ducks Unlimited.

Candace Wilder

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Page 18: Memphis Medical News April 2016

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UTHSC’S Dagogo-Jack Receives $1.1 Million Grant for Diabetes Study

Samuel Dagogo-Jack, MD, FRCP, of the University of Tennessee Health Science Center (UTHSC) has received a $1.1 million grant to continue the Dia-betes Prevention Program Outcomes Study (DPPOS). Dagogo-Jack who di-rects the Division of Endocrinology, Dia-betes and Metabolism in the College of Medicine,

The grant from the National Insti-tute of Diabetes and Digestive and Kid-ney Diseases, part of the National Insti-tutes of Health, is for $228,000 a year over five years. Dagogo-Jack leads the UTHSC site of the study that includes research sites across the U.S. This phase of the study is an extension of the origi-nal Diabetes Prevention Program that was launched in 1996.

Dysglycemia – the abnormal regu-lation of blood sugar – covers a long sequence of events from pre-diabetes to the onset of Type 2 diabetes, the development of clinically detectable changes, and finally the clinical compli-cations of diabetes, which can be life-threatening.

Dagogo-Jack led the original Dia-betes Prevention Program at Washing-ton University before joining UTHSC. Abbas Kitabchi, MD, led the UTHSC site and focused on the pre-diabetes stage and demonstrated the powerful benefi-cial effects of lifestyle intervention and the drug metformin in delaying or even preventing the onset of Type 2 diabe-tes.

Memphis Attorney Publishes ‘The Physician Immigration Handbook’

Greg Siskind, an immigration at-torney and the founding partner of the Memphis law firm Siskind Susser P.C., has released his fifth book, The Physi-cian Immigration Handbook, A Guide to the U.S. Immigration System for In-ternational Medical Graduates, Recruit-ers, and Employers.

According to Siskind, physician im-migration is perhaps the most compli-

cated area of United States immigration law, despite overwhelming evidence of a long-term physician shortage fac-ing the U.S. The book simplifies the visa process and explains what foreign physicians need to know to apply for graduate medical training at teaching hospitals in the U.S. It also tells how they can remain in the U.S.to pursue their careers.

The Handbook is structured as follows: first it reviews the application process through which IMGs receive ECFMG certification, eventually leading to admittance to U.S. graduate medical training programs. Then it discusses the two major immigration pathways open to IMGs who want to come to the U.S. for graduate medical training— the J-1 visa and the H-1B visa.

From there, The Handbook walks the IMG through training to post-train-ing work, then on to permanent resi-dency— the “green card” process, and ultimately to U.S. citizenship. Addition-ally, this book delves into employment issues, such as layoffs, mergers, and ac-quisitions, while also discussing special benefits available to foreign physicians in the U.S. military.

To learn more, visit http://www.visalaw.com/mdbook.

Le Bonheur Achieves Magnet Designation from ANCC

Le Bonheur Children’s Hospital has received Magnet designation by the American Nurses Credentialing Center (ANCC). Le Bonheur is among only 7 percent of hospitals in the country to have earned the distinction of Magnet status.

Directed by the ANCC, Magnet recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Consumers rely on the des-ignation as the ultimate credential for high quality patient care.

The ANCC Magnet Recognition Program designates healthcare organi-zations that demonstrate excellence in nursing practice, adherence to national standards for improving patient care,

leadership and sensitivity to cultural and ethnic diversity. Hospitals undergo a rigorous evaluation that includes a doc-ument submission and an onsite evalu-ation of patient care and outcomes. Magnet hospitals must provide an an-nual status report on their progress and must undergo re-evaluation every four years to retain the designation.

Statewide TMA Convention to Be Held April 28 to May 1

An anticipated 300 physicians, medical practice managers and other healthcare professionals from across the state will convene in Murfreesboro from April 28 to May 1 for the Tennes-see Medical Association’s annual con-vention.

MedTenn16 will feature four days of proprietary medical education, pro-fessional networking and social events.

The education agenda will feature 32.25 hours of CME for physicians on topics such as telemedicine, payment reform, physician burnout, physician-assisted suicide, team-based healthcare delivery models and more.

Featured events will include Formal installation of TMA’s new

President, Keith G. Anderson, MD, FACC of Memphis.

TMA House of Delegates, the an-nual policymaking session of the TMA.

Vendor exhibit hall featuring doz-ens of leading healthcare companies showcasing products and services, from technology to pharmaceuticals to pro-fessional consulting.

For more information, visit tnmed.org

Cardiovascular Rehabilitation Program Wins AACVPR Certification

Methodist Le Bonheur German-town Hospital has received certifica-tion for its cardiovascular rehabilitation program by the American Association of Cardiovascular and Pulmonary Reha-bilitation (AACVPR), a multidisciplinary organization dedicated to improving the quality of life for patients with car-diovascular problems including heart attack, coronary artery bypass graft sur-gery and congestive heart failure.

  AACVPR-certified programs are recognized as leaders in the field of cardiovascular and pulmonary reha-bilitation because they offer the most advanced practices available. These programs include exercise, education, counseling, and support for patients and their families. Methodist German-town was recognized for its commit-ment to improving the quality of life by enhancing standards of care.

  To earn certification, Methodist Germantown’s cardiovascular rehabili-tation program participated in an appli-cation process that requires extensive documentation of the program’s prac-tices. 

AACVPR Program Certification is valid for three years.

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Page 19: Memphis Medical News April 2016

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Memphis Ranks Second Nationally on 2016 Spring Allergy List

The Asthma and Allergy Founda-tion of America (AAFA), a U.S. patient advocacy organization, ranked Mem-phis second on its list of the 100 most challenging places to live with spring allergies inthe U.S.

The list ranked Jackson, Mississip-pi, as the most challenging U.S. city to live for the second year in a row based on higher than average pollen scores, higher than average medication usage, and availability of boardcertified aller-gists in the area.

The other top ten cities include: 3. Syracuse, New York; 4. Louisville, Kentucky; 5. McAllen, Texas; 6.Wichita, Kansas; 7. Oklahoma City, Oklahoma; 8.Providence, Rhode Island; 9. Knox-ville; 10. Buffalo.

To view the complete list of cities, visit www.AllergyCapitals.com.

Chattanooga’s Nita Wall Shumaker Elected President of TMA

Nita Wall Shumaker, MD, of Chatta-nooga has been named President-Elect of the Tennessee Medical Association.

Shumaker, who will be the second female president of the organi-zation, is a pediatrician at Galen North Pediatrics. She is a current member of the TMA Board of Trustees and for-mer president of the Chattanooga & Hamilton County Medical Society.

The TMA Board of Trustees and the TMA Judicial Council also held elec-tions in March.

James H. Batson, MD, of Cookev-ille was re-elected to the Board. New members are Kirk Stone, MD, Union City; Rodney Lewis, MD, Nashville; and Elise Denneny, MD, Knoxville.

Four new members were elected to the TMA Judicial Council: Justin Mon-roe, MD, Memphis; Omar Hamada, MD, Brentwood; James C. Gray, MD, Cookeville; and Richard Briggs, MD, Knoxville.

New officers will be installed at TMA’s Annual Convention on April 28 through May 1.

OrthoMemphis Participating in Trial of Memphis Firm’s Meniscus Implant

Active Implants, a Memphis-based company that develops orthopedic im-plant solutions, announced the com-pany’s VENUS (Verification of the Effec-tiveness of the NUsurface System) trial is underway at OrthoMemphis.

A company spokesperson said Or-thoMemphis is the only center in the South – and just one of 10 sites nation-wide – participating in the VENUS clini-cal trial to evaluate the Active Implants’

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David Archer Leaving Tenet, Saint Francis After 30-Year Career

David Archer, market CEO at Saint Francis Healthcare, announced in March he is leaving the hospital after serving the facility for 19-years and 30 years with Tenet Health Corporation.

Archer has been chief executive of-ficer at Saint Francis Hospital-Memphis of Tenet Healthcare Corporation since 1997 and the chief executive officer of the Memphis market since February 2006. During his tenure, the healthcare system has grown to include Saint Fran-cis Hospital-Bartlett, the Ambulatory Surgery Center, the Heart & Vascular Center, and the physician practice enti-ty, Saint Francis Medical Partners, which has seen substantial growth under his leadership.

Archer has been on the Board of Directors of The Greater Memphis Chamber of Commerce since Decem-ber 2015. He was also appointed to the Tennessee Hospital Association Board of Directors, the American Hospital As-sociation Regional Policy Board, the Hospital Wing Board of Directors and the Christian Brothers University Board of Directors.

Page 20: Memphis Medical News April 2016

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