December 2009 >> $5 PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ONLINE: M.MEMPHIS MEDICAL NEWS.COM ON ROUNDS PRINTED ON RECYCLED PAPER February 2014 >> $5 New Deﬁbrillator Offers Options, Advantages Stern physician implants recently developed system The old way was no longer an option. To live, the patient needed something new ... 4 Changing Healthcare Landscape Not Slowing Drive for Med School Now that the health insurance marketplace is open, many are wondering about the immediate effects the Affordable Care Act will have on the healthcare industry ... 11 FOCUS TOPICS CARDIOLOGY MERGERS & ACQUISITIONS HEALTH LAW Physicians’ Steps for Legal Recourse Shaky Hard for a doctor to counter derogatory comments or poor ratings BY JUDY OTTO The global economic crisis has affected not only millions of individuals and countless busi- nesses, but charitable institutions also are suffer- ing from dramatically reduced donations. Yet the children of St. Jude Children’s Research Hospital are ably provided for by a man whose passionate commitment and insightful fund- raising strategies have increased public support during each of the four years of his leadership. Reports show a 29 percent increase in donor revenue since 2009, when Richard C. Shadyac Jr. became CEO of ALSAC, the fund- raising and awareness organization for St. Jude Children’s Research Hospital. Even the weather-related cancellation of the (CONTINUED ON PAGE 12) HealthcareLeader Richard C. Shadyac Jr., JD CEO ALSAC/St. Jude Children’s Research Hospital BY EMILY ADAMS KEPLINGER Malpractice suits are ﬁled almost every day. Not all of them are justiﬁable. What steps are in place for physicians’ redress? According to Mike Cates, executive vice president of the Memphis Medical So- ciety, “Anybody can be sued. The difference is how much proof there is to sustain a case. And generally there is not much case law to support malpractice counter-suits.” And while the First Amendment of the U.S. Constitu- tion guarantees freedom of speech, slander and libel are not without their own consequences. A plaintiff making untrue, defamatory accusations against a physician can certainly impact future earnings. But the problem with defending such claims lies with the burden of proof. To prove a physician has been defamed, he or she has to prove their harm or injury was a direct result of a malpractice suit, or even from bad ratings on websites and social media. “Social media and websites offer visibility for physicians,” Cates added. “But if someone chooses to make derogatory comments or assign poor ratings, it is very hard for a doctor to counter because most of those postings are anonymous. It would be almost impossible to discern who to sue for defamation of character.” David Cook, a practicing healthcare defense attorney in Memphis for 37 years, said patients sue when they experience bad outcomes, whether the doctor Kenneth Sellers, MD PAGE 3 PHYSICIAN SPOTLIGHT (CONTINUED ON PAGE 14) FLEET INCENTIVES FOR MEDICAL PROFESSIONALS SERVING THE MID-SOUTH FOR OVER 30 YEARS. MERCEDES-BENZ OF MEMPHIS FOR ADDITIONAL PROGRAM DETAILS VISIT: mbofmemphis.com/ ama-special- programs.htm Available for qualified customers only.
New Defi brillator Offers Options, AdvantagesStern physician implants recently developed systemThe old way was no longer an option. To live, the patient needed something new ... 4
Changing Healthcare Landscape Not Slowing Drive for Med SchoolNow that the health insurance marketplace is open, many are wondering about the immediate effects the Affordable Care Act will have on the healthcare industry ... 11
FOCUS TOPICS CARDIOLOGY MERGERS & ACQUISITIONS HEALTH LAW
Physicians’ Steps for Legal Recourse ShakyHard for a doctor to counter derogatory comments or poor ratings
By JUDy OTTO
The global economic crisis has affected not only millions of individuals and countless busi-nesses, but charitable institutions also are suffer-ing from dramatically reduced donations. Yet the children of St. Jude Children’s Research Hospital are ably provided for by a man whose passionate commitment and insightful fund-
raising strategies have increased public support during each of the four years of his leadership.
Reports show a 29 percent increase in donor revenue since 2009, when Richard C. Shadyac Jr. became CEO of ALSAC, the fund-raising and awareness organization for St. Jude Children’s Research Hospital.
Even the weather-related cancellation of the (CONTINUED ON PAGE 12)
Richard C. Shadyac Jr., JDCEO ALSAC/St. Jude Children’s Research Hospital
By EMILy ADAMS KEPLINGER
Malpractice suits are fi led almost every day. Not all of them are justifi able. What steps are in place for physicians’ redress?
According to Mike Cates, executive vice president of the Memphis Medical So-ciety, “Anybody can be sued. The difference is how much proof there is to sustain a case. And generally there is not much case law to support malpractice counter-suits.”
And while the First Amendment of the U.S. Constitu-tion guarantees freedom of speech, slander and libel are not without their own consequences. A plaintiff making untrue, defamatory accusations against a physician can certainly impact future earnings. But the problem with defending such claims lies with the burden of proof. To prove a physician has been defamed, he or she has to prove their harm or injury was a direct result of a malpractice suit, or even from bad ratings on websites and social media.
“Social media and websites offer visibility for physicians,” Cates added. “But if someone chooses to make derogatory comments or assign poor ratings, it is very hard for a doctor to counter because most of those postings are anonymous. It would be almost impossible to discern who to sue for defamation of character.”
David Cook, a practicing healthcare defense attorney in Memphis for 37 years, said patients sue when they experience bad outcomes, whether the doctor
Kenneth Sellers, MD
(CONTINUED ON PAGE 14)
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mbofmemphis.com/a m a - s p e c i a l - programs.htm
Available for qualified customers only.
2 > FEBRUARY 2014 m e m p h i s m e d i c a l n e w s . c o m
m e m p h i s m e d i c a l n e w s . c o m FEBRUARY 2014 > 3
By RON COBB
Years ago, Kenneth Sellers, MD, learned of a quote from Mark Twain, and it has stuck with him ever since. He taught it to the residents at UT College of Medi-cine in Memphis when he was associate professor of surgery:
“Do the right thing. It will gratify some people and astonish the rest.”
Now, as medical director of Mid-South Transplant Foundation, Sellers is not necessarily astonished, but certainly gratified, when people do the right thing and donate hearts, lungs, livers or kidneys, either their own or a loved one’s.
Many years after he performed kid-ney transplants as a young surgeon in the early 1970s, Sellers now works on the pro-curement side, a job he calls “very reward-ing, very frustrating at times.”
“But I say that every time we get a donor, it’s a miracle for some family,” he said.
Sellers grew up in the Missouri Bootheel town of Caruthersville and was majoring in engineering at the University of Missouri when he decided to switch to medicine. At the University of Tennessee in Memphis, he found a mentor in Dr. Louis Britt, who had started doing kidney transplants.
“He was very much an inspiration to me,” Sellers said, “so I started helping him with his transplants because he was basically doing them alone in Memphis; nobody else was doing them.”
Britt later started the first trauma cen-ter at UT, “and he kind of pushed me to-ward trauma, so I did trauma for a couple of years,” said Sellers, who served as direc-tor of the emergency room at Memphis City Hospital.
He moved on to Blytheville, Arkan-sas, to open a practice, then came back to Memphis 13 years later at the urging of Britt, who wanted him to teach “old-fashioned general surgery.”
Soon thereafter Sellers joined the board at Mid-South Transplant Foun-dation, later became assistant medical director and then medical director five years ago. He retired from UT three years ago.
He supervises a staff of well-trained family care specialists and critical care nurses who perform what Sellers calls a “very complicated process, anywhere from 24 to 48 hours of intense activity to obtain an organ donor.” Once a donor’s consent is obtained by the family care specialists, the nurses are instrumental in maintaining the organs so they remain vi-able for transplant.
Heart transplantation is the trickiest, he said, because “they’re very fragile and probably the hardest for us to procure and transplant. They’re difficult because they have to be perfect hearts and fairly young
people. By the time a patient becomes a donor, often times the heart has had so much injury to it from whatever caused the patient to have the brain injury that they cannot be used.”
Most heart donations come in the wake of shootings and car accidents. Some come from stroke victims, but those peo-ple, Sellers said, are generally older and sicker, “so they’re not usually good candi-dates for heart donation. They’re usually in the range of 50 to 60 years old, and we don’t do hearts that are much older than 40.”
Despite best efforts, the number of those who need transplants is growing
faster than the number of donors. Sellers said close to 120,000 people are on the na-tional waiting list, including at least 80,000 for kidneys, which are the most common transplant, followed by livers and then hearts and lungs.
“Our goal several years ago was to stop the waiting list (from growing), and for about a year or so they were able to keep it relatively stable,” he said. “But it’s growing again. There’s just not enough donors for every organ. People are dying waiting for an organ.”
Having donor registries has helped, with people going to departments of motor vehicles or signing up online to in-dicate they want to be an organ donor.
“If everybody would register, it would make donation much more likely and the whole process less traumatic on the fami-lies,” Sellers said. “Families who have a sudden catastrophic event are often not making rational decisions and refuse to donate for reasons they probably, if they had time to think about it, they would not decline. Right now our biggest problem is getting donor families to agree to a dona-tion.”
Misconceptions, myths and occasion-ally religion sometimes result in families not donating. Fairly common is the fear that a hospital won’t care properly for a loved one “because all we want is the or-gans,” Sellers said. Some incorrectly be-
lieve the body will be mutilated, making it impossible for the family to have an open casket.
“A lot of families bring that up, but that just doesn’t occur,” he said. “It’s just an incision like you’d have for an opera-tion.”
Another misconception is that transplantation is experimental. On the contrary, Sellers said, liver and kidney recipients are long-term survivors with basically normal function. Transplanted hearts are lasting 10 to 15 years.
“If a young heart is in the right patient,” he said, “that patient will be able to do pretty much what they want to do.”
Transplants are more successful for longer periods of time and hospital stays are shorter than they were years ago be-cause modern drugs, primarily cyclospo-rine, suppress rejection.
“We have success stories every day,” Sellers said. “We have children who are 24 hours from dying who get a donated organ and they’re up and running around in a week.
“We have a ceremony every year where donor families come back and they are very happy. I’ve never had a donor family come back and say they were sorry they donated. We’ve had them come back and say they were sorry they didn’t do-nate.”
Kenneth Sellers, MDFor this physician, the miracles arrive on a consistent basis
4 > FEBRUARY 2014 m e m p h i s m e d i c a l n e w s . c o m
By AMy FRENCH
The old way was no longer an option. To live, the patient needed something new.
Over the years, doctors had placed conventional defibrillator implants in his chest twice. Each device had done its job, monitor-ing the patient’s disease-weakened heart and providing a jolt if neces-sary. But infections related to kidney problems forced removal both times and prohibited a third try with the previous approach.
That left the man, an Arkansas resident in his 60s, at great risk of cardiac arrest. By extension, it also rendered him ineligible for a kid-ney transplant, amplifying another threat to his life.
A workable new solution was out there, but it was so new that few doctors had access to it.
Fortunately for this patient, Chris Ingelmo, MD, at Stern Cardiovascular Foundation was among the few.
Last month, Ingelmo’s implant of a recently developed defi brillator called an S-ICD® System was thought to be the fi rst in Tennessee.
The S-ICD® doesn’t require direct
contact with the heart and surrounding blood vessels. That’s a big advantage for patients on dialysis or dealing with other health risks, such as cancer or past infec-tions.
“Also, it’s a fairly good option just from a cosmetic standpoint,” Ingelmo said.
The S-ICD® is bigger than a tradi-tional defi brillator, but its placement just under the skin on the left side of the chest makes it less obtrusive.
“Particularly young women with certain medical condi-tions might not want that old-
style defi brillator where it’s in the
top of their chest and visible all of the time,”
he said. “This can be inside the bra. So you still have a bump, but it’s not as conspicuous.”
The new device, which the FDA approved in 2012, is not in wide distribution yet. Demand has exceeded supply, and the manufac-turer – Boston Scientifi c – has given priority to doctors who gained ex-perience with the S-ICD® during clinical trials.
Ingelmo observed one S-ICD® implant procedure and per-formed another while in fellowship at Cleveland Clinic in Ohio before joining Stern. To pre-pare for January’s proce-dure, he sought further training and certifi cation through Boston Scientifi c.
Other doctors with Stern will train for the S-ICD® procedure in the next few months, enabling access for more patients. Ingelmo estimated that 20 percent or more of patients in need of a defi brillator implant could be considered for the S-ICD®.
Stern’s success with the S-ICD® comes on the heels of another procedural fi rst. In December, doctors at Stern per-formed one of the region’s fi rst LARIAT procedures – a surgery that cuts the risk of stroke for patients who can’t take blood thinners.
Stern’s efforts to make new technol-ogy and procedures available to patients as soon as – or before – they are FDA-approved or widely available is in keeping with a proud tradition of innovation that goes back to founder Neuton Stern, who brought Memphis’ fi rst EKG machine to the city in 1919.
At any given time, Stern is involved with 20 to 25 clinical trials, said Frank Mc-Grew III, MD, who coordinates much of that involvement.
“Almost all aspects of how we treat cardiovascular disease need improve-ment,” McGrew said. “So we’re always looking for new things. In fact, the num-ber of clinical trials we do really compares quite favorably to that of major medical centers.”
top of their chest and visible all of the time,”
PHOTO COURTESY OF BOSTON SCIENTIFIC
New Defi brillator Offers Options, AdvantagesStern physician implants recently developed system
Dr. Chris Ingelmo
m e m p h i s m e d i c a l n e w s . c o m FEBRUARY 2014 > 5
REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.
By CINDy SANDERS
What if gathering critical heart health information from around the world was as simple as entering a few keystrokes on a laptop or smartphone? Turns out there is an app for that … actually several apps … and researchers with the Health eHeart Study hope to turn those rich data sources into powerful tools to predict, prevent and treat heart disease and stroke.
“In my 30-year career as a re-searcher and physician, I’ve never seen a study as innovative as the Health eHeart Study,” said Elliott Antman, MD, president-elect of the American Heart Association (AHA) and co-chair of the study’s Scientific Advisory Board. “This is a seam-less way to participate in a research study while going about your daily activities.”
Launched last year, the AHA has joined forces with the University of Cali-fornia, San Francisco (UCSF) to support this long-term, large-scale health research project. The transformative study is led by three USCF faculty members — Jeffrey Olgin, MD, professor of Medicine and chief of the Division of Cardiology; Greg Marcus, MD, MAS, director of Clinical Research for the Division of Cardiology; and Mark Pletcher, MD, MPH, a cardio-vascular epidemiologist and the director of Research Consultation for UCSF’s Clini-cal and Translational Research Institute.
The goal is to enroll one million adults from around the globe, and the only inclusion criteria are that participants be over 18 and have access to the Internet. Researchers are seeking individuals across the spectrum … from the very healthy to those diagnosed with cardiovascular dis-ease or other chronic conditions. Rather than having to make an appointment to see a physician to submit or update health and activity information for the study, participants can log info on the go and at their convenience via computer or mobile device. Antman and colleagues are hope-ful that the ease of participation will trans-late into more robust data collection.
Initially, participants are asked to an-swer a series of demographic questions, in-cluding information on lifestyle habits and personal and family medical history, to es-tablish a baseline. Then every six months, they are asked to answer additional ques-tions about activities and health events. Additionally, participants have the oppor-tunity to share information gathered from
smartphone apps and wireless devices (such as blood sugar monitors, at-home blood pressure equipment, and digital scales) with the study’s protected data sys-tem. A number of apps are free, and sites including iHealth (ihealthlabs.com) and Withings (withings.com) have electronic health tracking devices that sync with the Health eHeart Study data collection.
“Getting a blood pressure reading or an ECG in your doctor’s offi ce is just a snapshot of the given moment, but now
we’ll be able to see big data streamed almost in real time as people are going about their daily activities,” noted Ant-man. “This presents a total paradigm shift in how we learn about human health.”
Antman, a professor of Medicine at Brigham & Women’s Hospital and as-sociate dean for Clinical/Translational Research at Harvard Medical School, is clearly excited about the possibilities af-forded by such a large collection of data among global populations. “This research initiative makes use of cutting-edge digital technology to perform not only a state-of-the-art observational study but also to provide the platform to facilitate random-ization. This is really an electronic, decen-tralized cohort,” he said.
“The goal,” he continued, “is to use the big data to predict who is going to develop heart or stroke problems.” How-ever, Antman noted, the immediacy of the media also opens up possibilities to test the effi cacy of various treatments and behav-ioral modifi cations.
“This is nimble and has the potential to change the way we study health behav-iors and test interventions to modify those behaviors,” he explained.
For example, Antman noted a sub-group of participants who identifi ed them-selves as regular smokers on the baseline questionnaire could be pulled from the larger study. From that subset, one group could be randomized to receive a weekly email from a health coach reminding them not to smoke, while another group
might receive a link to a website with in-formation on how to make behavioral changes. Subsequent follow-up could show one method to be more effective than the other. That, noted Antman, is where the nimbleness of the technology comes into play by allowing researchers to quickly switch all participants to the more effective intervention.
Antman said physicians and other providers could be major allies in help-ing get patients signed up for the study. He encouraged physicians to go online to learn more about the project and to share the website information with their adult patients. Antman added the AHA has bro-chures available for distribution at clinic and offi ce sites, as well.
Again, he stressed, the goal is to in-clude everyone across the health spectrum from young, active adults to those with multiple comorbid conditions. Antman also noted that while this is a long-term commitment, participation is extremely easy. “This is a study that doesn’t impose on a person’s time the way other research studies do,” he said.
Signing up is simple, too. Just go to health-eheartstudy.org to learn more about the project and join the thousands already enrolled.
Health eHeartAmbitious research project launched to advance heart & stroke science
Dr. Elliott Antman
Join the Movement to Stop Heart Disease & Stroke www.health-eheartstudy.org
The Health eHeart Study makes it easy to log important data without disrupting the day.
6 > FEBRUARY 2014 m e m p h i s m e d i c a l n e w s . c o m
When you think of the Red Cross, the first thing that comes to mind might be the word “disaster.” Because wherever there is a disaster, we know that the Red Cross will be there -- almost to the point that we take it for granted. We should all be re-minded that those Red Cross volunteers are our neighbors, friends and co-workers.
Think about it … Hurricane Katrina in 2005, the devastating earthquake in Haiti in 2010, tornados in Joplin, Missouri (2011) and Moore, Oklahoma (2013). Who was there to pick up the pieces and offer relief? Perhaps it was someone you know who stepped up to be an American Red Cross volunteer.
The history of the Red Cross starts with someone who volunteered to help someone else in need. It began in 1859 in Switzerland as a movement to help the wounded in war.
Today the Red Cross is active in 180 countries and includes the American Red Cross.
We’re very fortunate to have a chap-ter in Memphis that’s been in existence since 1917.
Their mission of pre-venting and alleviating human suffering aligns nicely with the work of this reading audience. And, like you, they respond to the needs of Mem-phians who are hurting. Every day the Memphis chapter handles two to three calls – many times in-volving a residential fire where ev-erything is lost, and food, shelter and clothing are immediate needs. Some-times those in need require emergency meds. Regardless of each individual situ-ation, Red Cross volunteers are dispatched and show up on the scene to help. Many times that help goes far beyond the call of duty. Stories and testimonials are on the chapter’s website: https://midsouthred-cross.wordpress.com/blog-posts.
I think you’ll be as surprised as I was to learn the range of services that the Red Cross provides. Basically, there are five main areas.
Disaster Preparedness and Re-lief - We know that they show up in a disaster. But were you aware that they can also teach us how to prepare for a di-saster? We’ll get into details later in this article.
Health and Safety Education - In their last fiscal year, they trained 6,495 area individuals in first aid, CPR and other life-saving skills.
Blood Services - Almost 40 per-cent of the blood used in Memphis hospi-tals comes from the Red Cross.
Volunteer Services - More than 1,100 caring individuals volunteer at our local Red Cross chapter.
Services to Armed Forces and Families - During the last fiscal year, they provided support services for more than 2,692 military service members and their families. This includes emergency communication services, support for the sick and wounded in military and veter-ans’ hospitals and assistance in obtaining emergency financial support. They be-come acquainted with deploying troops in their “Get to Know Us” presentations. Last year they introduced themselves to almost 4,000 troops.
Here’s another wonderful program of the American Red Cross. After a disaster, contacting loved ones may not be easy. You can go online: https://safeandwell.communityos.org and list yourself as safe and well or find loved ones who are miss-ing.
Help Is Literally In Your Hands
Preparedness is a word you hear frequently around the Red Cross. Seven Red Cross mo-bile applications can guide you through earthquakes, tornados, hurricanes, wild-fires and more! Brand-new to this list of helpful apps is Pet First Aid! If you go to the App Store on your smartphone and type in Red Cross, you’ll see all seven apps. They’re easy to
download and very in-formative and helpful.
How Can You Help?Two big ways: DONATE and VOL-
UNTEER. The Red Cross is a 501C (3) organization and does not rely on govern-ment funding. Rather, they rely on do-nors for support. Keep in mind that 91 cents of every dollar you donate goes to direct service and/or programs. Your do-nations can provide essential and tangible help for those in need:
$30 Covers the cost of a clean-up kit and comfort supplies for a family of four, including a mop, broom, squeegee, pail, sponge, disinfectant, degreaser, trash bags, etc. PLUS comfort kits with deodorant,
Mid-South Red Cross Chapter: 97 Years and Going Strong
MEMPHIS on the MEND
BY PAMELA HARRIS
Now with five convenient locations,
we're 10 minutes from wherever you are.
(CONTINUED ON PAGE 13)
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By CINDy SANDERS
The Affordable Care Act, coupled with new models of reimbursement, has undoubtedly impacted the way the health-care industry conducts business today and strategically plans for the future. For some industry sectors within healthcare services, a ‘strength in numbers’ mentality has caused a marked uptick in mergers and acquisitions in comparison to a few years ago. For others, the strategy has been to take more of a ‘wait and see approach’ while trying to figure out just how the new rules will impact their specific markets.
Frank Morgan, who serves as man-aging director for Healthcare Services and Equity Research with RBC Capital Markets, recently shared his thoughts with Medi-cal News on the level of activity in 2013 and his expectations for the com-ing year. With more than two decades experience in equity research and in-vestment banking, Mor-gan primarily focuses his research on facility-based healthcare services including hospitals, skilled nurs-ing and assisted living facilities, long-term acute care (LTAC), behavioral health ser-vices and rehabilitation. Morgan, who has
been recognized for his expertise within the health services industry by multiple national publications and industry rank-ings, is a popular speaker and participant in financial panels.
Overall, Morgan said there was a gen-eral uptick in activity in 2013 compared to 2012. That was particularly true within the hospital sector. “’13 … if not a record year … was a very good year for M&A activity,” he noted. “You really saw it on the not-for-profit side,” he added.
There are several reasons for the ‘super-sizing’ of hospital sys-tems starting with implementa-tion of ACA but exacerbated by other market forces in-cluding an increase in physi-cians seeking an employment model, implementation of EHR and changing payment methodologies.
“The overarching uncertainty about how the world is going to play out over the next four or five years has led to the leveraging of strengths,” said Morgan. He added the leaders of individual hospitals or small systems are faced with deciding to weather the changes on their own or join forces to be part of a bigger group that has the infrastructure in place to manage and deal with the new healthcare delivery landscape.
From mergers to acquisitions to strategic joint ventures, there was a lot of movement on the not-for-profit side, which makes up about 80 percent of hospitals in America. Dallas-based Bay-lor Health Care System and Temple, Texas-based Scott & White Healthcare completed their merger in late September to create the largest not-for-profit health system in Texas. Earlier in the year, Mich-igan-based Trinity Health merged with Pennsylvania-based Catholic East in one of the largest nonprofit mergers of 2013.
And some interesting partnerships occurred between not-for-profit hospitals and systems and publicly traded operators. LifePoint Hospitals and Duke continued to acquire hospitals for their joint ven-ture. One of the largest mergers occurred between a nonprofit hospital system and a major insurer when the Pennsylvania Insurance Department approved the af-filiation between Highmark (a BlueCross BlueShield subsidiary) and West Penn Allegheny Health System, both based in Pittsburgh. After closing that deal in April, Highmark went on to add two more Penn-sylvania-based hospital systems to its inte-grated delivery system, Allegheny Health
Network.While a lot happened on
the non-profit side, Morgan noted there were also major acquisitions
within the publicly traded hospital space. “On the for-profit side, there were two notable deals completed or announced in 2013 — Tenet Healthcare & Vanguard Health Systems and Community Health Systems & Health Management Associ-ates.”
In the first deal, Nashville-based Vanguard was the target of Dallas-based Tenet. The latter completed its acquisi-tion of Vanguard at the beginning of Oc-tober in a deal valued at approximately $4.3 billion ($1.8 billion purchase price plus assumption of $2.5 billion of Van-guard debt).
The second deal, Morgan said, was announced last year and is anticipated to close in the first quarter of 2014. In this case, Franklin, Tenn.-based Com-munity Health Systems seeks to acquire HMA, which is headquartered in Naples, Fla. Just before Thanksgiving, CHS and HMA announced the companies’ pro-posed merger had been declared effective by the Securities and Exchange Commis-sion (SEC), clearing the way for a vote by HMA stockholders for or against adoption of the merger agreement. With a purchase price close to $4 billion plus assumption of debt, the overall value of the merger is anticipated to be in excess of $7.5 bil-lion, making it the largest deal since the HCA buyout in 2006. Once the merger is executed, CHS will own and/or oper-ate 206 facilities with more than 30,000 licensed beds.
“From and M&A perspective, I would expect to see a continued robust level of activity,” Morgan said of 2014. However, given the limited number of publicly traded companies and the amount of activity that has already oc-curred in that space, he said he expects much of the future activity to be in the not-for-profit world.
Behavioral health had a “decent” 2013, Morgan said. Franklin, Tenn.-based Acadia Healthcare enjoyed another
healthy year of growth. The company began the year by completing previously announced deals acquiring Behavioral Centers of America and AmiCare Be-havioral Centers and then proceeded to acquire additional individual facilities in Georgia, Tennessee, Florida, and Puerto Rico during the remainder of the year. Morgan said he expected the company to continue to grow in 2014.
A behavioral health “marriage” an-nounced in late 2013 is expected to come to fruition in 2014. In November, the lead-ership of Centerstone, which has a major presence in Tennessee and Indiana, and the H Group, with facilities in Illinois and Kentucky, announced their intent to af-filiate. Although the H Group will operate under the Centerstone flag, David Guth, CEO of Centerstone of America, said the affiliation had no money or assets chang-ing hands and was instead a joint effort to “create a stronger and more effective behavioral health service organization.” Earlier in November, Hazelden and the Betty Ford Foundation also announced a mega-merger in the addiction space.
After a slow start, Morgan noted home health saw some movement by late 2013. “In home healthcare, we did see a little bit of pick up at the end of the year,” he said, noting Louisville, Ky.-based Al-most Family acquired Nashville-based SunCrest Healthcare in December. Going forward, Morgan said, “2014 could poten-tially be a year where you see more con-solidation in the home health space.”
Other sectors, said Morgan, were considerably quieter in 2013. Senior housing saw some limited activity, as did dialysis. Morgan said the latter was al-ready pretty consolidated with the two big players being DaVita and Fresenius. “Be-tween the two, they already control about 55 percent of the domestic market,” he pointed out.
It was also a fairly quite year for labs, hospice, skilled nursing and LTACs as these sectors restructure and re-evaluate expectations under ACA and the impact of post-acute bundled payments. In the lab space, Morgan noted, “They’re not redeploying capital for growth right now. They’re trying to pacify stockholders by buying back shares and paying dividends because of the weaker organic growth be-cause of pricing and volume pressures.”
In general, Morgan concluded, there was good news in the equity markets for a number of healthcare sectors in 2013. “The S&P was up almost 30 percent … healthcare services was up over 37 per-cent,” he noted. For some, the gains were even greater. Morgan said behavioral healthcare was up over 100 percent and hospitals up over 44 percent.
Looking ahead, he said, “I still think you can have really attractive returns for 2014 given valuations are still reasonable and the growth opportunities presented by the Affordable Care Act, but I think you need to pick your subsectors carefully.”
M&A Trends in the Reform EraA look back at 2013 … Look ahead in the new year
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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 FEBRUARY 2014 > 9
The UT Health Science Center (UTHSC) and UT Medical Group, Inc. (UTMG) have launched the university’s first-ever Department of Dermatology to expand the range of dermatological subspecialty care available in the Mid-South. The department focuses on the treatment of complex cases that may be difficult to manage, as well as skin conditions that result from systemic disease.
Dr. Kathryn Schwarzenberger was recruited from the University of Vermont College of Medicine by UTHSC to lead the Kaplan-Amonette Department of Dermatology. The department is named in honor of local pioneering dermatologists Dr. Robert Kaplan and Dr. Rex Amonette.
“I think there is incredible opportunity to grow here,” says Dr. Schwarzenberger, who holds the Amonette-Rosenberg Endowed Chair of Excellence in Dermatology. “Our residency training program is a major priority for all of us on the faculty; we train outstanding young dermatologists here and I hope to maintain and grow that tradition. We are working with the program to enhance and strengthen it. I look forward to working for the benefit of our patients and colleagues in Memphis and beyond.”
The department includes an outpatient clinic at 930 Madison Avenue, where the team of board certified dermatologists specializes in the management of a wide variety of skin disorders including allergies, contact dermatitis, lymphomas, and infectious diseases. UT Dermatology staff also have clinical expertise in treating conditions related to rheumatologic and other medical conditions, such as lupus and scleroderma. Doctors make every effort to see patients with emergent conditions the same or next day.
With six examination rooms and a procedure room for skin surgery, the office is equipped to serve a wide range of dermatologic patients. Doctors offer the latest topical and systemic therapies, including narrow-band UVB /PUVA phototherapy for severe or resistant cases of psoriasis, refractory atopic dermatitis and eczema, vitiligo, urticaria pigmentosa, and other skin disorders.
Adjacent to the clinic is UT DermPath, the department’s dermatopathology laboratory. Staffed by board certified dermatopathologists, the lab supports referring clinicians by rendering accurate, precise, and timely diagnoses of benign and malignant neoplasms and dermatologic diseases. UT DermPath holds accreditation from the College of American Pathologists and meets all Medicare CLIA (Clinical Laboratory Improvement Amendments) requirements. The lab offers 24/7 physician consultations and a full range of dermatopathology services for skin biopsies and other testing, including special and standard stains, direct immunofluorescent studies, immunohistochemistry, and diagnostic consultations on slides from other laboratories.
“What we’re hoping to do, is build an academically-oriented department that will take care of people with very complicated skin disorders, not just in Memphis, but in the surrounding areas,” Dr. Schwarzenberger says. “We also want to advance the knowledge base of our specialty, to learn new things and make new discoveries that advance the specialty of dermatology.”
Kathryn Schwarzenberger, MD• Chair & Professor of Dermatology• Board certified by American Board of Dermatology• Fellowship training in immunodermatology
Tejesh J. Patel, MD, MBBS • Dermatologist, Dermatopathologist & Assistant Professor• Board certified by American Board of Dermatology and in Dermatopathology by the American Boards of Dermatology and Pathology
Kris Fisher, MD• Dermatologist,
Dermatopathologist & Assistant Professor• Board certified by American Board of Dermatology and in Dermatopathology by the American Boards of Dermatology and Pathology• Fellow, American Academy of Dermatology
Emily H. Jones, MD• Dermatologist & Assistant Professor• Board certified by American Board of Dermatology
For more information:
UT Dermatology Clinic:901-866-8805
UT DermPath Lab: Toll-free 855-DERMPATH
New Department of Dermatology Specializes in Complex Skin Conditions
Above Dr. Schwarzenberger examines a patient in the new office.
Here are a few statistics that might be of interest to you. It involves the ranking of insured people under the age of 18 as a percentage of the total US population in 2012:
• Nevada was ranked first with 18.3 percent
• Michigan was ranked 50th with 3.5 percent
• Tennessee was ranked 29th with 7.3 percent
(Source U.S. Census Bureau, Current Population Survey)
Industry experts have speculated what 2014 will bring and how implementation of the Affordable Care Act will affect medical group professionals. The question, “Does healthcare reform represent incremental change or a fundamental shift?” was posed during the U.S. News Report Hospitals of Tomorrow conference, in Washington, D.C. last November and hospital executives pointed to mergers, acquisitions and new forms of integration to suggest that it is more of a fundamental change that demands new types of collaboration.
I have mentioned in numerous articles that as the MGMA/ACMPE board of directors went through three years of transforming its organization into fundamental change (1) Beginnings; Focus and Action toward the desired state. (2) Neutral Zone; A time where we are between what has been and what are in the future. (3) Endings; Letting go of what has been a consistent and/stable mindset, philosophy, belief, structure, time, environment, role, responsibility, idea, world. We must stop doing things one way and begin doing them another way. Providers must move quickly out of the neutral zone or we will find ourselves reactive to the payers.
The terms clinical integration (CI), accountable care organizations (ACOs) and population health management (PHM) are often uttered these days but can be somewhat ambiguous depending on the organization and the particular stakeholders. Although the terms allude to quality care, cost efficiencies and the future healthcare environment, it’s often difficult to ascertain the specifics.
I have been working in healthcare since 1987. One of the biggest barriers to successful integration is physician resistance (sometimes rightly so) because physicians aren’t used to thinking and acting in concert with hospital executives and others.
My biggest concern is that if physicians and hospitals don’t change this way of thinking we will lose control and insurance companies will continue to rake in millions of dollars at the expense of the patients and the providers.
Insurers will be closely watching the rolling implementation of federal and state exchanges through the coming year. The initial rocky launch caused mass confusion and hindered enrollment. In particular, they’ll be scrutinizing the demographics and health risk composition of the emerging marketplace. Most experts say the key will be whether the risk pool is balanced between younger and healthier people and older and sicker people.
If the website kinks are worked out – and they seemed to be at year’s end, insurers are poised to take advantage of a huge expansion in their customer base. “What’s not to like about the government saying everybody must have this product and we’re going to help people pay for it?”
asked Joel Ario, former director of HHS’ office of health insurance exchanges.
The first hint of how insurers did during the problematic first three months of open enrollment on the exchanges – and how investors will regard their prospects – came on January 16 when UnitedHealth Group detailed its fourth-quarter finances. Observers are also watching to see how the 80 new entrants to the individual and small group markets fare in 2014.
Experts also anticipate more employers will buy coverage for their employees through private insurance exchanges offering multiple plan options, similar to the public exchanges. In this arrangement, firms give their employees a fixed contribution and let them choose an insurer and plan.
Insurers are banking on continued growth in the Medicare Advantage. More than a quarter of all Medicare enrollees are now in private plans, and roughly 40 percent of new Medicare beneficiaries are choosing Advantage rather than traditional Medicare. Insurance consultant John Gorman expects the number of individuals enrolled in private Medicare plans to grow by 8 percent to 10 percent annually.
When we were organizing the fundamental change/changes of the MGMA/ACMPE the board recognized that we had to have various stakeholders and volunteers from throughout the organizations. We knew we could not be lacking in data and sound information and had to be transparent with our membership. If not the chances of success would be virtually nonexistent. The organization is the leading association for medical practices administrators and practices has been in existence since 1926. Its national membership represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties.
Organizations and associations have very strong, deeply ingrained cultures. They have profound, long-standing traditions. They have powerful and intricate political dynamics. They are manipulated by influential and formidable personalities, in many cases, a bank of opinionated past individuals. They often value the status quo. Most are reactive than proactive. Quite frankly, most organizations and associations are hostile environments for change. In this type of environment, you don’t stand much of a chance of making a case without data. But the facts can be a powerful strategic resource in promulgating change, particularly fundamental radical change.
Although the following four thoughts may seem too simple, I will tell you they were most helpful for the MGMA/ACMPE in our change and sanity. And they may help us keep our cool as we navigate the ACA waters that lie ahead…
• Don’t get overwhelmed. • If your data voids are considerable,
prioritize and get to work.• Concentrate data gathering in a
short, specific time frame.• When perfect data is not available,
use the best you have.
by Bill Appling
Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at [email protected].
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Since Congress passed the Affordable Care Act (ACA) in 2010, doctors have been bailing out of practices posthaste. Exasperated by surging expenses, shrink-ing reimbursements and costly-to-cover government mandates, frustrated physi-cians are citing healthcare reform-related spending as a major reason for selling practices as the rollout progresses.
According to a study by Jackson Healthcare, the nation’s third largest healthcare staffing agency, 12 percent of physicians who sold their practices be-fore sweeping federal legislation became law made the change because they didn’t have appropriate resources to comply with the law and maintain a reasonable ROI. Within the last three years, the rate of phy-sicians selling their practices for the same reason – especially now with dwindling ways to stay fiscally healthy – jumped to 30 percent.
“Of those now considering selling their practices, 36 percent cite the com-plexity of the healthcare reform law as a reason; and 24 percent say they don’t have the resources necessary to comply with the law,” according to Jackson Healthcare’s report. “The burdens also appear to be taking physicians away from their fami-lies. They want better work-life balance, with less time working and more time in their private lives. Forty-three percent feel employment, rather than ownership, will give them that balance.”
Even though no statistical differential denotes the type of physicians who want to remain in private practice versus those ac-tively marketing their practice, nearly half actively seeking to sell are internal medi-cine subspecialists (23 percent), primary care physicians (14 percent) and surgeons (12 percent). Of those internal medicine subspecialists, 23 percent are otolaryn-gologists, 17 percent are urologists, and 13 percent are cardiologists.
Reimbursement cuts (79 percent) and the cost of maintaining a practice (64 percent) were the most commonly cited reasons among internal medicine subspe-cialists who want to sell; 57 percent also pointed to the complexities of healthcare reform as a reason for selling, cited the report.
Three of four surgeons marketing their practices said reimbursement cuts and healthcare law complexities were con-tributing factors in the decision to sell.
Not surprisingly, hospitals and health systems are acquiring most physician practices (52 percent). Interestingly, solo practitioners accounted for 19 percent of physician practice buys, while physician-owned groups made 18 percent of group acquisitions. Ten percent of doctors who
sold their practices listed their buyer as “other.”
Even though physicians are leaving the ownership aspect of private practice, most aren’t departing the practice of medi-cine. Only 9 percent sold their practices because they wanted to retire; 6 percent sold because they wanted to leave the practice of medicine.
“Physicians in private practice still outnumber those employed, but this could be shifting as less than half of the respon-dents with an ownership stake say they plan to remain in private practice,” ac-cording to the report.
The last cycle of hospitals snapping up private practices occurred in the 1990s, when hospitals saw the acquisitions as a way of gaining access to more patients. As a result, physicians got sweet deals. But in this buying cycle, the deals aren’t as finan-cially rewarding. Yet the circumstances provide a way for private practice doctors to step out of time-consuming administra-tive roles while also appreciating a steady income and sometimes improved hours as employees. A post-sale downside that im-pacts physicians to widely varying degrees: adjusting to the loss of autonomy.
Simply put, the private practice model has become very expensive to op-erate, John Dubis, CEO of St. Elizabeth Healthcare in Cincinnati, Ohio, explained to CNN Money.
“That’s why it’s diminishing,” he said, noting that most of the 300 physicians em-ployed by the hospital’s specialty physi-cians group were plucked from private practices.
In December 2012, Montana-based St. Vincent Healthcare acquired Frontier Cancer Center, established in 1982. The close-knit group of five oncologists had struggled financially pre-healthcare re-form, taking a significant hit in 2003, when Medicare changed the way it reimbursed doctors for chemotherapy drugs. Despite taking significant pay cuts, the group closed one of its four locations in 2008. With the dark cloud of bankruptcy loom-ing, the group was happy to find a buyer.
“We have a joke,” said Patrick Cobb, MD, an oncologist in the Frontier group told CNN Money, “that there are two kinds of private practices left in America: those that sold to hospitals and those that are about to be sold.”
In a companion survey released by Jackson & Coker, a subsidiary of Jackson Healthcare, a majority of doctors want to see ACA defunded or repealed. A scant 6 percent said it should remain unchanged.
“The more physicians learn about ACA, the more they dislike it and want to start over,” said Richard L. Jackson, chair-man and CEO of Jackson Healthcare.
Physicians Selling PracticesTrend watch: who’s making the move now and why
m e m p h i s m e d i c a l n e w s . c o m FEBRUARY 2014 > 11
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By KIMBERLy ALEXANDER Now that the health insurance market-
place is open, many are wondering about the immediate effects the Affordable Care Act will have on the healthcare indus-try. For example, will medical degrees lose their luster? Will the financial uncertainty and politicizing of the pro-fession discourage students from pursuing a medical degree? Will there be enough healthcare professionals to care for a grow-ing population?
At this point, the long-term financial and political implications of the health-care overhaul, dubbed Obamacare, do not seem to be of real concern to students con-sidering a medical career, at least not yet. Local student response bears this out as few students, if any, are asking about how the ACA will affect their reimbursement or bottom line as physicians.
Jessica Clifford Kelso, a pre-profes-sional advisor with the University of Mem-phis, said she hasn’t received any such questions from students or their parents. Dr. Susan Brewer, assistant dean for clini-cal curriculum and associate professor of medicine at the University of Tennessee Health Science Center College of Medi-cine, agrees.
“As far as ‘will this [the Affordable Care Act] have an impact on me?’ there’s not a lot of worry,” Brewer said. “There’s curiosity.”
Another indicator that students aren’t yet concerned about how the ACA will af-fect their futures is the number of students applying to medical school. Nationally, these numbers are off the charts and don’t appear to be slowing down, even with the dismal rollout of the ACA marketplace. According to the Association of American Medical Colleges, the number of students applying to medical school in 2013 grew 6.1 percent to 48,014, which surpassed the previous record set in 1996 by 1,049 stu-dents.
Additionally, 20,055 students enrolled in medical school, which represents the first time that number has ever exceeded 20,000. The number of first-time ap-plicants, another indicator of interest in medical school according to the AAMC, increased by 5.8 percent to 35,727.
Local numbers and experiences sup-port this. Students expressing aspirations for medical school have not diminished at the U of M, according to Kelso. Rather, such interest has increased. At
the College of Medicine, medical school applications and enrollment are trending up.
“We increased the size of our medi-cal school class a few years ago from 150 to 165, and we are filling those slots and have plenty of applicants,” Brewer said. “So there’s been no decrease in enrollment in the last couple of years. In fact, just the opposite.”
The College of Medicine reports a 25 percent increase in applicants in 2012, a steady 2013 and a 5 percent increase for 2014. Additionally, Brewer said, medical school enrollment nationally jumped al-most 9 percent in 2012 and 2.8 percent in 2013. So filling vacant slots is not a concern for most medical programs.
“Our problem is going to be a bot-
tleneck that emerges when our current medical students ... try to get residencies,” Brewer said.
That’s primarily because the number of residency slots funded by Medicare has not increased since 1997. So the concern for most students, according to Brewer, is, “Am I going to be able to match in a resi-dency when I finish my medical degree?” That is the critical question, not how ACA will affect the student. The reason is simple.
“Because without a residency, no one can practice medicine,” Brewer said.
The College of Medicine is taking steps to help its students get the training they need. It has a robust counseling program in place, which is especially helpful for students pursuing a competitive residency, and the college also is engaging in public outreach to legislators to make them aware of the resi-dency and funding shortage.
While there are many challenges and uncertainties in the current healthcare en-vironment, Brewer doesn’t think these will “scare” students away from the profession. Rather, she’s more concerned about lower-income people in Tennessee having access to healthcare.
“I hope that the Affordable Care Act gets to be more affordable or leads to more affordable insurance options,” she said.
Changing Healthcare Landscape Not Slowing Drive for Med School
12 > FEBRUARY 2014 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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2013 St. Jude Memphis Marathon Week-end had a minimal impact on revenue, Shadyac said. “We had a record year and had raised about $8.2 million prior to the race, compared to $6.1 last year. Since very few people took advantage of the reg-istration rebate offer, the anticipated fi nal fi gure — between $7.8 and $8 million — still represents a substantial increase over the previous year.”
Shadyac credits St. Jude’s “amazing mission” — one that resonates with people around the world — and his “incredible team of ALSAC fund-raisers and market-ers who make it happen.”
But perhaps a large proportion of his success is a result of his family’s intimate connection with St. Jude’s early history.
“I’ve been involved with St. Jude all my life,” Shadyac said. “My father was one who, back in the late 1950s, answered Danny Thomas’ call when he fi rst asked people of Lebanese heritage to join him in creating St. Jude. My father was a Depart-ment of Justice lawyer in Washington, D.C., who just happened to be Lebanese; he met Danny Thomas and decided to sign up.”
Richard Shadyac Sr. served on the ALSAC Board of Directors for nearly three decades before taking over as ALSAC CEO from 1992 through his retirement in 2005.
Although Shadyac Jr. was too young to recall the actual opening of St. Jude in 1962, he has fond memories of being walked to church as a child by Danny
Thomas, a family friend who visited them in Washington.
“I have great memories of meeting Marlo Thomas for the fi rst time,” Shadyac said. “Our school at Falls Church, Vir-ginia, was the leading fund-raiser, and the big award was a personal visit from Marlo Thomas. I got to brag to all my friends that we were responsible for bringing ‘That Girl’ to our junior high school, and that was cool.
“As I was growing up, I was blessed to get to know Danny, and with the excep-tion of my parents, I don’t think there is any person that has had more of an impres-sion on me than Danny Thomas. I think of what a visionary he was and the courage that it took for him, my father and that en-tire fi rst generation to create St. Jude Chil-dren’s Research Hospital.”
In 1957 — the year American Leba-nese Syrian Associated Charities (ALSAC) was created — they committed to the mis-sion of treating children without regard for race, creed, religion or ability to pay; to build the hospital in the South and insist that it be integrated; to insure that no fam-ily would pay St. Jude for anything even though their early funding was limited; and to promise that their research would be shared freely with the world.
“These are concepts that would have been so foreign and so unique in the 1960s, yet their bravery, courage and vision have given us the premier pediatric cancer re-search hospital in the world,” Shadyac said.
Although he is the youngest CEO to serve in his position, the ALSAC/St. Jude mission is in Shadyac’s blood; after 27 years of practicing law in the Washington area he chose to transition his career and re-located to Memphis to accept the role of CEO. He previously served as chairman and president of the ALSAC Board, which he joined in 2000, also serving on multiple committees.
He is also active in the Memphis com-munity on the boards of directors for the Greater Memphis Chamber, and Memphis Tomorrow.
“I had two great parents that stressed the importance of giving back to your com-munity and being a servant leader,” he said. “It was the right time for me to make a change in my life and happily give back.”
Shadyac’s father passed away in 2009, shortly after learning that his son had been selected to follow in his footsteps as ALSAC/St. Jude CEO. “It meant a lot to him to know that,” Shadyac said.
His goals and initiatives for St. Jude include creating a more robust marketing function at ALSAC. “We knew we had a good brand, but I wanted to create a great
brand,” he said, “an iconic brand on a par with Apple or Google in the not-for-profi t world.”
He also spoke of reaching out to grow-ing demographic segments, including the African-American, Hispanic and Asian-American communities, and of his pride in the gratifying response they have already received. He describes a focus on amping up digital efforts and offering donors the opportunity for on-line transactions. He outlines plans for refi ning their messaging and their brand to make sure that people understand what St. Jude Children’s Re-search Hospital stands for. He stresses the expansion of their efforts internationally — relative not only to ALSAC fund-rais-ing but to help more children and families worldwide benefi t from the mission of St. Jude and the research it fosters.
And he hints at an exciting new proj-ect that his celebrity brother, writer, fi lm director and producer Tom Shadyac, is undertaking on behalf of St. Jude — to be unveiled soon. Like his brother, Tom has dedicated years of his life to giving back to the city of Memphis and to St. Jude. III
“I think people would be surprised at how diffi cult it is to fund-raise in the economic climate that we are currently operating in,” Shadyac said. “It’s a very competitive space. Compared to 10-15 years ago, there’s been a doubling of the number of 501 (c) 3’s across the United States, so it’s becoming increasingly diffi -cult to differentiate your charity in a very crowded space.”
With more than 14,000 people tour-ing St. Jude annually, however, clearly the mission conceived by Danny Thomas, and launched with support from Shadyac’s fa-ther more than 50 years ago, still fascinates and touches hearts.
So Shadyac is justifi ed in identifying his proudest accomplishment as two-fold: continuing to meet the needs of the hospi-tal on a daily basis and being one of the few charities that has grown — and grown robustly — through the Great Recession.
“There’s no greater mission on the planet than St. Jude Children’s Research Hospital,” he said. “I derive tremendous satisfaction from having the privilege of leading this organization. It has given me a great sense of direction, a great sense of satisfaction; there’s nothing better than coming to work every single morning at ALSAC and St. Jude Children’s Research Hospital, not only because you meet in-credible patients and families and feel like you’re making a difference, but I also could not work with better people than I do at ALSAC and St. Jude. They are truly re-markable folks that are dedicating their lives to giving back.”
He encourages others to think seri-ously about careers in the not-for-profi t world, where opportunities that are profes-sionally robust also allow greater personal satisfaction by doing good.
Married for 32 years to his college sweetheart who partners with him in his work at ALSAC/St. Jude, Shadyac has two grown children who also are involved with St. Jude.
Richard C. Shadyac Jr., JD, continued from page 1
m e m p h i s m e d i c a l n e w s . c o m FEBRUARY 2014 > 13
Couples who are having trouble becoming pregnant now have additional fertility resources with the opening of the Center for Reproductive Medicine in Germantown. Headed by Dr. Laura Detti, a board certi� ed reproductive endocrinologist who has repeatedly been named to Best Doctors®, the facility o� ers a full range of infertility services, including diagnosis, treatment and assisted reproduction.
Infertility Diagnosis & ManagementAccording to statistics from the U.S. Centers
for Disease Control, infertility a� ects more than 7 million Americans, including both men and women. � e Center for Reproductive Medicine provides diagnostic testing and treatment for female infertility-related conditions such as uterine � broids, polycystic ovarian syndrome, pelvic adhesions, tubal occlusion, endocrine dysfunctions, and recurrent miscarriages. Evaluations for male infertility are also o� ered, including sperm testing and analysis using Kruger strict morphology criteria.
Assisted FertilizationCouples who need assistance with
fertilization may be may be able to achieve pregnancy through techniques such as intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) using partner or donor sperm, and pre-implantation genetic screening (PGS).
Embryology Laboratory Director Lucy Williams, TS, ELD, conducts these procedures in the Center’s Andrology Lab using the latest equipment, including tri-gas benchtop incubators, which facilitate optimal embryo development and improve pregnancy rates as compared to older incubator technologies. An experienced certi� ed embryologist, Williams has a 20-year track record of achieving pregnancy rates above the national average at infertility laboratories in Tennessee, Illinois, Texas and Utah.
Dr. Detti, who is also a certi� ed sonographer, performs all ultrasound-guided procedures. In addition to providing a complete fertility evaluation of the couple, she uses ultrasound to monitor fertility treatments. She can determine when follicles are mature for ovulation and can determine the perfect timing for fertilization of the egg to occur.
To assist patients with the costs of assisted fertilization, the Center o� ers � nancing through Advanced Reproductive Care, Inc., an organization that specializes in � nancing IVF procedures for patients at university-a� liated fertility clinics across the nation. � e Center for Reproductive Medicine is the only ARC member in the state of Tennessee.
CryopreservationIn addition to sperm testing and fertilization
procedures, the Center helps couples preserve their fertility for the future by freezing sperm, eggs and tissue. Using a cutting edge process called “vitri� cation,” the lab extracts water from the egg, sperm or tissue before � ash freezing it. � e technique prevents the formation of ice crystals, resulting in cells that are more resilient and better able to survive and function a� er thawing.
A� er freezing, the specimens may be stored in a liquid nitrogen container in the lab for a
long time. Specimens that may not be needed for several years are transported to a cryobank for long-term storage.
Cancer patients who must undergo toxic chemotherapy and radiation treatments are prime candidates for fertility preservation. Eggs, sperm and tissue can be retrieved before cancer treatment, frozen, and used once the cancer is in remission and the patient is ready to have a family.
� e Center for Reproductive Medicine lab is registered with the Food and Drug Administration (FDA), the state of Tennessee, and certi� ed by � e Centers for Medicare & Medicaid Services, which regulates all clinical laboratory testing performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA).
About Dr. DettiDr. Laura Detti is a reproductive
endocrinologist who specializes in male and female infertility. She earned her medical degree at the University of Florence in Italy and completed OB/GYN residency there and at the University of Cincinnati and the University of Virginia. She completed fellowship training in reproductive endocrinology and infertility at Wayne State University School of Medicine in Detroit and research fellowships at Yale University, the University of Virginia, and the University
of Mississippi. Dr. Detti is board certi� ed by the American Board of Obstetrics and Gynecology with subspecialty certi� cation in reproductive endocrinology and infertility. She is a fellow of the American College of Obstetrics and Gynecology and a member of the American Society of Reproductive Medicine, American Institute for Ultrasound Medicine, and the Society of Gynecological Surgeons. She also serves as Associate Professor of Obstetrics and Gynecology at the UT Health Science Center.
About Lucy WilliamsLucy Williams holds certi� cation in
micromanipulation, embryology and andrology, and preimplantation genetic diagnoses. She has more than two decades of experience in clinical patient care, lab testing and analysis, and research and is widely-published. A� er earning her bachelor’s degree at Newman University in Wichita, Kansas and completing post-graduate study at the University of Minnesota in Minneapolis, she furthered her training at the Jones Institute for Reproductive Medicine and Eastern Virginia School of Medicine in Norfolk and at the Assisted Reproductive Technology Reproductive Center in Beverly Hills, California. She is a member of the American Society for Reproductive Medicine and the College of Reproductive Biologists and Technicians.
UT Medical Group Launches Center for Reproductive Medicine
Services Provided:• Semen analysis with Kruger strict morphology criteria
• In-vitro fertilization (IVF)
• Intrauterine insemination (IUI)
• Sperm washing and freezing
• Isolation of sperm from testicular aspiration or biopsy
• Male and female fertility preservation through sperm and egg cryopreservation
• Male and female infertility diagnosis and treatment
• Genetic counseling
• Fertility consultations prior to and after cancer treatments
• Diagnosis and treatment of endocrine dysfunctions
• Ultrasound services, including 3D and 4D ultrasound, sonohysterography, ovarian cancer screening, tubal patency detection, and follicular monitoring
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toothbrush, toothpaste, shampoo, soap, etc.
$100 Provides a full day of food and shelter for two people affected by a disas-ter.
$585 Covers the cost to deploy one Emergency Response Vehicle and two Red Cross workers to a disaster opera-tion for one day. This vehicle is designed to drive through disaster areas delivering meals and snacks, relief supplies, informa-tion and comfort.
$1,000 Covers the cost of diapers, wipes and soy formula for 20 infants dur-ing their stay at a Red Cross shelter.
$5,000 The Mid-South Red Cross chapter has a need for a supply of blankets and comfort kits.
Teddy Bears There is a need for NEW teddy bears
to give to children affected by disasters.
DONATE BLOOD or Host a Blood Drive
Medical practices can help by hosting a blood drive at your clinic and/or facil-ity. For more information, call Ryan Nor-ris at 501-772-3136 or email him at [email protected].
VOLUNTEER Do it as much and as often as your
schedule permits. This is a 130-year-old tradition of neighbors helping neighbors in need. There is a particular need for medical personnel to help out as mental health workers in a disaster. For more information, call Kevin Kuhns at 901-672-6351 or email him at [email protected].
BE AWARE AND SPREAD THE WORD
Follow, like, subscribe and then re-post and re-tweet to get the word out about what our local Red Cross chapter is doing:
For all other information, go to their website: www.redcross.org/tn/memphis.
Do you have suggestions on a non-profit or charity worth spotlighting in this column? Please send your nomination to me at [email protected].
Mid-South Red Cross Chapter,continued from page 6
REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.
14 > FEBRUARY 2014 m e m p h i s m e d i c a l n e w s . c o m
Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email [email protected]
By TIM NICHOLSON
For the better part of the Social Era, physicians have decried the use of social media among their target demographic: grownups and the elderly. But guess what? Dads, Moms and even Grandma are all up in social media tools like Facebook and it’s time you connected with them there.
In fact, a recent Pew Internet Research study found that 71 percent of adults online are on Facebook and that’s up from this time last year. Really, parents and grand-parents are the only real growth areas for Facebook with 45 percent of people 65 years and older using Facebook. However, it’s not the only site to see growth.
Twitter saw growth among adults. But it’s Pinterest that has the most mo-mentum as over 1/3 of all women online report using the image and idea sharing platform to curate inspiration, health tips, recipes, fashion and other topics – often from people like you.
Okay, let’s admit it. Most of the peo-ple offering these bits of hope and infor-mation are not nearly as well qualified as you to share ideas in a way that might lead to improved health.
I’m going to guilt you into this. You should be using social media if for no other reason than to make sure that at least some of what women are curating makes sense in the context of a healthy lifestyle.
Hey, when grandma falls down and can’t get up, we want her to have a button to push for help. But when we’re trying to coach mothers, grandmothers and other adults we’re willing to let the purveyors of gimmicks lead the way. It’s time for an intervention.
Want more evidence in the case for your being present online? Consider this:
From a recent study, 54 percent of patients are very comfortable with their
providers seeking advice from online com-munities to better treat their conditions. It’s evidence that many trust that crowd sourcing of information from other like-minded individuals is reliable. This shows how people perceive the social media to be beneficial for the exchange of information about their health. Why shouldn’t you be the one from whom they curate it?
Need a business reason? 41 percent of people said social media
would affect their choice of a specific doc-tor, hospital, or medical facility. This shows that social media can be a vehicle to help scale positive word of mouth, which makes it an important channel for an individual or organization in the health care industry to focus on in order to attract and retain patients. Consumers are using social media to discuss everything in their lives including health and it is up to your organization to choose whether it’s time to tune in.
Lest you think it’s just patient talk-ing, here’s this from professionals like you: 60 percent of doctors say social media improves the quality of care delivered to patients.
Wow! So there are doctors (maybe you’re one of them) who believe that the transparency and authenticity that social media helps spur is actually improving the quality of care provided to patients.
So if you’re still saying, “My patient demographic and providers like me don’t take social media seriously” and that “nei-ther patient nor doctor is there” – I say, oh yes they are.
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is at fault or not.“We don’t follow British rule, where
the loser of a case pays for all associ-ated costs. Instead, in America, jury verdict is the final resolution for a dispute, and we have a constitutional right that guarantees any citizen who feels aggrieved has the right to file suit.”
When physicians are beginning their practices, they are often advised to secure as much malpractice insurance as they can afford. Coverage is often calculated based on available data per specialty. Those going into higher-risk fields of medicine (i.e., obstetrics vs. dermatology) are advised to seek higher levels of coverage.
But assuming the worst does happen and a physician is sued for malpractice, what then?
“If the court finds in favor of the plain-tiff,” Cook said, “the physician always has a right to appeal. A motion can be made for a new trial. Or a motion can be made ask-ing the judge to reduce the verdict. In either scenario, the case would move along into the Tennessee Court of Appeals. Typically is takes six to 12 months for a case to be put on the docket and heard in the state Court of Appeals. The good news is that filing an appeal stops payment of court-ordered awards, but the clock doesn’t actually stop. Simple interest, at the rate of 10 percent, is being compounded annually from the day the original order was signed.”
And getting the case heard by a higher court is no guarantee that the verdict will be overturned. In fact, the ruling of an appel-late court could find errors in the original proceedings and order a new trial. Yes, the whole thing could start over again. Or the verdict could be upheld. In the latter sce-nario, the doctor has one more option, to appeal to the Tennessee Supreme Court. But that court has a right to refuse to hear the case.
If there is not a constitutional issue at stake or other jurisdictional basis for the court, the case does not qualify for Supreme Court jurisdiction. However, if the case is
accepted by the state Supreme Court, it is likely to be another six to 12 months before the case is heard.
Recent state reforms are lessening the number of malpractice cases that actually are filed. The state medical malpractice re-form acts of 2008 and 2010 put qualifying stipulations in place.
Plaintiffs are now required to file a certificate of good faith with the court to show that they have consulted with a medi-cal expert about their case AND that they have been told their case has merit. These procedures have led to approximately a 40 percent decline in the number of malprac-tice cases filed since 2010.
“Close to half of all physicians have been named in a lawsuit,” Cook said. “But many malpractice cases are dismissed or settled out of court and never go before a jury. Of the cases that do get heard, over 90 percent result in verdicts in favor of the defendant, the physician.”
Michael Gelfand, MD, an infectious disease specialist on the teaching faculty at the University of Tennessee Health Science Center, has been sued several times, as have his colleagues who practice in high-risk spe-cialties. One of Gelfand’s cases went to trial in federal court and resulted in a defense verdict. His other cases have been summar-ily dismissed with no payment ever having been made.
“When it happens the first time, it feels like a personal matter,” Gelfand said. “You don’t expect that it would happen to you. Most people who enter the field of medicine do so primarily to take care of other people. Generally, the population of physicians is preselected for being altruistic because they care about the suffering of others. So it is always a shock when a patient lashes out. This is someone you were trying to help . . .”
“The dynamics are not unlike a di-vorce. Feelings of ‘I did the best I could’ and ‘Why is this happening?’ are usually coupled with ‘How could someone I cared about lash out at me this way?’”
When people feel harmed, they often want to avenge themselves. For in-stance, in the case of an obstetrician, the hoped-for outcome is a healthy baby. But unfortunately that is not always the case. And when there are problems with a baby, families often look for someone else to blame.
Gelfand postulates that physicians have to erect psychological defenses in order to cope with being sued.
“Doctors have to learn to take being sued less personally and learn to deal with it in a business-like manner,” he said. “How-ever, there are some personal traits that can be remediated. For instance, if they have an ineffective communication style or do not establish interpersonal bonds with their pa-tients, then they can work to improve those skills. But the greater risk in the aftermath of being sued is that of becoming desensitized to the point that it can poison a physician’s relationship with other patients.
“A doctor doesn’t want to work from the prospective of preventing litigation. While negative emotions are normal, gen-erally it is best to proceed with the practice of medicine and not seek a counter-suit. Although the physician retains the right of appeal, it often proves to be too difficult to prove the plaintiff’s intent was malice.”
Physicians’ Steps, continued from page 1
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By LyNNE JETER
Rabih Bechara, MD, says the most difficult part of his job is telling patients, “You’ve got lung cancer.” Unfortunately, chances are three of four patients with lung cancer will be diagnosed at a late stage, when cure isn’t an option.
“Once you tell patients they have cancer, no matter the stage, they’re usu-ally very distraught,” said Bechara, chief of the pulmonary division at Cancer Treatment Centers of America at Southeastern Regional Medical Center (CTA at Southeastern) and professor of medicine at Georgia Regents Univer-sity. “The beauty is, if we catch it early, we can cure them.”
Bechara is a staunch supporter of the national push for lung cancer screening, hoping to see it join the ranks of the mam-mogram for breast cancer or colonoscopy for colon cancer. The trend of more non-smokers being diagnosed with late-stage lung cancer has expedited the movement.
“More people will die from lung can-cer this year than any other type of can-cer, including breast, prostate, colorectal and colon cancers combined,” said Bechara. “Unlike other types of cancers that are prominent among certain gen-ders and ethnicities, lung cancer doesn’t discriminate and remains the leading cause of cancer deaths, regardless of sex or race.”
According to the most recent data from the National Cancer Institute (NCI), roughly two-thirds of all new lung cancer diagnoses are among patients who have never smoked. Some are former smokers who quit decades ago.
“Despite the harsh realities of lung cancer, it simply doesn’t grab the head-lines of more popular forms of cancers,” said Bechara. “It also doesn’t get near the research funding as other cancers.”
Lung Cancer ScreeningsIn 2012, the American Lung Asso-
ciation (ALA) released guidelines on low-dose lung cancer screenings, based on the NCI’s National Lung Cancer Screening Trial. The U.S. Preventive Services Task Force recently issued draft recommenda-tions for annual low-dose CT screenings for patients at high risk for lung cancer, which translates to an estimated 7 million Americans, including smokers ages 55 to 79 who have consumed the equivalent of a pack a day for 30 years.
“We’re excited about launching this tool and the low-dose screenings,” said ALA president and CEO Harold
P. Wimmer. “It’s a big step in the fight against lung cancer. We created this on-line tool to help people understand quickly whether they’re candidates for low-dose CT screening.”
The upside of lung cancer screening was discussed in the Sept. 5, 2013 edition of the New England Journal of Medicine. “Probability of Cancer in Pulmonary Nodules Detected on First Screening CT” showed how the percentage of patients dying from lung cancer could be cut by 20 percent via a low-dose CT scan versus regular x-rays. The summary: “Predictive tools based on patient and nodule charac-teristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans are malignant.”
“Catching lung cancer early requires a very streamlined and collaborative pro-cess between PCPs (primary care provid-ers) and interventional pulmonologists,” said Bechara. “Getting the CT scan results in a timely manner and discussing the re-sults between specialists and subspecialists is vital so that patients have a ready plan when they receive a diagnosis.”
Determining who will pay for lung cancer screening remains a question mark, said Bechara, noting that a low-dose CT scan may cost up to $400. Most insurers don’t automatically cover lung cancer screening costs, as they do other cancer screenings like mammography.
“Most screening isn’t paid for. Differ-ent institutions have taken it upon them-selves to start a screening program for the benefit of patients at a reduced rate. Some offer free screenings. At Emory, we were working on (offering it free to patients) but couldn’t because of logistics and other obstacles,” said Bechara, who completed training, internship, residency and a fel-lowship in pulmonary and critical care at Emory University School of Medicine, and also founded and directed the institution’s interventional pulmonology program, fo-cusing on new endoscopic techniques for lung cancer. “Because (CTCA at South-eastern) is only 14 months old, we would probably start screening with stakeholders and their families to make sure the pro-cess is streamlined before we offer it to the general public. If there’s a fee-for-service, it will be amazingly cheap.”
Front Line Assistance“PCPs are at the forefront and play a
major role in identifying or at least raising the knowledge of patients with lung can-cer,” said Bechara. “Unfortunately, there are no specific symptoms for lung cancer. Patients may cough and be short of breath sometimes, but that can happen to anyone with sinus issues or allergies. I urge PCPs
Detecting Lung Cancer EarlierNational push for screening, research as more non-smokers are diagnosed
Dr. Rabih Bechara
(CONTINUED ON PAGE 16)
16 > FEBRUARY 2014 m e m p h i s m e d i c a l n e w s . c o m
By LyNNE JETER
An experienced practice manage-ment consultant best described the loom-ing ICD-10 conversion “as though 19 percent of the GDP will be required to start speaking French to each other … and if grammar, pronunciation and punctua-tion aren’t perfect, no money will move.”
The “frighteningly large change” coming Oct. 1 has caught many physi-cian practices off guard, said Jennifer O’Brien, MSOD, a practice man-agement consultant with KarenZupko & Associ-ates Inc. “We’re finding that some practices have done absolutely nothing to prepare.”
According to the latest Workgroup for Electronic Data Interchange (WEDI) ICD-10 readiness survey results, repre-senting a mix of practices and hospitals, “it’s clear the industry continues to make slow progress, but not the amount of prog-ress that’s needed for a smooth transition.”
Only one in three practices were conversion-ready, with the remainder citing significant obstacles to progress: competing priorities and other regulatory mandates. “All industry segments,” the re-port concludes, “haven’t gained sufficient ground to remove concern over meeting the Oct. 1 compliance deadline.”
“Apparently, there’s still a lot of hope on the part of providers that it’ll be post-poned again,” said O’Brien. (The ICD-10 conversion was originally slated for Oct. 1, 2013. In 2012, an extension was an-nounced.) “Because of the healthcare.gov debacle, people are thinking that CMS
will postpone it again. The experts are saying another postponement is highly unlikely.”
Noting that “denial is only going to make it more painful,” O’Brien recom-mended eight steps for every physician provider to take in early 2014.
Physician providers in a practice that allows them to control their own salary or draw should reduce that amount by 25 percent now. “Don’t pay out the rest,” she said. “You’ll likely need it to pay yourself during the fourth quarter (Q4).” By plan-ning for little to no Q4 revenue while also reducing the draw in the first three quarters of 2014, “you can pay yourself in Q4.” O’Brien explained: “Because the entire industry will make a change of such magnitude on the first day of Q4, the rev-enue cycle is going to be disrupted. Either the practice is going to make mistakes coding, payors are going to have difficulty processing the claims, or both. For prac-tices that don’t adequately prepare, Q4 could be bone dry.” By comparison, Ca-nadian physicians reported a productivity reduction of up to 50 percent during their conversion.
Secure a substantial Line of Credit (LOC) with a bank to cover payroll and operating expenses in Q4. “Like an insur-ance policy,” she pointed out, “a LOC must be secured before needed.”
Scale back in 2014. “This isn’t the year for capital expenditures, other pur-chasing and hiring that’s not absolutely necessary,” she said, noting the strategy applies to personal expenditures also. “2014 isn’t the year for physicians to build that dream vacation home.”
Because of increased expenses and decreased productivity, let employees know now that year-end bonuses are
highly unlikely. “It’ll be a belt tightening year,” she said.
Order ICD-10-CM books, software or apps. “Physician practices don’t need ICD-10-PCS, just ICD-10-CM,” she said, noting that CPT will continue to be used to report procedures and services for phy-sicians; ICD-10-PCS is the book hospitals use to report services and procedures. (See “Quick Definitions.”)
Depending on the practice, run a frequency report of the top 25 to 75 most commonly used ICD-9 codes with nomen-clature. “For specialty and subspecialty practices, the most common 25 diagnosis codes should be sufficient, but for inter-nal medicine, emergency medicine, and other practices with a broader scope, there will likely be more than 25,” cau-tioned O’Brien. “Once you have the list of your most commonly used ICD-9-CM codes, use your new ICD-10-CM books to crosswalk them to correct, complete ICD-10-CM codes. Don’t leave this up to the office staff. Do it on your own or with your staff. The process of converting your most commonly used diagnoses to ICD-10-CM will likely demonstrate a need for you to change your documentation of diagnoses and may show a one-to-many crosswalk. That is, what used to be covered with one code will now require additional informa-tion to select the correct code from a list of many.”
Don’t plan on leaving the conversion up to internal billing staff or an external billing service. “When asked, ‘What are you doing to prepare for ICD-10-CM?’ we’ve had physicians and managers re-spond, ‘Our billing service is going to take care of that.’ Guaranteed disaster! ICD-10-CM requires significant, documented input and details from the clinician for ac-curate, complete codes. There’s no billing service or even computer program that can crosswalk ICD-9-CM codes to ICD-10-CM codes without additional details and input from the clinician.”
Research available ICD-10-CM training. “Many national specialty societ-ies, hospitals and practice management software companies and other organiza-tions are offering ICD-10-CM training for physicians and their staff,” said O’Brien. “If your practice is large enough, it may be cost effective to hire the ICD-10-CM trainer to come to you and your staff. Plan to spend the next several months learning the ICD-10-CM coding system and changing your documentation. Don’t think you can cram for this by going to one or two seminars in the summer. This is like board examinations; only in this case, if you don’t study, prepare and perfect well in advance, the failure could mean financial ruin.”
Preparing for ICD-10 ConversionPractice management consultant shares 8 steps for physicians to take now
to recommend screening for high-risk pa-tients. They should at least be aware of the screening recommendation if patients come to them with non-specific symptoms they can’t explain. We can refer them to a low-dose CT scan of the chest, which identifies patients with lung problems and hopefully catches lung cancer in an early stage.”
Until recently, lung cancer was con-sidered a man’s disease; statistics show it’s now the leader of cancer deaths in both genders, said Bechara.
“The rate of smoking for the subsec-tion of young females is on the rise,” said the father of two adolescent daughters. “They may start smoking as young as 12 or 13, mainly because nicotine is an appe-
tite suppressant and being thin is the main goal. PCPs may tell them there are many other healthier ways to keep their bodies in shape. If we can reach them at an early age, and bring awareness to the younger generation of the consequences of choices they make early on, imagine how much cancer we can prevent down the road.”
Bechara is optimistic about curbing lung cancer. “We’re collaborating with multiple institutions and new technology,” he said. “Our aim is to look at new ways to kill lung cancer via multidisciplinary approach which includes endoscopy. It’s still in research mode, and the findings need to be validated. Definitely, more re-search is needed.”
Detecting Lung Cancer Earlier,continued from page 15
GrandRoundsNEA Baptist Cancer Center to Receive Largest Donation in Baptist Foundation History
Wallace and Jama Fowler of Jones-boro recently made the largest donation in Baptist Memorial Health Care’s 101-year history. The gift made to the NEA Baptist Charitable Foundation will be used to cre-ate the Fowler Family Patient Assistance Endowment. This fund will expand and en-hance support services for cancer patients and their families. In their honor, the NEA Baptist Cancer Center will be named the Fowler Family Center for Cancer Care.
The only facility of its kind in Northeast Arkansas, the 34,000 square foot Fowler Family Center for Cancer Care combines all components of cancer care under one roof, from diagnostics to chemotherapy treat-ments to support and educational resourc-es. The center will offer 22 chemotherapy infusion suites, designed to help ensure that patients can maintain fellowship with other patients as well as retain personal space; a new HopeCircle program area, prominently featured off the main entrance, with group meeting and private consultation rooms; close patient parking; nature-influenced dé-cor with floral space dividers and sky mosa-ics in radiation suites; a waiting room with seating for 75; and a private garden for pa-tient enjoyment and private reflection
The Baptist Foundation began actively seeking philanthropic support in 1994 and since then has raised nearly $100 million in ad-dition to awarding nearly $60 million in grants for Baptist hospitals and programs through-out the region. The Fowler’s gift is part of NEA Baptist’s first fundraising campaign.
NEA Baptist is transitioning to the NEA Baptist Health Care System. The new system will be located on a 76-acre, fully integrated medical campus that will include a new NEA Baptist Memorial Hospital Building, new headquarters for the new NEA Baptist Clinic and the Fowler Family Center for Cancer Care. Construction of the new facilities be-gan in April 2011 and will be complete early next year.
The new system follows the Mayo Clinic model of a side-by-side clinic hospital cam-pus. The new hospital is a six- story structure with 181 beds and expansion space for an additional 300 beds. The clinic consists of two multispecialty physician structures.
The new campus is a $400 million in-vestment in Jonesboro and the surrounding counties, one of the largest health care in-vestments ever made in Arkansas.
Semmes-Murphey Opens Neck & Back Care Clinic
Semmes-Murphey Clinic has opened an easily accessible clinic at the 6325 Hum-phreys Blvd. location. The new clinic exists to evaluate and appropriately diagnose pa-tients for the chief complaint of neck and back issues (particularly related to pain/dys-function) and recommend therapeutic inter-ventions. The clinic is staffed in a multi-disci-plinary fashion including nurse practitioners/physician assistants, physiatry/pain manage-ment, neurosurgery and physical therapy. The clinic will provide timely diagnosis and a treatment plan, but is not a replacement site for chronic pain management and medica-tion administration.
The initial team of physicians oversee-ing the Neck & Back Care Clinic includes Dr. Clarence Watridge, Dr. Manuel Carro, Dr Autry Parker, and Dr. Samuel Polk.
m e m p h i s m e d i c a l n e w s . c o m FEBRUARY 2014 > 17
UT Medical Group Adds Interventional Cardiologist
Interventional cardiologist Dr. Nadish Garg has joined the department of medi-cine at UT Medical Group, Inc. and been named as-sistant professor at the Uni-versity of Tennessee Health Science Center.
Garg earned his medi-cal degree at Dayanand Medical College and Hospi-tal in India. He completed internal medicine residency and a fellowship in cardiovascular medicine at the University of Missouri, fol-lowed by an advanced fellowship in cardiac imaging at Methodist Hospital in Houston. Most recently, he attended the University of Arkansas Medical Sciences in Little Rock, where he completed additional training in interventional cardiology. Garg is board certified by the American Board of Internal Medicine Subspecialty Board of Cardiovas-cular Disease, the National Board of Echo-cardiography, and the Society of Cardiovas-cular Computed Tomography.
He is a specialist in coronary and pe-ripheral vascular interventions, cardiovas-cular imaging, heart failure and heart valve replacement, nuclear cardiology, cardiac CT, and echocardiography.
Campbell Foundation Elects Two New Trustees
The Campbell Foundation has an-nounced the election of two new members to its board of trustees: Con-nie Lewis Lensing, J.D., and David D. Spence, M.D.
Connie Lewis Lensing, J.D. is Senior Vice President in the Legal Department at FedEx Express, the world’s largest express transporta-tion company. She heads a department with offices in Memphis, TN and Orange County, CA, which is com-prised of lawyers and pro-fessionals who handle all domestic employment mat-ters and litigation defense and prevention. She currently sits on the Board of Directors and the Executive Com-mittee of the U.S. Chamber of Commerce’s Institute for Legal Reform, and she sits on the Board of Directors for Lawyers for Civil Justice. She was Co-chair of the National Civil Rights Museum’s Twentieth Anniver-sary Freedom Awards and is a current Board Member.
David D. Spence, M.D. joined the Campbell Clinic staff as a Pediatric ortho-paedic surgeon in 2012. Spence completed his residency in Orthopaedic Surgery from Campbell Foundation in 2011, and a fellow-ship in Pediatric Orthopaedics at Children’s Hospital Boston/Harvard Medical School in 2012. Spence has conducted significant research in the field and has published sev-eral journal articles. He serves as a Clinical Instructor of Orthopaedic Surgery in the University of Tennessee -Campbell Clinic Department of Orthopaedic Surgery.
The Campbell Foundation was estab-
lished in 1946 by the physicians of Campbell Clinic to support the advancement of mus-culoskeletal research, physician education, and community health.
UT Medical Group Family Medicine Grows East Memphis Staff
UT Medical Group’s Department of Family Medicine office in east Memphis recently welcomed two new medical staff members who have a special interest in women’s health.
Dr. Carley Fox earned her medical degree at Albany Medical College in New York and completed family medicine residency at the University of Tennessee Health Sci-ence Center, where she is now an assistant professor. Fox is board certified by the American Board of Family Medicine.
Dr. Katosha Muse com-pleted her medical degree at Ross University School of Medicine in Dominica, West Indies, followed by family medicine residency at the UT Health Science Center. She is currently an instructor of family medicine at the UT Health Science Center and is board certified by the American Board of Family Medicine.
UTHSC Assistant Professor Zhaohui Wu Receives $720,000 Grant
According to experts, breast cancer is a leading cause of cancer-related deaths in women worldwide. Among breast cancer patients, those diagnosed with triple-neg-ative breast cancer (TNBC), an aggressive breast cancer subtype, have a lower sur-vival rate, in part because there is a lack of effective targeted therapy.
Chemotherapy is the only available sys-temic treatment for TNBC. However, many TNBC patients rapidly develop resistance to the treatments. They also develop aggres-sive metastasis, which is responsible for the majority of the deaths caused by the cancer. Zhaohui Wu, MD, PhD, is exploring other options that could lead to a breakthrough in treatment.
Dr. Wu, an assistant professor in the Department of Pathology and Laboratory Medicine at the University of Tennessee Health Science Center (UTHSC), is now be-ing supported by a Research Scholar Grant, RSG-13-186-01-CSM, from the American Cancer Society. The four-year grant, which totals $720,000, will fund his study titled “Role of Genotoxic NF-kB Activation in Breast Cancer Metastasis.”
Previous studies conducted by Dr. Wu and his research team have indicated that the activation of a transcription factor or protein known as NF-kB by chemothera-peutic drugs may promote cancer therapy resistance and metastasis. His team is work-ing to determine the factors responsible for
that resistance. The research team is also ex-ploring therapeutic regimens to effectively restore sensitivity of the breast cancer cells to chemotherapies and reduce secondary tumors.
Timothy Fabian, MD, Professor and Chair of Surgery at UTHSC to Step Down
David Stern, MD, executive dean of the College of Medicine at the University of Tennessee Health Science Center (UTHSC), has announced that Timothy C. Fabian, MD, professor and chair of the UTHSC Depart-ment of Surgery, will step down from his po-sition as chair once his successor has been named. Dr. Fabian has been chair of Surgery at UTHSC for more than 14 years. After he steps down as chair, Dr. Fabian will continue to serve as a professor in the department, fulfilling his ongoing academic role to train future generations of surgeons.
A national search will begin immediately to locate highly qualified candidates who are interested in the UTHSC chair of Surgery position. The search committee is being co-chaired by Lee S. Schwartzberg, MD, FACP, division chief of Hematology at UTHSC, and Medical Director, the West Cancer Center, and Sandeep Samant, MD, professor and vice chair in the UTHSC Department of Oto-laryngology (Head and Neck Surgery), and division chief for Head and Neck Surgery. An external search firm that specializes in health care leadership will assist the committee.
Methodist Administrative Director Receives Award
Chris Jenkins, administrative director, University of Tennessee Methodist Physi-cians, recently received the early career healthcare executive award from the American College of Health-care Executives (ACHE) dur-ing the Tennessee Hospital Association’s (THA) 75th annual meeting. The award recognized Jenkins’ commitment to ACHE.
Most recenlty, Jenkins rejoined the Methodist family, serving first as admin-istrator of the Cardiovascular Institute at Methodist University Hospital before being named administrator of Clinical Operations at Methodist University Hospital.
Jenkins completed his bachelor’s de-gree in Business and Communications at the University of Montana and earned his master’s in Health Administration from the University of Memphis. He holds the level of fellow in the American College of Health-care Executives and serves as an adjunct faculty member at the University of Mem-phis. He is a board member of The First Tee, American Cancer Society, and Alzheimer’s Association.
Dr. Nadish Garg
Connie Lewis Lensing
Dr. David D. Spence
Dr. Carley Fox
Dr. Katosha Muse
Dr. Zhaohui Wu
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18 > FEBRUARY 2014 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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Lee S. Schwartzberg, MD, FACP, Presents at San Antonio Breast Cancer Symposium
The West Clinic is pleased to announce that Lee S. Schwartzberg, MD, FACP, Medi-cal Director, presented several abstracts dur-ing sessions at the 2013 San Antonio Breast Cancer Symposium being held in San Anto-nio, Texas in December. The international scientific symposium offers exchange and
interaction among basic scientists and clini-cians in breast cancer. As innovative strides are being made in breast cancer research, the annual symposium is the foremost gath-ering of scientists, physicians and health care professionals dedicated to eradicating breast cancer.
Presentations included: PD3-Phase 1 - A phase 1 open-label,
dose-escalation study evaluating the safety,
tolerability, and pharmacokinetics of enzalu-tamide (previously MDV3100) alone or in combination with an aromatase inhibitor in women with advanced breast cancer
S1-03 - S1-03. Primary results from BETH, a phase 3 controlled study of adju-vant chemotherapy and trastuzumab ± bev-acizumab in patients with HER2-positive, node-positive or high risk node-negative breast cancer
P3-13-05 - Eribulin mesylate as first-line therapy for locally recurrent or meta-static HER2-negative breast cancer: Results of a phase 2, multicenter, single-arm study
OT 3-2-08 - A phase 2 single-arm study of the clinical activity and safety of enzalu-tamide in patients with advanced androgen receptor-positive triple-negative breast can-cer
P4-12-12 - Phase 2, multicenter, single-arm study of eribulin mesylate + trastuzum-ab as first-line therapy for locally recurrent or metastatic HER2-positive breast cancer
Paul Bourassa Joins Unity Hospice Care
Paul N. Bourassa has joined Unity Hos-pice Care as Director of Cor-porate Compliance. In this role Bourassa is responsible for compliance programs in-volving HIPAA, OSHA, OIG, and CMS as well as other Federal, State and local reg-ulatory agencies. Unity Hos-pice Care serves patients in West Tennessee, North Mississippi and Eastern Arkansas.
Kosten Foundation Awards Two Grants
The Memphis-based Herb Kosten Pan-creatic Cancer Research Charitable Fund announced it will award two research grants for 2014, one to the University of Nebraska and the other to the University of Tennessee Health Science Center (UTHSC).
The announcement was made by Alan Kosten, Chairman of the Herb Kosten Pan-creatic Cancer Research Foundation and brother of Herb Kosten, for whom the foun-dation was named.
A major portion of the funding for the grants awarded each year come from the proceeds of KICK IT 5K. This year’s KICK IT 5K is scheduled for 2 pm Sunday, March 23 at Shelby Farms Park. Please visit www.kickit5k.racesonline.com to register. This year’s event is dedicated to the memory of former Executive Director, Yvonne Ressel, who died from pancreatic cancer on Octo-ber 9, 2013.
All of the Kosten Foundation’s con-tinuing efforts to find a cure for pancreatic cancer and to provide support for the in-dividuals and families, who are touched by this disease are devoted in Yvonne’s mem-ory. Those wanting additional information about the Kosten Foundation are invited to visit www.kostenfoundation.com.
Kosten said the grant to Nebraska will benefit the laboratory of Dr. Ram Mahato for his continuing pancreatic cancer research.
Paul N. Bourassa
Memphis’ Mid-South Transplant Foundation honored Cory Horton as a floragraph honoree on the Donate Life Rose Parade Float on New Year’s Day.. A swimming teacher and coach, Horton founded the Memphis Thunder Aquatic Club and co-founded Memphis Thunder Racing. Horton was killed in a cycling accident, but he was able to save lives as an organ donor. The float has become the world’s most visible campaign to inspire people to register as organ and tissue donors. This year’s entry, “Light Up the World” won Best Theme.
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