memphis medical news september 2015

Financial Incentives Are Helping Providers Meet Tough Challenges As medical costs continue to rise, healthcare organizations are being forced to re-examine practices and procedures to fi nd the most economical ways to balance quality care with sustainable pricing ... 4

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

Work Proceeding To Reopen Crittenden K. Robert Bauer, Jr., chairman and CEO of Nashville-based Ameris Acquisitions, LLC, says plans are proceeding to reopen Crittenden Regional Hospital in West Memphis ... 10

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BY JUDY OTTO

Talk to James Hahn, Delta Medical Cen-ter’s new CEO, and it is quickly evident that building relationships is a skill he values highly. One suspects that this easy-going man’s decades of successful leadership in medical care facilities have been founded largely on a gift for bringing

people together to create partnerships that ben-efi t patients and their communities.

The specialty-referral hospital selected Hahn as its CEO in April. Delta, an Acadia Healthcare facility, offers inpatient and outpa-tient hospital care, including surgery, a 24-hour emergency department, acute medical care and

(CONTINUED ON PAGE 8)

HealthcareLeader

Delta Medical Center CEO Applies His Own Special Skill Building Partnerships for New and Expanded Patient Care

PAGE 3

PHYSICIANSPOTLIGHT Institutions Join Fight Against

Childhood ObesityPediatricians Sound Warning About Sports Specialization

BY PEGGY BURCH

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

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

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

“We know that children are certainly less active now than they’ve been at any point, and it stands to reason that has impacted their physical ability,” said Webb A. Smith, PhD, a clinical exercise physiologist for Healthy Lifestyle and an instructor in pediatrics at UTHSC.

According to data measured by the U.S. Centers for Disease Control and Prevention, more than 19 percent of high school-age youth in Memphis were obese in 2013, a rate that was 5 percent


Lelon O. Edwards, MD

FOCUS TOPICS PEDIATRICS REIMBURSEMENT POPULATION HEALTH BIG DATA

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Skip the Formalities; Just Call Him Dr. BubbaPediatrician Enjoys His Role in Helping Raise Parents as Well as Kids

PhysicianSpotlight

BY RON COBB

At birth he was given the rather awkward name of Lelon. To this day he’s not sure why. His father’s given name was Lealand, although his discharge papers from the Navy listed him as Lelon.

It doesn’t really mat-ter because for as long as he can remember, Lelon O. Ed-wards, MD, has been known as Bubba, a nickname given to him by his sister. His staff at Pediatrics East calls him Dr. Bubba. His patients call him Dr. Bubba. His wife, Debbie, calls him Bubba.

“It does pretty well for a pediatrician,” he said. “I’m not sure a neurosurgeon would want to go by ‘Dr. Bubba.’”

It does take some getting used to.“I’ve had comments from grand-

mothers in New Jersey who said their grandchild is absolutely not gonna go to a doctor named Bubba,” he said. “And then the grandmother comes down here and we get along fine.”

Edwards is a true son of West Ten-nessee, having been born in Memphis and raised in Dyersburg and then Ripley. He earned a degree in chemistry from the University of Tennessee at Martin, then a medical degree in Memphis from the Uni-versity of Tennessee College of Medicine.

He did his residency at Le Bonheur Children’s Hospital, where he also worked in the ER for four years, and joined Pe-diatrics East in 1988. He hasn’t budged from Memphis since his first day in med school.

“Probably the biggest reason is that all my friends are here – our fam-ily friends, church friends – everybody’s here,” he said. “Le Bonheur was a natural transition after I finished my residency. Pediatrics East was right there in front of me. This has been a practice opportunity that I don’t think I could duplicate any-where else.”

Over the years, a couple of things have taken Edwards by surprise. When he decided on pediatrics, he never expected he would be dealing with so many issues such as ADD, learning problems, behav-ior problems, depression and anxiety. Some days, he says, he feels as if he’s prac-ticing pediatric psychiatry.

But the one thing he said that has really changed in pediatrics is vaccines – “the hugest impact on healthcare you can imagine.” And so it boggles his mind that there is still resistance to getting them. He cited H. flu meningitis, chicken pox and rotavirus as scourges that vaccines made disappear.

“Dr. (William) Threlkeld, our senior partner, used to say 20 years ago that a pediatrician’s job is literally to vaccinate yourself out of business.’ I thought that was funny,” he said. “You look at it now and it’s had a huge impact on the kind of illnesses you see in the office and what you don’t see. It’s amazing.”

Thus, you can imagine the doctor’s frustration when a patient declines to be

vaccinated. Last month, as he was doing back-to-school check-ups, an 18-year-old told him she didn’t want the Hepatitis A vaccine.

“And she didn’t want the tetanus booster, which she hadn’t had now in 12 years,” he said. “She said, ‘I’ll just take my chances with that. We have to get the meningitis vaccine to go to school, and that’s all I’m gonna get.’

“You just don’t get it that these things will save your life.”

Still, he believes the anti-vaccine mentality among parents – generated largely by Dr. Andrew Wakefield’s assertion that vaccines can cause autism – is fading.

“They see where the whole vaccine thing was as

much falsehood as anything else,” he said.Part of his job as pediatrician, he tells

his med students, “is to raise the parents. If we do a good job raising the parents, the kids do OK.”

Not that he leaves all the rearing to the parents. Early on, he advises young-sters “to stay away from skunks. If you run around with skunks, you’re gonna look like a skunk, you’re gonna act like a skunk

and you’re gonna smell like a skunk. So choose your friends wisely.”

“I get to preach to the kids and that’s sort of fun, because the parents have al-ready told them that and they want to gag and throw up. But when I tell them the same thing, it’s like, ‘That makes sense.’”

Edwards met wife Debbie when he was an orderly at Lauderdale Community Hospital in Ripley and she was a nurse’s aide. She eventually worked as a nurse at Methodist for several years before their three children came along. Today, she keeps a hand in nursing by working on oc-casion for a friend who has a mobile vac-cine business.

All three of the Edwards children are in healthcare. One daughter is a labor and delivery nurse, and another daughter is a pediatrics recovery room nurse. Their son is in his third year of family medicine resi-dency.

According to Edwards, none of the three was pushed into medical careers.

“I didn’t encourage or discourage be-cause I wanted them to find out what they like, what their interest is and what their passion is without twisting an arm and say-ing ‘you need to do this’ or ‘you need to do that.’”

Dr. Bubba, at age 60, has no interest in retiring anytime soon.

“I’ll work as long as my partners will let me,” he said. “I’m having too much fun.”


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BY JAMES DOWD

As medical costs continue to rise,

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

Locally, physicians and healthcare providers are implementing new measures to operate more efficiently, say leaders at Baptist Memorial Health Care. And while these leaner processes are cutting hospital costs, they also are benefiting patients.

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

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

“It has to be a con-certed effort in order to effectively control

costs while providing quality care,” Swan-son said. “We don’t want to incur unneces-sary costs for the patients or the hospital.”

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

“We have to look more closely at how hospitals can control costs, and perhaps that may be by reducing the number of vendors we use,” Swanson said. “It also means working with physicians to see how they practiced and find ways to prevent in-curring unnecessary costs while at the same time being careful not to alter the outcome for the patient.”

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

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

“We looked at the diagnoses for areas with frequent admissions, such as heart failure or pneumonia, and we tried to de-termine the best tests and medicines and how quickly these patients will get better,”

Swanson said. “Some of the tests that were routinely performed may have been neces-sary in only a small number of cases and not for every patient. And if some guide-lines suggested that a patient should be in the hospital for three days, but we were keeping them four or five days, then we began trying to treat them more efficiently so that they could feel better and go home sooner.”

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

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

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

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

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

“The key is to prevent readmission,”

she said. “We work to-ward that in a number of ways, including enhanced admission processes that include family members or caregivers and de-termining what support systems our patients will have once they are re-leased. In addition, we have developed an extensive patient evalu-ation system that involves every healthcare professional involved with that patient’s case. We discuss every patient every day to see how they’re progressing and respond-ing to care.”

And in an effort to reduce patient hospital stays, facilities are developing pro-cedures that are less invasive and require shorter recovery periods. At Stern Cardio-vascular Foundation, a new device known as the MitraClip is being offered at Baptist to treat mitral regurgitation, caused by a leaky mitral valve that creates a backward flow of blood in the heart.

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

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

So far, the incentives for decreasing costs and improving patient care are work-ing, Swanson said. And that bodes well for the future of the healthcare system and pa-tients alike.

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

Financial Incentives Are Helping Providers Meet Tough Challenges

Dr. Mark Swanson

Susan Ferguson


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MGMA Releases Latest Provider Compensation Data

BY CINDY SANDERS

In late July, the Medical Group Man-agement Association (MGMA) released fi ndings from the 2015 Provider Compen-sation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating offi cer of the national organization for healthcare administration and medical practice management. “For the last 25 years, we’ve also been specializing in the space of physician com-pensation and non-phy-sician compensation.”

Based on 2014 data, this year’s survey found physicians reported sal-ary increases over the past year with primary care physician increases outpacing those of spe-cialists (3.56 percent increase vs. 2.39 per-cent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median com-pensation of $241,273 for primary care

physicians.The 2015 benchmark-

ing report included infor-mation on nearly 70,000 providers across the United States. In ad-dition to geographic diversity, Evenson said the data was rep-resentative of both large and small practices, various ownership struc-tures including hospital-based providers, and more than 170 specialties.

Evenson said the collected data is important for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

While primary care physicians en-joyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view. Even-

son noted physicians in this space have seen a 9.2 per-

cent increase in compensation

since 2012. “Will primary

care physicians be compensated at the

same levels as spe-cialists? Not likely,”

Evenson said. How-ever, he continued,

“They will continue to play an integral role as

care models evolve. Pri-mary care physicians are

truly the lynchpin of the new practice model as we

move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particu-lar demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was nor-mal to see 100 percent of compensation plans be productivity based,” explained Evenson. “In 2012, 50 percent of respon-

dents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data high-lights the gradual shift toward rewarding practitioners for improved operational effi ciencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physi-cian compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over volume concept that physicians seem to be embracing is really beginning to pay off for them.”

He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per capita cost of healthcare, improving the health of populations, and improving the patient experience of care.”

Evenson said those in the behavioral health sector are also seeing improved compensation as their work complements that of primary care providers in manag-ing a population’s health.

Todd Evenson

The 2015 benchmark-ing report included infor-mation on nearly 70,000 providers across the United States. In ad-dition to geographic diversity, Evenson said the data was rep-resentative of both large and small

Evenson said the collected data is important for a number of reasons, not the

son noted physicians in this space have seen a 9.2 per-

since 2012.

care physicians be compensated at the

same levels as spe-cialists? Not likely,”

Evenson said. How-ever, he continued,

“They will continue to play an integral role as

care models evolve. Pri-mary care physicians are

truly the lynchpin of the new practice model as we

move from fee-for-service to fee-for-value.”



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higher than the national figure. From 2003 to 2013, the number of obese high school-age youth in Memphis increased by 3.6 percent. Children whose body mass index was at the 95th percentile or higher are considered obese and at increased risk for diabetes, cardio-vascular disease and os-teoarthritis, among other conditions.

Pediatric health workers say “screen time” often stands between chil-dren and exercise.

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

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

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

A child’s screen time must be moni-tored, he said. “Once they get into that video game, they get in a trance and lose

track of all time. They can’t enforce it, and they don’t have the ability to control whether they do something else.”

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

“Sometimes I feel like ‘Where are all these obese kids you hear about?’ I’ll go days when I see thin kid after thin kid.” But he says they most often “come from active, athletic families.”

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

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

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

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

The plans are tailored to individual families.

“Some families are ready for us to give them a specific program and work with us directly,” Smith said. “They’re interested in what exercise to do, how many times to do it, how hard should they push. Other fami-lies are more interested in trying to make some basic changes like just going for a walk.”

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

And while doctors and clinicians worry about children who get too little exercise, they also worry about those who get too much of one kind.

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

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

Smith also laments the phenomenon.“Awhile ago when I was playing sports,

baseball season was a season, and it ended and you had to find another thing to do. So you played football or you played basket-ball,” he said. “Now the way youth sports is structured, it’s reasonable that you can play your specific sport year around, or at least train for it.

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

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

He pointed out that in recent years at the NFL Combine for college players hop-ing to play professionally, “a shockingly high number played multiple sports in high school.” Tracking Football’s website re-ported that 224 of the 256 players at this year’s NFL entry draft were multi-sport ath-letes in high school.

Smith observes, “So it goes back to the idea that if you’re trying to raise a profes-sional athlete, then you should focus on rais-ing an athlete.”

Liver Damage in Hep C Significantly Underestimated, Underreported

The number of Hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a new study led by researchers at Henry Ford Health System and the Centers for Disease Control and Prevention.

The findings, which were published in The American Journal of Gastroenterology (110, 1169-1177, August 2015), were the result of a study of nearly 10,000 patients suffering from Hepatitis C.

“Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of Hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling,” said lead researcher Stuart Gordon, MD, director of Hepatology at Henry Ford Hospital in Deroit.

The Chronic Hepatitis Cohort Study is an analysis of records from a large, geographically and racially diverse group of 9,783 patients receiving care at four large U.S. health systems. The records analyzed by researchers indicated evidence of cirrhosis in 29 percent, or 2,788, of the Hepatitis C patients included in the study. Surprisingly, however, 1,727 of those 2,788 patients, or 62 percent, had no formal documentation in their medical records that they had cirrhosis.

Gordon said the results suggest cirrhosis may be underdiagnosed in a large segment of the population. Clinicians, he continued, typically rely on liver biopsies to diagnose cirrhosis, but in the Hepatitis C patients studied, only 661 patients were diagnosed with cirrhosis through a liver biopsy.

“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” said Gordon.

The researchers discovered highly likely signs of liver damage by calculating the patients’ liver enzymes, platelet counts and age in a previously validated test called a FIB-4 score.

“It’s an underappreciated, easily obtained, and widely available test done through lab work that can point out there’s a problem,” noted Gordon. “It’s a simple test not routinely used by clinicians. A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. In addition, electronic medical record reports may not be a reliable indicator of just how many Hepatitis C patients may be suffering from cirrhosis.”

The results of such testing and reporting could have wide impact on the treatment of those with Hepatitis C, which is now curable in many cases with oral antivirals.

“People with Hepatitis C need to find out the severity of their underlying liver disease because they may not realize that they have cirrhosis,” said Gordon. “Obviously, treatment can slow down the progression.”

Institutions Join Fight Against Obesity, continued from page 1

Dr. Webb A. Smith


BY CINDY SANDERS

This summer, the Tennessee Depart-ment of Health (TDH) issued a public health advisory in the wake of a nationwide increase in the rate of Hepatitis C infection. The alert called for Tennesseans to learn more about the life-threatening disease and to consider being tested for chronic Hep C infection.

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

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

Tim Jones, MD, who has served as the state epidemiologist since 2007, noted, “The state of Tennes-see is number four in the country for the amount of Hepatitis C that we see. We have three times the national average of rates of disease.” Looking at the map of Tennessee, Jones said there are a particu-larly high number of cases along the eastern border and northeastern part of the state.

The good news, Jones added, is that

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

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

However, he continued, the problem is the cost of the three-month regimen, with a price tag coming in at $60,000-$90,000. He added it’s an issue public health offi cials, providers and insurers are all struggling to address. Time, he continued, could provide at least a partial solution. “It’s likely as more medications come on the market, and there are several in the pipeline, those costs will be driven down.”

And, Jones pointed out, the slow pro-gression of the disease gives those infected time to get into appropriate care. “About 20 percent of people will get rid of it on their

own. For the other 80 percent, the disease progresses very slowly. If people catch it early, it can take 20-30 years before getting to the end stages,” he said.

Although price is an issue, another con-sideration is the cost not to treat. “As (Hepa-titis C) progresses, it can lead to fi brosis of your liver up to liver failure. It’s the num-ber one cause for liver transplants,” Jones noted. He added, Hep C is also the main cause for cirrhosis of the liver. If the disease progresses to one of these conditions, the price of caring for individuals with Hep C could far outstrip the cost of the drugs to cure it.

A blood-borne pathogen, Jones said the nation’s blood supply up until the late ‘80s/early ‘90s helped spread the disease. Today, however, the biggest risk factor is IV drug use.

“There are pretty negative connota-tions when a disease is associated with IV drug use, but even one indiscretion decades ago can lead to these problems years later,” he pointed out.

Ideally, Jones said the following people should be tested:

• All baby boomers (anyone born 1945-1965),

• Anyone who has ever injected drugs

(even once),• Anyone who received a blood trans-

fusion or organ transplant before 1992,

• Any healthcare worker who might have had a needle stick injury,

• Anyone who has gotten an illegal tat-too or unsanitary piercing (from an unlicensed provider),

• Anyone with HIV or AIDS,• Those with abnormal liver tests or

other liver disease, and • Anyone on dialysis.While healthcare providers might be

able to rule out some of the risk factors for their patients, Jones said the only way to really determine if an individual should be tested is to broach the topic and ask ques-tions.

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

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

Tennessee’s Hep C EpidemicRecent TDH Advisory Draws Attention to Disease, New Treatments

Dr. Tim Jones

Additional information for healthcare providers and patients is available through the Tennessee Department of Health website. Go to tn.gov/health/article/health-advisories for Hepatitis C statistics, answers to frequently asked questions, and prevention messages. There is also a direct link to the information from our website at NashvilleMedicalNews.com.

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What CMS’ Mandatory Bundled Payment Rule for Elective Hip and Knee Replacements Means for All ProvidersBy Denise Burke

Last month, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule called the Comprehensive Care for Joint Replacement (CCJR) Model, which will require mandatory bundled payments for elective hip and knee replace-ments in 75 larger geographical markets, including Memphis. Hospitals will be expected to help patients avoid complications that could cause additional hospital stays by working closely with primary care physicians and various specialists and co-ordinating care with post-acute providers. All Part A and Part B services are included in the bundle with the exception of services clinically unrelated to the episode. Hos-pitals that are currently participating in voluntary joint replacement demonstration projects are excluded from the program, for now.

This marks the first time that participation in a bundled payment program has been mandatory, rather than voluntary, and the proposed rule reinforces CMS’s stated initiative to move 30% of Medicare payments to alternative payment models by 2016 with escalation to 50% by 2018. While the current program will be most interest-ing to orthopaedic surgeons, hospitals that perform orthopaedic surgeries, and orthopaedic medical device companies, it is a crystal clear indication of the direction in which CMS is moving for other services. Certainly, CMS had no hope of meeting its goal to move 50% of services to alternative payment methodologies by 2018 with voluntary programs.

Under the proposed rule, the episode of care will include all related care within 90 days of hospital discharge. The project will have a five-year performance period, beginning January 1, 2016, which seems like an unreasonable start date considering that the comment period on the proposed rule runs through September 8, 2015.

During the performance period, CMS will continue paying hospitals and other pro-viders according to the current Medicare payment methodologies. After the comple-tion of a performance year, the Medicare claims payments for services furnished to the beneficiary during the episode would be combined to calculate an actual episode payment. The actual episode payment would then be reconciled against an established target price. Up to 20% of the positive calculations would be shared with the participating hospitals (if three quality criteria are met) and up to 20% of nega-tive calculations would require repayment by participating hospitals (in years 3-5). (There is no downside risk in the first year. In year two, hospitals would be required to repay 10% of negative calculations.)

The rule would waive the current requirement of a three-day hospital stay to qualify for a skilled nursing facility, although a CMS official verbally stated that a direct ad-mission to a skilled nursing facility is not allowed.

So, the race is on across the country for partnerships between providers to meet this aggressive timeline. CMS anticipates that collaborators may include physicians and non-physician practitioners, home health agencies, skilled nursing facilities, long-term care hospitals, physician group practices, inpatient rehab facilities, and inpatient and outpatient physical and occupational therapists. Participant hospi-tals may share payments with collaborators, but are not required to do so, which could put hospitals at odds with each other. Prior demonstration projects allowed physicians to enroll in the projects more directly without being dependent upon the hospitals to share the savings. Collaborators would be required to engage with the hospital in its care redesign strategies to be eligible for such payments. Participant hospitals may also share up to 50% of the downside risk with collaborators pursuant to agreements between those entities. No more than 25% of the downside risk may be assigned to any one provider, however.

Local orthopaedic groups participating in demonstration projects report that hospi-tals, physicians and other providers are already working collaboratively to identify ef-ficiencies while maintaining quality. This is an early indication that bundled payment initiatives may accomplish their intended purpose.

Denise Burke is a partner in Waller’s Memphis office and a member of the firm’s Healthcare Compli-ance and Operations practice group. Hospitals, physicians, medical device companies and other healthcare clients trust Denise for practical and innovative solutions to a wide range of compliance and operations issues.

www.wallerlaw.com

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behavioral health medicine. Acadia, a pro-vider of inpatient behavioral healthcare services, operates a network of 225 facili-ties in 37 states, the United Kingdom and Puerto Rico.

Hahn’s “together we are better” phi-losophy is behind Delta’s current venture, the Crestwyn adult and adolescent psy-chiatric facility now under construction in Germantown’s Forest Hill Irene-Win-chester area. The 60-bed hospital, which is expected to be completed by mid-2016, is a joint undertaking between Delta, Saint Francis Health Care and Baptist Memorial Healthcare.

The new facility’s governing board will include board members from all three partners. Hahn will be one of the board members representing Delta/Aca-dia. The board will collaboratively select management for the new facility, which will develop its own staff of providers and patient-care professionals. Recruitment is expected to begin late this year.

Their interest, and one of their goals, according to Hahn, is “to raise the aware-ness, accessibility and quality of behavioral healthcare – and to establish partnerships and relationships within the Memphis community that allow us to provide mean-ingful healthcare service to this commu-nity.”

Hahn’s former 10-year tenure as CEO of a freestanding, 64-bed adult and adolescent psychiatric facility in Decatur, Alabama – in conjunction with his role as president/CEO at a 256-bed acute med-ical-surgical facility — prepared him for this project.

“That’s where I had my first profes-sional administrative introduction to psy-chiatric healthcare and began to develop my involvement in the behavioral health arena,” he said. “That was during the early 2000s, when psychiatric and behavioral healthcare began its real growth, which continues. It’s likely the fastest-growing as-pect of healthcare today.”

Delta’s approach to offering behav-ioral services within a medical facility has given him further insights into the benefits of combining both services under one con-venient roof.

The ability to treat the whole person can be a valuable plus, especially in cases like those within Delta’s senior care pro-gram, most of whose elderly psychiatric patients also have medical issues.

Behavioral health issues are gaining increasing recognition, Hahn said. “The way we deal with them now is changing, because we can treat them more effec-tively. Insurers are more willing and able to identify them as legitimate conditions they can reimburse for, and employers, family members and others understand now that these aren’t things that people just sign up for — these are legitimate medical condi-tions that can (each) be recognized and treated like what it is — a clinical medical condition.”

Other priorities on his agenda include efforts to develop Delta’s community part-nerships with churches, schools and other institutions. “It’s important that our hos-pital be a community-based hospital,” he

said. “We want to be a good neighbor and a good part of this community.”

Their new tagline, “Your hospital — Our community,” reflects that partnership commitment.

Under Hahn’s direction, Delta has taken another innovative partnering step, positioning itself as a teaching hospital. Hahn points to the medical education and training they now provide to Resurrec-tion Health’s family medicine interns and residents. In addition to the Resurrection trainees Delta recently began welcoming, they also offer mid-level provider training programs for physician assistants — and continue to develop similar programs in addiction medicine and other arenas.

He has also made the remodeling and improvement of Delta’s patient care envi-ronment a priority. Efforts began with the recently completed renovation of a new senior care area, and others are ongoing throughout the center.

While some perceive Delta as a small hospital, the number of square feet avail-able is less significant than how intelligently and effectively they are used — a principle one can observe in action at this thriving, growing and energy-charged facility, Hahn said.

“We’re getting better every day, add-ing new providers and new services, im-proving the quality of existing services, and committed to improving the quality of healthcare in the community where we serve,” he said.

Hahn describes himself as employ-ing a patient-focused management style in dealing with the omnipresent challenge of balancing cost and quality of care. It’s an attitude he learned early as a 16-year-old in his hometown of Columbia, Mississippi, where his father was a hospital administra-tor, and the younger Hahn began working as an orderly at the hospital.

At 18, he trained as an emergency medical technician (EMT) and then as an emergency room technician, working in Hattiesburg and Columbia emergency rooms during summer breaks from his un-dergraduate (BBA) and MBA studies at the University of Mississippi at Oxford.

Hahn is a man who knows his way around a hospital, from entry-level patient care to his early training as assistant ad-ministrator at Baptist Memorial Hospital North Mississippi in Oxford — and stints as CEO at Baptist North and Decatur General, and as administrator at Oktib-beha County Hospital in Starkville and North Mississippi Medical Center at West Point.

He offers thoughtful advice based on 40 years of healthcare experience, includ-ing 25-plus years in leadership. “Nothing in healthcare administration is ever as good or as bad as it seems! Take everything seri-ously, but keep it in perspective,” he said.

Hahn has been married for 34 years and has a daughter practicing law and a son in health services administration at the University of Memphis. A former Little League player, coach and supporter, he re-mains an avid Cardinals and Redbirds fan. He is owned by Archie, a cat who thinks he is a dog.

Delta Medical Center CEO, continued from page 1


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Today

01/01/13

BY BILL APPLING

MedicalEconomics

The State of the Medical PracticeWhat a tremendous task it is to weed

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

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

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

I would say both. Parts require in-cremental change (which is difficult with the speed of change in our industry) and also a major fundamental shift. But the different forms of integration suggest it is more of a fundamental change that demands new types of collaboration. You can see that the challenges facing medical practices and hospital/IDS chal-lenges are very similar and speak to a need for more collaboration.

Top 10 independent medical practice challenges

• Participating in the CMS EHR meaningful use incentive program.

• Dealing with rising operating costs.

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

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

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

• Managing current practice plan-ning and strategy (which is a moving tar-get) and being proactive in future plan-ning and strategy (which is difficult with a moving target.)

• Collecting patient-due balances (self-pay, high deductibles and HSAs in-stead of quality improvements and costs savings.) We face the challenge of not being able to respond to improvement and changes when the high costs of self-pay and high deductibles force many patients to put off care until the health of the patient has become critical thus requiring more costs and not being able to meet quality criterion.

• Participating in quality reporting

programs. (Interoperability is still a sig-nificant challenge and I do not see this changing much for the next few years.)

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

• Collecting and reporting non-standardized health plan/government quality measures.

Top 10 hospital/IDS challenges Preparing for value-based pay-

ments (shared savings, capitation/global payments, quality/outcomes).

• Dealing with rising operating costs.

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

• Managing physicians’ expecta-tions of their compensation levels.

• Recruiting physicians and non-physician providers.

• Managing finances and change with uncertainty with changes going on in the insurance industry.

• Understanding the total cost of an episode of care.

• Preparing for the transition to ICD-10.

• Adapting the physician compen-sation model to incentivize quality, pro-ductivity and/or outcomes.

• Engaging patients to improve out-comes.

Practice professionals keep a close eye on the business aspects of care de-livery to ensure the financial viability of their groups, but still greatly attempt to ensure the delivery of high- quality pa-tient care. The two are inextricably tied. Despite multifaceted barriers, practice professionals continue to experiment with new methods to keep patients healthier and disrupt the progression of disease. The common theme of this article is improving patient outcomes by ensuring that every piece of the practice puzzle aligns to deliver on the desired promises.

Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at [email protected].


BY BECKY GILLETTE

K. Robert Bauer, Jr., chairman and CEO of Nashville-based Ameris Acquisi-tions, LLC, says plans are proceeding to re-open Crittenden Regional Hospital in West Memphis, but he could not yet provide de-tails of when the hospital might reopen, or the services it might provide.

County officials have said it might be smaller than the previous 140 beds.

The hospital had about 500 employees when it closed in September 2014, citing challenges with a struggling economy, de-clines in patient volume and reimbursement, physician departures and two fires, including one that closed the facility for six weeks.

“We are working with the county to figure the exact structure of how this is done, whether it is non-profit or for-profit, and how the facility can be re-established as a legal entity,” Bauer said. “Then we have funding issues, which include raising the working capital to re-open the facilities.

“There are going to be a lot of expenses to get everyone recruited and trained. After you open, you don’t start collecting the money that day. You have to collect enough money to support yourselves during the startup issue.”

The old hospital is in bankruptcy, which means whatever is done with the fa-cility has to be approved by a bankruptcy judge. The reopening cannot proceed until the country can provide a clean lease for the building.

“The bankruptcy can be dealt with,” Bauer said. “We have some ideas in mind we think will work.”

In July voters approved a one percent sales tax to fund reopening of the hospital by a margin of nearly seven to one, with 2,846 in favor and 439 opposed. The tax set to go into effect in November for five years is expected to raise about $30 million.

“The longer the hospital was closed, the more it was missed,” said Bauer. “I wasn’t surprised, but I was impressed at the high percentage of residents who voted to approve a one percent sales tax to fund the hospital. There is no doubt that a popula-tion of that size – there are 50,000 people in that county – can support a hospital.

“When we had town hall meetings with people in the community prior to the vote, we heard again and again how much they had missed the hospital.”

Since the hospital closed, not only did the county suffer a great loss of jobs and business activity, but most residents had to travel to Memphis, Jonesboro or Forrest City for medical care.

Bauer said Ameris Health of Nashville is a good fit for taking over management of the Crittenden General Hospital.

“We have a good track record,” he said. “We have been around since 1992.

Our principals have been in healthcare their entire careers. Our top three officers have more than 100 years of experience, collectively. And our focus has always been small, community, rural hospitals. We have reopened closed facilities in the past, two of which are still open. You don’t always suc-ceed because of the challenges. But you give it your best shot.”

One thing that is expected to help is the large number of people in Crittenden County who signed up for the private option Medicaid expansion in Arkansas. A major effort was made to get people signed up for health coverage prior to the hospital closing.

Paul Cunningham, senior vice presi-dent, Arkansas Hospital Association, said in addition to enhancing the health and well-being of the communities it served, Crit-tenden Regional Hospital also contributed significantly to the area’s economic health. In 2010, the estimated total annual eco-nomic impact was nearly $100 million.

Those figures included nearly $24 mil-lion on goods and services and $29 million in salaries.

“Hospital payroll expenditures serve as an important economic stimulus, creating and supporting jobs throughout the local and state economies,” Cunningham said. “Dollars earned by Crittenden Regional Hospital employees and spent on grocer-ies, clothing, mortgage payments, rent, etc., generated approximately $53,343,000 in economic activity and created an additional 350 jobs for the local economy.

In 2010, Crittenden Regional Hospital spent $1,562,000 on buildings and equip-ment.

Capital spending by Crittenden Re-gional Hospital generated approximately $2,875,000 for the local economy per year.

Cunningham said the high rate of ap-proval for passage of the tax increase shows that people in the community certainly val-ued their hospital.

Local tax support for hospitals is com-mon, particularly in rural areas where hos-pitals are often the biggest employer and largest contributor to the economy.

“Including the new vote, there 22 com-munities in the state who have voted over the years to provide local tax support for their hospital,” Cunningham said. “There are a couple of exceptions where property taxes are used to subsidize the hospital, but typically they are funded through sales taxes. Most of these hospitals have common characteristics of being small and rural, usu-ally under 100 beds and possibly, in most cases, even under 50 beds.”

Crittenden County voters approved an earlier sales tax increase. Cunningham said if the sale tax increase approved by Crit-tenden County voters that had kicked in sooner, it might have prevented the hospital from closing down.

Work Proceeding To Reopen Crittenden Ameris Official Says Too Soon for Target Date or Details

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BY CINDY SANDERS

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

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

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

Headquartered in Nashville, Tenn., the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primar-ily with public school systems,” he said, noting the company partners with about 250 different systems. He added ESA also works directly with some state govern-ments and insurance carriers.

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

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

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

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.” Today, EAP reaches four times the num-ber of children and continues to expand with additional clinics coming online at

a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Carolina and Tennessee in the Southeast.

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

Applied BehaviorAt the heart of the program is the use

of Applied Behavioral Analysis (ABA). “We know the evidence supports ABA as

the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

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

work skills.“The same model of behavioral ther-

apy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individ-ual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of chil-dren diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,”

At the Intersection of Education and Healthcare

For More Info & ReferralsFor more information on

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



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BY LYNNE JETER

Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprec-edented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“ P e r h a p s w e shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services, a 4,000-member group with physicians in all 50 states. “High speed inter-net connections are now the norm. Ser-

vices like Facetime and Skype are more popular than ever. Under continued pres-sure to cut costs and cope with declining reimbursements, administrators believe telemedicine offers a tool for increasing ef-ficiency. Patients also like the convenience and increased options that flow from tele-medicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compli-ance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

LicensureMedical providers “must be licensed

by, or under the jurisdiction of, the Medi-cal Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so the medical provider does not accidentally practice in a state without a license.”

Professional LiabilityMost professional liability insurance

policies provide state-specific coverage, meaning that if a provider accidentally practices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested. “Another consideration relates to cyber issues. Traditional medical malpractice policies provide little to no coverage for electronic breaches. The nature of a tele-medicine generates exposures to a variety of cyber risks. Any practice moving for-ward with offering telemedicine should have a comprehensive cyber insurance policy.”

Standard of Care It’s imperative to note that telemedi-

cine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stat-ing: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physician-to-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological condition? If the condition is normally

Telemedicine: A Virtual Compliance Jigsaw PuzzleA Closer Look at the New Wave in Healthcare Delivery

Michael Sacopulos



� is is the opening line for many divorce cases and it is a more compli-cated problem than it sounds.

“Stuff ” is legally known as property. Property includes real estate and per-sonal property, both tangible (a car) and intangible (a copyright). Property can include houses, pensions, businesses, and coin collections – almost anything. � e legislature has set a method for property division. First, you fi nd and value the property (equity in the house, value of pensions, worth of a business).

“My” is the determination of whether the particular piece of property is separate property and remains with the person who owned it or it is marital property that gets divided during the divorce. Separate property is usually acquired before the marriage or outside the marriage, such as by gift or in-heritance. Marital property is usually acquired during the marriage. Marital property can include increases in the value of separate property that occurs during the marriage if your spouse contributed to its appreciation or preserva-tion - even if only indirectly.

To determine who gets what portion of marital property, the court will basically consider:

• Length of marriage;• Age, health, skills, and abilities of the parties;• Contribution to the education or to the earning power of the other;• Relative ability of the parties to acquire property in the future;• Contribution to the value of the marital property or the separate prop-

erty;• Amount of separate property owned by each spouse;• Premarital property;• Financial conditions of each party;• Tax consequences;• Social Security benefi ts;• Allowing the custodian and children to continue to live in the marital

home (most often until remarriage of the custodian or until the children turn eighteen); and

• Other factors that the court considers appropriate.If you and your spouse can agree on how property will be divided, and if

your agreement is reasonable, it will usually be approved by the court. If you cannot agree, the court will divide the property.

Sometimes there are important tax issues to consider. Transfer of property

(such as a bank account) from spouse to spouse during a divorce is usually not taxable, but transfer of income (for example, interest) from an asset can be tax-able. You can transfer retirement assets with a Qualifi ed Domestic Relations Order (QDRO) and preserve the tax free status. If you try to shortcut this by cashing out an IRA or 401K, and then giving your spouse a check the amount withdrawn is immediately taxed to the person withdrawing it and may be sub-ject to a penalty. By using a QDRO the tax falls on the other spouse when they withdraw from the account. Normally, this is at a lower rate and works to everyone’s benefi t.

Your interest in your professional practice is a diffi cult thing to value. Val-uation of a business can be:

• Value of the assets and debts – Book Value - usually the lowest value;• Value a buyer would pay for the business – Market Value; or• Value of the income for the business less the cost – Income Method -

usually the highest value.Goodwill is the value of the business above the Book Value. Goodwill

can be “enterprise” and divisible. In this case the doctor is like an owner or an investor in a business (Shareholder in “Memphis Orthopedic”). Goodwill can be “personal” and is not divisible (being Bob Smith practicing in “� e offi ce of Dr. Bob Smith, MD”). � e closer you are to owning part of a business the more likely you are to having to share the business interest with your spouse. � e closer you are to a sole proprietor practicing the art of healing the more likely you are to keep the goodwill you personally created. For more reading on this go to Lunn v. Lunn, E2014-00865-COA-R3-CV-FILED-JUNE 29, 2015.

� is is the tip of the property division iceberg. Be sure to counsel with a knowledgeable attorney about any issues in this area. You can fi nd a certifi ed Family Law specialist at cletn.com/index.php/general-information/specialist.

For more information about divorce, visit aboutdivorce.com.

Larry Rice Nick Rice

Rice Divorce Team275 Jeff erson Avenue • Memphis, TN 38103 • 901.526.6701

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What Doctors Need to Know About Property Division

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photographed when a patient is in the office, then the practice should be ready to capture the same quality of image via telemedicine. Each step of the consulta-tion should be planned in advance to en-sure it is equal in quality to an in-office evaluation.”

Patient PrivacySacopulos said it’s also important to

note that any form of electronic communi-cation with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text mes-saging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines spe-cifically state: “Physicians should meet or exceed applicable federal and state requirements of medical/health informa-tion privacy, including compliance with HIPAA and state privacy, confidential-

ity, security, and medical retention rules,” said Sacopulos, adding that FSMB Guide-lines suggest maintaining written policies to address:

• Privacy; • Healthcare personnel who will be

processing messages and patient communications;

• Hours of operations; • Types of transactions that will be

permitted electronically; • Required patient information to

be included in the communication, such as patient’s name, identifica-

tion number and type of transac-tion;

• Archival and retrieval; and • Quality oversight mechanisms. “Finally, telemedicine practitioners

are cautioned to periodically evaluate their policies and procedures to insure they remain current and readily acces-sible,” he said. “FSMB informs us that electronic communications received from patients must be maintained within se-cured technology password-protected en-crypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to as-sume that additional patient privacy re-quirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem In-surance experienced earlier this year,” he said. “Studies show that medical identity theft grew at an alarming rate in 2014. Government officials, including the FBI and California Attorney General, have specifically cautioned medical provid-ers that their patients’ electronic data is at risk for hacking and theft. All of this should serve as a warning to telemedicine providers to comply with existing state and federal regulations. Telemedicine providers should also anticipate increas-ing privacy standards.”

Informed ConsentBefore practicing telemedicine, a

medical provider should obtain appro-priate patient informed consent. The in-formed consent document should:

Clearly state the patient’s identity; Clearly state the physician’s identity

and qualifications; Specify the scope of activities the

practice will be using telemedicine tech-nologies to fulfill, such as patient educa-tion, prescription refills, and scheduling appointments;

The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/or treat the patient;

The patient should acknowledge the possibility of, and hold harmless the medi-cal provider for, any technology failures and/or interruptions;

The practice should, as part of the informed consent process, provide infor-mation on the telemedicine technologies privacy and security standards, such as the inscription of data and firewalls; and

The informed consent document should specify express patient consent to forward patient information to a third party if necessary.

Referrals for Emergency Service

“The FSMB suggests that telemedi-cine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos. “This emergency protocol should cover possible scenarios when patients require

Telemedicine: A Virtual Compliance Jigsaw Puzzle, continued from page 12



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

BY LYNNE JETER

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

Several years ago, Christine A. Sinsky, MD, FACP, made two significant time-sav-ing changes to her prac-tice life that allowed her to leave work sooner and have more time for fam-ily and personal interests.

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

Second: taking pro-active planned care mea-sures with patients via previsit laboratory tests.

“Just making a single change – pre-scription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes of nursing time per doctor per day,” said Sinsky, an internist and partner in Medical Associates Clinic, a multispecialty group

practice with sites in Iowa, Wisconsin and Illinois.

Sinsky is also the point person at the American Medical Association (AMA) for an ambitious new initiative offering physi-cians strategies to revitalize their medical practices and improve patient care. The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

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

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction phy-sicians derive from their work is quickly eroding as time continues to be taken away from direct patient care because of gruel-ing, bureaucratic obstacles.

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

Broadly, the 16 modules address four key areas: practice efficiency and patient care, patient health, physician health, and tech-nology and innovation.

Specifically, the modules cover these topics:

• Conducting effective team meetings• Creating strong team culture• Electronic health record (EHR) im-

plementation

• EHR software selection and pur-chase

• Expanding rooming and discharge protocols

• Improving blood pressure control• Improving physician resiliency• Medication adherence• Panel management• Preventing physician burnout• Preventing type 2 diabetes in at-risk

patients• Pre-visit laboratory testing• Pre-visit planning• Starting lean healthcare• Synchronized prescription renewal• Team documentationEach module requires only snippets

of time to study either online or printed in PDF format for a more traditional ap-proach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, participants must view the module content in its en-tirety, successfully complete the quiz an-swering four of five questions correctly, and complete the evaluation.

Modules include steps for implementa-tion, case studies and downloadable videos, tools and resources.

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

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

• Identify the team.• Meet routinely and “on the clock.”• Agree on ground rules.• Set a consistent meeting agenda.• Rotate meeting roles.• Solve problems as a group.• Record action steps, owners and due

dates.

• Practice good meeting skills.• Have fun!• Celebrate success.Under ground rules, helpful hints in-

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

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

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

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

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acute care. How and where referrals are to be made should be covered in this pro-tocol.”

State-Specific RequirementsThe scope of permissible telemedicine

varies significantly by state. Some states specifically require a physician/patient re-lationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much at-tention at the moment,” said Sacopulos. “The American Medical Association is in the process of adopting a Code of Ethics for physicians who provide clinical ser-vices through telemedicine. Texas has re-cently issued new telemedicine guidelines to its practitioners. All of this should serve as a warning to those interested in tele-medicine to consult with their State Board of Medicine before engaging in telemedi-cine activities.”

Physicians’ Telemedicine ChecklistPhysicians interested in electronically interacting with their patients should

first work their way through this checklist:• Examine the electronic communication between the practice and its

patients. From patients portals to staff testing, a complete picture is needed of the practice’s electronic communications before engaging in telemedicine;

• Make sure forms of electronic patient communications are HIPAA-compliant and secure;

• The internet may know no bounds, but a medical license does. Be careful not to provide medical services to individuals who live in states in which there’s no license;

• Check with the State Board of Medicine to determine state-specific telemedicine limitations;

• Develop a specific informed consent document that complies with state requirements and also the Federation of State Medical Board’s suggestions;

• Develop a list of disclosures to provide to prospective patients before engaging in telemedicine services; and

• ºMake sure there’s adequate insurance coverage. Check with a professional liability carrier and secure a cyber-insurance policy.

“With advanced planning and a little effort, you’ll be able to weave your way through the compliance requirements to practice telemedicine, leaving you and your patients to enjoy the benefits of a telemedicine practice,” said Michael J. Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services.

SOURCE: Michael J. Sacopulos, JD.

The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likeli-hood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evident in the MGMA compensation sur-vey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Even-son said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts.

Economic forces of supply and de-mand are another issue factoring into phy-sician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensa-tion rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between 46,000 and 90,000 physicians by 2025.

In addition to compensation figures,

Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data al-lows those in healthcare to dissect the in-formation in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing better care by understanding your colleagues’ ac-tivities in the industry,” Evenson concluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataD-ive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare man-agement will be explored in depth at MG-MA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn.

MGMA Releases Data, continued from page 5Claypool pointed out.

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

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

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

The Intersection of Healthcare & Education

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

Claypool explained Part C of the In-dividuals with Disabilities Education Act requires public school systems to identify preschool children with special needs. However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with au-tism to find another way to have their chil-dren identified, diagnosed and treated.”

Of importance, he continued, is the

understanding that special education, as it is constructed, is built on civil rights law. “That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

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

According to the Autism Health In-surance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law. While the specifics vary from state-to-state, each of the mandates requires insur-ers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance man-date. Ohio, Hawaii, Mississippi and North Carolina were in process of enacting a mandate, and Utah had passed legisla-tion, but it won’t go into effect until 2016. Additionally, the federal government has recently told all states their Medicaid pro-grams must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

At the Intersection, continued from page 11

Telemedicine: A Virtual Compliance Jigsaw Puzzle, continued from page 14


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GrandRoundsBrooks Named Director of IT Technical Services at Methodist Le Bonheur

DeAngelo Brooks has joined Meth-odist Le Bonheur Healthcare as director, IT technical services.

Brooks has more than 10 years of experience in the information technol-ogy field. He comes to Methodist from Caesar’s Entertainment in Tunica, Mississippi.

Survey Shows Many Tennessee Physicians Feel MOC a Costly Burden

A survey released by the Tennes-see Medical Association regarding physicians’ required maintenance of certification (MOC) by various medi-cal specialty boards revealed that most Tennessee physicians feel the cost and effort associated with certification and/or recertification of a medical specialty is unreasonable and does not produce a measurable return on investment in terms of patient care.

The MOC process for years has stirred controversy in the medical com-munity from physicians who have grown weary of what they consider to be ex-

cessive fees and overly frequent testing requirements. The TMA House of Dele-gates passed a resolution during the As-sociation’s annual convention calling for the Board of Trustees to report the find-ings of the survey, which was conducted in 2014, and study the results to deter-mine what, if any, national advocacy ef-forts it can support to improve the MOC process. MOC is not a state-level issue.

Key findings of the survey: • Approximately 64 percent of re-

spondents have had multiple recertifi-cations after their residency or fellow-ship, and more than half of those have undergone recertification two or more times.

• Other than a written test, 88 per-cent of respondents said their board has additional requirements to satisfy a specialty certification.

• The average cost among respon-dents to become certified by their spe-cialty boards is approximately $2,250, and sometimes thousands of dollars more to be recertified. More than 80 percent felt these costs are unreason-able, especially when adding indirect costs such as travel, time away from the office and lost productivity.

• A majority of respondents in-vested significant amounts of time and

money in review courses to prepare for recertification. More than one in three physicians begin preparing at least one year in advance.

• One in four physicians said they intend to relinquish their board spe-cialty certifications before retiring from medicine, while 74 percent plan to let it lapse after they retire. Only 20 percent of respondents plan to retire within the next five years.

According to the American Board of Medical Specialties, programs for board certification and MOC provide a trusted credential and uphold the integ-rity of medical specialty care. Certifica-tion is a voluntary process designed to demonstrate a physician’s expertise in a particular medical specialty and/or sub-specialty. MOC is a system for ongoing professional development.

R. Lebron Cooper Appointed Chair of Anesthesiology at UTHSC

R. Lebron Cooper, MD, has been named chair for the Department of An-esthesiology at the University of Ten-nessee Health Science Center (UTHSC).

An alumnus of the UTHSC College of Medicine, he will begin his new role on September 28.

Cooper will oversee research, education, and focus on clinical care in Anesthesiology at Re-gional One Health, one of UTHSC’s core teaching hospital partners. He will also re-establish the An-esthesiology Residency Program.

With some 25 years of hands-on health care expertise, Cooper has been included multiple times on the list of America’s Best Doctors. He has solid ac-ademic credentials at several colleges and universities, especially in teaching residents, fellows and students in the operating room.

His work includes more than 80 lec-tures and mock oral exams, and more than 40 regional, national and interna-tional presentations to his credit, along with more than 100 peer-reviewed pub-lications, book chapters, and abstracts. His research interests are in reducing risks and errors in anesthesia practice, and improving quality and safe anesthe-sia patient care. He has served on several quality control boards and committees, and currently leads the Anesthesiology Quality Assurance and Process Improve-ment initiatives at Henry Ford Hospital.

DeAngelo Brooks

Dr. R. Lebron Cooper


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GrandRounds

St. Jude Selects Keith Perry Chief Information Officer

Keith Perry has been named chief information officer at St. Jude Chil-dren’s Research Hospital and will provide strategic counsel and leadership for the hospital’s infor-mation technology initia-tives.

Perry joins St. Jude from the University of Texas MD Anderson Cancer Center in Houston where he served as associate vice president and deputy chief infor-mation officer. Some of his most note-worthy accomplishments in this role in-clude managing the division’s $290-mil-lion annual budget, and implementing high-performance computing pro-grams to support research and clinical applications, such as next-generation genomic sequencing and proton beam modeling.

Perry earned a bachelor’s degree in computer science from Harding Uni-versity in Searcy, Arkansas, and an MBA from the University of Houston.

UTHSC Announces Six Grant Awards Totaling $402,000

The UT Institute for Research, Inno-vation, Synergy and Health Equity at the University of Tennessee Health Science Center (UTHSC) has announced the lat-est round of grant recipients from its Pilot Translational and Clinical Studies (PTCS) Program. Six UTHSC researchers were chosen from a field of 28 submissions. The PTCS Program provides funding and support to promoting clinical and trans-lational science, bringing health care dis-coveries from “bench to bedside” and from “bedside to community.”

Beyond financial support, PTCS award recipients are also provided with program and business management support, and mentoring to navigate the process of establishing sustainable funding. The program prioritizes sup-port for junior investigators, multidis-ciplinary teams and projects focusing specifically on health disparities.

Each of the six current award recipi-ents will perform and complete their re-search within a one-year period.

• Ilana Graetz, PhD, assistant pro-fessor, Department of Preventive Medi-cine, will receive $75,000 for a project that uses a mobile application to track adverse effects of endocrine therapy for breast cancer treatment.

• Shalini Narayana, PhD, assistant professor, Department of Pediatrics, will receive $80,000 for her project using transcranial magnetic stimulation (TMS) to reduce the effects of seizures in pa-tients with refractory epilepsy.

• Brooke Sanford, PhD, assistant

professor, Department of Orthopaedic Surgery and Biomedical Engineering, will receive $47,000 to develop new clinical guidelines for patients to return to unrestricted activity following ACL surgery.

• Thomas J. Schroeppel, MD, as-sociate professor, Department of Sur-gery, will receive $50,000 for his project exploring the use of beta-adrenergic blockade to lessen the catecholamine surge (a surge of stress hormones which impair cardiac function) following trau-matic brain injuries (TBI) to lower mor-tality

• Nhu Quynh T. Tran, PhD, assistant professor, Department of Preventive Medicine, will receive $75,000 for her project to identify genetic mutations and clinical risk factors associated with recurrent non-alcoholic steatohepati-tis (NASH) in patients undergoing liver transplantation.

• Dahui You, PhD, assistant profes-sor, Department of Pediatrics, will re-ceive $75,000 for her project exploring the pathogenesis of respiratory syncy-tial virus (RSV).

Yunna Jiang Joins Methodist Primary Care Group

Yunna Jiang, MD, has joined the Methodist Primary Care Group and will practice at the Endocrinology Clinic.

Jiang has received her Bachelor of Medicine degree from Chengde Medi-cal College in Hebei, Chi-na, and earned a Master of Medicine degree and completed a residency in general internal medicine at Beijing University of Traditional Chinese Med-icine. Jiang completed a second residency in general internal medicine at the University of Tennes-see Health Science Center followed by a fellowship focusing on endocrinology, diabetes, and metabolism.

Jiang is board certified in inter-nal medicine. She is a member of the American Association of Clinical Endo-crinologist, Endocrine Society, Ameri-can Thyroid Association, and the Ameri-can College of Physicians.

Transplant Pioneer, Louis G. Britt, Dies at Age 84

Dr. Louis G. Britt, who led what has been called “the ‘phenomenal journey of organ donation and trans-plantation” in the Mid-South, died August 22.

Britt, a transplant surgeon who performed the first kidney transplant in Memphis and was founder and president of the Mid-South Transplant Foundation,

Inc., was 84. He performed organ trans-plants and facilitated the procurement of organs in the Memphis area for more than 40 years.

“Dr. Britt not only had a tremen-dous impact on the medical community, but also touched thousands of lives in the Mid-South,” said Kim Van Frank, ex-ecutive director of the Mid-South Trans-plant Foundation.

In addition to the first kidney trans-plant, Britt was a major reason the Uni-versity of Tennessee Health Science Center (UTHSC) began liver transplants in 1982.

Britt served as consulting staff at many area hospitals, including Methodist Hospitals, Le Bonheur Children’s Hospital, Saint Francis Hospital, Baptist Memorial Hospital and Regional One Hospital. Dr. Britt also served the medical community as a professor of surgery at the UTHSC, where he served as the Chair of the De-partment of Surgery for 10 years.

He received his medical education and training at the University of Tennes-see College of Medicine.

University of Memphis Opens Community Health Building

The University of Memphis opened one of the largest facilities for commu-nity health-related education and re-search in the Mid-South when it cut the ribbon on the four-story, 177, 000-square foot Community Health Building at the school’s Kennedy Complex at Park and Getwell.

The $60-million facility on the site of the old Kennedy General Hospital was officially opened August 23 and now unites the faculty and facilities of both the Loewenberg School of Nurs-ing and the School of Communica-tion Sciences and Disorders. The two schools represent two of the university’s leading healthcare programs.

Features of the new structure in-clude:

• 170-seat lecture hall and learning center

• On-site branch of the university libraries

• 16 classrooms for student instruc-tion and seminar presentations

• 39 laboratories for faculty and stu-dent research, and nursing skills, assessment, and simulation edu-cation

• An easily-accessible home for the Memphis Speech and Hearing Center and nurse-led community clinic

• Designated conference rooms, collaborative faculty space, and work areas undergraduate and graduate students.

Keith Perry

Dr. Yunna Jiang

Dr. Louis G. Britt


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

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

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

Jack C. MasseyCo-Founder, HCA

R. Clayton McWhorterCo-Founder, HealthTrust

and Clayton Associates

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

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

Professor

Danny ThomasFounder, St. Jude Children’s

Research Hospital

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MEMPHIS BRIGHTON COLLIERVILLE COVINGTON MILLINGTON WEST MEMPHIS

901.201.6200 www.colonscreening.com

Join us in the fight against cancer by championing prevention with your patients — colorectal cancer is the second

biggest cancer killer in the U.S. Through education we can increase our practice of early detection via screening for CRC

and adenomatous polyps. GI Specialists have been at the forefront of digestive disease care for over 20 years, from IBS

and liver disorders to esophageal, pancreatic and all forms of gastrointestinal cancers. Consider us your valued partners

in the care and well-being of your patients, we want to help them beat cancer before it starts.

SEND YOUR PATIENTS TO US FOR THEIR SCREENING COLONOSCOPY.

Help us Fight Colorectal Cancer.

memphis medical news september 2015

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